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Clinical manifestations and complications of rickettsiosis in southern Taiwan.
J Formos Med Assoc. 2002 Jun; 101(6):385-92.JF

Abstract

BACKGROUND AND PURPOSE

Taiwan is an endemic area for scrub typhus. Recent increases have been noted in two other infectious diseases caused by obligate intracellular organisms, Q fever and murine typhus. These diseases usually present as an acute febrile illness with non-specific symptoms and are difficult to distinguish. This study describes the clinical manifestations and complications of cases of rickettsial infections treated at a medical center in southern Taiwan.

METHODS

Serum samples from patients with acute febrile illness with or without shock, but without a clinical diagnosis of localized bacterial infection after a preliminary work-up, were collected for serologic study. Medical records of cases with serologic evidence of infection were reviewed and their clinical manifestations were analyzed.

RESULTS

From October 1992 to July 2000, 51 serologically diagnosed cases of rickettsiosis were studied. Q fever predominated (28 cases). All cases of acute Q fever presented with hepatitis during the course of the illness and more than half (54%) reported an animal contact history. Most patients with Q fever (96%) and murine typhus (86%) were male, Serious complications, especially pneumonitis, occurred more frequently with scrub typhus than with acute Q fever. Spontaneous remission frequently occurred with acute Q fever. Administration of tetracycline or its analogues usually resulted in defervescence by the third day of treatment of scrub typhus.

CONCLUSIONS

In our study, serious complications including pneumonitis, meningitis/meningoencephalitis, shock, acute renal failure, and disseminated intravascular coagulation were not uncommon in patients with scrub typhus. Physicians should include scrub typhus in the differential diagnosis of suspected cases of community-acquired febrile illness with multiple organ dysfunction in this endemic area. As Q fever is an emerging infectious disease in southern Taiwan, further large-scale epidemiologic surveillance and clinical data are needed.

Authors+Show Affiliations

Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, 138 Sheng Li Road, Tainan, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12189643

Citation

Lee, Hsin-Chun, et al. "Clinical Manifestations and Complications of Rickettsiosis in Southern Taiwan." Journal of the Formosan Medical Association = Taiwan Yi Zhi, vol. 101, no. 6, 2002, pp. 385-92.
Lee HC, Ko WC, Lee HL, et al. Clinical manifestations and complications of rickettsiosis in southern Taiwan. J Formos Med Assoc. 2002;101(6):385-92.
Lee, H. C., Ko, W. C., Lee, H. L., & Chen, H. Y. (2002). Clinical manifestations and complications of rickettsiosis in southern Taiwan. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 101(6), 385-92.
Lee HC, et al. Clinical Manifestations and Complications of Rickettsiosis in Southern Taiwan. J Formos Med Assoc. 2002;101(6):385-92. PubMed PMID: 12189643.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical manifestations and complications of rickettsiosis in southern Taiwan. AU - Lee,Hsin-Chun, AU - Ko,Wen-Chien, AU - Lee,Hsin-Ling, AU - Chen,Hour-Young, PY - 2002/8/23/pubmed PY - 2002/9/14/medline PY - 2002/8/23/entrez SP - 385 EP - 92 JF - Journal of the Formosan Medical Association = Taiwan yi zhi JO - J Formos Med Assoc VL - 101 IS - 6 N2 - BACKGROUND AND PURPOSE: Taiwan is an endemic area for scrub typhus. Recent increases have been noted in two other infectious diseases caused by obligate intracellular organisms, Q fever and murine typhus. These diseases usually present as an acute febrile illness with non-specific symptoms and are difficult to distinguish. This study describes the clinical manifestations and complications of cases of rickettsial infections treated at a medical center in southern Taiwan. METHODS: Serum samples from patients with acute febrile illness with or without shock, but without a clinical diagnosis of localized bacterial infection after a preliminary work-up, were collected for serologic study. Medical records of cases with serologic evidence of infection were reviewed and their clinical manifestations were analyzed. RESULTS: From October 1992 to July 2000, 51 serologically diagnosed cases of rickettsiosis were studied. Q fever predominated (28 cases). All cases of acute Q fever presented with hepatitis during the course of the illness and more than half (54%) reported an animal contact history. Most patients with Q fever (96%) and murine typhus (86%) were male, Serious complications, especially pneumonitis, occurred more frequently with scrub typhus than with acute Q fever. Spontaneous remission frequently occurred with acute Q fever. Administration of tetracycline or its analogues usually resulted in defervescence by the third day of treatment of scrub typhus. CONCLUSIONS: In our study, serious complications including pneumonitis, meningitis/meningoencephalitis, shock, acute renal failure, and disseminated intravascular coagulation were not uncommon in patients with scrub typhus. Physicians should include scrub typhus in the differential diagnosis of suspected cases of community-acquired febrile illness with multiple organ dysfunction in this endemic area. As Q fever is an emerging infectious disease in southern Taiwan, further large-scale epidemiologic surveillance and clinical data are needed. SN - 0929-6646 UR - https://www.unboundmedicine.com/medline/citation/12189643/Clinical_manifestations_and_complications_of_rickettsiosis_in_southern_Taiwan_ L2 - http://www.diseaseinfosearch.org/result/6328 DB - PRIME DP - Unbound Medicine ER -
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