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Scrub typhus cases in a teaching hospital in Penghu, Taiwan, 2006-2010.
Vector Borne Zoonotic Dis 2013; 13(3):154-9VB

Abstract

Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi (previously called Rickettsia tsutsugamushi). The severity of this disease varies from only mild symptoms to death, and its manifestations are nonspecific. Therefore, clinicians may not correctly diagnose scrub typhus early enough for successful treatment. Reports of infections in travelers returning from Asia to their home countries are increasingly common. Thus, it is important that even clinicians in nonepidemic regions be alert for this disease. Here we describe the epidemiological aspects and clinical manifestations of scrub typhus encountered at a teaching hospital in Penghu, Taiwan, over the past 5 years. A total of 126 patients were confirmed to be positive for scrub typhus at the hospital from 2006 to 2010. All cases were confirmed by the Centers for Disease Control and Prevention or its contract laboratory through pathogen isolation and an indirect immunofluorescence assay. Medical records of these patients were reviewed, and demographic and clinical characteristics, laboratory data, seasonal data, geographic distribution, complications, and outcome were analyzed. The incidence of scrub typhus peaked in individuals aged 0-10 and 51-60 years, with the highest incidence among those ≤10 years of age. No significant difference was noted between sexes. Fever was the most common symptom (93.6%), followed by chills (23.8%), cough (18.3%), and headache (14.3%). Eschars were observed in 78 (61.9%) patients, with the axilla being the most frequent site (n=17; 21.8%). Most patients were retirees (n=63; 50%), followed by students (n=16; 12.7%). Patients were more likely to live in rural areas than urban areas. Scrub typhus was epidemic in the spring (April to June) and fall (October to December) in a bimodal distribution similar to that observed in Japan. Leukocytosis was not common, but most patients had abnormal C-reactive protein levels, thrombocytopenia, and elevated liver function test results. Residents of Penghu, particularly Makung City and Husi Township, as well as travelers to the region during the spring and fall seasons should be educated about the signs and symptoms of scrub typhus. All physicians who come into contact with individuals residing in or traveling to or from epidemic regions should remain alert about the manifestations of this disease.

Authors+Show Affiliations

Department of Family Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23421889

Citation

Wang, Ying-Chuan, et al. "Scrub Typhus Cases in a Teaching Hospital in Penghu, Taiwan, 2006-2010." Vector Borne and Zoonotic Diseases (Larchmont, N.Y.), vol. 13, no. 3, 2013, pp. 154-9.
Wang YC, Chen PC, Lee KF, et al. Scrub typhus cases in a teaching hospital in Penghu, Taiwan, 2006-2010. Vector Borne Zoonotic Dis. 2013;13(3):154-9.
Wang, Y. C., Chen, P. C., Lee, K. F., Wu, Y. C., & Chiu, C. H. (2013). Scrub typhus cases in a teaching hospital in Penghu, Taiwan, 2006-2010. Vector Borne and Zoonotic Diseases (Larchmont, N.Y.), 13(3), pp. 154-9. doi:10.1089/vbz.2012.1059.
Wang YC, et al. Scrub Typhus Cases in a Teaching Hospital in Penghu, Taiwan, 2006-2010. Vector Borne Zoonotic Dis. 2013;13(3):154-9. PubMed PMID: 23421889.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Scrub typhus cases in a teaching hospital in Penghu, Taiwan, 2006-2010. AU - Wang,Ying-Chuan, AU - Chen,Po-Chuan, AU - Lee,Kwai-Fong, AU - Wu,Yu-Cheng, AU - Chiu,Chun-Hsiang, Y1 - 2013/02/19/ PY - 2013/2/21/entrez PY - 2013/2/21/pubmed PY - 2013/9/6/medline SP - 154 EP - 9 JF - Vector borne and zoonotic diseases (Larchmont, N.Y.) JO - Vector Borne Zoonotic Dis. VL - 13 IS - 3 N2 - Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi (previously called Rickettsia tsutsugamushi). The severity of this disease varies from only mild symptoms to death, and its manifestations are nonspecific. Therefore, clinicians may not correctly diagnose scrub typhus early enough for successful treatment. Reports of infections in travelers returning from Asia to their home countries are increasingly common. Thus, it is important that even clinicians in nonepidemic regions be alert for this disease. Here we describe the epidemiological aspects and clinical manifestations of scrub typhus encountered at a teaching hospital in Penghu, Taiwan, over the past 5 years. A total of 126 patients were confirmed to be positive for scrub typhus at the hospital from 2006 to 2010. All cases were confirmed by the Centers for Disease Control and Prevention or its contract laboratory through pathogen isolation and an indirect immunofluorescence assay. Medical records of these patients were reviewed, and demographic and clinical characteristics, laboratory data, seasonal data, geographic distribution, complications, and outcome were analyzed. The incidence of scrub typhus peaked in individuals aged 0-10 and 51-60 years, with the highest incidence among those ≤10 years of age. No significant difference was noted between sexes. Fever was the most common symptom (93.6%), followed by chills (23.8%), cough (18.3%), and headache (14.3%). Eschars were observed in 78 (61.9%) patients, with the axilla being the most frequent site (n=17; 21.8%). Most patients were retirees (n=63; 50%), followed by students (n=16; 12.7%). Patients were more likely to live in rural areas than urban areas. Scrub typhus was epidemic in the spring (April to June) and fall (October to December) in a bimodal distribution similar to that observed in Japan. Leukocytosis was not common, but most patients had abnormal C-reactive protein levels, thrombocytopenia, and elevated liver function test results. Residents of Penghu, particularly Makung City and Husi Township, as well as travelers to the region during the spring and fall seasons should be educated about the signs and symptoms of scrub typhus. All physicians who come into contact with individuals residing in or traveling to or from epidemic regions should remain alert about the manifestations of this disease. SN - 1557-7759 UR - https://www.unboundmedicine.com/medline/citation/23421889/Scrub_typhus_cases_in_a_teaching_hospital_in_Penghu_Taiwan_2006_2010_ L2 - https://www.liebertpub.com/doi/full/10.1089/vbz.2012.1059?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -