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Associated factors and clinical implications of serum aminotransferase elevation in scrub typhus.
J Microbiol Immunol Infect 2016; 49(6):941-946JM

Abstract

BACKGROUND/PURPOSE

Timely diagnosis and prompt treatment can reduce the complications of scrub typhus. It is thus important to find easy laboratory tests to help in the diagnosis, especially in patients without eschar at initial presentation. Because serum aminotransferase elevation is common in scrub typhus, its associated factors and clinical implications need further investigations.

METHODS

We conducted a retrospective study in Kinmen, Taiwan, to collect clinically suspected scrub typhus patients notified to Taiwan Centers for Disease Control for confirmation during 2005-2010. Scrub typhus was diagnosed and Orientia tsutsugamushi was genotyped by serological or molecular assays. The laboratory data and clinical information were recorded for analysis.

RESULTS

Overall, 344 suspected scrub typhus patients were reported to Taiwan Centers for Disease Control and 288 of them were certified scrub typhus. Scrub typhus patients had significantly more thrombocytopenia, serum aminotransferase elevation (76% vs. 54%, p = 0.001), higher frequency of fever, eschar, and lymphadenopathy, compared with nontyphus patients. Hepatic dysfunction in scrub typhus was associated with older age, longer fever duration, and absence of lymphadenopathy, but seemed to be unrelated to the rickettsial genotypes. Multivariate analysis showed that serum aminotransferase elevation (odds ratio: 3.75; p = 0.003; 95% confidence interval: 1.56-9.01) independently predicted scrub typhus. Furthermore, in suspected scrub typhus patients without eschar, 92% of true typhus patients had serum aminotransferase elevation compared with the nontyphus ones (odds ratio: 6.47; p = 0.028, 95% confidence interval: 1.23-34.11).

CONCLUSION

Hepatic dysfunction in scrub typhus patients is associated with older age, longer fever duration, and absence of lymphadenopathy. Serum aminotransferase elevation can aid in the diagnosis of scrub typhus, especially in suspected patients without eschar.

Authors+Show Affiliations

Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.Centers for Disease Control, Taipei, Taiwan.Department of Internal Medicine, Kinmen Hospital, Ministry of Health and Welfare, Executive Yuan, Kinmen, Taiwan.Department of Internal Medicine, Kinmen Hospital, Ministry of Health and Welfare, Executive Yuan, Kinmen, Taiwan.Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: kaojh@ntu.edu.tw.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25556044

Citation

Su, Tung-Hung, et al. "Associated Factors and Clinical Implications of Serum Aminotransferase Elevation in Scrub Typhus." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 49, no. 6, 2016, pp. 941-946.
Su TH, Liu CJ, Shu PY, et al. Associated factors and clinical implications of serum aminotransferase elevation in scrub typhus. J Microbiol Immunol Infect. 2016;49(6):941-946.
Su, T. H., Liu, C. J., Shu, P. Y., Fu, Y. H., Chang, C. H., Jao, P., & Kao, J. H. (2016). Associated factors and clinical implications of serum aminotransferase elevation in scrub typhus. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 49(6), pp. 941-946. doi:10.1016/j.jmii.2014.10.005.
Su TH, et al. Associated Factors and Clinical Implications of Serum Aminotransferase Elevation in Scrub Typhus. J Microbiol Immunol Infect. 2016;49(6):941-946. PubMed PMID: 25556044.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associated factors and clinical implications of serum aminotransferase elevation in scrub typhus. AU - Su,Tung-Hung, AU - Liu,Chun-Jen, AU - Shu,Pei-Yun, AU - Fu,Yang-Hsien, AU - Chang,Chi-Hsien, AU - Jao,Ping, AU - Kao,Jia-Horng, Y1 - 2014/11/11/ PY - 2014/08/20/received PY - 2014/09/30/revised PY - 2014/10/07/accepted PY - 2015/1/4/pubmed PY - 2017/3/16/medline PY - 2015/1/4/entrez KW - Orientia tsutsugamushi KW - liver function tests KW - rickettsia SP - 941 EP - 946 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 49 IS - 6 N2 - BACKGROUND/PURPOSE: Timely diagnosis and prompt treatment can reduce the complications of scrub typhus. It is thus important to find easy laboratory tests to help in the diagnosis, especially in patients without eschar at initial presentation. Because serum aminotransferase elevation is common in scrub typhus, its associated factors and clinical implications need further investigations. METHODS: We conducted a retrospective study in Kinmen, Taiwan, to collect clinically suspected scrub typhus patients notified to Taiwan Centers for Disease Control for confirmation during 2005-2010. Scrub typhus was diagnosed and Orientia tsutsugamushi was genotyped by serological or molecular assays. The laboratory data and clinical information were recorded for analysis. RESULTS: Overall, 344 suspected scrub typhus patients were reported to Taiwan Centers for Disease Control and 288 of them were certified scrub typhus. Scrub typhus patients had significantly more thrombocytopenia, serum aminotransferase elevation (76% vs. 54%, p = 0.001), higher frequency of fever, eschar, and lymphadenopathy, compared with nontyphus patients. Hepatic dysfunction in scrub typhus was associated with older age, longer fever duration, and absence of lymphadenopathy, but seemed to be unrelated to the rickettsial genotypes. Multivariate analysis showed that serum aminotransferase elevation (odds ratio: 3.75; p = 0.003; 95% confidence interval: 1.56-9.01) independently predicted scrub typhus. Furthermore, in suspected scrub typhus patients without eschar, 92% of true typhus patients had serum aminotransferase elevation compared with the nontyphus ones (odds ratio: 6.47; p = 0.028, 95% confidence interval: 1.23-34.11). CONCLUSION: Hepatic dysfunction in scrub typhus patients is associated with older age, longer fever duration, and absence of lymphadenopathy. Serum aminotransferase elevation can aid in the diagnosis of scrub typhus, especially in suspected patients without eschar. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/25556044/Associated_factors_and_clinical_implications_of_serum_aminotransferase_elevation_in_scrub_typhus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1684-1182(14)00232-1 DB - PRIME DP - Unbound Medicine ER -