Tags

Type your tag names separated by a space and hit enter

Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan.
J Microbiol Immunol Infect 2017; 50(1):104-111JM

Abstract

BACKGROUND

Dengue fever, rickettsial diseases, and Q fever are acute febrile illnesses with similar manifestations in tropical areas. Early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever may be made by understanding the distinguishing clinical characteristics and the significance of demographic and weather factors.

METHODS

We conducted a retrospective study to identify clinical, demographic, and meteorological characteristics of 454 dengue fever, 178 scrub typhus, 143 Q fever, and 81 murine typhus cases in three Taiwan hospitals.

RESULTS

Case numbers of murine typhus and Q fever correlated significantly with temperature and rainfall; the scrub typhus case number was only significantly related with temperature. Neither temperature nor rainfall correlated with the case number of dengue fever. The rarity of dengue fever cases from January to June in Taiwan may be a helpful clue for diagnosis in the area. A male predominance was observed, as the male-to-female rate was 2.1 for murine typhus and 7.4 for Q fever. Multivariate analysis revealed the following six important factors for differentiating the rickettsial diseases and Q fever group from the dengue fever group: fever ≥8 days, alanine aminotransferase > aspartate aminotransferase, platelets >63,000/mL, C-reactive protein >31.9 mg/L, absence of bone pain, and absence of a bleeding syndrome.

CONCLUSION

Understanding the rarity of dengue in the first half of a year in Taiwan and the six differentiating factors may help facilitate the early differential diagnosis of rickettsial diseases and Q fever from dengue fever, permitting early antibiotic treatment.

Authors+Show Affiliations

Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Taiwan.Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Electronic address: d830166@gmail.com.School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25648664

Citation

Chang, Ko, et al. "Identification of Factors for Physicians to Facilitate Early Differential Diagnosis of Scrub Typhus, Murine Typhus, and Q Fever From Dengue Fever in Taiwan." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 50, no. 1, 2017, pp. 104-111.
Chang K, Lee NY, Ko WC, et al. Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan. J Microbiol Immunol Infect. 2017;50(1):104-111.
Chang, K., Lee, N. Y., Ko, W. C., Tsai, J. J., Lin, W. R., Chen, T. C., ... Chen, Y. H. (2017). Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 50(1), pp. 104-111. doi:10.1016/j.jmii.2014.12.001.
Chang K, et al. Identification of Factors for Physicians to Facilitate Early Differential Diagnosis of Scrub Typhus, Murine Typhus, and Q Fever From Dengue Fever in Taiwan. J Microbiol Immunol Infect. 2017;50(1):104-111. PubMed PMID: 25648664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan. AU - Chang,Ko, AU - Lee,Nan-Yao, AU - Ko,Wen-Chien, AU - Tsai,Jih-Jin, AU - Lin,Wei-Ru, AU - Chen,Tun-Chieh, AU - Lu,Po-Liang, AU - Chen,Yen-Hsu, Y1 - 2014/12/26/ PY - 2014/01/05/received PY - 2014/09/30/revised PY - 2014/12/09/accepted PY - 2015/2/5/pubmed PY - 2017/3/23/medline PY - 2015/2/5/entrez KW - Q fever KW - dengue fever KW - murine typhus KW - rainfall KW - scrub typhus KW - temperature SP - 104 EP - 111 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 50 IS - 1 N2 - BACKGROUND: Dengue fever, rickettsial diseases, and Q fever are acute febrile illnesses with similar manifestations in tropical areas. Early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever may be made by understanding the distinguishing clinical characteristics and the significance of demographic and weather factors. METHODS: We conducted a retrospective study to identify clinical, demographic, and meteorological characteristics of 454 dengue fever, 178 scrub typhus, 143 Q fever, and 81 murine typhus cases in three Taiwan hospitals. RESULTS: Case numbers of murine typhus and Q fever correlated significantly with temperature and rainfall; the scrub typhus case number was only significantly related with temperature. Neither temperature nor rainfall correlated with the case number of dengue fever. The rarity of dengue fever cases from January to June in Taiwan may be a helpful clue for diagnosis in the area. A male predominance was observed, as the male-to-female rate was 2.1 for murine typhus and 7.4 for Q fever. Multivariate analysis revealed the following six important factors for differentiating the rickettsial diseases and Q fever group from the dengue fever group: fever ≥8 days, alanine aminotransferase > aspartate aminotransferase, platelets >63,000/mL, C-reactive protein >31.9 mg/L, absence of bone pain, and absence of a bleeding syndrome. CONCLUSION: Understanding the rarity of dengue in the first half of a year in Taiwan and the six differentiating factors may help facilitate the early differential diagnosis of rickettsial diseases and Q fever from dengue fever, permitting early antibiotic treatment. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/25648664/Identification_of_factors_for_physicians_to_facilitate_early_differential_diagnosis_of_scrub_typhus_murine_typhus_and_Q_fever_from_dengue_fever_in_Taiwan_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1684-1182(14)00251-5 DB - PRIME DP - Unbound Medicine ER -