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Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome.
Am J Trop Med Hyg. 2016 10 05; 95(4):769-773.AJ

Abstract

Scrub typhus is endemic in Thailand. Of the 495 patients with acute undifferentiated fever studied in Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, from June 1, 2011, to December 31, 2012, 146 patients (29.5%) had confirmed scrub typhus. The majority of cases were male, farmers, with the mean (±standard deviation) age of 54.1 ± 15.2 years. A total of 59 patients (40.4%) had eschar lesion. The commonest sites for an eschar in male patients were the perineum, inguinal, and buttock area; whereas in females, it was the head and neck area. Abnormal electrocardiogram was found in 39 of 79 patients (49.4%) with sinus tachycardia being the most frequent finding (17, 21.5%). A total of 73 patients (50%) had at least one complication. Myocarditis was the cause of complete heart block in a scrub typhus patient, and he fully recovered after receiving intravenous chloramphenicol treatment. The case fatality rate was 6.2% (nine deaths).The independent predictors for fatal outcome were age over 65 years (odds ratio [OR] = 14.49, 95% confidence interval [CI] = 1.26-166.44, P = 0.03), acute kidney injury (OR = 12.75, 95% CI = 1.77-92.07, P = 0.01), and hyperbilirubinemia (OR = 24.82, 95% CI = 2.12-286.61, P = 0.01). Early diagnosis and prompt appropriate treatment can improve the patient's outcome.

Authors+Show Affiliations

Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand. wthipmontree@gmail.com.Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27573633

Citation

Thipmontree, Wilawan, et al. "Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome." The American Journal of Tropical Medicine and Hygiene, vol. 95, no. 4, 2016, pp. 769-773.
Thipmontree W, Tantibhedhyangkul W, Silpasakorn S, et al. Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome. Am J Trop Med Hyg. 2016;95(4):769-773.
Thipmontree, W., Tantibhedhyangkul, W., Silpasakorn, S., Wongsawat, E., Waywa, D., & Suputtamongkol, Y. (2016). Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome. The American Journal of Tropical Medicine and Hygiene, 95(4), 769-773.
Thipmontree W, et al. Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome. Am J Trop Med Hyg. 2016 10 5;95(4):769-773. PubMed PMID: 27573633.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome. AU - Thipmontree,Wilawan, AU - Tantibhedhyangkul,Wiwit, AU - Silpasakorn,Saowaluk, AU - Wongsawat,Ekkarat, AU - Waywa,Duangdao, AU - Suputtamongkol,Yupin, Y1 - 2016/08/29/ PY - 2016/02/05/received PY - 2016/07/07/accepted PY - 2016/8/31/pubmed PY - 2017/7/14/medline PY - 2016/8/31/entrez SP - 769 EP - 773 JF - The American journal of tropical medicine and hygiene JO - Am J Trop Med Hyg VL - 95 IS - 4 N2 - Scrub typhus is endemic in Thailand. Of the 495 patients with acute undifferentiated fever studied in Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, from June 1, 2011, to December 31, 2012, 146 patients (29.5%) had confirmed scrub typhus. The majority of cases were male, farmers, with the mean (±standard deviation) age of 54.1 ± 15.2 years. A total of 59 patients (40.4%) had eschar lesion. The commonest sites for an eschar in male patients were the perineum, inguinal, and buttock area; whereas in females, it was the head and neck area. Abnormal electrocardiogram was found in 39 of 79 patients (49.4%) with sinus tachycardia being the most frequent finding (17, 21.5%). A total of 73 patients (50%) had at least one complication. Myocarditis was the cause of complete heart block in a scrub typhus patient, and he fully recovered after receiving intravenous chloramphenicol treatment. The case fatality rate was 6.2% (nine deaths).The independent predictors for fatal outcome were age over 65 years (odds ratio [OR] = 14.49, 95% confidence interval [CI] = 1.26-166.44, P = 0.03), acute kidney injury (OR = 12.75, 95% CI = 1.77-92.07, P = 0.01), and hyperbilirubinemia (OR = 24.82, 95% CI = 2.12-286.61, P = 0.01). Early diagnosis and prompt appropriate treatment can improve the patient's outcome. SN - 1476-1645 UR - https://www.unboundmedicine.com/medline/citation/27573633/Scrub_Typhus_in_Northeastern_Thailand:_Eschar_Distribution_Abnormal_Electrocardiographic_Findings_and_Predictors_of_Fatal_Outcome_ DB - PRIME DP - Unbound Medicine ER -