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Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea.
Korean J Intern Med. 2018 03; 33(2):323-330.KJ

Abstract

BACKGROUND/AIMS

Scrub typhus is known as a self-limited infectious disease. Cardiac complication is uncommon and usually not life-threatening. Until now, few cases of fulminant myocarditis by scrub typhus have been reported. So, we investigated incidence and predictors of acute myocarditis in severe scrub typhus.

METHODS

We retrospectively reviewed 89 patients among 91 scrub typhus confirmed patients who examined an echocardiogram and cardiac biomarkers from 2005 to 2015 in the intensive care unit at our hospital. We excluded two patients who didn't have electrocardiography. Patients were divided into two groups and compared between scrub typhus with (n = 13) and without (n = 76) acute myocarditis.

RESULTS

Age, sex, and underlying diseases were similar between the groups. The existence of eschar and duration of general ache and fever were similar between the groups. However, patients with acute myocarditis had more elevated total bilirubin, high incidence of ST elevations and paroxysmal atrial fibrillation (PAF) than those without acute myocarditis. Receiver operating characteristic analysis showed that the PAF was a predictor of myocarditis with a sensitivity of 70% and specificity of 84%. Predictive power of combination of ST-segment elevation and PAF was significantly associated with myocarditis in the multivariate analysis (odds ratio, 1.57; 95% confidence interval [CI], 1.21 to 11.7; p = 0.041) and area under the curve was 0.947 (95% CI, 0.878 to 0.983; p < 0.001).

CONCLUSIONS

Acute myocarditis with scrub typhus may be more common than previously reported. Patients with high bilirubin and PAF are at increased risk of acute myocarditis with scrub typhus. These patients warrant closer follow-up and echocardiogram would be needed.

Authors+Show Affiliations

Division of Cardiology, Eulji University Hospital, Daejeon, Korea.Division of Cardiology, Eulji University Hospital, Daejeon, Korea.Division of Intensive Care, Eulji University Hospital, Daejeon, Korea.Division of Cardiology, Eulji University Hospital, Daejeon, Korea.Division of Cardiology, Eulji University Hospital, Daejeon, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28226202

Citation

Chin, Jung Yeon, et al. "Predictors of Acute Myocarditis in Complicated Scrub Typhus: an Endemic Province in the Republic of Korea." The Korean Journal of Internal Medicine, vol. 33, no. 2, 2018, pp. 323-330.
Chin JY, Kang KW, Moon KM, et al. Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea. Korean J Intern Med. 2018;33(2):323-330.
Chin, J. Y., Kang, K. W., Moon, K. M., Kim, J., & Choi, Y. J. (2018). Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea. The Korean Journal of Internal Medicine, 33(2), 323-330. https://doi.org/10.3904/kjim.2016.303
Chin JY, et al. Predictors of Acute Myocarditis in Complicated Scrub Typhus: an Endemic Province in the Republic of Korea. Korean J Intern Med. 2018;33(2):323-330. PubMed PMID: 28226202.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea. AU - Chin,Jung Yeon, AU - Kang,Ki-Woon, AU - Moon,Kyung Min, AU - Kim,Jongwoo, AU - Choi,Yu Jeong, Y1 - 2017/02/23/ PY - 2016/09/29/received PY - 2016/11/17/revised PY - 2016/12/11/accepted PY - 2017/2/23/pubmed PY - 2019/3/8/medline PY - 2017/2/23/entrez KW - Atrial fibrillation KW - Myocarditis KW - Scrub typhus SP - 323 EP - 330 JF - The Korean journal of internal medicine JO - Korean J Intern Med VL - 33 IS - 2 N2 - BACKGROUND/AIMS: Scrub typhus is known as a self-limited infectious disease. Cardiac complication is uncommon and usually not life-threatening. Until now, few cases of fulminant myocarditis by scrub typhus have been reported. So, we investigated incidence and predictors of acute myocarditis in severe scrub typhus. METHODS: We retrospectively reviewed 89 patients among 91 scrub typhus confirmed patients who examined an echocardiogram and cardiac biomarkers from 2005 to 2015 in the intensive care unit at our hospital. We excluded two patients who didn't have electrocardiography. Patients were divided into two groups and compared between scrub typhus with (n = 13) and without (n = 76) acute myocarditis. RESULTS: Age, sex, and underlying diseases were similar between the groups. The existence of eschar and duration of general ache and fever were similar between the groups. However, patients with acute myocarditis had more elevated total bilirubin, high incidence of ST elevations and paroxysmal atrial fibrillation (PAF) than those without acute myocarditis. Receiver operating characteristic analysis showed that the PAF was a predictor of myocarditis with a sensitivity of 70% and specificity of 84%. Predictive power of combination of ST-segment elevation and PAF was significantly associated with myocarditis in the multivariate analysis (odds ratio, 1.57; 95% confidence interval [CI], 1.21 to 11.7; p = 0.041) and area under the curve was 0.947 (95% CI, 0.878 to 0.983; p < 0.001). CONCLUSIONS: Acute myocarditis with scrub typhus may be more common than previously reported. Patients with high bilirubin and PAF are at increased risk of acute myocarditis with scrub typhus. These patients warrant closer follow-up and echocardiogram would be needed. SN - 2005-6648 UR - https://www.unboundmedicine.com/medline/citation/28226202/Predictors_of_acute_myocarditis_in_complicated_scrub_typhus:_an_endemic_province_in_the_Republic_of_Korea_ L2 - https://dx.doi.org/10.3904/kjim.2016.303 DB - PRIME DP - Unbound Medicine ER -