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Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity.
J Microbiol Immunol Infect. 2019 Feb; 52(1):54-61.JM

Abstract

BACKGROUND/PURPOSE

The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear.

METHODS

We conducted a retrospective study to identify the characteristics of the elderly aged ≥65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011.

RESULTS

Among 441 cases, including 187 cases of scrub typhus, 166 acute Q fever, and 88 murine typhus, 68 (15.4%) cases were elderly patients. The elderly had a higher severe complication rate (10.3% vs. 3.5%, p = 0.022), but did not have a significantly higher mortality rate (1.47% vs. 0.54%, p = 0.396). Compared with those without severe complications, we found the elderly (p = 0.022), dyspnea (p = 0.006), less relative bradycardia (p = 0.004), less febrile illness (p = 0.004), prolonged prothrombin time (PT) (p = 0.002), higher levels of initial C-reactive protein (p = 0.039), blood leukocyte counts (p = 0.01), and lower platelet counts (p = 0.012) are significantly associated with severe complications. Only prolonged prothrombin time was associated with severe complications in multivariate analysis (p = 0.018, CI 95% 0.01-0.66). Among clinical symptoms and laboratory data, multivariate analysis revealed chills was less frequently occurred in the elderly (p = 0.012, 95% confidence interval [CI]: 1.33-9.99).

CONCLUSION

The elderly cases with scrub typhus, murine typhus, or acute Q fever would be more likely to have severe complications, for which prothrombin time prolongation is an important predictor for severe complications.

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Authors+Show Affiliations

Chang K
Department of Internal Medicine, Kaohsiung Municipal Siao-Kang Hospital, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Lee NY
National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Internal Medicine and Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
Ko WC
National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Internal Medicine and Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
Lin WR
Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chen YH
School of Medicine, Kaohsiung Medical University, Taiwan; Graduate Institute of Medicine and Sepsis Research Center, College of Medicine, Kaohsiung Medical University, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: infchen@gmail.com.
Tsai JJ
School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chen TC
School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Lin CY
School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chang YT
Department of Internal Medicine, Kaohsiung Municipal Siao-Kang Hospital, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Lu PL
School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: d830166@gmail.com.

MeSH

AgedAged, 80 and overFemaleHumansMaleProthrombin TimeQ FeverRetrospective StudiesScrub TyphusSeverity of Illness IndexTaiwanTyphus, Endemic Flea-Borne

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28709838

Citation

Chang, Ko, et al. "Characteristics of Scrub Typhus, Murine Typhus, and Q Fever Among Elderly Patients: Prolonged Prothrombin Time as a Predictor for Severity." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 52, no. 1, 2019, pp. 54-61.
Chang K, Lee NY, Ko WC, et al. Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity. J Microbiol Immunol Infect. 2019;52(1):54-61.
Chang, K., Lee, N. Y., Ko, W. C., Lin, W. R., Chen, Y. H., Tsai, J. J., Chen, T. C., Lin, C. Y., Chang, Y. T., & Lu, P. L. (2019). Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 52(1), 54-61. https://doi.org/10.1016/j.jmii.2016.08.023
Chang K, et al. Characteristics of Scrub Typhus, Murine Typhus, and Q Fever Among Elderly Patients: Prolonged Prothrombin Time as a Predictor for Severity. J Microbiol Immunol Infect. 2019;52(1):54-61. PubMed PMID: 28709838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity. AU - Chang,Ko, AU - Lee,Nan-Yao, AU - Ko,Wen-Chien, AU - Lin,Wei-Ru, AU - Chen,Yen-Hsu, AU - Tsai,Jih-Jin, AU - Chen,Tun-Chieh, AU - Lin,Chun-Yu, AU - Chang,Ya-Ting, AU - Lu,Po-Liang, Y1 - 2017/06/22/ PY - 2016/01/29/received PY - 2016/08/25/revised PY - 2016/08/31/accepted PY - 2017/7/16/pubmed PY - 2019/9/13/medline PY - 2017/7/16/entrez KW - Acute Q fever KW - Complications KW - Elderly KW - Murine typhus KW - Scrub typhus SP - 54 EP - 61 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 52 IS - 1 N2 - BACKGROUND/PURPOSE: The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear. METHODS: We conducted a retrospective study to identify the characteristics of the elderly aged ≥65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011. RESULTS: Among 441 cases, including 187 cases of scrub typhus, 166 acute Q fever, and 88 murine typhus, 68 (15.4%) cases were elderly patients. The elderly had a higher severe complication rate (10.3% vs. 3.5%, p = 0.022), but did not have a significantly higher mortality rate (1.47% vs. 0.54%, p = 0.396). Compared with those without severe complications, we found the elderly (p = 0.022), dyspnea (p = 0.006), less relative bradycardia (p = 0.004), less febrile illness (p = 0.004), prolonged prothrombin time (PT) (p = 0.002), higher levels of initial C-reactive protein (p = 0.039), blood leukocyte counts (p = 0.01), and lower platelet counts (p = 0.012) are significantly associated with severe complications. Only prolonged prothrombin time was associated with severe complications in multivariate analysis (p = 0.018, CI 95% 0.01-0.66). Among clinical symptoms and laboratory data, multivariate analysis revealed chills was less frequently occurred in the elderly (p = 0.012, 95% confidence interval [CI]: 1.33-9.99). CONCLUSION: The elderly cases with scrub typhus, murine typhus, or acute Q fever would be more likely to have severe complications, for which prothrombin time prolongation is an important predictor for severe complications. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/28709838/Characteristics_of_scrub_typhus_murine_typhus_and_Q_fever_among_elderly_patients:_Prolonged_prothrombin_time_as_a_predictor_for_severity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1684-1182(17)30066-X DB - PRIME DP - Unbound Medicine ER -