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Severe fever with thrombocytopenia syndrome: comparison with scrub typhus and clinical diagnostic prediction.
BMC Infect Dis. 2019 Feb 19; 19(1):174.BI

Abstract

BACKGROUND

Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes.

METHODS

Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus.

RESULTS

The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm3; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm3; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1% (95% confidence interval [CI], 87.9-96.4%) and a specificity of 96.1% (95% CI, 93.8-97.6%) for SFTS.

CONCLUSION

This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings.

Authors+Show Affiliations

Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea. Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea.Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea.Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea.Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea.Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea.Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea.Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea.Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.Department of Internal Medicine, School of Medicine, Kyungpook National University Kyungpook National University Hospital, Daegu, Republic of Korea.Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea.Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea.Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea.Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea. mdohmd@snu.ac.kr.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30782137

Citation

Park, Sang-Won, et al. "Severe Fever With Thrombocytopenia Syndrome: Comparison With Scrub Typhus and Clinical Diagnostic Prediction." BMC Infectious Diseases, vol. 19, no. 1, 2019, p. 174.
Park SW, Lee CS, Kim JH, et al. Severe fever with thrombocytopenia syndrome: comparison with scrub typhus and clinical diagnostic prediction. BMC Infect Dis. 2019;19(1):174.
Park, S. W., Lee, C. S., Kim, J. H., Bae, I. G., Moon, C., Kwak, Y. G., Kim, B. N., Lee, J. H., Ryu, S. Y., Jang, H. C., Hur, J., Jun, J. B., Jung, Y., Chang, H. H., Kim, Y. K., Hwang, J. H., Kim, Y. S., Jeong, H. W., Song, K. H., ... Oh, M. D. (2019). Severe fever with thrombocytopenia syndrome: comparison with scrub typhus and clinical diagnostic prediction. BMC Infectious Diseases, 19(1), 174. https://doi.org/10.1186/s12879-019-3773-1
Park SW, et al. Severe Fever With Thrombocytopenia Syndrome: Comparison With Scrub Typhus and Clinical Diagnostic Prediction. BMC Infect Dis. 2019 Feb 19;19(1):174. PubMed PMID: 30782137.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe fever with thrombocytopenia syndrome: comparison with scrub typhus and clinical diagnostic prediction. AU - Park,Sang-Won, AU - Lee,Chang-Seop, AU - Kim,Jeong-Han, AU - Bae,In-Gyu, AU - Moon,Chisook, AU - Kwak,Yee Gyung, AU - Kim,Baek-Nam, AU - Lee,Jae Hoon, AU - Ryu,Seong Yeol, AU - Jang,Hee-Chang, AU - Hur,Jian, AU - Jun,Jae-Bum, AU - Jung,Younghee, AU - Chang,Hyun-Ha, AU - Kim,Young Keun, AU - Hwang,Jeong-Hwan, AU - Kim,Yeon-Sook, AU - Jeong,Hye Won, AU - Song,Kyoung-Ho, AU - Park,Wan Beom, AU - Kim,Eu Suk, AU - Oh,Myoung-Don, Y1 - 2019/02/19/ PY - 2018/11/23/received PY - 2019/02/01/accepted PY - 2019/2/21/entrez PY - 2019/2/21/pubmed PY - 2019/4/9/medline KW - Korea KW - Prediction KW - SFTS KW - Score KW - Scrub typhus KW - Severe fever with thrombocytopenia syndrome KW - Tsutsugamushi SP - 174 EP - 174 JF - BMC infectious diseases JO - BMC Infect Dis VL - 19 IS - 1 N2 - BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes. METHODS: Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus. RESULTS: The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm3; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm3; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1% (95% confidence interval [CI], 87.9-96.4%) and a specificity of 96.1% (95% CI, 93.8-97.6%) for SFTS. CONCLUSION: This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/30782137/Severe_fever_with_thrombocytopenia_syndrome:_comparison_with_scrub_typhus_and_clinical_diagnostic_prediction_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3773-1 DB - PRIME DP - Unbound Medicine ER -