Abnormal Liver Function in Scrub Typhus

Hu, Ming‐Luen; Liu, Jien-Wei; Wu, Keng‐Liang; Lu, Sheng–Nan; Chiou, Shue-Shian; Kuo, Chia-Hua; Chuah, Seng‐Kee; Wang, Jing‐Houng; Hu, Tsung–Hui; Chiu, King-Wah; Lee, Chuan–Mo; Changchien, Chi‐Sin

doi:10.4269/ajtmh.2005.73.667

Cited by 64 publications

(55 citation statements)

References 12 publications

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“…42 Liver involvement; hypoalbuminemia; and elevated alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and bilirubin levels have been described in scrub typhus patients. 13,21,42,49 Elevated liver enzymes is the most frequent finding in a previous report 50 and also in our study. Hyperbilirubinemia was an independent predictor of fatal outcome in our study, in accordance with a study from Varghese and others.…”

Section: Methodssupporting

confidence: 52%

Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome

Thipmontree

Tantibhedhyangkul

Silpasakorn

et al. 2016

The American Society of Tropical Medicine and Hygiene

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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.

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Section: Methodssupporting

confidence: 52%

Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome

Thipmontree

Tantibhedhyangkul

Silpasakorn

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…Scrub typhus is well documented in the literature as a cause of hepatic dysfunction (1,6,7,9,12,22,26). Renal impairment together with rare cases of renal failure is also recognized to occur during scrub typhus (27), and an elevated creatinine level has been reported to be an independent predictor of mortality (22).…”

Section: Discussionmentioning

confidence: 99%

Association of High Orientia tsutsugamushi DNA Loads with Disease of Greater Severity in Adults with Scrub Typhus

et al. 2009

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Orientia tsutsugamushi, the cause of scrub typhus, is a major pathogen in the Asia-Pacific region. The severity of infection ranges from mild features to multiorgan failure and death. The aim of this prospective study was to define the O. tsutsugamushi loads in the blood samples of patients with scrub typhus on the day of hospital admission and to determine whether this was associated with disease severity. Quantitation was performed using a real-time PCR Orientia tsutsugamushi, the cause of scrub typhus, is a major pathogen in the Asia-Pacific region, where it accounts for up to 23% of all febrile episodes (4). Infection commonly presents as an acute febrile illness 7 to 10 days after the bite of an infected larval trombiculid mite (chigger). The major presenting features are fever, severe headache, and myalgia. Other signs and symptoms include rash, lymphadenopathy, hepatosplenomegaly, cough, sore throat, abdominal pain, and central nervous system involvement. The severity of infection ranges from mild features to multiorgan failure and death, which occurs for around 4% of patients presenting to a hospital (10, 21). Severity of illness has been reported to show geographical variability (10), although the basis for this is unknown and has multiple explanations, including differences in host genetic susceptibility or response to infection and variability in the virulence of the organism. A relationship between magnitude of bacteremia and severity of clinical picture has been reported for a range of bacterial infections in both adults and children, based on quantitative bacterial culture (25) and, more recently, molecular techniques (5, 8). A previous study reported the O. tsutsugamushi DNA loads in 7 patients with scrub typhus, as defined by quantitative real-time PCR targeting a gene encoding a 47-kDa protein (20). This ranged from 1,076 to 28,812 DNA copies/l in blood, but clinical features and outcomes were not described (20).The aim of this study was to define the O. tsutsugamushi loads in blood samples taken on the day of hospital admission from a large, unselected population of patients with scrub typhus in northeast Thailand and to compare this with disease severity. MATERIALS AND METHODSPatients with scrub typhus were identified during a prospective study of acute febrile illness in Udon Thani hospital, northeast Thailand, between October 2000 and December 2001, as described previously (21). In brief, the inclusion criteria were an age of Ն15 years, the presence of a fever (Ͼ37.8°C) of unknown cause, and agreements to participate and to attend an outpatient follow-up for a convalescent-phase serum sample at 2 weeks. The exclusion criterion was a blood smear positive for malaria parasites or the presence of other definable infections, such as pneumonia or urinary tract infection. Blood was drawn on admission for aerobic blood culture, serological testing, and molecular diagnostics. The duration of symptoms prior to admission, antibiotic treatment at presentation, and clinical features, including the prese...

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“…Typical signs include eschar formation and acute febrile illness with symptoms that include abrupt fever, chills, rash, lymphadenopathy, abdominal pain, and myalgia (2,3). The clinical manifestations and complications of scrub typhus vary; most symptoms are mild but severe complications have been reported, including acute respiratory distress syndrome, encephalitis, interstitial pneumonia, myocarditis and pericarditis, acute renal failure, and acute hepatic failure (4)(5)(6)(7)(8)(9)(10). Very few reports describe the clinical course beyond the occurrence of fever after the appropriate antimicrobial agents have been administered (11).…”

mentioning

confidence: 99%

Dynamics of Clinical Symptoms in Patients with Scrub Typhus

Lee

Chung

et al. 2013

Jpn J Infect Dis

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SUMMARY:The clinical manifestations and complications of scrub typhus are variable. Few studies have examined the timeline of clinical symptoms after the appropriate antimicrobial agents have been administered. The most prevalent clinical manifestations are fever and cough, followed by headache, myalgia, eschar, skin rash, and nausea. Systemic symptoms are most severe during the early stages of illness (i.e., the first 5 days), but resolve slowly within 2 weeks. The associated skin rash is most severe during the first 8 days of infection, but it resolves slowly within 21 days.Scrub typhus is a potentially fatal infectious disease caused by the organism Orientia tsutsugamushi (1). Typical signs include eschar formation and acute febrile illness with symptoms that include abrupt fever, chills, rash, lymphadenopathy, abdominal pain, and myalgia (2,3). The clinical manifestations and complications of scrub typhus vary; most symptoms are mild but severe complications have been reported, including acute respiratory distress syndrome, encephalitis, interstitial pneumonia, myocarditis and pericarditis, acute renal failure, and acute hepatic failure (4-10). Very few reports describe the clinical course beyond the occurrence of fever after the appropriate antimicrobial agents have been administered (11). An established timeline of the clinical symptoms may help physicians manage patients with scrub typhus more effectively.This study was conducted in 5 university medical centers in Korea between October and December 2010. In the current study, we used several diagnostic criteria for scrub typhus. First, a diagnosis of scrub typhus was made according to the World Health Organization criteria in 4 out of 5 hospitals when specific IgM antibody titers were equal to or greater than 1:10, or IgG titers were either equal to or greater than 1:256, or a 4-fold increase in titer was demonstrated using paired serum samples in an indirect immunofluorescence antibody (IFA) test (11,12). The O. tsutsugamushi strains used in the IFA test included Gilliam, Karp, Kato, and Boryong. Second, in the remaining hospital, O. tsutsugamushi was detected in passive hemagglutination assay (PHA) against O. tsutsugamushi with an antibody titer of 1:80 or greater in a single serum sample or 4-fold increase or greater during follow-up (13,14). The PHA was conducted using the Genedia Tsutsu PHA II test kit (Green Cross Corp., Yongin, Korea), which provides qualitative and quantitative detection of serum antibodies against O. tsutsugamushi. Sheep erythrocytes for the PHA were sensitized with the Karp and Gilliam strains, including the Boryong strain found in Korea (11,12).Respiratory symptoms included cough and dyspnea. Systemic symptoms included subjective fever, chills, headache, weight loss, and myalgia. Gastrointestinal symptoms included nausea, vomiting, diarrhea, and abdominal pain (15). Neurologic symptoms included mental confusion and delirium. Moreover, a skin rash was also observed. Symptom severity was scored using a 4-point scale: no symptoms...

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Abnormal Liver Function in Scrub Typhus

Cited by 64 publications

References 12 publications

Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome

Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome

Association of High Orientia tsutsugamushi DNA Loads with Disease of Greater Severity in Adults with Scrub Typhus

Dynamics of Clinical Symptoms in Patients with Scrub Typhus

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