Clinical Role of Interstitial Pneumonia in Patients with Scrub Typhus: A Possible Marker of Disease Severity

Abstract

Interstitial pneumonia (IP) frequently occurs in patients with scrub typhus, but its clinical significance is not well known. This study was designed to evaluate interstitial pneumonia as a marker of severity of the disease for patients with scrub typhus. We investigated clinical parameters representing the severity of the disease, and the chest radiographic findings for 101 patients with scrub typhus. We then compared these clinical factors between patients with and without IP. We also studied the relationship between IP and other chest radiographic findings. The chest radiography showed IP (51.4%), pleural effusion (42.6%), cardiomegaly (14.9%), pulmonary alveolar edema (20.8%), hilar lymphadenopathy (13.8%) and focal atelectasis (11.8%), respectively. The patients with IP (n=52) had higher incidences in episode of hypoxia (p=0.030), hypotension (p=0.024), severe thrombocytopenia (p=0.036) and hypoalbuminemia (p=0.013) than the patients without IP (n=49). The patients with IP also had higher incidences of pleural effusion (p<0.001), focal atelectasis (p=0.019), cardiomegaly (p<0.001), pulmonary alveolar edema (p=0.011) and hilar lymphadenopathy (p<0.001) than the patients without IP. Our data suggest that IP frequently occurs for patients with scrub typhus and its presence is closely associated with the disease severity of scrub typhus.

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“…Scrub typhus is reported to cause lung and pleural involvement which includes pneumonia, interstitial pneumonitis, pleural effusion pulmonary edema, and life-threatening pulmonary hemorrhage. Song et al [11] have reported a close association between pneumonia and severity of scrub typhus. Among 101 patients with scrub typhus, 59% showed lung abnormalities in radiography.…”

Lymphadenopathy by Scrub Typhus Mimicking Metastasis on FDG PET/CT in a Patient with a History of Breast Cancer

“…Patients with scrub typhus usually have lymphadenopathy with tenderness in the region of the eschar and generalized lymphadenopathy is a common finding [2]. Furthermore, chest radiographic abnormalities [1,3] and inflammatory changes with spleen enlargement [2,4] were also observed in a previous case of scrub typhus.…”

Pulmonary Manifestations of Scrub Typhus: Wisdom May Prevail Obstacles

“…Interstitial pneumonia is considered as important determining factor for predicting the clinical course and prognosis by some authors as presence of interstitial pneumonia is related with more severe clinical presentation, prolonged hospitalization and higher mortality compared to the patients who did not develop this complication [16]. The outcome is determined by multiple factors including age of the patient and genetic factors but the virulence of infecting strain of O. tsutsugamushi is believed to be the most important one.…”

“…[16] in a study of 101 patients reported interstial pneumonia (51.4%) as most common radiological finding followed by pleural effusion (42.6%), cardiomegaly (37.6%), pulmonary alveolar edema (20.8%), hilar adenopathy (13.8%) and focal atelectasis (11.8%) [16].…”

“…Most common radiological findings reported in the literature include bilateral diffuse areas of reticulonodular opacity, hilar lymph node enlargement, and septal lines implying interstitial involvement. Airspace consolidation is relatively uncommon and affects lower zones of both lungs [13,16]. Song et al…”