Liver Involvement in Tsutsugamushi Disease.

Kanno, Atsushi; Yamada, Miki; Murakami, Kazuhiro; Torinuki, Wakio

doi:10.1620/tjem.179.213

Cited by 15 publications

(12 citation statements)

References 5 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: 87%

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: 87%

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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“…Elevated levels of AST and ALT are detected in 74.5-89.3% and 74.5-91.7% of patients, respectively, but serious liver involvement is rarely reported [5][6][7]. Although some pathological liver findings of scrub typhus in surviving patients have been reported, such as nonspecific reactive hepatitis and granulomatous hepatitis [13,14], acute liver failure with histological findings has been rarely reported [2][3][4]8].…”

Section: Discussionmentioning

confidence: 99%

Autopsy case of acute liver failure due to scrub typhus

Shioi

Murakami

Takikawa

et al. 2009

Clin J Gastroenterol

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Scrub typhus (Tsutsugamushi disease) is an acute febrile disease caused by infection with Orientia tsutsugamushi transmitted by mites. Although patients with scrub typhus commonly display mild liver injury, few die of acute liver failure. We describe herein an autopsy case of acute liver failure due to scrub typhus, which was complicated by disseminated intravascular coagulation and showed rapid progression of liver injury just before death. Histopathological findings revealed submassive hepatocellular necrosis, inflammatory cell infiltration in Glisson's capsules, and sporadic fibrin thrombi in the hepatic sinusoids. Cause of death was primarily associated with acute liver failure related to disseminated intravascular coagulation.

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“…The mechanism of hepatic impairment is unknown so far. It might be a result of direct invasion of Orientia tsutsugamushi [17,18], and cellular immunity may be attributed to the pathogenesis of the hepatic injury [19].…”

Section: Discussionmentioning

confidence: 99%

Hepatic Impairment Induced by Scrub Typhus is Associated with New Onset of Renal Dysfunction

Liang¹,

Huang²,

Li³

et al. 2014

Clin. Lab.

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Background: Scrub typhus is a potentially fatal infectious disease caused by Orientia tsutsugamushi. There is little attention given to hepatic impairment in the adults with scrub typhus. This study investigated the incidence and the prognostic implications of hepatic impairment in patients with scrub typhus. Methods: We retrospectively reviewed a total of 143 adult patients with scrub typhus who were admitted between January 1999 and December 2010 in Guangdong province, China. The patients were divided into three groups, e.g., normal, mild, and moderate to severe groups based on the elevated serum ALT and/or total bilirubin levels. Furthermore, clinical characteristics and prognosis of the patient groups were compared. Results: 109 patients (76.2%) had abnormal liver function. Among the patients with hepatic impairment 45 cases (31.4%), 54 cases (37.8%), and 10 cases (7.0%) had mild, moderate, and severe hepatic damage, respectively. The moderate to severe hepatic impairment group had higher levels of serum creatinine compared with that of normal hepatic function. The incidence of new onset of renal dysfunction -defined as peak serum creatinine ≥ 176 µmol/L during hospital stay with no evidence of renal disease prior hospitalization -was 0% in the mild hepatic impairment group, 8.9% in the moderate hepatic impairment group, and 21.9% in the severe hepatic impairment group, (p = 0.005 for trend). Additionally, the patients with hepatic impairment (n = 109) had higher incidences of episodes of thrombocytopenia (45.9% vs. 8.82%, p < 0.001), hypoalbuminemia (50.5% vs. 11.8%, p < 0.001), new onset of renal dysfunction (16.5% vs. 0.0%, p = 0.011), and electrocardiogram abnormality (28.4% vs. 8.82%, p = 0.019) than the patients without hepatic impairment. Conclusions: The degree of hepatic impairment induced by scrub typhus is associated with new onset of renal dysfunction. (Clin. Lab. 2014;60:xx-xx.

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Liver Involvement in Tsutsugamushi Disease.

Cited by 15 publications

References 5 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

Autopsy case of acute liver failure due to scrub typhus

Hepatic Impairment Induced by Scrub Typhus is Associated with New Onset of Renal Dysfunction

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