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Title: Scrub typhus in northeastern Thailand: Eschar distribution, abnormal electrocardiographic findings, and predictors of fatal outcome
Authors: Wilawan Thipmontree
Wiwit Tantibhedhyangkul
Saowaluk Silpasakorn
Ekkarat Wongsawat
Duangdao Waywa
Yupin Suputtamongkol
Maharaj Nakhon Ratchasima Hospital
Mahidol University
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Oct-2016
Citation: American Journal of Tropical Medicine and Hygiene. Vol.95, No.4 (2016), 769-773
Abstract: Copyright © 2016 by The American Society of Tropical Medicine and Hygiene. 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.
ISSN: 00029637
Appears in Collections:Scopus 2016-2017

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