title: Clinical characteristics of acute Q fever, scrub typhus, and murine typhus with delayed defervescence despite doxycycline treatment.
abstract: Doxycycline is the recommended antibiotic for acute Q fever, scrub typhus, and murine typhus and defervescence often occurs within 3 days of treatment. Patients with delayed defervescence (> 3 days) are troublesome for clinicians. To investigate the characteristics of such patients, 18 and 88 cases with and without delayed defervescence, respectively, were studied. By univariate analysis, absence of headache (P = 0.004), jaundice (P = 0.030), icteric sclera (P = 0.030), relative bradycardia (P = 0.003), and pulmonary involvement on chest x-ray (P = 0.028) were significant findings in patients with delayed defervescence. By multivariate analysis, absence of headache (odds ratio [OR] = 8.310; 95% confidence interval [CI] = 1.990-34.706, P = 0.004), jaundice (OR = 6.242; 95% CI = 1.374-28.365, P = 0.018), and relative bradycardia (OR = 10.449; 95% CI = 2.137-51.088, P = 0.004) were the independent characteristics of patients with delayed defervescence. In treating acute Q fever, scrub typhus, and murine typhus with doxycycline, clinicians should be aware that delayed defervescence may occur in patients presenting with jaundice, relative bradycardia, and absence of headache.
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaoshiung County, Taiwan, Republic of China. laich6363@yahoo.com.tw
authors.forename: Chung-Hsu
authors.initials: CH
authors.lastname: Lai
authors.forename: Chun-Kai
authors.initials: CK
authors.lastname: Huang
authors.forename: Hui-Ching
authors.initials: HC
authors.lastname: Weng
authors.forename: Hsing-Chun
authors.initials: HC
authors.lastname: Chung
authors.forename: Shiou-Haur
authors.initials: SH
authors.lastname: Liang
authors.forename: Jiun-Nong
authors.initials: JN
authors.lastname: Lin
authors.forename: Chih-Wen
authors.initials: CW
authors.lastname: Lin
authors.forename: Chuan-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: Hsi-Hsun
authors.initials: HH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis; D006526:Hepatitis C / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011778:Q Fever / Q000188:drug therapy*; D012612:Scrub Typhus / Q000188:drug therapy*; D013624:Taiwan; D014437:Typhus, Endemic Flea-Borne / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline