Clinical characteristics of acute Q fever, scrub typhus, and murine typhus with delayed defervescence despite doxycycline treatment.
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.
Lai
Chung-Hsu
CH
Section of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaoshiung County, Taiwan, Republic of China. laich6363@yahoo.com.tw
Huang
Chun-Kai
CK
Weng
Hui-Ching
HC
Chung
Hsing-Chun
HC
Liang
Shiou-Haur
SH
Lin
Jiun-Nong
JN
Lin
Chih-Wen
CW
Hsu
Chuan-Yuan
CY
Lin
Hsi-Hsun
HH
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*
D000900:Anti-Bacterial Agents; D004318:Doxycycline