The difference in clinical characteristics between acute Q fever and scrub typhus in southern Taiwan.
OBJECTIVE
To identify the differences in clinical characteristics between acute Q fever and scrub typhus in southern Taiwan.


METHODS
A prospective observational study was conducted in which serological tests for acute Q fever and scrub typhus were performed simultaneously regardless of which disease was suspected clinically. From April 2004 to December 2007, 80 and 40 cases of serologically confirmed acute Q fever and scrub typhus, respectively, were identified and included in the study for comparison.


RESULTS
By univariate analysis, being male (p<0.001) and having an alanine aminotransferase (ALT) >88U/l (p=0.015) were more common in acute Q fever, whereas residence or travel in a mountainous region or offshore island of Taiwan (p<0.001), skin rash (p<0.001), eschar (p<0.001), lymphadenopathy (p=0.04), leukocytosis (p=0.002), and pulmonary involvement on chest X-ray (p=0.003) were more common in scrub typhus. In the multivariate analysis, being male (odds ratio (OR) 10.883, 95% confidence interval (CI) 2.079-56.441, p=0.005) was an independent characteristic of acute Q fever, while residence or travel in a mountainous region or offshore island (OR 0.073, 95% CI 0.019-0.275, p<0.001) and skin rash (OR 0.152, 95% CI 0.024-0.945, p=0.043) were independent characteristics of scrub typhus. The response to doxycycline treatment was not different.


CONCLUSIONS
In southern Taiwan, sex, area of residence, travel history, and physical examination are important in the differentiation of acute Q fever from scrub typhus.
Lai
Chung-Hsu
CH
Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China.
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
D003937:Diagnosis, Differential; D005076:Exanthema / Q000382:microbiology; D006785:Hospitals, University; D006801:Humans; D007565:Jaundice / Q000209:etiology; D016017:Odds Ratio; D011446:Prospective Studies; D011778:Q Fever / Q000150:complications / Q000175:diagnosis*; D012307:Risk Factors; D012612:Scrub Typhus / Q000150:complications / Q000175:diagnosis*; D012698:Serologic Tests; D012737:Sex Factors; D013624:Taiwan; D014195:Travel