title: The difference in clinical characteristics between acute Q fever and scrub typhus in southern Taiwan.
abstract: 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.
authors.affiliation: 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.
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: 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