title: Delay in tetracycline treatment increases the risk of complications in Tsutsugamushi disease: data from the Japanese Diagnosis Procedure Combination database.
abstract: OBJECTIVE
  Tsutsugamushi disease (scrub typhus) is caused by Orientia tsutsugamushi, and has been endemic in Asia and Western Pacific islands. Though sporadic case reports have described the clinical consequences of this vector-borne disease, data on the actual incidence of complications or mortality are scarce. It also remains unclear how a delay in effective treatments affects the occurrence of complications associated with this Rickettsial disease.
  
  
  METHODS
  Using the Japanese Diagnosis Procedure Combination inpatient database in Japan, we identified patients with Tsutsugamushi disease between July 1 and December 31 in 2007 and 2008. We examined location of hospitals, patient's age, sex, comorbidities, complications, inhospital deaths, date of admission, date of starting therapy with tetracyclines. A logistic regression was conducted to analyze the association between delay in effective treatments and the occurrence of complications.
  
  
  RESULTS
  A total of 210 cases were identified. Overall, 29 (13.8%) had at least one complication and two deaths were identified. Age was a significant risk factor for complications [odds ratio (OR), 1.48; 95% confidence interval (CI), 1.08-2.03; p=0.014, for a 10-year age increase]. Patients with ≥2 days delay in treatment with tetracyclines had a significantly higher risk of complications compared to those with no delay (OR, 2.71; 95% CI, 1.03-7.12; p=0.044).
  
  
  CONCLUSIONS
  Tsutsugamushi disease remains a threat to public health. Our study clearly indicates the importance of early diagnosis and immediate tetracycline treatment to prevent severe complications in Tsutsugamushi disease.
authors.affiliation: Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Japan. yasunagah-jyo@h.u-tokyo.ac.jp
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012612:Scrub Typhus / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D013754:Tetracyclines / Q000008:administration & dosage*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D013754:Tetracyclines