title: Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan.
abstract: BACKGROUND
  Dengue fever, rickettsial diseases, and Q fever are acute febrile illnesses with similar manifestations in tropical areas. Early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever may be made by understanding the distinguishing clinical characteristics and the significance of demographic and weather factors.
  
  
  METHODS
  We conducted a retrospective study to identify clinical, demographic, and meteorological characteristics of 454 dengue fever, 178 scrub typhus, 143 Q fever, and 81 murine typhus cases in three Taiwan hospitals.
  
  
  RESULTS
  Case numbers of murine typhus and Q fever correlated significantly with temperature and rainfall; the scrub typhus case number was only significantly related with temperature. Neither temperature nor rainfall correlated with the case number of dengue fever. The rarity of dengue fever cases from January to June in Taiwan may be a helpful clue for diagnosis in the area. A male predominance was observed, as the male-to-female rate was 2.1 for murine typhus and 7.4 for Q fever. Multivariate analysis revealed the following six important factors for differentiating the rickettsial diseases and Q fever group from the dengue fever group: fever ≥8 days, alanine aminotransferase > aspartate aminotransferase, platelets >63,000/mL, C-reactive protein >31.9 mg/L, absence of bone pain, and absence of a bleeding syndrome.
  
  
  CONCLUSIONS
  Understanding the rarity of dengue in the first half of a year in Taiwan and the six differentiating factors may help facilitate the early differential diagnosis of rickettsial diseases and Q fever from dengue fever, permitting early antibiotic treatment.
authors: Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Ko
authors: K
authors: Chang
authors: Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
authors: Nan-Yao
authors: NY
authors: Lee
authors: Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
authors: Wen-Chien
authors: WC
authors: Ko
authors: School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Taiwan.
authors: Jih-Jin
authors: JJ
authors: Tsai
authors: Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Wei-Ru
authors: WR
authors: Lin
authors: School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Tun-Chieh
authors: TC
authors: Chen
authors: School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Electronic address: d830166@gmail.com.
authors: Po-Liang
authors: PL
authors: Lu
authors: School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Yen-Hsu
authors: YH
authors: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis*; D003661:Decision Support Techniques; D003710:Demography; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008685:Meteorological Concepts; D008875:Middle Aged; D010820:Physicians; D011778:Q Fever / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D012612:Scrub Typhus / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D013624:Taiwan / Q000453:epidemiology; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Q fever; dengue fever; murine typhus; rainfall; scrub typhus; temperature