title: Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome.
abstract: Scrub typhus is endemic in Thailand. Of the 495 patients with acute undifferentiated fever studied in Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, from June 1, 2011, to December 31, 2012, 146 patients (29.5%) had confirmed scrub typhus. The majority of cases were male, farmers, with the mean (±standard deviation) age of 54.1 ± 15.2 years. A total of 59 patients (40.4%) had eschar lesion. The commonest sites for an eschar in male patients were the perineum, inguinal, and buttock area; whereas in females, it was the head and neck area. Abnormal electrocardiogram was found in 39 of 79 patients (49.4%) with sinus tachycardia being the most frequent finding (17, 21.5%). A total of 73 patients (50%) had at least one complication. Myocarditis was the cause of complete heart block in a scrub typhus patient, and he fully recovered after receiving intravenous chloramphenicol treatment. The case fatality rate was 6.2% (nine deaths).The independent predictors for fatal outcome were age over 65 years (odds ratio [OR] = 14.49, 95% confidence interval [CI] = 1.26-166.44, P = 0.03), acute kidney injury (OR = 12.75, 95% CI = 1.77-92.07, P = 0.01), and hyperbilirubinemia (OR = 24.82, 95% CI = 2.12-286.61, P = 0.01). Early diagnosis and prompt appropriate treatment can improve the patient's outcome.
authors: Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand. wthipmontree@gmail.com.
authors: Wilawan
authors: W
authors: Thipmontree
authors: Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Wiwit
authors: W
authors: Tantibhedhyangkul
authors: Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Saowaluk
authors: S
authors: Silpasakorn
authors: Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Ekkarat
authors: E
authors: Wongsawat
authors: Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Duangdao
authors: D
authors: Waywa
authors: Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Yupin
authors: Y
authors: Suputtamongkol
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002701:Chloramphenicol / Q000627:therapeutic use*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005334:Fever / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D006932:Hyperbilirubinemia; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012285:Orientia tsutsugamushi / Q000302:isolation & purification*; D011446:Prospective Studies; D012612:Scrub Typhus / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002701:Chloramphenicol