Ko Chang1, Nan-Yao Lee2, Wen-Chien Ko2, Wei-Ru Lin3, Yen-Hsu Chen4, Jih-Jin Tsai5, Tun-Chieh Chen6, Chun-Yu Lin6, Ya-Ting Chang7, Po-Liang Lu8. 1. Department of Internal Medicine, Kaohsiung Municipal Siao-Kang Hospital, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 2. National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Internal Medicine and Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan. 3. Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 4. School of Medicine, Kaohsiung Medical University, Taiwan; Graduate Institute of Medicine and Sepsis Research Center, College of Medicine, Kaohsiung Medical University, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, HsinChu, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: infchen@gmail.com. 5. School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 6. School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 7. Department of Internal Medicine, Kaohsiung Municipal Siao-Kang Hospital, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 8. School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: d830166@gmail.com.
Abstract
BACKGROUND/ PURPOSE: The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear. METHODS: We conducted a retrospective study to identify the characteristics of the elderly aged ≥65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011. RESULTS: Among 441 cases, including 187 cases of scrub typhus, 166 acute Q fever, and 88 murine typhus, 68 (15.4%) cases were elderly patients. The elderly had a higher severe complication rate (10.3% vs. 3.5%, p = 0.022), but did not have a significantly higher mortality rate (1.47% vs. 0.54%, p = 0.396). Compared with those without severe complications, we found the elderly (p = 0.022), dyspnea (p = 0.006), less relative bradycardia (p = 0.004), less febrile illness (p = 0.004), prolonged prothrombin time (PT) (p = 0.002), higher levels of initial C-reactive protein (p = 0.039), blood leukocyte counts (p = 0.01), and lower platelet counts (p = 0.012) are significantly associated with severe complications. Only prolonged prothrombin time was associated with severe complications in multivariate analysis (p = 0.018, CI 95% 0.01-0.66). Among clinical symptoms and laboratory data, multivariate analysis revealed chills was less frequently occurred in the elderly (p = 0.012, 95% confidence interval [CI]: 1.33-9.99). CONCLUSION: The elderly cases with scrub typhus, murine typhus, or acute Q fever would be more likely to have severe complications, for which prothrombin time prolongation is an important predictor for severe complications.
BACKGROUND/ PURPOSE: The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear. METHODS: We conducted a retrospective study to identify the characteristics of the elderly aged ≥65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011. RESULTS: Among 441 cases, including 187 cases of scrub typhus, 166 acute Q fever, and 88 murine typhus, 68 (15.4%) cases were elderly patients. The elderly had a higher severe complication rate (10.3% vs. 3.5%, p = 0.022), but did not have a significantly higher mortality rate (1.47% vs. 0.54%, p = 0.396). Compared with those without severe complications, we found the elderly (p = 0.022), dyspnea (p = 0.006), less relative bradycardia (p = 0.004), less febrile illness (p = 0.004), prolonged prothrombin time (PT) (p = 0.002), higher levels of initial C-reactive protein (p = 0.039), blood leukocyte counts (p = 0.01), and lower platelet counts (p = 0.012) are significantly associated with severe complications. Only prolonged prothrombin time was associated with severe complications in multivariate analysis (p = 0.018, CI 95% 0.01-0.66). Among clinical symptoms and laboratory data, multivariate analysis revealed chills was less frequently occurred in the elderly (p = 0.012, 95% confidence interval [CI]: 1.33-9.99). CONCLUSION: The elderly cases with scrub typhus, murine typhus, or acute Q fever would be more likely to have severe complications, for which prothrombin time prolongation is an important predictor for severe complications.
Authors: Sandhya Dhawan; Matthew T Robinson; John Stenos; Stephen R Graves; Tri Wangrangsimakul; Paul N Newton; Nicholas P J Day; Stuart D Blacksell Journal: Am J Trop Med Hyg Date: 2020-04-02 Impact factor: 2.345
Authors: José María Robaina-Bordón; Cristina Carranza-Rodríguez; Michele Hernández-Cabrera; Margarita Bolaños-Rivero; Elena Pisos-Álamo; Nieves Jaén-Sánchez; Araceli Hernández-Betancor; Laura Suárez-Hormiga; José Luis Pérez-Arellano Journal: Emerg Infect Dis Date: 2021-02 Impact factor: 6.883
Authors: Weerawat Phuklia; Phonepasith Panyanivong; Davanh Sengdetka; Piengchan Sonthayanon; Paul N Newton; Daniel H Paris; Nicholas P J Day; Sabine Dittrich Journal: J Antimicrob Chemother Date: 2019-01-01 Impact factor: 5.790