Radiologic Pulmonary Findings, Clinical Manifestations and Serious Complications in Scrub Typhus: Experiences From A Teaching Hospital in Eastern Taiwan

Abstract

Background: Scrub typhus (tsutsugamushi disease) is an endemic infectious disease in eastern Taiwan caused by Orientia tsutsugamushi. Methods: A total of 136 cases of scrub typhus were diagnosed from patients' blood samples. Medical records were reviewed and clinical manifestations and chest X-rays were analyzed. Results: Scrub typhus was diagnosed in 136 patients, with a mean age of 40.7 ± 21.5 years. The most common symptom was fever in 134 patients (98.5%), and the most common sign was eschar in 82 (60.3%). Chest X-rays were performed in 115 cases and showed abnormalities in 63 patients (54.8%). Patients with chest X-rays abnormalities had an increased incidence of cough (p < 0.001), septic shock (p = 0.006), congestive heart failure (p < 0.001), acute respiratory failure (p < 0.001), severe jaundice (p = 0.03) and acute renal failure (p = 0.007), and requirement for intensive care unit treatment (p < 0.001) and prolonged length of hospital stay (p = 0.002), compared with patients without chest X-rays abnormalities. Patients aged £ 16 years had an increased incidence of meningoencephalitis (p = 0.006) compared with the others. Patients aged ≥ 65 years had a higher incidence of complications and requirement for intensive care unit care (p = 0.02) compared with the other two groups. Conclusion: Patients with abnormal chest X-rays had higher rates of serious complications. Central nervous system infection was most frequent in pediatric patients. Patients aged ≥ 65 years had a higher incidence of serious complications. Physicians should have increased awareness of scrub typhus when caring for patients with acute febrile illness in endemic areas.

Keywords

• fever
• rickettsial pneumonia
• scrub typhus