Clinical and Epidemiological Characteristics of Scrub Typhus and Murine Typhus among Hospitalized Patients with Acute Undifferentiated Fever in Northern Vietnam

Abstract

A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non–scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting.

Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome

“…The incidence of eschar lesion in our study (40.4%) was higher than the previous study in adult Thai patients (20.9%), 21 but lower than studies in Thai children (68%) 37 and other Asian countries. 38,39 The commonest locations for eschar in males were the perineum, inguinal, and buttock areas, similar to the report from Korea 39 ; whereas in females, the eschar predominantly occurred in the head and neck area, as opposed to the chest as described in the study by Kim and others. 39 Eschar lesion is a pathognomonic sign of scrub typhus infection.…”

The temporal dynamics of humoral immunity to Rickettsia typhi infection in murine typhus patients

“…Murine typhus studies in Asia have inconsistently applied diagnostic cut-offs for when using the IFA (see Supplementary material, Table S1). IFA cut-off reciprocal titres from previous studies for IgM ranged from 64 [16] to 400 [7] and for IgG ranged from 128 [16] to 400 [3]. Whole antibody (IgM and IgG) was consistently applied at 400 in reported studies [17e19].…”

Distinguishing Japanese Spotted Fever and Scrub Typhus, Central Japan, 2004– 2015

“…The typical signs and symptoms of JSF and ST are similar (e.g., fever, rash, and eschar), although in patients with ST, the frequency of rash varies from 14% to 93% and of eschar from 8% to 93% ( 9 – 13 ). For a few patients with JSF and ST, severe conditions develop ( 14 – 17 ).…”