Delay in Tetracycline Treatment Increases the Risk of Complications in Tsutsugamushi Disease: Data from the Japanese Diagnosis Procedure Combination Database

Abstract

Objective Tsutsugamushi disease (scrub typhus) is caused by Orientia tsutsugamushi, and has been endemic in Asia and Western Pacific islands. Though sporadic case reports have described the clinical consequences of this vector-borne disease, data on the actual incidence of complications or mortality are scarce. It also remains unclear how a delay in effective treatments affects the occurrence of complications associated with this Rickettsial disease. Methods Using the Japanese Diagnosis Procedure Combination inpatient database in Japan, we identified patients with Tsutsugamushi disease between July 1 and December 31 in 2007 and 2008. We examined location of hospitals, patient's age, sex, comorbidities, complications, inhospital deaths, date of admission, date of starting therapy with tetracyclines. A logistic regression was conducted to analyze the association between delay in effective treatments and the occurrence of complications. Results A total of 210 cases were identified. Overall, 29 (13.8%) had at least one complication and two deaths were identified. Age was a significant risk factor for complications [odds ratio (OR), 1.48; 95% confidence interval (CI), 1.08-2.03; p=0.014, for a 10-year age increase]. Patients with !2 days delay in treatment with tetracyclines had a significantly higher risk of complications compared to those with no delay (OR, 2.71; 95% CI, 1.03-7.12; p=0.044). Conclusion Tsutsugamushi disease remains a threat to public health. Our study clearly indicates the importance of early diagnosis and immediate tetracycline treatment to prevent severe complications in Tsutsugamushi disease.

A Case of Scrub Typhus Imported from South Korea to Yamagata, Japan

“…One million cases of this disease occur in the endemic region annually (5). This disease is treatable with antibiotics (5), but a delay in antibiotic treatment increases the risk of severe complications (6). Furthermore, the mortality rate of untreated patients is estimated to be 10z (5).…”

“…However, in general, early diagnosis and treatment of imported infectious diseases tends to be difficult (13). Therefore, imported scrub typhus may cause severe complications due to delays in diagnosis (6). Recently, the number of scrub typhus cases is increasing in Asian countries (2-4) and these countries are now closely connected with the rest of the world through globalization.…”

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

“…Serology is the mainstay for diagnosing scrub typhus. 2 Patient outcome varies depending on pathogen factors (strain virulence 14 and high bacterial load 15 ), severity of the disease, 16 time to diagnosis, 17 commencement of appropriate treatment, 3 and the presence of drug resistance. 18 This study aims to demonstrate the clinical and laboratory manifestation, particularly eschar distribution and abnormal ECG findings, and the predictors of fatal outcome in scrub typhus patients.…”

A Case Report of an Unusual Presentation: Could the Early Use of Interventional Radiology have Saved this Patient of Scrub Typhus

“…Though GI symptoms occur in approximately 22.7% patients of Scrub Typhus, 1 clinical GI Bleeding incidence is relatively uncommon ranging from 1.9% to 3.4%. 1,3 Scrub Typhus is prevalent in India and currently there appears to be a resurgence. 4 Though most of the infections are mild, about 13.8 % cases land up with at least one complication.…”