Risk factors associated with severe scrub typhus in Shandong, northern China

Zhang, Luyan; Zhao, Zhong; Bi, Zhuanfang; Kou, Zengqiang; Zhang, Meng; Yang, Li; Zheng, Li

doi:10.1016/j.ijid.2014.09.019

Cited by 23 publications

(12 citation statements)

References 17 publications

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“…Other common complications include meningo-encephalitis, shock and renal failure [9, 11]. Complications may be avoided by early administration of antibiotics such as doxycycline, chloramphenicol or azithromycin [12]. Adverse pregnancy outcomes resulting in stillbirth, prematurity and low birthweight may occur in 40% of pregnant women with scrub typhus [13, 14].…”

Section: Introductionmentioning

confidence: 99%

Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study

et al. 2019

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Background The burden of scrub typhus in endemic areas is poorly understood. This study aimed at estimating the proportion of hospitalisations and outpatient visits for undifferentiated fever in the community that may be attributable to scrub typhus. Methodology and principal findings The study was a retrospective cohort with a nested case-control study conducted in the South Indian state of Tamil Nadu. We conducted house-to-house screening in 48 villages (42965 people, 11964 households) to identify hospitalised or outpatient cases due to undifferentiated fever during the preceding scrub typhus season. We used scrub typhus IgG to determine past infection. We calculated adjusted odds ratios for the association between IgG positivity and case status. Odds ratios were used to estimate population attributable fractions (PAF) indicating the proportion of hospitalised and outpatient fever cases attributable to scrub typhus. We identified 58 cases of hospitalisation and 236 outpatient treatments. 562 people were enrolled as control group to estimate the background IgG sero-prevalence. IgG prevalence was 20.3% in controls, 26.3% in outpatient cases and 43.1% in hospitalised cases. The PAFs suggested that 29.5% of hospitalisations and 6.1% of outpatient cases may have been due to scrub typhus. In villages with a high IgG prevalence (defined as ≥15% among controls), the corresponding PAFs were 43.4% for hospitalisations and 5.6% for outpatients. The estimated annual incidence of scrub typhus was 0.8/1000 people (0.3/1000 in low, and 1.3/1000 in high prevalence villages). Evidence for recall error suggested that the true incidences may be about twice as high as these figures. Conclusions The study suggests scrub typhus as an important cause for febrile hospitalisations in the community. The results confirm the adequacy of empirical treatment for scrub typhus in hospitalised cases with undifferentiated fever. Since scrub typhus may be rare among stable outpatients, the use of empirical treatment remains doubtful in these.

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Section: Introductionmentioning

confidence: 99%

Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study

et al. 2019

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“…The median case fatality rate in untreated patients was estimated to be between 6 and 10% [1,13], but fatalities of up to 70% have been reported [1]. The duration of illness before effective antibiotic treatment is positively associated with progression to severe disease [14]. Hospital-based studies in South India reported a case fatality of 8–9% in ST patients reporting to the hospital, with multi-organ dysfunction observed in 34% of these patients [9,15].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan

et al. 2019

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Scrub typhus (ST) is a vector-borne rickettsial infection causing acute febrile illness. The re-emergence of ST in the Asia-Pacific region represents a serious public health threat. ST was first detected in Bhutan in 2008. However, the disease is likely to be under-diagnosed and under-reported, and the true impact is difficult to estimate. At the end of 2014, the SD Bioline Tsutsugamushi TestTM rapid diagnostic test (RDT) kits became available in all hospitals to assist clinicians in diagnosing ST. We conducted a retrospective descriptive study, reviewing records from all hospitals of Bhutan to identify all RDT-positive clinical cases of ST in Bhutan in 2015. The aim was to evaluate the burden of ST in Bhutan, describe the demographic, spatial and temporal patterns of disease, and identify the typical clinical presentations. The annual incidence of RDT-positive cases of ST reporting to Bhutanese hospitals in 2015 was estimated to be 62 per 100,000 population at risk. The incidence of disease was highest in the southern districts with a subtropical climate and a high level of agricultural production. The highest proportion of cases (87%) was rural residents, with farmers being the main occupational category. The disease was strongly seasonal, with 97% of cases occurring between June and November, coinciding with the monsoon and agricultural production seasons. Common ST symptoms were not specific, and an eschar was noted by clinicians in only 7.4% of cases, which is likely to contribute to an under-diagnosis of ST. ST represents an important and neglected burden, especially in rural communities in Bhutan. The outcomes of this study will inform public health measures such as timely-awareness programmes for clinicians and the public in high-risk areas, to improve the diagnosis, treatment and clinical outcomes of this disease.

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“…Scrub typhus is known to be an endemic disease in China. 8 The number of cases has been reported in many parts of China [6,8,[10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Another element is that ST infection in Luhe district is more common in female than male. It may be because most women generally spend more time on the farm and engaged in outdoor activities [11].A study conducted in Korea reported that females are more likely to be at risk of ST infection than males [16]. Moreover, the rise of farming activities has traditionally been associated with ST infection.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with scrub typhus infection: A case-control study from Luhe, China

Musa

et al. 2019

Preprint

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Background: Globally, Scrub typhus (ST) is a serious public health issues in the rural of Asia-Pacific area. This study aimed to determine the risk factors associated with ST infection in Luhe District, China. Methods: The case-control study was conducted which involved (N=116) cases consisted of a patient who diagnosed with scrub typhus, and nearest neighbours control (N=232) subjects were selected by matching for occupation, place of residence and age (within 5-years) and lacked a history of scrub typhus. Statistical analysis was performed using SPSS version 25.0 for Windows. Results: The mean age of confirmed cases was 58.1(10.15) years, while that of control subjects were 56.14 (11.57). The ratio of farmers in cases and controls subjects was 90 (77.6%) and 187 (80.6%) respectively. There are no significant differences in the demographic characteristics of the study population (P>0.05). Factors including residential site (χ2=8.57, P=0.05), raising small animal and livestock (χ2=31.53, P<0.001), living in the house near to grassland and vegetable (χ2=16.61, P<0.001), piling weeds in the yard (χ2=15.48, P<0.001), piling weed inside the house and around the house (χ2=56.64, P<0.001), and presence of mouse activities in the house (χ2= 3.88, P<0.054) are significant associated with developing of ST infection. The logistic regression analysis showed that Two out of five general exposure factors were identified which include morning exercise in the park (AOR=3.848, 95% CI=1.018-4.544, P=0.047), and working as labourers in vegetable fields (AOR =1.792, 95% CI=1.12-2.87, P=0.016) posed a significant association with ST infection. Conclusions: The people who tend to involved in outdoor activities are exposure to ST infection. The findings derived from this study provide an information in the control and prevention of ST in Luhe, China.

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Risk factors associated with severe scrub typhus in Shandong, northern China

Cited by 23 publications

References 17 publications

Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study

Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study

Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan

Risk factors associated with scrub typhus infection: A case-control study from Luhe, China

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