Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity

Ko Chang, Nan Yao Lee, Wen Chien Ko, Wei Ru Lin, Yen Hsu Chen, Jih Jin Tsai, Tun Chieh Chen, Chun Yu Lin, Ya Ting Chang, Po Liang Lu

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)54-61
Number of pages8
JournalJournal of Microbiology, Immunology and Infection
Volume52
Issue number1
DOIs
Publication statusPublished - 2019 Feb

Fingerprint

Endemic Flea-Borne Typhus
Scrub Typhus
Q Fever
Prothrombin Time
Multivariate Analysis
Confidence Intervals
Chills
Bradycardia
Platelet Count
Taiwan
Leukocyte Count
Dyspnea
C-Reactive Protein
Fever
Retrospective Studies
Mortality

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Chang, Ko ; Lee, Nan Yao ; Ko, Wen Chien ; Lin, Wei Ru ; Chen, Yen Hsu ; Tsai, Jih Jin ; Chen, Tun Chieh ; Lin, Chun Yu ; Chang, Ya Ting ; Lu, Po Liang. / Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients : Prolonged prothrombin time as a predictor for severity. In: Journal of Microbiology, Immunology and Infection. 2019 ; Vol. 52, No. 1. pp. 54-61.
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title = "Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity",
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.",
author = "Ko Chang and Lee, {Nan Yao} and Ko, {Wen Chien} and Lin, {Wei Ru} and Chen, {Yen Hsu} and Tsai, {Jih Jin} and Chen, {Tun Chieh} and Lin, {Chun Yu} and Chang, {Ya Ting} and Lu, {Po Liang}",
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Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients : Prolonged prothrombin time as a predictor for severity. / Chang, Ko; Lee, Nan Yao; Ko, Wen Chien; Lin, Wei Ru; Chen, Yen Hsu; Tsai, Jih Jin; Chen, Tun Chieh; Lin, Chun Yu; Chang, Ya Ting; Lu, Po Liang.

In: Journal of Microbiology, Immunology and Infection, Vol. 52, No. 1, 02.2019, p. 54-61.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients

T2 - Prolonged prothrombin time as a predictor for severity

AU - Chang, Ko

AU - Lee, Nan Yao

AU - Ko, Wen Chien

AU - Lin, Wei Ru

AU - Chen, Yen Hsu

AU - Tsai, Jih Jin

AU - Chen, Tun Chieh

AU - Lin, Chun Yu

AU - Chang, Ya Ting

AU - Lu, Po Liang

PY - 2019/2

Y1 - 2019/2

N2 - 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.

AB - 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.

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