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

3 Citations (Scopus)

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 1

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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 Nan-Yao Lee and Wen-Chien Ko 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, 01.02.2019, 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 - 2019/2/1

Y1 - 2019/2/1

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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