Risk Factors Associated with Life-threatening Rickettsial Infections

We retrospectively analyzed 92 cases of severe rickettsial infections in patients (median age = 49 years, 57% male, 37.0% with scrub typhus) in Hong Kong. Immunofluorescence assay was used for diagnostic confirmation. Identification of > or = 1 diagnostic sign (exposure history, rash, or eschar)...

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Veröffentlicht in:The American journal of tropical medicine and hygiene 2008-06, Vol.78 (6), p.973-978
Hauptverfasser: Lee, Nelson, Ip, Margaret, Wong, Bonnie, Lui, Grace, Tsang, Owen Tak Yin, Lai, Jak Yiu, Choi, Kin Wing, Lam, Rebecca, Ng, Tak Keung, Ho, Jenny, Chan, Yin Yan, Cockram, Clive S, Lai, Sik To
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Sprache:eng
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Zusammenfassung:We retrospectively analyzed 92 cases of severe rickettsial infections in patients (median age = 49 years, 57% male, 37.0% with scrub typhus) in Hong Kong. Immunofluorescence assay was used for diagnostic confirmation. Identification of > or = 1 diagnostic sign (exposure history, rash, or eschar) was possible in 94.6% of the cases. Multivariate analysis suggested that pulmonary infiltrates (odds ratio [OR] = 25.2, 95% confidence interval [CI] = 3.9-160.9, P = 0.001) and leukocytosis (OR = 1.3, 95% CI = 1.0-1.5 per unit increase, P = 0.033) were independent predictors of admission to an intensive care unit (14.1%). Delayed administration of doxycycline was independently associated with major organ dysfunction (23.9%; oxygen desaturation, renal failure, severe jaundice, encephalopathy, cardiac failure) (OR = 1.2, 95% CI = 1.0-1.5 per day delay, P = 0.046; adjusted for age and rickettsia biogroup) and prolonged hospitalization > 10 days (25%) (OR = 1.4, 95% CI = 1.1-1.9 per day delay, P = 0.014). Treatment with fluoroquinolone/clarithromycin did not correlate with clinical outcomes (P > 0.05). Early empirical doxycycline therapy should be considered if clinico-epidemiologic signs of rickettsial infections are present.
ISSN:0002-9637
1476-1645
DOI:10.4269/ajtmh.2008.78.973