Abstract
Scrub typhus is endemic in rural Southeast Asia. The district of Umphang in northwestern Thailand is a prototype environment for this disease. We report the clinical manifestations and outcomes of patients diagnosed with scrub typhus in this area. Patients diagnosed with scrub typhus between 2011 and 2014 were analyzed. Diagnosis was based on clinical symptoms in conjunction with a positive rapid test or a pathognomonic eschar lesion. A total of 857 patients were included, of which 488 were adults and 369 were children. Most patients (728; 84.9%) were included via a positive serology on rapid test, 86 patients (10.0%) had eschar only, and 43 patients (5.0%) had both sero-confirmation and presence of eschar. The most common symptom was fever (93.8%), followed by headache (48.1%) and cough (33.1%). Eschars were reported in 129 patients, with a significantly higher percentage in children (p < 0.001), and a different anatomical distribution was found when adults and children were compared. Common complications were elevated transaminases, acute kidney injury, and pneumonia. Most patients recovered from the disease. Scrub typhus in Umphang district is common. Patients can present with a variety of clinical symptoms, regardless of the presence of fever. Standard treatment led to a favorable outcome in most patients.
Highlights
Scrub typhus is endemic in rural Southeast Asia
Scrub typhus is an acute febrile illness caused by the obligatory intracellular bacteria Orientia tsutsugamushi
Diagnostic confirmation of scrub typhus was different between adults and children, as children were significantly more likely to be diagnosed based on the presence of an eschar lesion
Summary
Scrub typhus is endemic in rural Southeast Asia. The district of Umphang in northwestern Thailand is a prototype environment for this disease. We report the clinical manifestations and outcomes of patients diagnosed with scrub typhus in this area. Scrub typhus is an acute febrile illness caused by the obligatory intracellular bacteria Orientia tsutsugamushi. It is endemic in an area described as the “tsutsugamushi triangle” that covers large parts of Asia and the Western Pacific region [1]. Transmission occurs through the bite of an infected mite of the genus Leptotrombidium [2] As these mites can be found in many different types of vegetation (e.g., forests, rice paddies, or plantations), farmers and people who engage in outdoor activities have a higher risk of contracting scrub typhus [3,4,5]. Umphang Hospital is the focal point in the region for people, both Thais and immigrants from neighboring countries or refugee camps, who require medical attention
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