Abstract
What is already known about this topic?Scrub typhus (ST) causes public health challenges in the “tsutsugamushi triangle” in the Asia-Pacific area greater than 13 million square kilometers, affecting an estimated one million people each year.What is added by this report?A retrospective study based on 4,501 hospitalized patients with ST in Guangzhou City, China, described the epidemiological and clinical characteristics, laboratory findings of ST, and determined the related factors and a predictive model for severe disease.What are the implications for public health practice?The current study provided updated knowledge that might enable public health policymakers to formulate appropriate measures to prevent ST and medical workers to perform targeted management to recognize and treat severe ST patients.
Highlights
Scrub typhus (ST) is a vector-borne rickettsial zoonosis caused by the organism Orientia tsutsugamushi, transmitted to humans by the bite of the larva of trombiculid mites (1–2)
Count and increased levels of serum creatinine (CREA) and total bilirubin (TBIL) in the blood, as well as the occurrence of dyspnea for ST patients, with estimated relative contributions more than 10% in the final boosted regression trees models, which could be helpful for the recognization and treatment of severe ST in the early clinical management
Severe illness was determined from 366 patients, with a disease severity rate (DSR) of 8.1%, which did not differ across the studied years (Table 1, Figure 2A)
Summary
TBIL, hemoglobin (HGB), and NEU count that were significantly related to severe ST (Supplementary Table S3, available in http://weekly.chinacdc.cn/). The final BRT model that included 10 factors attained a high prediction efficiency, with the mean AUC of 0.92 (95% CI: 0.90–0.93) and an accuracy of 0.88 (95% CI: 0.86–0.89) on testing data. The highest relative contribution (RC) to severe ST was observed for ALB, estimated to be 24.77% (95% CI: 23.70–25.85), followed by dyspnea, PLT count, CREA, and TBIL with their RCs more than 10% The highest relative contribution (RC) to severe ST was observed for ALB, estimated to be 24.77% (95% CI: 23.70–25.85), followed by dyspnea, PLT count, CREA, and TBIL with their RCs more than 10% (Supplementary Table S4, available in http://weekly. chinacdc.cn/)
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