Clinical Features, Laboratory Characteristics and Prognostic Factors of Severity in Patients with Rickettsiaceae at Two Military Hospitals, Northern Vietnam

• Published in: Infection and drug resistance Vol. 13; pp. 2129 - 2138
• Main Authors: Le Van, Nam, Pham Van, Chung, Nguyen Dang, Manh, Dao Van, Thang, Le T Do, Quyen, Vu Hoang, Hung, Tran Viet, Tien, Nhu Do, Binh
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2020; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Bacteria; Care and treatment; Communicable diseases; Conjunctiva; Data collection; Deoxyribonucleic acid; Disease; DNA; EDTA; Epidemiology; Fever; Geography; Gram-negative bacteria; Hospitals; Infections; Infectious diseases; Lymphadenopathy; Medical laboratories; Military hospitals; Mortality; Orientia tsutsugamushi; Original Research; Pathogens; Patients; Pleural fluid; Respiration; Rickettsia; rickettsia spp; rickettsiaceae; Scrub typhus; Self employment; Thrombocytopenia; Tropical diseases; Typhus; Ulcers; Urban areas; Variables; Vietnam; United States > US; Orientia tsutsugamushi; Rickettsia spp; Rickettsiaceae; scrub typhus
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S253540

Rickettsioses are diseases caused by intracellular Gram-negative bacteria of the Rickettsiaceae family and transmitted through the bite of infected ticks or mites. To investigate the clinical and subclinical characteristics and prognostic severe factors of the disease caused by Rickettsiaceae. A prospective, descriptive cross-sectional study was conducted at Department of Infectious Diseases of two military hospitals in Northern Vietnam from May 2013 to June 2019, in which 88 adult febrile patients caused by (50 patients) or spp. (38 patients) were enrolled. We recorded information regarding epidemiological characteristics (age, geography, residence, occupation), medical history, clinical and subclinical findings, life-threatening complications during treatment, outcomes and some factors predicting serious life-threatening complications in a case record form. Scrub typhus (ST) patients had eschar (70%), skin-conjunctiva congestion (60%) and lymphadenopathy (44%). patients had a higher rate of maculopapular rash (39.5%), no ulcers and no lymphadenopathy detected. The majority of patients had elevated PCT >0.05 ng/µL and increase in liver enzymes and thrombocytopenia. Major prognostic factors for severe complications included diffuse infiltrates on lung X-ray (OR: 19.5; p = 0.014), coarse crackles (OR: 18; p = 0.016), respiratory rate ≥25 cycles/minute (OR: 18; p = 0.016), shortness of breath (OR: 7.44; p = 0.003), pleural fluid (OR: 4.3; p = 0.035) and increase in AST ≥ 200 UI/l (OR: 4.42; p = 0.012). The PCT value is able to distinguish between the two groups with quite high reliability (the area under the ROC curve is 0.75). Eschar and peripheral lymphadenopathy were two valuable clinical symptoms for the diagnosis of scrub typhus and distinguishing 2 groups of diseases. Respiratory distress, increase in AST ≥ 200 UI/l and level of PCT were used as major prognostic factors in patients with Rickettsiaceae.