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Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients

BACKGROUND: Scrub typhus (ST) is a life-threatening infectious disease if appropriate treatment is unavailable. Large discrepancy of clinical severity of ST patients was reported among age groups, and the underlying risk factors for severe disease are unclear. METHODS: Clinical and epidemiological d...

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Autores principales: Guan, Xiu-Gang, Wei, Yue-Hong, Jiang, Bao-Gui, Zhou, Shi-Xia, Zhang, An-Ran, Lu, Qing-Bin, Zhou, Zi-Wei, Chen, Jin-Jin, Zhang, Hai-Yang, Ji, Yang, Yang, Yang, Fang, Li-Qun, Li, Hao, Yang, Zhi-Cong, Liu, Wei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9053809/
https://www.ncbi.nlm.nih.gov/pubmed/35486642
http://dx.doi.org/10.1371/journal.pntd.0010357
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author Guan, Xiu-Gang
Wei, Yue-Hong
Jiang, Bao-Gui
Zhou, Shi-Xia
Zhang, An-Ran
Lu, Qing-Bin
Zhou, Zi-Wei
Chen, Jin-Jin
Zhang, Hai-Yang
Ji, Yang
Yang, Yang
Fang, Li-Qun
Li, Hao
Yang, Zhi-Cong
Liu, Wei
author_facet Guan, Xiu-Gang
Wei, Yue-Hong
Jiang, Bao-Gui
Zhou, Shi-Xia
Zhang, An-Ran
Lu, Qing-Bin
Zhou, Zi-Wei
Chen, Jin-Jin
Zhang, Hai-Yang
Ji, Yang
Yang, Yang
Fang, Li-Qun
Li, Hao
Yang, Zhi-Cong
Liu, Wei
author_sort Guan, Xiu-Gang
collection PubMed
description BACKGROUND: Scrub typhus (ST) is a life-threatening infectious disease if appropriate treatment is unavailable. Large discrepancy of clinical severity of ST patients was reported among age groups, and the underlying risk factors for severe disease are unclear. METHODS: Clinical and epidemiological data of ST patients were collected in 55 surveillance hospitals located in Guangzhou City, China, from 2012 to 2018. Severe prognosis and related factors were determined and compared between pediatric and elderly patients. RESULTS: A total of 2,074 ST patients including 209 pediatric patients and 1,865 elderly patients were included, with a comparable disease severity rate of 11.0% (95% CI 7.1%–16.1%) and 10.3% (95% CI 9.0%–11.8%). Different frequencies of clinical characteristics including lymphadenopathy, skin rash, enlarged tonsils, etc. were observed between pediatric and elderly patients. Presence of peripheral edema and decreased hemoglobin were the most important predictors of severe illness in pediatric patients with adjusted ORs by 38.99 (9.96–152.67, p<0.001) and 13.22 (1.54–113.50, p = 0.019), respectively, while presence of dyspnea and increased total bilirubin were the potential determinants of severe disease in elderly patients with adjusted ORs by 11.69 (7.33–18.64, p<0.001) and 3.17 (1.97–5.11, p<0.001), respectively. Compared with pediatric patients, elderly patients were more likely to receive doxycycline (64.8% v.s 9.9%, p<0.001), while less likely to receive azithromycin therapy (5.0% v.s 41.1%, p<0.001). CONCLUSION: The disease severity rate is comparable between pediatric and elderly ST patients, while different clinical features and laboratory indicators were associated with development of severe complications for pediatric and elderly patients, which is helpful for diagnosis and progress assessment of disease for ST patients.
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spelling pubmed-90538092022-04-30 Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients Guan, Xiu-Gang Wei, Yue-Hong Jiang, Bao-Gui Zhou, Shi-Xia Zhang, An-Ran Lu, Qing-Bin Zhou, Zi-Wei Chen, Jin-Jin Zhang, Hai-Yang Ji, Yang Yang, Yang Fang, Li-Qun Li, Hao Yang, Zhi-Cong Liu, Wei PLoS Negl Trop Dis Research Article BACKGROUND: Scrub typhus (ST) is a life-threatening infectious disease if appropriate treatment is unavailable. Large discrepancy of clinical severity of ST patients was reported among age groups, and the underlying risk factors for severe disease are unclear. METHODS: Clinical and epidemiological data of ST patients were collected in 55 surveillance hospitals located in Guangzhou City, China, from 2012 to 2018. Severe prognosis and related factors were determined and compared between pediatric and elderly patients. RESULTS: A total of 2,074 ST patients including 209 pediatric patients and 1,865 elderly patients were included, with a comparable disease severity rate of 11.0% (95% CI 7.1%–16.1%) and 10.3% (95% CI 9.0%–11.8%). Different frequencies of clinical characteristics including lymphadenopathy, skin rash, enlarged tonsils, etc. were observed between pediatric and elderly patients. Presence of peripheral edema and decreased hemoglobin were the most important predictors of severe illness in pediatric patients with adjusted ORs by 38.99 (9.96–152.67, p<0.001) and 13.22 (1.54–113.50, p = 0.019), respectively, while presence of dyspnea and increased total bilirubin were the potential determinants of severe disease in elderly patients with adjusted ORs by 11.69 (7.33–18.64, p<0.001) and 3.17 (1.97–5.11, p<0.001), respectively. Compared with pediatric patients, elderly patients were more likely to receive doxycycline (64.8% v.s 9.9%, p<0.001), while less likely to receive azithromycin therapy (5.0% v.s 41.1%, p<0.001). CONCLUSION: The disease severity rate is comparable between pediatric and elderly ST patients, while different clinical features and laboratory indicators were associated with development of severe complications for pediatric and elderly patients, which is helpful for diagnosis and progress assessment of disease for ST patients. Public Library of Science 2022-04-29 /pmc/articles/PMC9053809/ /pubmed/35486642 http://dx.doi.org/10.1371/journal.pntd.0010357 Text en © 2022 Guan et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Guan, Xiu-Gang
Wei, Yue-Hong
Jiang, Bao-Gui
Zhou, Shi-Xia
Zhang, An-Ran
Lu, Qing-Bin
Zhou, Zi-Wei
Chen, Jin-Jin
Zhang, Hai-Yang
Ji, Yang
Yang, Yang
Fang, Li-Qun
Li, Hao
Yang, Zhi-Cong
Liu, Wei
Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients
title Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients
title_full Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients
title_fullStr Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients
title_full_unstemmed Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients
title_short Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients
title_sort clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9053809/
https://www.ncbi.nlm.nih.gov/pubmed/35486642
http://dx.doi.org/10.1371/journal.pntd.0010357
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