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題名 | Epidemiology of Acute Q Fever, Scrub Typhus, and Murine Typhus, and Identification of Their Clinical Characteristics Compared to Patients with Acute Febrile Illness in Southern Taiwan |
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作者姓名(外文) | Lai, Chung-hsu; Huang, Chun-kai; Chen, Yen-hsu; Chang, Lin-li; Weng, Hui-ching; Lin, Jiun-nong; Chung, Hsing-chun; Liang, Shiou-haur; Lin, Hsi-hsun; | 書刊名 | Journal of the Formosan Medical Association |
卷期 | 108:5 2009.05[民98.05] |
頁次 | 頁367-376 |
分類號 | 415.26 |
關鍵詞 | Endemic flea-borne typhus; Q fever; Rickettsia infections; Scrub typhus; Taiwan; |
語文 | 英文(English) |
英文摘要 | Background/Purpose In Taiwan, acute Q fever, scrub typhus, and murine typhus (QSM diseases) are the most common rickettsioses, but their epidemiology and clinical characteristics have not been clarified. Diagnosis of these three diseases based on clinical manifestations is difficult, and most of their reported characteristics are identified by describing the predominant manifestations, without being compared with other diseases. Methods Serological tests for QSM diseases were examined simultaneously in patients suspected of the three diseases, regardless of which one was suspected. Clinical manifestations were recorded retrospectively from their charts. The characteristics of QSM diseases were identified by comparison with patients who had non-QSM diseases. Results From April 2004 to April 2007, a total of 226 cases of suspected QSM diseases were included. One hundred (44.2%) cases were serologically confirmed as QSM diseases (68 acute Q fever, 23 scrub typhus, and 9 murine typhus), and 126 (55.8%) cases were non-QSM diseases. Only 33 cases (33.0%) of QSM diseases were initially suspected at the time of hospital visit, whereas 54 cases (42.9%) of non-QSM diseases were incorrectly suspected as QSM diseases. Cases of Q fever and scrub typhus were distributed over plain and mountain areas, respectively. By multivariate analysis, relative bradycardia (OR [95% CI], 2.885 [1.3–6.4]; p = 0.009), radiographic hepatomegaly (OR [95% CI], 4.454 [1.6–12.3]; p = 0.004), and elevated serum aminotransferases (OR [95% CI], 5.218 [1.2–23.1]; p = 0.029) were independent characteristics for QSM diseases, and leukocytosis (OR [95% CI], 0.167 [0.052–0.534]; p = 0.003) was negative for the diagnosis of QSM diseases. Conclusion In southern Taiwan, acute Q fever is the most common rickettsiosis. QSM diseases should be suspected in febrile patients who present with relative bradycardia, hepatomegaly, and elevated serum aminotransferases, but without leukocytosis. |
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