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Volume 24, Number 9—September 2018

Synopsis

Distinguishing Japanese Spotted Fever and Scrub Typhus, Central Japan, 2004– 2015

Eiichiro Sando, Motoi SuzukiComments to Author , Shungo Katoh, Hiromi Fujita, Masakatsu Taira, Makito Yaegashi, and Koya Ariyoshi
Author affiliations: Nagasaki University, Nagasaki, Japan (E. Sando, M. Suzuki, S. Katoh, K. Ariyoshi); Kameda Medical Center, Kamogawa, Japan (E. Sando, M. Yaegashi); Mahara Institute of Medical Acarology, Anan, Japan (H. Fujita); Chiba Prefectural Institute of Public Health, Chiba, Japan (M. Taira)

Main Article

Table 3

Laboratory and treatment data for patients with JSF, ST, and nonrickettsial diseases central Japan, 2004–2015*

             Characteristic
              JSF, 
             no. (%), n = 31
              ST, 
             no. (%), n = 188
              Non-R, no. (%), n = 97
             JSF vs. non-R†
              ST vs. non-R†
              JSF vs. ST‡
             OR (95% CI)
              p value
              OR (95% CI)
              p value
              OR (95% CI)
              p value
             Laboratory data
             Leukocytes 
>9,800/μL              5 (16)              23 (12)              42 (45)              0.2 (0.1–0.7)              0.006              0.2 (0.1–0.3)              <0.001              1.4 (0.5–3.9)              0.556
             Hb <11 g/dL (F) 
or <13.5 g/dL 
(M)              5 (16)              29 (16)              46 (49)              0.2 (0.1–0.6)              0.002              0.2 (0.1–0.3)              <0.001              1.0 (0.4–2.9)              0.939
             Platelets 
<130,000/μL              22 (71)              59 (32)              28 (30)              5.7 (2.3–13.9)              <0.001              1.1 (0.6–1.8)              0.806              5.3 (2.3–12.2)              <0.001
             Albumin 
<3.4 g/dL              14 (61)              37 (29)              31 (55)              1.3 (0.5–3.4)              0.653              0.3 (0.2–0.6)              0.001              3.8 (1.5–9.6)              0.004
             AST >33 IU/L              29 (94)              154 (83)              46 (50)              14.5 
(3.3–64.3)              <0.001              4.8 (2.8–8.4)              <0.001              3.0 (0.7–13.3)              0.145
             ALT >42 IU/L              16 (52)              100 (54)              42 (46)              1.3 (0.6–2.9)              0.566              1.4 (0.8–2.3)              0.204              0.9 (0.4–2.0)              0.824
             LDH >229 IU/L              30 (97)              179 (97)              70 (78)              8.6 (1.1–66.8)              0.040              8.5 (3.3–22.1)              <0.001              1.0 (0.1–8.7)              0.996
             Total bilirubin 
>1.0 mg/dL              9 (29)              13 (7)              15 (17)              2.0 (0.8–5.1)              0.166              0.4 (0.2–0.8)              0.016              5.2 (2.0–13.6)              0.001
             Direct bilirubin 
>0.4 mg/dL              4 (22)              7 (5)              16 (28)              0.8 (0.2–2.6)              0.652              0.1 (0.1–0.4)              <0.001              5.2 (1.3–19.9)              0.017
             Creatine kinase 
>150 IU/L              19 (66)              46 (29)              21 (28)              4.9 (2.0–12.2)              0.001              1.2 (0.6–1.9)              0.861              4.6 (2.0–10.7)              <0.001
             BUN >22 mg/dL              15 (48)              35 (19)              20 (22)              3.4 (1.4–8.0)              0.006              0.8 (0.5–1.6)              0.58              4.0 (1.8–8.9)              0.001
             Creatinine 
>1.2 mg/dL              11 (35)              22 (12)              7 (8)              6.7 (2.3–19.4)              <0.001              1.6 (0.7–4.0)              0.277              4.1 (1.7–9.6)              0.001
             Sodium 
<135 mEq/L              24 (77)              71 (39)              16 (17)              16.3 
(6.0–44.3)              <0.001              3.0 (1.6–5.6)              <0.001              5.4 (2.2–13.2)              <0.001
             Chloride 
<98 mEq/L              17 (55)              37 (22)              15 (16)              6.2 (2.5–15.3)              <0.001              1.4 (0.7–2.7)              0.302              4.4 (2.0–9.7)              <0.001
             CRP >10 mg/dL              16 (52)              32 (18)              34 (40)              1.6 (0.7–3.7)              0.266              0.3 (0.2–0.6)              <0.001              5.0 (2.2–11.1)              <0.001
             Urine protein              27 (87)              116 (75)              34 (62)              4.2 (1.3–13.6)              0.018              1.8 (1.0–3.5)              0.068              2.3 (0.7–6.9)              0.148
             Urine blood
              29 (94)
              122 (79)
              31 (56)
              11.2 (2.4–51.8)
              0.002
             2.9 (1.5–5.5)
              0.002
             3.9 (0.9–17.3)
              0.071
             Treatment and prognosis
             Duration of 
illness§ <5 d              16 (59)              74 (39)              24 (27)              4.0 (1.6–9.8)              0.002              1.8 (1.0–3.1)              0.039              2.2 (1.0–5.1)              0.054
             Treatment: 
MINO/DOXY              31 (100)              180 (99)              42 (91)              Not applicable              0.144¶              17.1 (1.9–157.4)              0.012              Not applicable              1.000¶
             Delayed 
defervescence#              11 (37)              17 (13)              30 (67)              0.3 (0.1–0.8)              0.012              0.1 (0–0.2)              <0.001              3.8 (1.5–9.3)              0.004
             Hospitalization              28 (90)              104 (55)              80 (82)              2.0 (0.5–7.3)              0.302              0.3 (0.1–0.5)              <0.001              7.5 (2.2–25.7)              0.001
             30-d mortality              0              1 (1)              2 (2)              Not applicable              1.000§              0.3 (0–3.0)              0.287              Not applicable              1.000¶

             *ALT, alanine aminotransferase; AST, aspartate aminotransferase; BT, body temperature; BUN, blood urea nitrogen; CRP, C-reactive protein; DOXY, doxycycline; F, female patients; Hb, hemoglobin; JSF, Japanese spotted fever; LDH, lactate dehydrogenase; M, male patients; MINO, minocycline; non-R, nonrickettsial diseases; OR, odds ratio; ST, scrub typhus.
             †Non-R = reference.
             ‡ST = reference.
             §Duration from the onset of symptoms to the first diagnostic test.
             ¶Fisher exact tests.
             #>3 d to decline of fever <37.3°C.

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Page created: August 17, 2018
Page updated: August 17, 2018
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