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Volume 25, Number 4—April 2019
CME ACTIVITY - Synopsis

Clinical Manifestations and Molecular Diagnosis of Scrub Typhus and Murine Typhus, Vietnam, 2015–2017

Nguyen Vu Trung, Le Thi Hoi, Vu Minh Dien, Dang Thi Huong, Tran Mai Hoa, Vu Ngoc Lien, Phan Van Luan, Sonia Odette Lewycka, Marc Choisy, Juliet E. Bryant, Behzad Nadjm, H. Rogier van Doorn, Allen L. RichardsComments to Author , and Nguyen Van Kinh
Author affiliations: National Hospital for Tropical Diseases, Hanoi, Vietnam (N.V. Trung, L.T. Hoi, V.M. Dien, D.T. Huong, T.M. Hoa, V.N. Lien, N.V. Kinh); Hanoi Medical University, Hanoi (N.V. Trung, L.T. Hoi, P.V. Luan, N.V. Kinh); Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi (S.O. Lewycka, M. Choisy, J.E. Bryant, B. Nadjm, H.R. van Doorn); University of Oxford, UK (S.O. Lewycka, B. Nadjm, H.R. van Doorn); Institute of Research for Development, Marseille, France (M. Choisy); Merieux Foundation, Lyon, France (J.E. Bryant); Naval Medical Research Center, Silver Spring, Maryland, USA (A.L. Richards); Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (A.L. Richards)

Main Article

Table 3

Demographic information, signs and symptoms, and laboratory results for 115 patients with PCR-confirmed scrub typhus or murine typhus, northern Vietnam, March 2015–March 2017*

Category qPCR-positive Scrub typhus, n = 103 Murine typhus, n = 12 p value†
Age, y, mean ± SD
 50.0 ± 15.8
 50.0 ± 16.5
 48.4 ± 8.6
 0.709‡
Demographics
Sex
M 56 (48.7) 46 (44.7) 10 (83.3) 0.014
F 59 (51.3) 57 (55.3) 2 (16.7) 0.001
Residence
Hanoi 44 (38.3) 34 (33.0) 10 (83.3) 0.001
Rural area 70 (60.9) 66 (64.1) 4 (33.3) 0.059
Illness during summer, April–August 80 (69.6) 72 (69.9) 8 (66.7) 1.0
Farmer 57 (49.6) 52 (50.5) 5 (41.7) 0.762
Treatment in previous hospitals 82 (71.3) 74 (71.8) 8 (66.7) 0.741
Prior antimicrobial drug treatment, n = 109
 33 (30.3)
 32 (33.0)
 1 (8.3)
 0.152
Symptoms at illness onset
Headache 92 (80.0) 81 (78.6) 11 (91.7) 0.513
Myalgia 81 (69.9) 73 (70.9) 8 (66.7) 0.769
Retro-orbital pain 21 (18.3) 18 (17.5) 3 (25.0) 0.535
Sore throat 13 (11.3) 13 (12.6) 0 0.529
Cough 42 (36.5) 38 (36.9) 4 (33.3) 1.0
Nausea 30 (26.1) 28 (27.2) 2 (16.7) 0.718
Vomiting 21 (18.4) 21 (20.6) 0 0.228
Abdominal pain, n = 114 12 (10.5) 12 (11.8) 0 0.527
Diarrhea
 18 (15.7)
 15 (14.6)
 3 (25.0)
 0.664
Physical signs
Congested skin 90 (78.3) 82 (79.6) 8 (66.7) 0.290
Conjunctivitis 74 (64.4) 66 (64.1) 6 (66.7) 1.0
Eschar 55 (48.8) 55 (53.4) 0 0
Rash 39 (33.9) 35 (34.0) 4 (33.3) 1.0
Lymphadenopathy, n = 114 19 (16.7) 19 (18.6) 0 0.212
Hepatomegaly 11 (9.6) 10 (9.7) 1 (8.3) 1.0
Splenomegaly 7 (6.1) 6 (5.8) 1 (8.3) 0.548
Edema 14 (12.2) 13 (12.6) 1 (8.3) 1.0
Rales 24 (20.9) 22 (21.4) 2 (16.7) 1.0
Decreased breath sounds, n = 114 16 (14.0) 16 (15.7) 0 0.212
Convulsion
10 (8.7)
 10 (9.7)
 0
 0.596
Laboratory test results
Erythrocytes, T/L, median (IQR) 4.28 (3.9–4.72) 4.25 (3.86–4.69) 4.34 (4.16–4.85) 0.392§
Leukocytes, g/L, median (IQR) 8.73 (6.7–11.1) 9.1 (6.62–11.17) 8.14 (6.9–10.2) 0.631§
Platelets, g/L, median (IQR) 123 (66–194) 128 (65–194) 96 (79.5–196.5) 0.902§
Platelet <100 g/L 49 (42.6) 43 (41.8) 6 (50.0) 0.759
Alanine aminotransferase >40 IU/L, n = 113 102 (90.3) 91 (89.2) 11 (100.0) 0.597
Aspartate aminotransferase ST >37 IU/L, n = 113 106 (93.8) 95 (93.1) 11 (100.0) 1.0
Total bilirubin >17 µmol/L, n = 69 27 (39.1) 24 (40.0) 3 (33.3) 1.0
Albumin <32 g/L, n = 80 39 (48.8) 36 (50.7) 3 (33.3) 1.0
Creatinine >120 µmol/L, n = 113 16 (14.2) 15 (14.9) 1 (8.3) 1.0
Procalcitonin >0.25 ng/mL, n = 101 80 (79.2) 69 (77.5) 11 (91.7) 0.451
C-reactive protein >12 mg/L, n = 93
 85 (91.4)
 75 (90.4)
 10 (100)
 0.592
Treatment
Doxycycline, n = 114 72 (63.2) 63 (61.8) 9 (75.0) 0.839
Chloramphenicol, n = 114 2 (1.8) 2 (2.0) 0 (0.0) 0.839
Doxycycline and chloramphenicol, n = 114 30 (26.3) 28 (27.5) 2 (16.7) 0.839
Albumin transfusion, n = 113 12 (10.6) 12 (11.9) 0 (0.0) 0.357
Respiratory support, n = 111
 29 (25.7)
 27 (26.7)
 2 (16.7)
 0.728
Outcomes
Fever before admission, d, median (IQR) 9 (7–11) 9 (7–11) 8.5 (5–10) 0.130§
Afebrile¶ ≤72 h after treatment began, n = 73 37 (50.7) 31 (49.2) 6 (60.0) 0.736
Median no. days to afebrile, n = 73 (IQR) 3 (3–5) 4 (3–5) 3 (3–5) 0.694§
Median no. days in hospital (IQR) 7 (5–10) 7 (5–10) 8 (7–8.5) 0.822§
Death or palliative discharge 5 (4.4) 5 (4.9) 0 (0.0) 1.0

*Values are no. (%), except as indicated. Bold text indicates statistical significance. IQR, interquartile range.
†p value calculated using Fisher exact test, except where noted.
‡p value calculated using the analysis of variance test.
§p value calculated using Mann-Whitney test.
¶No temperature recorded >37.5°C over a 24-h period.

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Page created: March 16, 2019
Page updated: March 16, 2019
Page reviewed: March 16, 2019
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