Hamaguchi Sugihiro, Cuong Ngo Chi, Tra Doan Thu, Doan Yen Hai, Shimizu Kenta, Tuan Nguyen Quang, Yoshida Lay-Myint, Mai Le Quynh, Duc-Anh Dang, Ando Shuji, Arikawa Jiro, Parry Christopher M, Ariyoshi Koya, Thuy Pham Thanh
Am J Trop Med Hyg. 2015 May;92(5):972-978. doi: 10.4269/ajtmh.14-0806. Epub 2015 Mar 16.
A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non-scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting.
在越南河内最大的转诊医院开展了一项关于立克次体病的描述性研究,以确定特定立克次体病的流行病学和临床特征。2001年3月至2003年2月期间,我们纳入了579例急性未分化发热(AUF)患者,排除了疟疾、登革热和伤寒患者,并对恙虫病东方体和斑疹伤寒立克次体进行了血清学检测。其中,237例(40.9%)患有恙虫病,193例(33.3%)患有鼠型斑疹伤寒,149例(25.7%)既没有患恙虫病也没有患鼠型斑疹伤寒(非恙虫病和鼠型斑疹伤寒[非ST/MT])。鼠型斑疹伤寒在河内居住的患者中比例最高,而恙虫病在国家或地区边境地区比例最高。焦痂、呼吸困难、低血压和淋巴结病的存在与恙虫病诊断显著相关(OR分别为46.56、10.90、9.01和7.92)。鼠型斑疹伤寒患者出现这些症状的可能性较小,但更可能出现肌痛、皮疹和相对心动过缓(OR分别为1.60、1.56和1.45)。尽管未确定斑点热群立克次体的发生情况,但恙虫病和鼠型斑疹伤寒被证明是越南北部AUF的常见病因。临床和流行病学信息可能有助于当地临床医生在资源有限的情况下对特定立克次体病进行临床诊断。