老年患者恙虫病、鼠型斑疹伤寒和 Q 热的特征：凝血酶原时间延长可预测严重程度。

Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity.

机构信息

Department of Internal Medicine, Kaohsiung Municipal Siao-Kang Hospital, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Internal Medicine and Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.

出版信息

J Microbiol Immunol Infect. 2019 Feb;52(1):54-61. doi: 10.1016/j.jmii.2016.08.023. Epub 2017 Jun 22.

DOI:10.1016/j.jmii.2016.08.023

PMID:28709838

Abstract

BACKGROUND/PURPOSE: The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear.

METHODS

We conducted a retrospective study to identify the characteristics of the elderly aged ≥65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011.

RESULTS

Among 441 cases, including 187 cases of scrub typhus, 166 acute Q fever, and 88 murine typhus, 68 (15.4%) cases were elderly patients. The elderly had a higher severe complication rate (10.3% vs. 3.5%, p = 0.022), but did not have a significantly higher mortality rate (1.47% vs. 0.54%, p = 0.396). Compared with those without severe complications, we found the elderly (p = 0.022), dyspnea (p = 0.006), less relative bradycardia (p = 0.004), less febrile illness (p = 0.004), prolonged prothrombin time (PT) (p = 0.002), higher levels of initial C-reactive protein (p = 0.039), blood leukocyte counts (p = 0.01), and lower platelet counts (p = 0.012) are significantly associated with severe complications. Only prolonged prothrombin time was associated with severe complications in multivariate analysis (p = 0.018, CI 95% 0.01-0.66). Among clinical symptoms and laboratory data, multivariate analysis revealed chills was less frequently occurred in the elderly (p = 0.012, 95% confidence interval [CI]: 1.33-9.99).

CONCLUSION

The elderly cases with scrub typhus, murine typhus, or acute Q fever would be more likely to have severe complications, for which prothrombin time prolongation is an important predictor for severe complications.

摘要

背景/目的：恙虫病、鼠型斑疹伤寒和急性 Q 热在老年人中的临床表现并不明确。

方法

我们进行了一项回顾性研究，以确定在台湾的三家医院于 2002 年至 2011 年间通过血清学确诊的恙虫病、鼠型斑疹伤寒或急性 Q 热患者中年龄≥65 岁的老年患者与年龄 18-64 岁的比较组之间的特征。

结果

在 441 例患者中，包括 187 例恙虫病、166 例急性 Q 热和 88 例鼠型斑疹伤寒，有 68 例（15.4%）为老年患者。老年患者严重并发症发生率较高（10.3%比 3.5%，p=0.022），但死亡率无显著差异（1.47%比 0.54%，p=0.396）。与无严重并发症的患者相比，我们发现老年患者（p=0.022）、呼吸困难（p=0.006）、相对心动过缓较少（p=0.004）、发热性疾病较少（p=0.004）、凝血酶原时间延长（p=0.002）、初始 C 反应蛋白水平较高（p=0.039）、白细胞计数较高（p=0.01）和血小板计数较低（p=0.012）与严重并发症显著相关。只有凝血酶原时间延长与多变量分析中的严重并发症相关（p=0.018，95%置信区间[CI]：0.01-0.66）。在临床症状和实验室数据中，多变量分析显示老年患者畏寒较少（p=0.012，95%CI：1.33-9.99）。