Department of Internal Medicine-Infectious Diseases, University of Texas Medical Branch, Galveston, Texas.
Department of Pathology, University of Texas Medical Branch, Galveston, Texas.
Am J Trop Med Hyg. 2018 Jun;98(6):1594-1598. doi: 10.4269/ajtmh.17-0411. Epub 2018 Apr 5.
Murine typhus, caused by , is an undifferentiated febrile illness with no available rapid and sensitive diagnostic assay for use during early disease. We aimed to compare the health-care charges in those diagnosed with murine typhus to those with influenza, a febrile illness with an available rapid diagnostic test. A comparison of health-care-associated charges at the University of Texas Medical Branch at Galveston demonstrated a median of $817 for influenza versus $16,760 for murine typhus ( < 0.0001). Median laboratory ($184 versus $3,254 [ < 0.0001]) and imaging charges ($0 versus $514 [ < 0.0001]) were also higher in those with murine typhus. Those receiving at least one imaging study during their illness were greater in the murine typhus group (91.3% versus 20.3%) ( < 0.0001). The median time needed to establish a confirmed or presumptive diagnosis was 2 days for influenza compared with 9 days for murine typhus ( < 0.0001). The median number of health-care encounters was greater for those with murine typhus (2 versus 1) ( < 0.0001). Eleven patients (15.9%) with influenza were hospitalized as a result of their illness compared with 16 (69.6%) with murine typhus ( < 0.0001). The estimated mortality based on disease severity at presentation by Acute Physiology and Chronic Health Evaluation II scoring was similar in the two groups-both had a median 4% mortality risk ( = 0.0893). These results highlight the need for improved clinical recognition and diagnostics for acute rickettsioses such as murine typhus.
地方性斑疹伤寒由引起，是一种无特征性的发热性疾病，在疾病早期阶段尚无快速、敏感的诊断检测方法。我们旨在比较诊断为地方性斑疹伤寒和流感的患者的医疗保健费用，流感是一种有可用快速诊断检测方法的发热性疾病。在德克萨斯大学加尔维斯顿医学分部进行的医疗保健相关费用比较表明，流感的中位数为 817 美元，而地方性斑疹伤寒为 16760 美元（<0.0001）。实验室（184 美元对 3254 美元[<0.0001]）和影像学检查（0 美元对 514 美元[<0.0001]）的中位数费用也在地方性斑疹伤寒患者中更高。在患病期间接受至少一次影像学检查的患者在地方性斑疹伤寒组中更多（91.3%对 20.3%）（<0.0001）。确诊或疑似诊断所需的中位时间为流感 2 天，而地方性斑疹伤寒为 9 天（<0.0001）。患有地方性斑疹伤寒的患者的中位医疗保健接触次数更多（2 次对 1 次）（<0.0001）。11 例（15.9%）流感患者因疾病住院，而 16 例（69.6%）地方性斑疹伤寒患者因疾病住院（<0.0001）。根据急性生理学和慢性健康评估 II 评分在发病时的疾病严重程度估计的死亡率在两组中相似，均有 4%的中位死亡率风险（=0.0893）。这些结果强调需要改善对地方性斑疹伤寒等急性立克次体病的临床识别和诊断。
