Department of Medicine, Cairns Hospital, Cairns, Australia.
College of Medicine and Dentistry, James Cook University, Cairns, Australia.
PLoS Negl Trop Dis. 2019 Jul 18;13(7):e0007583. doi: 10.1371/journal.pntd.0007583. eCollection 2019 Jul.
Rickettsial infections are a common cause of hospitalization in tropical settings, although early diagnosis is challenging in the rural locations where these infections are usually seen.
This retrospective, clinical audit of microbiologically-confirmed cases of scrub typhus or spotted fever group (SFG) rickettsial infection between 1997 and 2016 was performed a tertiary referral hospital in tropical Australia. Clinical, laboratory and radiological findings at presentation were correlated with the patients' subsequent clinical course.
There were 135 locally-acquired cases (95 scrub typhus, 37 SFG, 3 undifferentiated). There were nine hospitalizations during the first 5 years of the study period and 81 in the last 5 years (p for trend = 0.003). Eighteen (13%) of the 135 cases required ICU admission, all of whom were adults. A greater proportion of patients with SFG infection required ICU support (8/37 (22%) compared with 10/95 (11%) scrub typhus cases), although this difference did not reach statistical significance (p = 0.10). Three (8%) of the 37 patients with SFG infection had severe disease (1 died, 2 developed permanent disability) versus 0/95 scrub typhus patients (p = 0.02). Adults with a high admission qSOFA score (≥2) had an odds ratio (OR) of 19 (95% CI:4.8-74.5) for subsequent ICU admission (p<0.001); adults with a high NEWS2 score (≥7) had an OR of 14.3 (95% CI:4.5-45.32) for ICU admission (p<0.001). A patient's respiratory rate at presentation had strong prognostic utility: if an adult had an admission respiratory rate <22 breaths/minute, the negative predictive value for subsequent ICU admission was 95% (95% CI 88-99).
In the well-resourced Australian health system outcomes are excellent, but the local burden of rickettsial disease appears to be increasing and the clinical phenotype of SFG infections may be more severe than previously believed. Simple, clinical assessment on admission has prognostic utility and may be used to guide management.
在热带地区，立克次体感染是住院治疗的常见原因，尽管在这些感染通常发生的农村地区，早期诊断具有挑战性。
本研究回顾性分析了 1997 年至 2016 年间在热带澳大利亚一家三级转诊医院确诊的恙虫病或斑点热群（SFG）立克次体感染的微生物病例。将患者就诊时的临床、实验室和影像学检查结果与患者随后的临床病程相关联。
共有 135 例本地获得性病例（95 例恙虫病，37 例 SFG，3 例未分化）。在研究期间的前 5 年中有 9 例住院，后 5 年中有 81 例（p 趋势=0.003）。18 例（13%）135 例患者需要入住 ICU，均为成年人。感染 SFG 的患者需要 ICU 支持的比例较高（37 例中的 8/37（22%）与 95 例恙虫病中的 10/95（11%）），尽管这一差异无统计学意义（p=0.10）。37 例 SFG 感染患者中有 3 例（8%）病情严重（1 例死亡，2 例遗留永久性残疾），而 95 例恙虫病患者中无此类情况（p=0.02）。高入院 qSOFA 评分（≥2）的成年人入住 ICU 的优势比（OR）为 19（95%CI：4.8-74.5）（p<0.001）；高 NEWS2 评分（≥7）的成年人入住 ICU 的 OR 为 14.3（95%CI：4.5-45.32）（p<0.001）。患者就诊时的呼吸频率具有很强的预后价值：如果成年人的入院呼吸频率<22 次/分钟，随后入住 ICU 的阴性预测值为 95%（95%CI 88-99）。
在资源充足的澳大利亚卫生系统中，结果非常好，但立克次体疾病的本地负担似乎在增加，而且 SFG 感染的临床表型可能比以前认为的更严重。入院时简单的临床评估具有预后价值，可用于指导治疗。
