State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
PLoS Negl Trop Dis. 2022 Apr 29;16(4):e0010357. doi: 10.1371/journal.pntd.0010357. eCollection 2022 Apr.
Scrub typhus (ST) is a life-threatening infectious disease if appropriate treatment is unavailable. Large discrepancy of clinical severity of ST patients was reported among age groups, and the underlying risk factors for severe disease are unclear.
Clinical and epidemiological data of ST patients were collected in 55 surveillance hospitals located in Guangzhou City, China, from 2012 to 2018. Severe prognosis and related factors were determined and compared between pediatric and elderly patients.
A total of 2,074 ST patients including 209 pediatric patients and 1,865 elderly patients were included, with a comparable disease severity rate of 11.0% (95% CI 7.1%-16.1%) and 10.3% (95% CI 9.0%-11.8%). Different frequencies of clinical characteristics including lymphadenopathy, skin rash, enlarged tonsils, etc. were observed between pediatric and elderly patients. Presence of peripheral edema and decreased hemoglobin were the most important predictors of severe illness in pediatric patients with adjusted ORs by 38.99 (9.96-152.67, p<0.001) and 13.22 (1.54-113.50, p = 0.019), respectively, while presence of dyspnea and increased total bilirubin were the potential determinants of severe disease in elderly patients with adjusted ORs by 11.69 (7.33-18.64, p<0.001) and 3.17 (1.97-5.11, p<0.001), respectively. Compared with pediatric patients, elderly patients were more likely to receive doxycycline (64.8% v.s 9.9%, p<0.001), while less likely to receive azithromycin therapy (5.0% v.s 41.1%, p<0.001).
The disease severity rate is comparable between pediatric and elderly ST patients, while different clinical features and laboratory indicators were associated with development of severe complications for pediatric and elderly patients, which is helpful for diagnosis and progress assessment of disease for ST patients.
如果得不到适当的治疗，恙虫病（ST）可能会危及生命。据报道，恙虫病患者的临床严重程度在不同年龄组之间存在较大差异，且重症疾病的潜在危险因素尚不清楚。
收集了 2012 年至 2018 年期间中国广州市 55 家监测医院的恙虫病患者的临床和流行病学数据。比较了儿科和老年患者之间的严重预后和相关因素。
共纳入 2074 例恙虫病患者，包括 209 例儿科患者和 1865 例老年患者，疾病严重程度率相当，分别为 11.0%（95%CI 7.1%-16.1%）和 10.3%（95%CI 9.0%-11.8%）。儿科和老年患者的临床特征，如淋巴结肿大、皮疹、扁桃体肿大等，存在不同的频率。外周水肿和血红蛋白降低是儿科重症患者的最重要预测因素，调整后的 OR 值分别为 38.99（9.96-152.67，p<0.001）和 13.22（1.54-113.50，p=0.019），而呼吸困难和总胆红素升高是老年重症患者的潜在决定因素，调整后的 OR 值分别为 11.69（7.33-18.64，p<0.001）和 3.17（1.97-5.11，p<0.001）。与儿科患者相比，老年患者更可能接受多西环素治疗（64.8%比 9.9%，p<0.001），而更不可能接受阿奇霉素治疗（5.0%比 41.1%，p<0.001）。
儿科和老年恙虫病患者的疾病严重程度相当，但不同的临床特征和实验室指标与儿科和老年患者重症并发症的发生有关，这有助于恙虫病患者的诊断和疾病进展评估。
