Journal of the Formosan Medical Association
Volume 108, Issue 5 , Pages 367-376, May 2009

Epidemiology of Acute Q Fever, Scrub Typhus, and Murine Typhus, and Identification of Their Clinical Characteristics Compared to Patients with Acute Febrile Illness in Southern Taiwan

  • Chung-Hsu Lai

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Taipei, Taiwan
    • Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taipei, Taiwan
    • ,
  • Chun-Kai Huang

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Taipei, Taiwan
    • ,
  • Yen-Hsu Chen

      Affiliations

    • Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taipei, Taiwan
    • Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taipei, Taiwan
    • ,
  • Lin-Li Chang

      Affiliations

    • Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taipei, Taiwan
    • Department of Microbiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taipei, Taiwan
    • ,
  • Hui-Ching Weng

      Affiliations

    • Department of Health Management, I-Shou University, Kaohsiung;, Taipei, Taiwan
    • ,
  • Jiun-Nong Lin

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Taipei, Taiwan
    • Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taipei, Taiwan
    • ,
  • Hsing-Chun Chung

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Taipei, Taiwan
    • ,
  • Shiou-Haur Liang

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Taipei, Taiwan
    • ,
  • Hsi-Hsun Lin

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Taipei, Taiwan
    • Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Hsi-Hsun Lin, Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung 824, Taiwan

Received 18 July 2008; received in revised form 27 October 2008; accepted 4 November 2008.

Background/Purpose 

In Taiwan, acute Q fever, scrub typhus, and murine typhus (QSM diseases) are the most common rickettsioses, but their epidemiology and clinical characteristics have not been clarified. Diagnosis of these three diseases based on clinical manifestations is difficult, and most of their reported characteristics are identified by describing the predominant manifestations, without being compared with other diseases.

Methods

Serological tests for QSM diseases were examined simultaneously in patients suspected of the three diseases, regardless of which one was suspected. Clinical manifestations were recorded retrospectively from their charts. The characteristics of QSM diseases were identified by comparison with patients who had non-QSM diseases.

Results

From April 2004 to April 2007, a total of 226 cases of suspected QSM diseases were included. One hundred (44.2%) cases were serologically confirmed as QSM diseases (68 acute Q fever, 23 scrub typhus, and 9 murine typhus), and 126 (55.8%) cases were non-QSM diseases. Only 33 cases (33.0%) of QSM diseases were initially suspected at the time of hospital visit, whereas 54 cases (42.9%) of non-QSM diseases were incorrectly suspected as QSM diseases. Cases of Q fever and scrub typhus were distributed over plain and mountain areas, respectively. By multivariate analysis, relative bradycardia (OR [95% CI], 2.885 [1.3–6.4]; p = 0.009), radiographic hepatomegaly (OR [95% CI], 4.454 [1.6–12.3]; p = 0.004), and elevated serum aminotransferases (OR [95% CI], 5.218 [1.2–23.1]; p = 0.029) were independent characteristics for QSM diseases, and leukocytosis (OR [95% CI], 0.167 [0.052–0.534]; p = 0.003) was negative for the diagnosis of QSM diseases.

Conclusion

In southern Taiwan, acute Q fever is the most common rickettsiosis. QSM diseases should be suspected in febrile patients who present with relative bradycardia, hepatomegaly, and elevated serum aminotransferases, but without leukocytosis.

Key Words:  endemic flea-borne typhus , Q fever , rickettsia infections , scrub typhus , Taiwan

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PII: S0929-6646(09)60080-2

doi:10.1016/S0929-6646(09)60080-2

Journal of the Formosan Medical Association
Volume 108, Issue 5 , Pages 367-376, May 2009

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