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      The clinical differences between dengue and scrub typhus with acute respiratory failure in southern Taiwan

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          Abstract

          Background

          For both dengue and scrub typhus, acute respiratory failure (ARF) is a serious complication. The present study was carried out in order to investigate the clinical courses and outcomes of adult dengue and scrub typhus patients with ARF, and to identify the clinical differences between adult dengue and scrub typhus patients with ARF.

          Methods

          We conducted a retrospective study of the serologically confirmed adult dengue or scrub typhus patients admitted between 1998 and 2008 at Kaohsiung Chang Gung Memorial Hospital. A total of 980 dengue and 102 scrub typhus adult patients were included in our study.

          Results

          Eighteen of the 980 adult dengue patients and 8 of the 102 adult scrub typhus patients had ARF. There were significant differences that existed for eschar ( P = 0.001; dengue 0%; scrub 62.5%), cough ( P = 0.016; dengue 55.6%; scrub typhus 100%), white blood cell (WBC) count [ P = 0.026; dengue 7.40 ± 5.74; scrub typhus 11.84 ± 4.95 (×10 3/μL)], platelet count [ P = 0.008; dengue 42.2 ± 33.9; scrub typhus 104.1 ± 93.3 (×10 9/L)], prothrombin time (PT) [ P = 0.007; dengue 12.82 ± 1.36; scrub typhus 10.74 ± 0.98 (s)], activated partial thromboplastin time (APTT) [ P = 0.002; dengue 50.81 ± 10.08; scrub typhus 37.44 ± 4.06 (s)], blood urea nitrogen (BUN) [ P < 0.001; dengue 64.6 ± 43.2; scrub typhus 20.9 ± 9.1 (mg/dL)], creatinine [ P < 0.001; dengue 3.77 ± 3.37; scrub typhus 1.05 ± 0.37 (mg/dL)], admission day (A-day) [ P = 0.027; dengue 2.9 ± 1.3; scrub typhus 5.4 ± 2.6 (days)], and ventilator duration [ P = 0.022; dengue 9.4 ± 14.0; scrub typhus 14.8 ± 10.4 (days)] between both groups.

          Conclusions

          This study provides relatively rare data regarding the clinical differences between adult dengue and scrub typhus patients with ARF.

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          Most cited references21

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          Early clinical and laboratory indicators of acute dengue illness.

          S Suntayakorn, Francis Ennis, W Viramitrachai … (1997)
          A prospective observational study was conducted to identify early indicators of acute dengue virus infection. Children with fever for <72 h without obvious cause were studied at hospitals in Bangkok and Kamphaeng Phet, Thailand, until resolution of fever. Of 172 evaluable subjects (91% of enrollees), 60 (35%) had dengue, including 32 with dengue fever (DF) and 28 with dengue hemorrhagic fever (DHF). At enrollment, children with dengue were more likely than children with other febrile illnesses (OFI) to report anorexia, nausea, and vomiting and to have a positive tourniquet test, and they had lower total white blood cell counts, absolute neutrophil and absolute monocyte counts, and higher plasma alanine and aspartate (AST) aminotransferase levels than children with OFI. Plasma AST levels were higher in children who developed DHF than in those with DF. These data identify simple clinical and laboratory parameters that help to identify children with DF or DHF.
          Article 0 comments Cited 157 times – based on 0 reviews     Review now
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            Differences in dengue severity in infants, children, and adults in a 3-year hospital-based study in Nicaragua.

            Y Palacios-Rodriguez, Leonel Pérez, E Videa … (2005)
            To investigate age-related differences in dengue severity, 114 infants, 1,211 children, and 346 adults with laboratory-confirmed dengue virus (DEN) infections presenting to three hospitals in major urban centers in Nicaragua were recruited from 1999 to 2001. The age distribution of dengue cases and the circulating serotype (predominantly DEN2) were representative of national data. Similar results were obtained when either dengue hemorrhagic fever/dengue shock syndrome or its principal manifestations (vascular permeability, internal hemorrhage, marked thrombocytopenia, and/or shock) were analyzed in relation to age and immune status. The burden of disease and of severe dengue was found predominantly in infants 4-9 months of age and in children 5-9 years old, and secondary DEN infection was a risk factor for severity in children. Age-related differences were identified in the prevalence of specific clinical manifestations as well as in their association with a confirmed DEN diagnosis. This represents one of the few comprehensive studies to analyze characteristics of dengue in infants, children, and adults in the same population and highlights age-related differences in dengue severity.
            Article 0 comments Cited 118 times – based on 0 reviews     Review now
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              Serotype-specific differences in clinical manifestations of dengue.

              Eva Harris, Y Téllez, Roberto Perez … (2006)
              Dengue, the most prevalent arthropod-borne viral disease of humans, is caused by four serotypes of dengue virus (DENV 1-4). Although all four DENV serotypes cause a range of illness, defining precisely which clinical characteristics are associated with the distinct serotypes has been elusive. A cross-sectional study was conducted on 984 and 313 hospitalized children with confirmed DENV infections during two time periods, respectively, in the same hospitals in Nicaragua: a 3-year period (1999-2001) when DENV-2 accounted for 96% of the viruses identified, and the 2003 dengue season when DENV-1 predominated (87% of identified serotypes). When the two periods were compared, more shock (OR 1.91, 95% CI 1.35-2.71) and internal hemorrhage (OR 2.05, CI 1.16-3.78) were observed in the period when DENV-2 predominated, whereas increased vascular permeability was associated to a greater degree with the DENV-1 period (OR 2.36, CI 1.80-3.09). Compared with the DENV-2 period, the DENV-1 season was associated with more hospitalized primary dengue cases (OR 3.86, CI 2.72-5.48) and more primary DENV infections with severe manifestations (OR 2.93, CI 2.00-4.28). These findings provide new data to characterize the pathogenic potential of distinct DENV serotypes in human populations.
              Article 0 comments Cited 117 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                C.-C. Wang: +886-7-7317123 , +886-7-7322402 , ccwang52@adm.cgmh.org.tw
                Journal
                Journal ID (nlm-ta): Infection
                Journal ID (iso-abbrev): Infection
                Title: Infection
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Print): 0300-8126
                ISSN (Electronic): 1439-0973
                Publication date (Electronic): 12 January 2012
                Publication date (Print): 2012
                Volume: 40
                Issue: 4
                Pages: 359-365
                Affiliations
                [1 ]GRID grid.413804.a, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, ; No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301 Taiwan
                [2 ]GRID grid.412019.f, ISNI 0000000094765696, Graduate Institute of Occupational Safety and Health, , Kaohsiung Medical University, ; Kaohsiung, Taiwan
                Article
                Publisher ID: 239
                DOI: 10.1007/s15010-011-0239-9
                PMC ID: 7102315
                PubMed ID: 22237473
                SO-VID: 6dca297c-e01b-4211-bfc8-12d0140302e5
                Copyright © © Springer-Verlag 2012
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 2 May 2011
                Date accepted : 21 December 2011
                Categories
                Subject: Clinical and Epidemiological Study
                Custom metadata
                issue-copyright-statement © Springer-Verlag 2012

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: dengue,scrub typhus,acute respiratory failure,ards,taiwan
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: dengue, scrub typhus, acute respiratory failure, ards, taiwan

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