RESULT: (1) Four patients were diagnosed as
scrub typhus based on clinical manifestations only, while 15 patients met the criteria of laboratory diagnosis. All 19 patients with
scrub typhus had
hemophagocytic syndrome. Eschar lesion was identified in 12 patients, 7 patients were described as an
ulcer. A seasonal pattern (78.9% from June through September in 15 patients) was observed. Clinical misdiagnosis was common (all 19 cases). There were 9 patients with admitting diagnosis of
scrub typhus, 10 patients were not diagnosed as
scrub typhus after admission. In 5 cases within 3 days after admission diagnosis was corrected as
scrub typhus. Until discharge from the hospital, 5 cases were not diagnosed with
scrub typhus. In this study, the length of time from the illness onset (beginning of
fever) to the occurrence of clinical symptoms was (9 ± 4) days. (2) All 19 patients had changed AST levels (149 ± 37) U/L,
albumin levels (23 ± 4) g/L,
C-reactive protein levels (103 ± 51) mg/L, and platelet count (48 ± 41) × 10⁹/L; bone marrow aspiration revealed in 16 patients marked hemophagocytosis. Weil-Felix agglutination test revealed positive results in 6 of 15 cases. Diagnostic IFA results were positive for 14 patients; 19 patients had
interstitial pneumonitis and 17 patients had
pleural effusion. (3) Five cases with failure to diagnose the disease had ineffective
antibiotics treatment (
imipenem or β-
lactam-based regimens). These patients did not receive appropriate treatment with
antibiotics against
scrub typhus. Fourteen patients with admitting diagnosis of
scrub typhus were successfully treated with appropriate
antibiotics, 8 cases with
chloramphenicol, 3 cases with
azithromycin, and in 3 patients (2 cases of
azithromycin and one case of
erythromycin),
therapy was then switched to
chloramphenicol. Four patients were treated with
methylprednisolone and 10 patients with
dexamethasone. (4) During their hospitalization, the
clinical course in five cases with failure to diagnose the disease rapidly developed and progressed to the life-threatening
MODS, four of five cases died. However, the course in 14 patients were relieved and did not progress to
MODS.
CONCLUSION: