Risk factors associated with life-threatening rickettsial infections
We retrospectively analyzed 92 cases of severe rickettsial infections in patients (median age = 49 years, 57% male, 37.0% with scrub typhus) in Hong Kong. Immunofluorescence assay was used for diagnostic confirmation. Identification of > or = 1 diagnostic sign (exposure history, rash, or eschar) was possible in 94.6% of the cases. Multivariate analysis suggested that pulmonary infiltrates (odds ratio [OR] = 25.2, 95% confidence interval [CI] = 3.9-160.9, P = 0.001) and leukocytosis (OR = 1.3, 95% CI = 1.0-1.5 per unit increase, P = 0.033) were independent predictors of admission to an intensive care unit (14.1%). Delayed administration of doxycycline was independently associated with major organ dysfunction (23.9%; oxygen desaturation, renal failure, severe jaundice, encephalopathy, cardiac failure) (OR = 1.2, 95% CI = 1.0-1.5 per day delay, P = 0.046; adjusted for age and rickettsia biogroup) and prolonged hospitalization > 10 days (25%) (OR = 1.4, 95% CI = 1.1-1.9 per day delay, P = 0.014). Treatment with fluoroquinolone/clarithromycin did not correlate with clinical outcomes (P > 0.05). Early empirical doxycycline therapy should be considered if clinico-epidemiologic signs of rickettsial infections are present.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2008 |
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| Erschienen: |
2008 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:78 |
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| Enthalten in: |
The American journal of tropical medicine and hygiene - 78(2008), 6 vom: 10. Juni, Seite 973-8 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lee, Nelson [VerfasserIn] |
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| Themen: |
Anti-Bacterial Agents |
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| Anmerkungen: |
Date Completed 06.08.2008 Date Revised 21.11.2013 published: Print Citation Status MEDLINE |
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| Förderinstitution / Projekttitel: |
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NLM180098713 |
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| 520 | |a We retrospectively analyzed 92 cases of severe rickettsial infections in patients (median age = 49 years, 57% male, 37.0% with scrub typhus) in Hong Kong. Immunofluorescence assay was used for diagnostic confirmation. Identification of > or = 1 diagnostic sign (exposure history, rash, or eschar) was possible in 94.6% of the cases. Multivariate analysis suggested that pulmonary infiltrates (odds ratio [OR] = 25.2, 95% confidence interval [CI] = 3.9-160.9, P = 0.001) and leukocytosis (OR = 1.3, 95% CI = 1.0-1.5 per unit increase, P = 0.033) were independent predictors of admission to an intensive care unit (14.1%). Delayed administration of doxycycline was independently associated with major organ dysfunction (23.9%; oxygen desaturation, renal failure, severe jaundice, encephalopathy, cardiac failure) (OR = 1.2, 95% CI = 1.0-1.5 per day delay, P = 0.046; adjusted for age and rickettsia biogroup) and prolonged hospitalization > 10 days (25%) (OR = 1.4, 95% CI = 1.1-1.9 per day delay, P = 0.014). Treatment with fluoroquinolone/clarithromycin did not correlate with clinical outcomes (P > 0.05). Early empirical doxycycline therapy should be considered if clinico-epidemiologic signs of rickettsial infections are present | ||
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| 700 | 1 | |a Ip, Margaret |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Bonnie |e verfasserin |4 aut | |
| 700 | 1 | |a Lui, Grace |e verfasserin |4 aut | |
| 700 | 1 | |a Tsang, Owen Tak Yin |e verfasserin |4 aut | |
| 700 | 1 | |a Lai, Jak Yiu |e verfasserin |4 aut | |
| 700 | 1 | |a Choi, Kin Wing |e verfasserin |4 aut | |
| 700 | 1 | |a Lam, Rebecca |e verfasserin |4 aut | |
| 700 | 1 | |a Ng, Tak Keung |e verfasserin |4 aut | |
| 700 | 1 | |a Ho, Jenny |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Yin Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Cockram, Clive S |e verfasserin |4 aut | |
| 700 | 1 | |a Lai, Sik To |e verfasserin |4 aut | |
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