J Korean Med Sci.  2004 Oct;19(5):668-673. 10.3346/jkms.2004.19.5.668.

Clinical Role of Interstitial Pneumonia in Patients with Scrub Typhus: A Possible Marker of Disease Severity

• Song SW
• Kim KT
• Ku YM
• Park SH
• Kim YS
• Lee DG
• Yoon SA
• Kim YO

• KMID: 1733506
• DOI: http://doi.org/10.3346/jkms.2004.19.5.668

Abstract

Interstitial pneumonia (IP) frequently occurs in patients with scrub typhus, but its clinical significance is not well known. This study was designed to evaluate interstitial pneumonia as a marker of severity of the disease for patients with scrub typhus. We investigated clinical parameters representing the severity of the disease, and the chest radiographic findings for 101 patients with scrub typhus. We then compared these clinical factors between patients with and without IP. We also studied the relationship between IP and other chest radiographic findings. The chest radiography showed IP (51.4%), pleural effusion (42.6%), cardiomegaly (14.9%), pulmonary alveolar edema (20.8%), hilar lymphadenopathy (13.8%) and focal atelectasis (11.8%), respectively. The patients with IP (n=52) had higher incidences in episode of hypoxia (p=0.030), hypotension (p=0.024), severe thrombocytopenia (p=0.036) and hypoalbuminemia (p=0.013) than the patients without IP (n=49). The patients with IP also had higher incidences of pleural effusion (p<0.001), focal atelectasis (p=0.019), cardiomegaly (p<0.001), pulmonary alveolar edema (p=0.011) and hilar lymphadenopathy (p<0.001) than the patients without IP. Our data suggest that IP frequently occurs for patients with scrub typhus and its presence is closely associated with the disease severity of scrub typhus.

Keyword

Orientia tsutsugamushi; Scrub Typhus; Pneumonia, Rickettsial; Severity of Illness Index

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Fluorescent Antibody Technique, Indirect
Humans
Incidence
Lung/microbiology/radiography
Lung Diseases, Interstitial/epidemiology/*microbiology/*radiography
Male
Middle Aged
Pleural Effusion/epidemiology/microbiology/radiography
Predictive Value of Tests
Prognosis
Scrub Typhus/*complications/epidemiology/*radiography
*Severity of Illness Index

Figure

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  Fig. 1 Thin-section CT through the lower lung zones in a 43-yr-old woman with scrub typhus. There is thickening of the interlobular septa and small bilateral pleural effusions.

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  Fig. 2 Chest radiograph and thin-section CT in a 58-yr-old woman with scrub typhus. (A) Chest radiograph shows diffuse bronchial wall thickening, diffuse ground glass opacities, mild cardiomegaly, bilateral pleural effusions and subsegmental atelectasis. (B) CT of lower zones shows interlobular septal thickening, bronchial wall thickening, diffuse ground glass opacities and patchy consolidations in the dependent lung zones, increased vascular diameter, mild cardiomegaly, bilateral pleural effusions and subsegmental atelectasis.

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  Fig. 3 Chest radiograph in a 70-yr-old man with scrub typhus. There are bilateral multiple patchy ground glass opacities and minimal right pleural effusion. The consolidations in the upper and peripheral lung zones are suggestive of ARDS.

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