A Clinical Analysis of Tsutsugamushi Disease Patients with Abdominal Pain

Lee, Gyeong Il; Kim, Jeong Soo; Jeon, Hae Myung

Abstract

Tsutsugamushi disease cases occur throughout the rural area in Korea, and the number of the reported cases has been increased recently. Tsutsugamushi disease is a kind of rickettsiosis, and causative organism of that is Rickettsia tsutsugamushi. The field rodents, especially Apodemus agrarius, are the animal hosts, and main vector is chigger, Leptotrombidium pallidum. The pathogen is transmitted to human via this chigger bite. We experienced 60 cases of tsutsugamushi disease at Uijungbu Saint Mary's Hospital from January 1993 to December 1996. A group(study group) consists of 8 patients. They complained of abdominal (RUQ or epigastric) pain and had a finding of GB wall thickening by ultrasonogram and computerized tomogram. B group (control group) consists of 52 patients. They had no abnormal findings of GB by that. A clinical analysis of those patients was done retrospectively. Then A group was compared to B group. The obtained results were as follows. 1) All patients(A group and B group) those visited emergency room from October to December complaining of fever had lived at north area of Kyonggi-Do and had experienced outdoor play in field two weeks before expression of symptoms. 2) Percentage of leukocytopenia was 26%(2/8 cases) and 10%(5/52 cases) in A and B group respectively. Thrombocytopenia was found in many patients, and serum AST and ALT level was elevated in all patients of A and B group. 3) Percentage of patients with hypoalbuminemia was 87%(7/8 cases) and 67%(35/52 cases) in A and B group respectively. 4) Mean age of A group patients was higher than that of B group patients(A:62.4, B:49-years-old), and only all patients of A group had abdominal pain and hyperbilirubinemia. 5) Mean thickness of GB wall in A group patients was 7.3 mm(range 4~14 mm) by ultrasonogram. Conclusively, tsutsugamushi disease should be considered as differential diagnosis when old patient with fever and abdominal pain visits ER in endemic area of that despite jaundice, leukocytopenia, thrombocytopenia, and GB wall thickening founded by ultrasonogram.