Tuberc Respir Dis.  2009 Feb;66(2):116-121.

A Correlation between Pulmonary Involvement of Acute Febrile Illness with High Incidence during the Fall and C-reactive Protein

• Kim GW
• Lee WJ
• Hong WK
• Lee SH
• Lee CY
• Lee MG
• Hyun IG
• Jung KS

Abstract

BACKGROUND
Tsutsugamushi, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are the prevalent diseases among the acute febrile illnesses in Korea. Pulmonary involvement in the patients with these diseases remains poorly recognized in endemic regions, and this is despite reports of recent outbreaks and epidemic episodes. Pulmonary involvement and a higher CRP level as clinical manifestations show a more severe form of infection. The aim of this study is to analyze the correlation of pulmonary involvement and the CRP level in patients with acute febrile illnesses.
METHODS
We retrospectively reviewed the clinical records of 105 patients who were diagnosed with tsutsugamushi, HFRS and leptospirosis from January 2002 to May 2008 in Chuncheon Sacred Heart Hospital. The radiographic images were retrospectively analyzed by two radiologists. We analyzed the pulmonary complications of the patients with these febrile diseases and we checked the CRP level at admission.
RESULTS
The study included 105 patients who were diagnosed with febrile diseases. Of these patients, 32 patients had hantaan, 10 patients had leptospirosis and 63 patients had tsutsugamushi disease. 42 (40%) patients had pulmonary complications, 20 patients had pulmonary edema, 20 patients had pleural effusion and 2 patients had interstitial pneumonitis. The patients with pulmonary involvement showed a more severe form of infection and a higher CRP level than that of those patients without pulmonary involvement (p=0.0073).
CONCLUSION
Pulmonary involvement in patients with acute febrile diseases might be correlated with a higher CRP level. Identification of this factor on admission might provide useful selection criteria for the patients who need early intensive care.

Keyword

Tsutsugamushi; Leptospirosis; Hemorrhagic fever with renal syndrome; Pumonary involvement; C-reactive protein

MeSH Terms

C-Reactive Protein
Disease Outbreaks
Heart
Hemorrhagic Fever with Renal Syndrome
Humans
Incidence
Critical Care
Korea
Leptospirosis
Lung Diseases, Interstitial
Patient Selection
Pleural Effusion
Pulmonary Edema
Retrospective Studies
Scrub Typhus
C-Reactive Protein

Figure

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  Figure 1 Distribution of 105 acute febrile disease patients.

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  Figure 2 Diagnostic distribution of acute febrile disease patients.

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  Figure 3 Pulmonary involvement distribution of acute febrile disease patients.

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  Figure 4 Diagnosis and CRP level. Data are presented as box-plots, where the horizontal line represents the mean.

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  Figure 5 Lung involvement and CRP level. Pulmonary edema and interstitial pneumonia pattern showed increased CRP level with statistically significance. *p<0.05.

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