Clinical and Epidemiological Characteristics of Scrub Typhus and Murine Typhus among Hospitalized Patients with Acute Undifferentiated Fever in Northern Vietnam

Sugihiro Hamaguchi, Ngo Chi Cuong, Doan Thu Tra, Yen Hai Doan, Kenta Shimizu, Nguyen Quang Tuan, Lay-Myint Yoshida, Le Quynh Mai, Dang Duc-Anh, Shuji Ando, Jiro Arikawa, Christopher M Parry, Koya Ariyoshi, Pham Thanh Thuy, Sugihiro Hamaguchi, Ngo Chi Cuong, Doan Thu Tra, Yen Hai Doan, Kenta Shimizu, Nguyen Quang Tuan, Lay-Myint Yoshida, Le Quynh Mai, Dang Duc-Anh, Shuji Ando, Jiro Arikawa, Christopher M Parry, Koya Ariyoshi, Pham Thanh Thuy

Abstract

A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non-scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting.

© The American Society of Tropical Medicine and Hygiene.

Figures

Figure 1.
Figure 1.
Investigation flow of patients in the study. OT = Orientia tsutsugamushi; RT = Rickettsia typhi; non-ST/MT = non–scrub and murine typhus; ELISA = enzyme-linked immunosorbent assay; IFA = immunofluorescent assay.
Figure 2.
Figure 2.
Regional demographics of proportion of patients with scrub typhus, murine typhus, and non-scrub and murine typhus. ST = scrub typhus; MT = murine typhus; NO = non–scrub and murine typhus.
Figure 3.
Figure 3.
Seasonality of frequency of murine typhus.

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