Clinical Features of Tsutsugamushi Disease in the Emergency Department

ABSTRACT

PURPOSE: Many of the febrile diseases developing in Korea during the autumn are tsutsugamushi disease. The pathogen of the disease is rickettsia of oriental tsutsugamushi. The aim of this research was to help in the early diagnosis and treatment by analyzing the clinical features of patients with tsutsugamushi disease and the factors affecting the duration of antibiotic use and admission. METHODS: A total of 177 patients diagnosed with tsutsugamushi disease who visited the emergency department between 2004 and 2008 were included. We retrospectively reviewed the medical records on OCS by comparing the relationship between clinical features and the duration of antibiotic use or admission. RESULTS: In the outbreaks occurring in 2005 and 2007 no significant clinical differences were seen. Tsutsugamushi disease occurred in females(61.0%), the elderly (over 60 years old, 66.1%), and urban areas(56.5%). Common clinical findings were eschar(80.8%) and skin rash(96.6%). Complications(58.8%) included pneumonia, meningitis, DIC, and acute renal failure. The duration of antibiotic use was increased with increasing age over 60 years old and with increasing body temperature. The duration of admission was significantly correlated with the absence of eschar, age over 40 years old, and abnormal findings of BUN/Cr, PT/PTT, albumin. CONCLUSION: In conclusion, several factors such as age, hemoglobin, eschar, BUN/Cr, albumin and PT/PTT were correlated with the duration of antibiotic use and admission. Therefore, efforts to reduce them are required