Severe fever with thrombocytopenia syndrome

Comparison with scrub typhus and clinical diagnostic prediction

Sang Won Park, Chang Seop Lee, Jeong Han Kim, In Gyu Bae, Chisook Moon, Yee Gyung Kwak, Baek Nam Kim, Jae Hoon Lee, Seong Yeol Ryu, Hee Chang Jang, Jian Hur, Jae Bum Jun, Younghee Jung, Hyun Ha Chang, YoungKeun Kim, Jeong Hwan Hwang, Yeon Sook Kim, Hye Won Jeong, Kyoung Ho Song, Wan Beom Park & 2 others Eu Suk Kim, Myoung Don Oh

Research output: Contribution to journalArticle

Abstract

Background: Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes. Methods: Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus. Results: The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm 3 ; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm 3 ; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1% (95% confidence interval [CI], 87.9-96.4%) and a specificity of 96.1% (95% CI, 93.8-97.6%) for SFTS. Conclusion: This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings.

Original languageEnglish
Article number174
JournalBMC Infectious Diseases
Volume19
Issue number1
DOIs
Publication statusPublished - 2019 Feb 19

Fingerprint

Scrub Typhus
Thrombocytopenia
Fever
Exanthema
Odds Ratio
Orientia tsutsugamushi
Confidence Intervals
Republic of Korea
Leukopenia
Korea
Platelet Count
Leukocyte Count
Routine Diagnostic Tests
C-Reactive Protein
Headache
China
Primary Health Care
Japan
Logistic Models
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Infectious Diseases

Cite this

Park, Sang Won ; Lee, Chang Seop ; Kim, Jeong Han ; Bae, In Gyu ; Moon, Chisook ; Kwak, Yee Gyung ; Kim, Baek Nam ; Lee, Jae Hoon ; Ryu, Seong Yeol ; Jang, Hee Chang ; Hur, Jian ; Jun, Jae Bum ; Jung, Younghee ; Chang, Hyun Ha ; Kim, YoungKeun ; Hwang, Jeong Hwan ; Kim, Yeon Sook ; Jeong, Hye Won ; Song, Kyoung Ho ; Park, Wan Beom ; Kim, Eu Suk ; Oh, Myoung Don. / Severe fever with thrombocytopenia syndrome : Comparison with scrub typhus and clinical diagnostic prediction. In: BMC Infectious Diseases. 2019 ; Vol. 19, No. 1.
@article{c3d34db45ad04094997ac9d0b0f1d2a7,
title = "Severe fever with thrombocytopenia syndrome: Comparison with scrub typhus and clinical diagnostic prediction",
abstract = "Background: Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes. Methods: Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus. Results: The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm 3 ; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm 3 ; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1{\%} (95{\%} confidence interval [CI], 87.9-96.4{\%}) and a specificity of 96.1{\%} (95{\%} CI, 93.8-97.6{\%}) for SFTS. Conclusion: This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings.",
author = "Park, {Sang Won} and Lee, {Chang Seop} and Kim, {Jeong Han} and Bae, {In Gyu} and Chisook Moon and Kwak, {Yee Gyung} and Kim, {Baek Nam} and Lee, {Jae Hoon} and Ryu, {Seong Yeol} and Jang, {Hee Chang} and Jian Hur and Jun, {Jae Bum} and Younghee Jung and Chang, {Hyun Ha} and YoungKeun Kim and Hwang, {Jeong Hwan} and Kim, {Yeon Sook} and Jeong, {Hye Won} and Song, {Kyoung Ho} and Park, {Wan Beom} and Kim, {Eu Suk} and Oh, {Myoung Don}",
year = "2019",
month = "2",
day = "19",
doi = "10.1186/s12879-019-3773-1",
language = "English",
volume = "19",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",
number = "1",

}

Park, SW, Lee, CS, Kim, JH, Bae, IG, Moon, C, Kwak, YG, Kim, BN, Lee, JH, Ryu, SY, Jang, HC, Hur, J, Jun, JB, Jung, Y, Chang, HH, Kim, Y, Hwang, JH, Kim, YS, Jeong, HW, Song, KH, Park, WB, Kim, ES & Oh, MD 2019, 'Severe fever with thrombocytopenia syndrome: Comparison with scrub typhus and clinical diagnostic prediction', BMC Infectious Diseases, vol. 19, no. 1, 174. https://doi.org/10.1186/s12879-019-3773-1

Severe fever with thrombocytopenia syndrome : Comparison with scrub typhus and clinical diagnostic prediction. / Park, Sang Won; Lee, Chang Seop; Kim, Jeong Han; Bae, In Gyu; Moon, Chisook; Kwak, Yee Gyung; Kim, Baek Nam; Lee, Jae Hoon; Ryu, Seong Yeol; Jang, Hee Chang; Hur, Jian; Jun, Jae Bum; Jung, Younghee; Chang, Hyun Ha; Kim, YoungKeun; Hwang, Jeong Hwan; Kim, Yeon Sook; Jeong, Hye Won; Song, Kyoung Ho; Park, Wan Beom; Kim, Eu Suk; Oh, Myoung Don.

In: BMC Infectious Diseases, Vol. 19, No. 1, 174, 19.02.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Severe fever with thrombocytopenia syndrome

T2 - Comparison with scrub typhus and clinical diagnostic prediction

AU - Park, Sang Won

AU - Lee, Chang Seop

AU - Kim, Jeong Han

AU - Bae, In Gyu

AU - Moon, Chisook

AU - Kwak, Yee Gyung

AU - Kim, Baek Nam

AU - Lee, Jae Hoon

AU - Ryu, Seong Yeol

AU - Jang, Hee Chang

AU - Hur, Jian

AU - Jun, Jae Bum

AU - Jung, Younghee

AU - Chang, Hyun Ha

AU - Kim, YoungKeun

AU - Hwang, Jeong Hwan

AU - Kim, Yeon Sook

AU - Jeong, Hye Won

AU - Song, Kyoung Ho

AU - Park, Wan Beom

AU - Kim, Eu Suk

AU - Oh, Myoung Don

PY - 2019/2/19

Y1 - 2019/2/19

N2 - Background: Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes. Methods: Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus. Results: The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm 3 ; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm 3 ; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1% (95% confidence interval [CI], 87.9-96.4%) and a specificity of 96.1% (95% CI, 93.8-97.6%) for SFTS. Conclusion: This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings.

AB - Background: Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes. Methods: Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus. Results: The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm 3 ; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm 3 ; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1% (95% confidence interval [CI], 87.9-96.4%) and a specificity of 96.1% (95% CI, 93.8-97.6%) for SFTS. Conclusion: This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings.

UR - http://www.scopus.com/inward/record.url?scp=85061849462&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061849462&partnerID=8YFLogxK

U2 - 10.1186/s12879-019-3773-1

DO - 10.1186/s12879-019-3773-1

M3 - Article

VL - 19

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

IS - 1

M1 - 174

ER -