Scrub typhus: chest radiographic and clinical findings in 130 Thai patients

To describe chest radiographic findings and their clinical correlation in patients with scrub typhus diagnosed in Thailand and to determine abnormalities that assist in the diagnosis of scrub typhus.

Between July 2001 and December 2002, 130 patients with scrub typhus admitted to three hospitals in the northeastern Thailand were studied. Data of clinical presentations and chest radiographic findings, reviewed by two radiologists who were unaware of the final diagnosis, were analyzed.

There were 33 women, 97 men; age range, 11-92 years; median age, 45 years old. Pulmonary symptoms occurred in 61.5% of the patients and eschar was found in 33.1%. Hepatic dysfunction occurred in 58.5% and cardiovascular dysfunction in 33%. Pulmonary involvement was the major presentation in 41.5%. Acute respiratory distress syndrome developed in 7 patients. Overall 5 patients died. The initial radiography showed abnormalities in 64.6% of the patients. Common radiographic abnormalities included bilateral reticular opacities (48.5%), cardiomegaly (28.5%), congestive heart failure (18.5%), air space nodules (13.1%), and pleural effusion (10.8%). Significant association between chest radiographic abnormalities and hepatic and cardiovascular dysfunction were documented.

Chest radiography should be included in the initial evaluation of patients with suspected scrub typhus. Bilateral reticular infiltration, with or without cardiomegaly or congestive heart failure, was the most frequent radiographic finding of scrub typhus.