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Severity predictors in eschar-positive scrub typhus and role of serum osteopontin

Sang-Won Park1, Chang-Seop Lee, Chi Kug Lee

  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. hswon1@snu.ac.kr

The American Journal of Tropical Medicine and Hygiene
|November 4, 2011
PubMed

Insights

Predicting scrub typhus severity is possible using patient factors like age and diabetes, not bacterial strains. High osteopontin levels can rule out severe complications in scrub typhus patients.

Area of Science:

  • Infectious Diseases
  • Clinical Medicine
  • Epidemiology

Background:

  • Scrub typhus, caused by Orientia tsutsugamushi, is a significant public health concern.
  • Predicting disease severity is crucial for timely and appropriate patient management.
  • Host, microbial, and treatment factors may influence scrub typhus outcomes.

Purpose of the Study:

  • To identify independent predictors of severity in eschar-positive scrub typhus patients.
  • To evaluate the role of host factors, microorganism genotypes, and treatment delays in disease severity.
  • To assess the utility of serum osteopontin as a severity marker.

Main Methods:

  • Prospective evaluation of 153 eschar-positive scrub typhus patients.
  • Severity assessment using Acute Physiology and Chronic Health Evaluation (APACHE) II score and predefined criteria for severe complications.
  • Determination of Orientia tsutsugamushi genotypes.

Main Results:

  • Independent risk factors for severity (APACHE II score ≥ 10) included old age, diabetes mellitus, serum osteopontin > 100 ng/mL, and underlying diseases.
  • Anemia (≤ 10 g/dL) and elevated C-reactive protein (> 10 mg/dL) indicated current severity.
  • Neither antibiotic delay nor specific Orientia tsutsugamushi strain types (Boryong, Taguchi, Kanda/Kawasaki) correlated with severity.
  • Serum osteopontin > 100 ng/mL demonstrated a 96% negative predictive value for severe complications.

Conclusions:

  • Host-related factors, particularly old age, diabetes, and pre-existing conditions, are key predictors of scrub typhus severity.
  • Serum osteopontin is a valuable negative predictive marker for severe complications, aiding in ruling out severe disease.
  • Microorganism strain types and antibiotic administration timing do not appear to influence scrub typhus severity in this cohort.

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