The epidemiology and clinical features of rickettsial diseases in North Queensland, Australia: Implications for patient identification and management.
Background Rickettsial infections are a common cause of hospitalization in tropical settings, although early diagnosis is challenging in the rural locations where these infections are usually seen. Methods This retrospective, clinical audit of microbiologically-confirmed cases of scrub typhus or spo...
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ftdoajarticles:oai:doaj.org/article:f2ceee52dd5a47f984cb688f9fcf0d00 2023-05-15T15:18:23+02:00 The epidemiology and clinical features of rickettsial diseases in North Queensland, Australia: Implications for patient identification and management. Alexandra G A Stewart Simon Smith Enzo Binotto William J H McBride Josh Hanson 2019-07-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007583 https://doaj.org/article/f2ceee52dd5a47f984cb688f9fcf0d00 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0007583 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007583 https://doaj.org/article/f2ceee52dd5a47f984cb688f9fcf0d00 PLoS Neglected Tropical Diseases, Vol 13, Iss 7, p e0007583 (2019) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2019 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007583 2022-12-31T10:07:30Z Background Rickettsial infections are a common cause of hospitalization in tropical settings, although early diagnosis is challenging in the rural locations where these infections are usually seen. Methods This retrospective, clinical audit of microbiologically-confirmed cases of scrub typhus or spotted fever group (SFG) rickettsial infection between 1997 and 2016 was performed a tertiary referral hospital in tropical Australia. Clinical, laboratory and radiological findings at presentation were correlated with the patients' subsequent clinical course. Results There were 135 locally-acquired cases (95 scrub typhus, 37 SFG, 3 undifferentiated). There were nine hospitalizations during the first 5 years of the study period and 81 in the last 5 years (p for trend = 0.003). Eighteen (13%) of the 135 cases required ICU admission, all of whom were adults. A greater proportion of patients with SFG infection required ICU support (8/37 (22%) compared with 10/95 (11%) scrub typhus cases), although this difference did not reach statistical significance (p = 0.10). Three (8%) of the 37 patients with SFG infection had severe disease (1 died, 2 developed permanent disability) versus 0/95 scrub typhus patients (p = 0.02). Adults with a high admission qSOFA score (≥2) had an odds ratio (OR) of 19 (95% CI:4.8-74.5) for subsequent ICU admission (p<0.001); adults with a high NEWS2 score (≥7) had an OR of 14.3 (95% CI:4.5-45.32) for ICU admission (p<0.001). A patient's respiratory rate at presentation had strong prognostic utility: if an adult had an admission respiratory rate <22 breaths/minute, the negative predictive value for subsequent ICU admission was 95% (95% CI 88-99). Conclusions In the well-resourced Australian health system outcomes are excellent, but the local burden of rickettsial disease appears to be increasing and the clinical phenotype of SFG infections may be more severe than previously believed. Simple, clinical assessment on admission has prognostic utility and may be used to guide management. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Queensland PLOS Neglected Tropical Diseases 13 7 e0007583 |
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Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Alexandra G A Stewart Simon Smith Enzo Binotto William J H McBride Josh Hanson The epidemiology and clinical features of rickettsial diseases in North Queensland, Australia: Implications for patient identification and management. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Rickettsial infections are a common cause of hospitalization in tropical settings, although early diagnosis is challenging in the rural locations where these infections are usually seen. Methods This retrospective, clinical audit of microbiologically-confirmed cases of scrub typhus or spotted fever group (SFG) rickettsial infection between 1997 and 2016 was performed a tertiary referral hospital in tropical Australia. Clinical, laboratory and radiological findings at presentation were correlated with the patients' subsequent clinical course. Results There were 135 locally-acquired cases (95 scrub typhus, 37 SFG, 3 undifferentiated). There were nine hospitalizations during the first 5 years of the study period and 81 in the last 5 years (p for trend = 0.003). Eighteen (13%) of the 135 cases required ICU admission, all of whom were adults. A greater proportion of patients with SFG infection required ICU support (8/37 (22%) compared with 10/95 (11%) scrub typhus cases), although this difference did not reach statistical significance (p = 0.10). Three (8%) of the 37 patients with SFG infection had severe disease (1 died, 2 developed permanent disability) versus 0/95 scrub typhus patients (p = 0.02). Adults with a high admission qSOFA score (≥2) had an odds ratio (OR) of 19 (95% CI:4.8-74.5) for subsequent ICU admission (p<0.001); adults with a high NEWS2 score (≥7) had an OR of 14.3 (95% CI:4.5-45.32) for ICU admission (p<0.001). A patient's respiratory rate at presentation had strong prognostic utility: if an adult had an admission respiratory rate <22 breaths/minute, the negative predictive value for subsequent ICU admission was 95% (95% CI 88-99). Conclusions In the well-resourced Australian health system outcomes are excellent, but the local burden of rickettsial disease appears to be increasing and the clinical phenotype of SFG infections may be more severe than previously believed. Simple, clinical assessment on admission has prognostic utility and may be used to guide management. |
format |
Article in Journal/Newspaper |
author |
Alexandra G A Stewart Simon Smith Enzo Binotto William J H McBride Josh Hanson |
author_facet |
Alexandra G A Stewart Simon Smith Enzo Binotto William J H McBride Josh Hanson |
author_sort |
Alexandra G A Stewart |
title |
The epidemiology and clinical features of rickettsial diseases in North Queensland, Australia: Implications for patient identification and management. |
title_short |
The epidemiology and clinical features of rickettsial diseases in North Queensland, Australia: Implications for patient identification and management. |
title_full |
The epidemiology and clinical features of rickettsial diseases in North Queensland, Australia: Implications for patient identification and management. |
title_fullStr |
The epidemiology and clinical features of rickettsial diseases in North Queensland, Australia: Implications for patient identification and management. |
title_full_unstemmed |
The epidemiology and clinical features of rickettsial diseases in North Queensland, Australia: Implications for patient identification and management. |
title_sort |
epidemiology and clinical features of rickettsial diseases in north queensland, australia: implications for patient identification and management. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2019 |
url |
https://doi.org/10.1371/journal.pntd.0007583 https://doaj.org/article/f2ceee52dd5a47f984cb688f9fcf0d00 |
geographic |
Arctic Queensland |
geographic_facet |
Arctic Queensland |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 13, Iss 7, p e0007583 (2019) |
op_relation |
https://doi.org/10.1371/journal.pntd.0007583 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007583 https://doaj.org/article/f2ceee52dd5a47f984cb688f9fcf0d00 |
op_doi |
https://doi.org/10.1371/journal.pntd.0007583 |
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PLOS Neglected Tropical Diseases |
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13 |
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7 |
container_start_page |
e0007583 |
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