Clinical features of 59 patients with scrub typhus in Kunming City

Objective To study the clinical features of patients with scrub typhus and provide scientific basis for clinical diagnosis and treatment. Methods Clinical data of patients with scrub typhus in the First Affiliated Hospital of Kunming Medical University from January 2016 to December 2016 were collected. Epidemiological data, clinical manifestations, laboratory findings, image examination results, treatment and outcome were retrospectively analyzed. Results The clinical manifestations included 59 cases (100.0%) with fever, 44 cases (74.6%) with headache, 39 cases (66.1%) with chills, 34 cases (57.6%) with muscle and joint pain, 29 cases (49.2%) with prostration, 49 cases (83.1%) with eschar or ulcer, 42 cases (71.2%) with lymphadenectasis, 23 cases (39.0%) with hepatosplenomegaly. Laboratory test results: 51 cases (86.4%) had normal or elevated white blood cell count, 50 cases of eosinophil reduced (84.7%), 27 cases of blood platelet (PLT) reduced (45.8%), 33 cases of albumin reduced (55.9%), 50 cases of alanine aminotransferase (ALT) increased (84.7%), 48 cases of aspartate aminotransferase (AST) increased (81.4%), and 56.1% (23/41) of the patients with triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3) and free thyroxine (FT4) levels significantly lowered, with predominantly free FT3 reduction (82.6%,19/23); C reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and ferritin were increased in 93.9% (46/49), 35.4% (17/48), 64.9% (24/37), and 83.8% (31/37) of the patients, and 95.6% (43/45) was accompanied with chest radiographic abnormalities. Tetracycline, doxycycline and azithromycin treatment were all effective. Conclusions The clinical manifestations of patients with scrub typhus, involving multisystem, are diverse and thyroid hormones decrease is observed. Early diagnosis and treatment is the key to improve the prognosis of patients with scrub typhus. Key words: Scrub typhus; Thyroid hormones; Clinical features