Korean J Crit Care Med.  2014 Aug;29(3):189-193. 10.4266/kjccm.2014.29.3.189.

Patients with Acute Respiratory Distress Syndrome Caused by Scrub Typhus: Clinical Experiences of Eight Patients

• Kim SY
• Jang HJ
• Kim H
• Shin K
• Kim MH
• Lee K
• Kim KU
• Park HK
• Lee MK

• KMID: 1892250
• DOI: http://doi.org/10.4266/kjccm.2014.29.3.189

Abstract

BACKGROUND
The aim of this study is to describe the clinical course and outcome of patients who were diagnosed with acute respiratory distress syndrome (ARDS) caused by scrub typhus and who received ventilator care in the intensive care units (ICU) of two university hospitals.
METHODS
We performed a retrospective analysis of all adult ventilated patients who were diagnosed with ARDS caused by scrub typhus.
RESULTS
Eleven (1.7%) of 632 scrub typhus patients were diagnosed with ARDS (median age 72; seven were male). Eight patients had underlying diseases, the most common of which was hypertension (four patients). Eight patients (72.7%) were admitted in November. The most common chief complaints of the patients were fever and rash (63.6%). All patients had skin eschar and rash; seven were treated for shock. On the day of diagnosis with ARDS, the median Acute Physiology and Chronic Health Evaluation score was 20 (range 11-28) and Sequential Organ Failure Assessment score was 7 (range 4-14). All patients had PaO2/FiO2 < 200 mmHg, high serum aspartate aminotransferase level (> 40 IU/L), and hypoalbuminemia (< 3.3 g/dl). Nine patients were treated with doxycycline on the day of admission. Their median lengths of stay in the ICU and hospital were 10 (range 4-65) and 14 (4-136) days, respectively. The mortality rate during treatment in the hospital was 36.4%.
CONCLUSIONS
In our study, the risk of ARDS among patients diagnosed with scrub typhus was at least 1.7%, with a hospital mortality rate of 36.4%.

Keyword

acute respiratory distress syndrome; intensive care unit; scrub typhus

MeSH Terms

Adult
APACHE
Aspartate Aminotransferases
Diagnosis
Doxycycline
Exanthema
Fever
Hospital Mortality
Hospitals, University
Humans
Hypertension
Hypoalbuminemia
Intensive Care Units
Mortality
Respiratory Distress Syndrome, Adult*
Retrospective Studies
Scrub Typhus*
Shock
Skin
Ventilators, Mechanical
Aspartate Aminotransferases
Doxycycline