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INTRODUCTION: Scrub typhus is endemic in rural Southeast Asia. The district of Umphang in northwestern Thailand is a prototype environment for this disease. We report the clinical manifestations and outcomes of patients diagnosed with scrub typhus in this area. METHODOLOGY: Patients diagnosed with scrub typhus between 2011 and 2014 were analyzed. Diagnosis was based on clinical symptoms in conjunction with a positive rapid test or a pathognomonic eschar lesion. RESULTS: A total of 857 patients were included, of which 488 were adults and 369 were children. Most patients (728; 84.9%) were included via a positive serology on rapid test, 86 patients (10.0%) had eschar only, and 43 patients (5.0%) had both sero-confirmation and presence of eschar. The most common symptom was fever (93.8%), followed by headache (48.1%) and cough (33.1%). Eschars were reported in 129 patients, with a significantly higher percentage in children (p < 0.001), and a different anatomical distribution was found when adults and children were compared. Common complications were elevated transaminases, acute kidney injury, and pneumonia. Most patients recovered from the disease. CONCLUSIONS: Scrub typhus in Umphang district is common. Patients can present with a variety of clinical symptoms, regardless of the presence of fever. Standard treatment led to a favorable outcome in most patients.
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Dengue infection (DI) is a major vector-borne disease in southeast Asia and an important cause of morbidity. The complications such as hepatic impairment are common, and because the physiology of the liver differs between children and adults, the DI-associated liver impairments might be expected to differ as well. This study aims to compare the differences in liver impairment between adults and children with DI. We retrospectively studied 158 adults and 79 children with serologically confirmed DI admitted to the Bangkok Hospital for Tropical Diseases from 2008 to 2012. In total, 93% of adults and 87% of children exhibited abnormal liver enzyme levels during hospitalization. Overall, 76 (42.4%) adults and 16 (20.3%) children had dengue hemorrhagic fever (DHF). Compared with children, adults with dengue fever (DF) presented a significantly higher incidence of liver function impairment (alanine transaminase [ALT] > 2 × upper limit of normal [ULN]) (47.1% versus 25.5%), hepatitis (ALT > 4 × ULN) (29.4% versus 12.8%), and severe hepatitis (aspartate transaminase [AST]/ALT > 10 × ULN) (16.5% versus 4.3%). Children with DHF showed a significantly higher incidence of liver function impairment due to AST derangement than did adults (100% versus 73%). There were no differences in the total bilirubin, albumin, or total protein levels between adults and children. Liver enzymes normalized significantly more slowly in adults, and AST recovery was faster than ALT. In conclusion, liver function impairment was more common among adults than children with DF. As the severity progressed to DHF, liver injury became more common in children.