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Narita M, Monma N, Chiba K, Suzuki R, Fujita S, Hoshino C, Nakamura K, Sekikawa Y, Ikeda H, Inoue M, Shimbo T, Yamamoto S, Ando S, Takada N, Fujita H. Masqueraders Around Disaster: Clinical Features of Scrub Typhus in Fukushima, Japan. Open Forum Infect Dis 2024; 11:ofae215. [PMID: 38756759 PMCID: PMC11096087 DOI: 10.1093/ofid/ofae215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background Scrub typhus (ST) is endemic in Fukushima, with the largest number of cases reported in Japan from 2009 to 2010. Although ST is highly treatable, its atypical clinical presentation impedes diagnosis, causing delays in treatment. Methods We review the clinical features of ST in adults from 2008 to 2017 at Ohta Nishinouchi General Hospital in Fukushima, Japan. Results Fifty-five cases (serotype Karp 24, Irie/Kawasaki 21, Hirano/Kuroki 10) of ST were confirmed via serology based on elevated immunoglobulin (Ig)M and IgG and polymerase chain reaction positivity of eschar samples. The mean age was 69 years, and 64% were female. The case fatality rate was 1.8% (1/55). Approximately 70% of cases (38/55) were not diagnosed as ST upon the initial clinic visit. Inappropriate use of antibiotics was identified in 22% of cases (12/55). In terms of atypical clinical features, 1 or more of the manifestations, fever, rash, and eschar, was absent in 31% of cases (17/55). Approximately 11% of cases presented without eschar (6/55; Karp 1, Irie/Kawasaki 1, Hirano/Kuroki 4). Moreover, severe complications were observed with shock and disseminated intravascular coagulation in 7% of cases (4/55), Thus, while 53% of cases presented with the typical triad (29/55), unusual complications and atypical features occurred in 40% (22/55). Conclusions Diagnosis of ST becomes clinically challenging in the absence of typical features. In Fukushima, an endemic area of ST, an atypical presentation involving multisystem disease is common.
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Affiliation(s)
- Masashi Narita
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Nambu Medical Center & Children's Medical Center, Haebaru, Japan
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan
- Department of Medicine, Ohta Nishinouch General Hospital, Koriyama, Japan
| | - Naota Monma
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan
| | - Kazuki Chiba
- Fukushima Prefectural Institute of Public Health, Fukushima, Japan
| | - Rie Suzuki
- Fukushima Prefectural Institute of Public Health, Fukushima, Japan
| | - Shohei Fujita
- Fukushima Prefectural Institute of Public Health, Fukushima, Japan
| | | | - Kiwamu Nakamura
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan
| | - Yoshiyuki Sekikawa
- Division of Infectious Diseases, Department of Internal Medicine, Japanese Red Cross Musashino Hospital, Musashino, Japan
| | | | - Minoru Inoue
- Department of Medicine, Ohta Nishinouch General Hospital, Koriyama, Japan
| | - Takuro Shimbo
- Department of Medicine, Ohta Nishinouch General Hospital, Koriyama, Japan
| | - Seigo Yamamoto
- Miyazaki Prefectural Institute for Public Health and Environment, Miyazaki, Japan (former affiliation)
| | - Shuji Ando
- National Institute of Infectious Diseases, Tokyo, Japan
| | - Nobuhiro Takada
- Department of Pathological Sciences, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiromi Fujita
- Institute of Rickettsioses, Kita-Fukushima Medical Center, Fukushima, Japan
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Emergency Department Preparedness of Hospitals for Radiation, Nuclear Accidents, and Nuclear Terrorism: A Qualitative Study in Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2019. [DOI: 10.5812/ircmj.87107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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