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Abstract
Purpose
We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. Methods: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. Results: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P=0.001) and eschar (P=0.004) were more common in children, while myalgia was more common in adults. Child-ren had a high prevalence of anemia (P=0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P˂0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. Conclusion: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.
References
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Fig. 1.
Comparison of number of patients with tsutsu-gamushi disease between children and adults during 2003–2012.∗ Children defines under 15-year-old.
Table 1.
Comparison of Distribution of Patients with Tsutsugamushi Disease between Children and Adults by Months
| Months | No. of patients (%) | |
|---|---|---|
| Children∗ | Adults | |
| January | 0 (0.0) | 11 (1.5) |
| February | 1 (2.0) | 3 (0.4) |
| March | 0 (0.0) | 2 (0.3) |
| April | 0 (0.0) | 5 (0.7) |
| May | 0 (0.0) | 4 (0.6) |
| June | 0 (0.0) | 5 (0.7) |
| July | 0 (0.0) | 2 (0.3) |
| August | 0 (0.0) | 9 (1.3) |
| September | 1 (2.0) | 12 (1.7) |
| October | 19 (38.8) | 350 (48.7) |
| November | 28 (57.1) | 296 (41.2) |
| December | 0 (0.0) | 20 (2.8) |
| Total | 49 (100.0) | 719 (100.0) |
Table 2.
Comparison of Distribution of Patients with Tsutsugamushi Disease between Children and Adults by Sex
| Group | Sex | Ratio | P-value | |
|---|---|---|---|---|
| Male (%) | Female (%) | |||
| Children∗ | 26 (53.1) | 23 (46.9) | 1.13:1 | 0.029 |
| Adults | 269 (37.4) | 450 (62.6) | 0.60:1 | |
Table 3.
Distribution of Patients with Tsutsugamush Disease in Children According to Age and Sex
| Age (years) | Sex | No. of patients (%) | |
|---|---|---|---|
| Male (n=295) | Female (n=473) | ||
| <1 | 2 | 0 | 2 (0.3) |
| 1–5 | 13 | 12 | 25 (3.3) |
| 6–10 | 9 | 9 | 18 (2.3) |
| 11–14 | 2 | 2 | 4 (0.5) |
| ≥15 | 269 | 450 | 719 (93.6) |
Table 4.
Comparison of Clinical Findings of Patients with Tsutsugamushi Disease between Children and Adults
Table 5.
Comparison of Location of Eschar in Patients with Tsutsugamushi Disease between Children and Adults
| Location | No. of eschar (%) | |
|---|---|---|
| Children∗ | Adults | |
| Trunk | 11 (22.4) | 228 (38.0) |
| Extremity | 11 (22.4) | 166 (27.8) |
| Head and neck | 9 (18.4) | 43 (7.2) |
| Inguinal area | 5 (10.2) | 55 (9.2) |
| Hip | 5 (10.2) | 16 (2.7) |
| Axillary area | 4 (8.2) | 62 (10.3) |
| Genitalia | 3 (6.1) | 19 (3.2) |
| Unknown site | 1 (2.0) | 10 (1.6) |
| Total | 49 (100.0) | 599 (100.0) |
Table 6.
Comparison of Laboratory Findings of Patients with Tsutsugamushi Disease between Children and Adults
| Laboratory findings | No. of patients (%) | P-value | |
|---|---|---|---|
| Children∗ | Adults | ||
| Hematologic | |||
| Anemia (<11 g/dL) | 13 (26.5) | 100 (15.4) | 0.041 |
| Leukocytosis (≥10,000/μ L) | 5 (10.2) | 103 (15.8) | 0.292 |
| Leukopenia (<5,000/μ L) | 19 (38.8) | 205 (31.5) | 0.295 |
| Thrombocytopenia (<150,000/μ L) | 20 (40.8) | 395 (60.7) | 0.006 |
| Liver function | |||
| Elevated AST (≥40 U/L) | 42 (85.7) | 546 (81.7) | 0.484 |
| Elevated ALT (≥40 U/L) | 21 (42.9) | 434 (65.1) | 0.002 |
| Hypoalbuminemia (<3.0 g/dL) | 0 (0.0) | 92 (14.2) | 0.005 |
| Renal function | |||
| Elevated BUN (≥20 mg/dL) | 0 (0.0) | 188 (29.0) | 0.001 |
| Elevated Cr (≥1.2 mg/dL) | 0 (0.0) | 161 (24.8) | 0.001 |
| Urine analysis | |||
| Proteinuria (≥2+, 100 mg/dL) | 0 (0.0) | 104 (16.5) | 0.002 |
| Hematuria (≥2+, 50/μ L) | 0 (0.0) | 116 (18.4) | 0.001 |
| Chest X-ray | |||
| Pneumonia | 1 (2.0) | 38 (5.8) | 0.275 |
| Pleural effusion | 1 (2.0) | 27 (4.1) | 0.483 |
| Others† | 0 (0.0) | 14 (2.1) | 0.305 |
Table 7.
Comparison of Seropositive Cases of Patients with Tsutsugamushi Disease between Children and Adults
| Group | No. of seropositive∗cases (%) | P-value |
|---|---|---|
| Children† (n=39) | 23 (59.0) | 0.210 |
| Adults (n=650) | 447 (68.8) |
Table 8.
Comparison of Duration of Hospitalization of Patients with Tsutsugamushi Disease between Children and Adults
| Duration of hospitalization | Group | P-value | |
|---|---|---|---|
| Children† (n=49) | Adults (n=719) | ||
| Mean (day†) | 5.61±1.39 | 8.66±8.20 | <0.001 |
| <1 week (%†) | 38 (77.6) | 280 (38.9) | |
| ≥1 week (%†) | 11 (22.4) | 439 (61.1) | |
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