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 Home > Available Issues |
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 Original Articles |
| Accuracy of Clinical Diagnosis of Scrub Typhus at Primary-Care Clinics in an Endemic Area |
| Dang Su Yi1), Yunsop Chong8), Sung Kun Yoo1), Ki Whan Chun2), Chin Ki Pae3), Kwan Shik Hong4), Dong Min Yook5), Sang Ho Yang6), Chung Shik Lim7) |
| Clinics of Hyundai1), Cheil2) and Minjung3), Medical Clinics of Hong4), Yook5), Yang6) and Lim Chung Shik7), Chinhae, Korea, and Department of Clinical Pathology, Yonsei University College of Medicine, Seoul, Korea8) |
Vol.28 Num.2 (p179~184)
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Background : Scrub typhus is endemic in many parts of Korea including Chinhae. Accurate and rapid diagnosis for effective treatment is usually based on clinical diagnosis without laboratory aids in endemic area. The aim of the study was to assess the accuracy of clinical diagnosis at primary-care clinics in an endmic area.
Methods : During the period of October through November, 1994, 18 patients were clinically diagnosed as scrub typhus at primary-care clinics in Chinhae city. Clinical diagnosis was based on the presence of fever, rash, lymphadenitis and eschar (primary lesion). The accuracy of clinical diagnosis was assessed by the serological test and efficacy of treatment with tetracycline.
Results : Among the 18 patients, rashes were noted in all patients, whereas lymphadenitis in 13 patients, eschars in 15 patients, and a pustule in one patient. Serologic studies showed high or rising IFA titer to Rickettsia tsutsugamushi in 15 patients. Clinical diagnosis of 3 patients without serologic evidences were considered accurate based on the clinical response to antimicrobial therapy. Two patients showed negative serology because of taking blood samples on the 3rd or 4th day of illness, respectively, and serologic test was not done in one patient. IFA test with polyvalent conjugate did not give faster positive results.
Conclusion : Accurate and rapid clinical diagnosis of scrub typhus at primary-care clinics in endemic area is possible mainly based on clinical features, which makes early treatment with appropriate antimicrobial agents possible.
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Keywords : Rickettsia tsutsugamushi, Scrub typhus, Eschar |
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