Table 1 Clinical and laboratory features of patients diagnosed with murine typhus (patient 1 and 2) and scrub typhus (patients 3 and 4) at the Institute of Tropical Medicine/University Hospital, Antwerp between 2013 and 2015
Patient | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
Age (years) | 37 | 34 | 23 | 23 |
Gender | F | F | F | F |
Visited country(ies) | Indonesia | Ethiopia | Vietnam-Cambodia | Thailand -Cambodia |
Dates of travel (duration in days) | 26/07–18/08/2013 (24) | 05–13/02/2015 (8) | 28/09–28/10/2015 (30) | 03/10–10/11/2015 (37) |
Date of fever onset (days post-travel) | 28/08/2013 (10) | 21/02/2015 (8) | 29/10/2015 (1) | 13/11/2015 (3) |
Date of first-line medical evaluation (days after fever onset) | 01/09/2013 (3) | 27/02/2015 (6) | 1/11/2015 (4) | 16/11/2015 (3) |
Antibiotic received before 1st contact ITM | NA | NA | ciprofloxacin | NA |
Date of first contact with ITM (days after fever onset) | 05/09/2013 (8) | 27/02/2015 (6) | 4/11/2015 (5) | 16/11/2015 (3) |
Date of admission at UHA (days after fever onset) | 06/09/2013 (9) | 28/02/2015 (7) | 4/11/2015 (5) | 18/11/2015 (5) |
Duration of hospital stay (days) | 7 | 13 | 6 | 3 |
Symptoms and signs (at admission) | ||||
Headache | yes | yes | yes | no |
Muscle and/or joint pain | yes | yes | yes | yes |
Dyspnoea | yes | no | no | no |
Dry cough | yes | yes | yes | yes |
Abdominal pain | yes | no | yes | no |
Nausea | yes | no | no | no |
Fever | yes | yes | yes | yes |
Rash | yes | yes | yes | no |
Eschar | no | no | yes | no |
Laboratory results (normal value range) | ||||
WBC (3500–9000 /μL) | 8110 | 8800 | 10560 | 3800 |
Platelets (150-450 × 103/mL) | 148 | 113 | 161 | 99 |
CRP (<10Â mg/L) | 147 | 182 | 238 | 10 |
AST (17–59 IU/L) | 276 | 147 | 1237 | 39 |
ALT (21–72 IU/L) | 222 | 184 | 1491 | 42 |
LDH (313–618 IU/L) | 2822 | 640 | 3115 | 247 |
Diagnostic work-up for other pathogens | negative | negative | negative | negative |
Polymerase Chain Reaction (PCR) results | ||||
Pathogen | Rickettsia typhi | Rickettsia typhi | O tsutsugamushi | O tsutsugamushi |
Sample type | serum | serum | whole blood/eschar | whole blood |
Cycle threshold value (Ct) | Ct 38.67 | Ct 35.65 | Ct 31.73/Ct 25,42 | Ct 36.33 |
Date of sampling (days after fever onset) | 6/09/2013 (9) | 5/03/2015 (12) | 4/11/2015 (6) | 18/11/2015 (5) |
Serological results (IgG titer) | ||||
R. typhi acute serum (days after fever onset) | 1/128 (9) | 1/256 (12) | negative | negative |
R.typhi convalescent serum (days after fever onset) | 1/1024 (23) | 1/1024 (26) | negative | negative |
O. tsutsugamushi acute serum | ND | ND | ND | ND |
O. tsutsugamushi convalescent (days after fever onset) | ND | ND | negative (28) | negative (19) |
R. conorii (acute-convalescent) | negative-negative | negative-ND | negative-negative | negative-negative |
C. burneti (acute-convalescent) | negative-negative | ND-ND | negative-negative | ND-ND |
Diagnosis | ||||
Interval hospital admission - PCR diagnosis (days) | 13 | 20 | 9 | 8 |
Interval hospital admission - seroconversion (days) | 21 | 27 | NA | NA |