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 (<10 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 |
ITM Institute of Tropical Medicine, UHA University Hospital Antwerp, NA not applicable, ND not done