Table 3.

Summary of clinical characteristics of cases 1–3

Case	Key presenting features	Factors necessitating ICU transfer	Complications	Hospital day when doxycycline was started	Days in ICU	Clinical and laboratory indicators of increased severity*
1	Vomiting/diarrhea	Hypotension	Acute kidney injury	1	7	Bleeding coagulopathy (suspected)
	Fever	Melena	Coagulopathy			CNS abnormalities
	Rash		Encephalopathy			Hepatic dysfunction
	Hyponatremia		Hypotension			Hypoalbuminemia
	Acute kidney injury		Pancreatitis			Hyponatremia
	Elevated LFTs		Upper gastrointestinal bleed (suspected)			Leukocytosis
	Thrombocytopenia					Renal dysfunction
	Coagulopathy					Thrombocytopenia
2	Headache	Hypotension	Acute kidney injury	1	6	Hepatic dysfunction
	Cough	Hypoxic respiratory failure	Hypoxic respiratory failure			Hyponatremia
	Hyponatremia		Septic shock			Leukocytosis
	Acute kidney injury		Right heart failure			Pulmonary compromise
	Hypoalbuminemia					Renal dysfunction
	Elevated LFTs					Thrombocytopenia
	Bandemia
	Thrombocytopenia
	Lung infiltrate
3	Abdominal	Hypotension	Hypotension	4	6	Delayed diagnosis
	Pain	Hypoxic respiratory failure	Hypoxic respiratory failure			Hepatic dysfunction
	Headache		Pneumonia			Hypoalbuminemia
	Fever					Leukocytosis
	Dyspnea					Pulmonary compromise
	Chills					Thrombocytopenia
	Fatigue
	Tachycardia
	Rash
	Hypoalbuminemia
	Elevated LFTs
	Bandemia

ICU = intensive care unit; LFTs = liver function tests (AST/ALT/alkaline phosphatase). All three patients had minimally abnormal potassium and calcium level when corrected for albumin.

* Based on reference ⁸—disease severity related to older patient age, hyponatremia, hypokalemia, hypocalcemia, renal dysfunction, hypoalbuminemia, leukocytosis, delayed diagnosis, thrombocytopenia, bleeding coagulopathy, cardiac arrhythmias, hepatic dysfunction, pulmonary compromise, CNS abnormalities, previous therapy with sulfa-containing antimicrobial agents, and hemolysis usually associated with glucose-6-phosphate dehydrogenase deficiency.