Kim et al reported factors associated with severe scrub typhus. These can help to identify a patient who may benefit from more aggressive management. The authors are from Chosun University in South Korea.
Patient selection: scrub typhys
Predictors of severe diseases:
(1) serum TNF-alpha concentration in pg/mL
(2) serum CRP concentration
(3) modified APACHE II score (exclusion of arterial blood gas results)
The TNF-alpha concentration in mild disease had a mean of 8.8 pg/mL with an upper limit of 16 pg/mL. The higher the concentration the greater the disease severity.
A serum CRP > 10 mg/dL was associated with severe disease, overlapping with mild disease from 8 to 10.
A modified APACHE II score >= 10 was associated with severe disease, overlapping with mild disease in the 5 to 9 range.
Serum TNF-alpha concentrations often decline once antibiotic therapy is started. A rising concentration after antibiotics are started is cause for concern.
