Key result
Rifampin use linked to ~58-fold higher thromboembolism risk in scrub typhus.
Why the study?
Thromboembolic events are a known cause of in-hospital death in infectious diseases, but they have rarely been reported in patients with scrub typhus.
Are rifampin use, Taguchi genotype, atrial fibrillation, and advanced age associated with an increased risk of thromboembolic events in patients with scrub typhus?
Case-Control (n=93)
No
Are rifampin use, Taguchi genotype, atrial fibrillation, and advanced age associated with an increased risk of thromboembolic events in patients with scrub typhus?
Thromboembolic events in scrub typhus are significantly associated with advanced age, atrial fibrillation, the Taguchi genotype, and rifampin treatment, highlighting the need for vigilance and preventive management in these high-risk patients.
Answers are grounded in this paper and cite their sources.
May warrant thromboembolism vigilance with rifampin in scrub typhus; leaves open whether associations are causal or require prospective confirmation.
BACKGROUND: Thromboembolic events are a well-recognized cause of in-hospital deaths of patients with infectious diseases. However, thromboembolic events in patients with scrub typhus, caused by Orientia tsutsugamushi have rarely been reported. This study aimed to assess risk factors associated with thromboembolic events in patients with scrub typhus. METHODS: All 93 scrub typhus patients' diagnoses were confirmed serologically or by positive nested polymerase chain reaction (PCR). The clinical and laboratory findings from 12 scrub typhus patients with thromboembolic events and 81 scrub typhus patients with nonthromboembolic events were retrospectively studied. To determine the factors implicated in thromboembolic events, we performed multivariate logistic regression analysis using the six independent factors identified by the univariate analysis. FINDINGS: The mean age of the patients in the thromboembolic group was 76.4 years (median, 76 years), and in nonthromboembolic group it was 64.6 years (median, 65 years) (P<0·001). Thromboembolic events were observed in 12 patients. These events included acute coronary syndrome (n = 5), acute limb ischemia (n = 4), ischemic stroke (n = 1), deep vein thrombosis combined with pulmonary thromboembolism (n = 1), and left common iliac artery aneurysm with a thrombus (n = 1). According to multivariate analysis, the following four factors were significantly associated with the thromboembolic events: 1) treatment with rifampin (OR = 57.63; P = 0.039; CI 1.230-2700.27)., 2) Taguchi genotype (OR = 41.5; P = 0.028; CI 1.5-1154.6), 3) atrial fibrillation (OR = 9.4; P = 0.034; CI 1.2-74.0), and 4) age (OR = 1.1; P = 0.046; CI 1.0-1.3). CONCLUSIONS: Our study suggests that clinicians should be cautious when managing patients with scrub typhus to avoid the development of thromboembolic events, especially in patients with risk factors such as treatment with rifampin, Taguchi genotype, atrial fibrillation, and advanced age.
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Ki et al. (2024) conducted a case-control in Scrub typhus (n=93). Treatment with rifampin vs. No treatment with rifampin was evaluated on Thromboembolic events (OR 57.63, 95% CI 1.230-2700.27, p=0.039). In patients with scrub typhus, treatment with rifampin was significantly associated with an increased risk of thromboembolic events (OR 57.63, p=0.039), alongside Taguchi genotype, atrial fibrillation, and advanced age.
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