Scrub typhus in patients with liver cirrhosis: a preliminary study

Scrub typhus is a potentially fatal infectious disease caused by the organism Orientia tsutsugamushi. However, to date, there have been no clearly identified determinants or reports published on the clinical severity of scrub typhus in liver cirrhosis (LC) patients. This study was carried out by retrospectively reviewing medical records accumulated over 7 years at a tertiary hospital. Sixteen patients of 160 had underlying LC, and they were defined as ‘cases'; those without underlying LC were defined as ‘controls'. The duration of hospital stay (23.0 ± 24.8 days for cases and 6.8 ± 7.0 days for controls, p 0.020) and APACHE II scores (14.1 ± 6.0 for cases and 7.2 ± 4.6 for controls, p <0.001) were, respectively, significantly longer and significantly higher on admission in the cases than in the controls. Surprisingly, hospital mortality was significantly higher in the cases than in the controls (31.3% and 3.5%, respectively, p 0.001). Among the LC group, the highest Model for End-stage Liver Disease (MELD) score during hospitalization (MELD-Peak) (p 0.024) and the lowest blood sodium concentration during hospitalization (MELD-Na-Lo) (p 0.003) were higher in fatal cases than in the survivors (MELD-Na-to). Physicians should be aware of an adverse relationship between LC and scrub typhus, and patients with LC should be advised to avoid exposure to O. tsutsugamushi, particularly in endemic areas and epidemic seasons.