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. 2018 Mar;33(2):323-330.
doi: 10.3904/kjim.2016.303. Epub 2017 Feb 23.

Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea

Jung Yeon Chin  1 , Ki-Woon Kang  1 , Kyung Min Moon  2 , Jongwoo Kim  1 , Yu Jeong Choi  1
Affiliations

Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea

Jung Yeon Chin et al. Korean J Intern Med. 2018 Mar.

Abstract

Background/aims: Scrub typhus is known as a self-limited infectious disease. Cardiac complication is uncommon and usually not life-threatening. Until now, few cases of fulminant myocarditis by scrub typhus have been reported. So, we investigated incidence and predictors of acute myocarditis in severe scrub typhus.

Methods: We retrospectively reviewed 89 patients among 91 scrub typhus confirmed patients who examined an echocardiogram and cardiac biomarkers from 2005 to 2015 in the intensive care unit at our hospital. We excluded two patients who didn't have electrocardiography. Patients were divided into two groups and compared between scrub typhus with (n = 13) and without (n = 76) acute myocarditis.

Results: Age, sex, and underlying diseases were similar between the groups. The existence of eschar and duration of general ache and fever were similar between the groups. However, patients with acute myocarditis had more elevated total bilirubin, high incidence of ST elevations and paroxysmal atrial fibrillation (PAF) than those without acute myocarditis. Receiver operating characteristic analysis showed that the PAF was a predictor of myocarditis with a sensitivity of 70% and specificity of 84%. Predictive power of combination of ST-segment elevation and PAF was significantly associated with myocarditis in the multivariate analysis (odds ratio, 1.57; 95% confidence interval [CI], 1.21 to 11.7; p = 0.041) and area under the curve was 0.947 (95% CI, 0.878 to 0.983; p < 0.001).

Conclusions: Acute myocarditis with scrub typhus may be more common than previously reported. Patients with high bilirubin and PAF are at increased risk of acute myocarditis with scrub typhus. These patients warrant closer follow-up and echocardiogram would be needed.

Keywords: Atrial fibrillation; Myocarditis; Scrub typhus.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Receiver operating characteristic curves for paroxysmal atrial fibrillation in patients with scrub typhus myocarditis.
See this image and copyright information in PMC

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