Murine Typhus in Southern Taiwan during 1992–2009

Ko Chang Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Yen-Hsu Chen Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Nan-Yao Lee Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Hsin-Chun Lee Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Chun-Yu Lin Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Jih-Jin Tsai Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Po-Liang Lu Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Tun-Chieh Chen Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Hsiao-Chen Hsieh Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Wei-Ru Lin Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Ping-Chang Lai Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Chia-Ming Chang Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Chi-Jung Wu Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Chung-Hsu Lai Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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Wen-Chien Ko Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; Departments of Internal Medicine and Graduate Institute of Clinical Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Department of Internal Medicine, Tian-Sheng Memorial Hospital, Pingtung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

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DOI:
https://doi.org/10.4269/ajtmh.2012.11-0465
Volume/Issue:
Volume 87: Issue 1
Page(s):
141–147
Restricted access
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Clinical information regarding murine typhus in Taiwan is limited. In this study, 81 cases of serologically documented murine typhus during 1992–2009 at four referral hospitals in southern Taiwan were analyzed. There was a significant correlation between average environmental temperature and case numbers of murine typhus (r = 0.747, P = 0.005). Acute hepatitis was found in 67% of cases, and hyperbilirubinemia (serum total bilirubin ≥ 23.9 μmol/L) was found in 38%. The intervals between the initiation of appropriate therapy to defervescence were longer in patients with hyperbilirubinemia than those without hyperbilirubinemia (6.1 versus 4.1 days; P = 0.015). Nine (11.1%) showed development of severe illnesses such as acute respiratory distress syndrome (2 patients), aseptic meningitis (3), and acute renal failure (4). Only one died of acute respiratory distress syndrome. Cases of murine typhus were often found during the summer and had acute febrile hepatitis. Those patients with hyperbilirubinemia tended to have a delayed recovery even with appropriate therapy.

Author Notes

* Address correspondence to Wen-Chien Ko, Department of Internal Medicine, National Cheng Kung University Hospital and Medical College; #138, Sheng Li Road, Tainan 704, Taiwan. E-mail: winston@mail.ncku.edu.tw
† These authors contributed equally.

Financial support: This study was supported by grants from a foundation of the Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung Medical University (KMKH-96-013), and the Department of Health, Executive Yuan, Taiwan (DOH101-TD-B–111-002).

Disclosure: None of the authors have any conflicts of interest.

Authors' addresses: Ko Chang, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Hsiao Kang District, Kaohsiung 812, Taiwan, E-mail: johnsonckk@yahoo.com.tw. Yen-Hsu Chen, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, E-mail: d810070@cc.kmu.edu.tw. Nan-Yao Lee, Hsin-Chun Lee, Chia-Ming Chang, Chi-Jung Wu, and Wen-Chien Ko, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, E-mails: nanyao@mail.ncku.edu.tw, lhc0918@mail.ncku.edu.tw, cmchang@mail.ncku.edu.tw, wucj@nhri.org.tw, and winston@mail.ncku.edu.tw. Chun-Yu Lin, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, E-mail: infectionman@gmail.com. Jih-Jin Tsai, Division of Infectious Diseases, Department of Internal Medicine, and College of Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; and Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, E-mail: jijits@cc.kmu.edu.tw. Po-Liang Lu, Tun-Chieh Chen, and Wei-Ru Lin, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, E-mails: idpaul@gmail.com, idchen.tunchieh@gmail.com, and lwru@mail2000.com.tw. Hsiao-Chen Hsieh, Department of Internal Medicine, Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan; and Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Hsiao Kang District, Kaohsiung 812, Taiwan, E-mail: cheetah.hsieh@msa.hinet.net. Ping-Chang Lai, Section of Infectious Diseases, Department of Internal Medicine, Tian-Sheng Memorial Hospital, No. 210, Section 1, Donggang Township, Pingtung County 928, Taiwan, E-mail: pclai.tw@msa.hinet.net. Chung-Hsu Lai, Section of Infectious Disease, Department of Internal Medicine, E-Da Hospital/I-Shou University, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung 824, Taiwan, E-mail: laich6363@yahoo.com.tw.

Copyright:
©The American Society of Tropical Medicine and Hygiene 2012
Received:
18 Jul 2011
|
Accepted:
12 Apr 2012
|
Published Online:
02 Jul 2012
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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