쯔쯔가무시병 환자에서 위장관 출혈의 위험인자

Abstract

ABSTRACT

Risk factors for Gastrointestinal Bleeding in Scrub Typhus

Byeon Yu-Mi Advisor : Prof. Park Chan-Kuk M.D. Ph.D Department of Medicine, Graduate School of Chosun University

(Background) Scrub typhus is an acute febrile illness caused by Orientia Tsutsugamushi-induced vasculitis. Although scrub typhus has been treated successfully with effective antibiotics, life-threatening serious complications including gastrointestinal bleeding were still remained. The authors here intended to describe clinical characteristics of gastrointestinal bleeding in scrub typhus, and then to evaluate the clinical significance of upper gastrointestinal endoscopic feature and clinical severity as risk factors for gastrointestinal bleeding.

(Method) Analyzed retrospectively 249 patients diagnosed Scrub typhus (by indirect immunofluorescent test or polymerase chain reaction) and were taken esophagogastroduodenoscopy at Chosun University Hospital from October 2004 to December 2008. Correlation among clinical symptoms, laboratory findings, hospital stay and gastrointestinal bleeding were analyzed.

(Result) Out of the 249 patients of scrub typhus, 16 patients had clinically important bleeding. The older patients (p<0.0001) and the patients with higher white blood cell counts (p=0.001), lower serum hemoglobin (p=0.007), lower serum albumin (p<0.001), lower serum fibrinogen (p<0.0001), higher APACHE II (Acute Physiology And Chronic Health Evaluation) score (p<0.001) were associated with an increased bleeding risk. The patients with longer hospital stay (p=0.030) and complicated pneumonia (p<0.001), meningitis (p=0.020) had significantly severe esophagogastroduodenoscopic findings.

(Conclusion) A few scrub typhus patients have clinically important gastrointestinal bleeding. There were significant correlation between some clinical characteristics, laboratory findings and gastrointestinal bleeding in this study. Therefore these findings may be useful to predict gastrointestinal bleeding in scrub typhus.

Key word : Scrub typhus, Gastrointestinal bleeding