쯔쯔가무시병 환자에서 응고 cascade의 활성화

Abstract

(Background) Scrub typhus is an acute febrile illness caused by Orientia Tsutsugamushi. Although scrub typhus runs a mild clinical course and shows a good response to antibiotic therapy, serious complications such as interstitial pneumonia, acute renal failure, meningoencephalitis, gastrointestinal bleeding, and multiple organ failure may develop. Disseminated intravascular coagulation (DIC) is common among patients with sepsis. Though sepsis is not common in scrub typhus, scrub typhus runs to sepsis when diagnosis is delayed. The author here intended to describe clinical characteristics of abnormal bleeding in scrub typhus, and to evaluate coagulation factors and the presence of DIC in patients with scrub typhus.

(Method) We measured plasma concentrations of fibronogen, D-dimer, Fibrin degradation products (FDP) and evaluated the DIC score in 410 patients diagnosed Scrub typhus (by indirect immunofluorescent test or polymerase chain reaction) and in 39 healthy control subjects.

(Result) The median concentrations of FDP(p=0.001), D-dimer (p<0.001) were significantly elevated and DIC score in 410 patients with scrub typhus, compared with healthy control subjects. Patients with scrub typhus had significantly longer prothrombin times, longer activated partial thromboplastin times, and lower platelet counts. Out of the 410 patients of scrub typhus, 28 patients had abnormal bleeding. The median concentrations of FDP were significantly elevated(p=0.02) and the median concentrations of fibronogen were decreased(p=0.021) in abnormal bleeding patients with scrub typhus, compaired with non-bleeding patients. Abnormal bleeding patients more significantly had overt DIC as defined by an International Society on Thrombosis and Hemostasis DIC score (p=0.003). Thrombocytopenia was present in 23.7% of case patients and occurred more frequently among patients with abnormal bleeding(p=0.013).

(Conclusion) A few scrub typhus patients have clinically important bleeding complication. Activation of the coagulation system is an important feature in abnormal bleeding patients with scrub typhus. Thrombocytopenia and fibronogen, FDP are indicator of severe disease and risk of bleeding.