Rickettsia typhi infection in severe fever with thrombocytopenia patients, China

Figures & data

Table1. Demographic and clinical characteristics of the patients with R. typhi infection vs. SFTSV infection, 2014–2015, China.

Characteristics	R. typhi infection (n = 60)	SFTS single infection (n = 767)	P-value
Demographic characteristics
Age, Mean ± SD, years	58.4±11.3	62.0±12.3	0.028*
Sex, female	34 (56.7)	450 (58.7)	0.762
Reported history of insect bite	9 (15.0)	91 (11.8)	0.473
Hospital duration, median (IQR)	10 (8–12)	7 (5–9)	<0.001*
Delay days from onset to admission, median (IQR)	5 (4–7)	5 (4–7)	0.039*
Clinical manifestations
Common signs
Fever	59 (98.3)	764 (99.6)	0.261
Fever duration, days, median (IQR)	5 (4–7)	5 (4–7)	0.039*
Maximum temperature, Mean±SD, °C	38.6±0.6	38.7±1.0	0.731
Chills	4 (6.7)	66 (8.6)	0.810
Malaise	56 (93.3)	741 (96.6)	0.267
Lymphadenectasis	32 (53.3)	338 (44.1)	0.165
Myalgia	42 (70.0)	625 (81.5)	0.030*
Dizziness	10 (16.7)	131 (17.1)	0.935
Headache	5 (8.3)	61 (8.0)	0.917
Rash	1 (1.7)	4 (0.5)	0.314
Arthralgia	1 (1.7)	10 (1.3)	0.566
Respiratory syndrome	30 (50.0)	378 (49.3)	0.915
Cough	30 (50.0)	373 (48.6)	0.838
Productive cough	24 (40.0)	279 (36.4)	0.575
Gastrointestinal illness	54 (90.0)	659 (85.9)	0.377
Anorexia	27 (45.0)	360 (46.9)	0.772
Nausea	41 (68.3)	496 (64.7)	0.567
Vomit	18 (30.0)	212 (27.6)	0.694
Abdominal pain	3 (5.0)	33 (4.3)	0.740
Abdominal distension	3 (5.0)	26 (3.4)	0.461
Diarrhoea	4 (6.7)	174 (22.7)	0.003*
Hemorrhage manifestations	14 (23.3)	182 (23.7)	0.945
Gingival bleeding	6 (10.0)	61 (8.0)	0.576
Melena	5 (8.3)	47 (6.1)	0.498
Hemoptysis	3 (5.0)	29 (3.8)	0.500
Epistaxis	1 (1.7)	6 (0.8)	0.411
Hematuria	4 (6.7)	71 (9.3)	0.644
Neurological symptom	11 (18.3)	285 (37.2)	0.003*
Apathy	5 (8.3)	159 (20.7)	0.020*
Dysphoria	3 (5.0)	94 (12.3)	0.099
Convulsion	5 (8.3)	119 (15.5)	0.133
Lethargy	2 (3.3)	72 (9.4)	0.156
Confusion	4 (6.7)	147 (19.2)	0.014*
Coma	1 (1.7)	56 (7.3)	0.114
Plasma leakage	9 (15.0)	132 (17.2)	0.661
Hydrothorax	8 (13.3)	123 (16.0)	0.581
Hydropericardium	2 (3.3)	16 (2.1)	0.380
Ascites	2 (3.3)	15 (2.0)	0.353
Pelvis fluidify	0 (0.0)	1 (0.1)	1.000
Respiratory complications	37 (61.7)	429 (55.9)	0.388
Pulmonary infection	36 (60.0)	368 (48.0)	0.073
Bronchitis	6 (10.0)	176 (23.0)	0.020*
Respiratory failure	0	23 (3.0)	0.402
Renal failure	2 (3.3)	20 (2.6)	0.670

Notes: Continuous variables were analysed by t-test or nonparametric test; categorical variables were analysed by chi-square test or Fisher’s exact test.

*All P values were 2-tailed and P < .05 was considered statistically significant.

Table

Gene	Primer	Sequence (5′-3′)	Reference
ompA	Rr190.70p	ATGGCGAATATTTCTCCAAAA	[19]
	Rr190.602n	AGTGCAGCATTCGCTCCCCCT
	190.70-38s1	AAAACCGCTTTATTCACC	[20]
	190.602-384r1	GGCAACAAGTTACCTCCT
gltA	CS1d	ATGACTAATGGCAATAATAA	[21]
	CSEndr	CTTATACTCTCTATGTACA
	RpCS877p	GGGGACCTGCTCACGGCGG
	RpCS1258n	ATTGCAAAAAGTACAGTGAACA
17-kDa	17k-5	GCTTTACAAAATTCTAAAAACCATATA	[22]
	17k-3	TGTCTATCAATTCACAACTTGCC
	17kD1	GCTCTTGCAACTTCTATGTT
	17kD2	CATTGTTCGTCAGGTTGGCG
Eh16S rRNA	Eh-out1	TTGAGAGTTTGATCCTGGCTCAGAACG	[23]
	Eh-out2	CACCTCTACACTAGGAATTCCGCTATC
	Eh-gs1	GTAATAACTGTATAATCCCTG
	Eh-gs2	GTACCGTCATTATCTTCCCTA
SSU rRNA	Bab1	CTTAGTATAAGCTTTTATACAGC	[24]
	Bab4	ATAGGTCAGAAACTTGAATGATACA
	Bab2	GTTATAGTTTATTTGATGTTCGTTT
	Bab3	AAGCCATGCGATTCGCTAAT
Bor16SrRNA	BorITS4F	GGCTTCGGGTCTACCACATCTA	[25]
	BorITS4R	CCGGGAGGGGAGTGAAATAG
	BorITS4PFAM	FAMTGCAAAAGGCACGCCATCACCBHQ1

Table

Laboratory parameters	R. typhi patients (n = 60)	SFTSV patients (n = 767)	P-value
WBC count < 4 × 109/L	49 (81.7)	632 (82.4)	0.886
PLT count < 100 × 109/L	41 (68.3)	648 (84.5)	0.001*
Neutrophils > 70%	30 (50.0)	350 (45.6)	0.513
Lymphocytes < 20%	24 (40.0)	278 (36.3)	0.561
HGB < 110 g/L	9 (15.0)	114 (14.9)	0.977
AST > 40 U/L	44 (73.3)	645 (84.1)	0.031*
ALT > 40 U/L	29 (48.3)	438 (57.1)	0.187
ALB < 35 g/L	5 (8.3)	95 (12.4)	0.354
ALP > 150 U/L	2 (3.3)	49 (6.4)	0.574
GGT > 50 U/L	13 (21.7)	174 (22.7)	0.856
LDH > 245 U/L	48 (80.0)	654 (85.3)	0.273
CK > 200 U/L	32 (53.3)	482 (62.8)	0.144
BUN > 7.14 mmol/L	19 (31.7)	247 (32.3)	0.921
CREA > 97 μmol/L	6 (10.0)	147 (19.2)	0.077
AMY > 115 U/L	11 (26.8)	190 (39.9)	0.099
Ca < 2.1 mmol/L	24 (48.0)	399 (59.4)	0.115
Cl < 95 mmol/L	9 (15.5)	89 (12.0)	0.426
K < 3.5 mmol/L	32 (53.3)	331 (43.2)	0.128
Na < 135 mmol/L	44 (73.3)	530 (69.2)	0.502

Notes: All P values were 2-tailed and P < .05 was considered statistically significant. Categorical variables were analysed by chi-square test or Fisher’s exact test. WBC: White blood cell; PLT: Platelet count; HGB: Haemoglobin; AST: Aspartate aminotransferase; ALT: Alanine transaminase; ALB: Albumin; ALP: Alkaline phosphatase; GGT: γ-glutamyl transpeptadase; LDH: Lactate dehydrogenase; CK: Creatine kinase; BUN: Blood urea nitrogen; CREA: Creatinine; AMY: Serum amylase; Ca: Calcium; Cl: Chlorine; K: Potassium; Na: Natrium.

Table

Characteristics
Demographic characteristics
Age, years	64
Sex	Male
Reported history of insect bite	−
Hospital duration	8
Delay days from onset to admission	4
Underlying diseases	Hypertension
Clinical manifestations
Common signs
Fever	+
Maximum temperature	40
Chills	−
Malaise	+
Lymphadenectasis	+
Myalgia	+
Dizziness	−
Headache	−
Rash	−
Arthralgia	−
Respiratory syndrome
Cough	+
Productive cough	−
Gastrointestinal illness
Anorexia	+
Nausea	+
Vomit	+
Abdominal pain	−
Abdominal distension	−
Diarrhoea	−
Haemorrhage manifestations
Gingival bleeding	−
Melena	+
Hemoptysis	−
Epistaxis	−
Hematuria	−
Ecchymosis	+
Neurological symptom
Apathy	+
Dysphoria	+
Convulsion	+
Lethargy	+
Confusion	+
Coma	+
Plasma leakage
Hydrothorax	−
Hydropericardium	−
Ascites	−
Pelvis fluidify	−
Respiratory complications
Pulmonary infection	+
Bronchitis	+
Respiratory failure	+

Table

Laboratory parameters	Normal range	Patient
WBC count (×10^9/L)	4.0–10.0	5.0
PLT count (×10^9/L)	100–300	57
Neutrophils (%)	50.0–70.0	83.6
Lymphocytes (%)	20.0–40.0	14.0
HGB (g/L)	110–170	136
AST (U/L)	0–40	51
ALT (U/L)	0–40	29
ALB (g/L)	35.0–55.0	39.3
ALP (U/L)	40–150	85
GGT (U/L)	7–50	15
LDH (U/L)	109–245	313
CK (U/L)	25–200	92
BUN (mmol/L)	1.4–7.1	8.94
CREA (μmol/L)	40–97	98
AMY (U/L)	25–115	129
Ca (mmol/L)	2.1–2.7	2.12
Cl (mmol/L)	95–108	101
K (mmol/L)	3.5–5.5	3.6
Na (mmol/L)	135–155	131

Notes: WBC: White blood cell; PLT: Platelet count; HGB: Haemoglobin; AST: Aspartate aminotransferase; ALT: Alanine transaminase; ALB: Albumin; ALP: Alkaline phosphatase; GGT: γ-glutamyl transpeptadase; LDH: Lactate dehydrogenase; CK: Creatine kinase; BUN: Blood urea nitrogen; CREA: Creatinine; AMY: Serum amylase; Ca: Calcium; Cl: Chlorine; K: Potassium; Na: Natrium.

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