Epidemiology, Risk Factors and Seasonal Variation of Scrub Typhus Fever in Central Nepal
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Demographic Profile
3.2. Clinical Characteristics
3.3. Experimental Findings
3.4. Antibiotics
3.5. Seasonal Variation and Monthly Data
3.6. Risk Factor Analysis
4. Discussion
- Females
- Rural residential locations
- Houses near grassland
- The presence of mice inside the house and
- Working in the field.
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | ELISA Report | p-Value | Odds Ratio | 95% Confidence Interval | |
---|---|---|---|---|---|
Positive | Negative | ||||
Sex | |||||
Male | 138 (16.7%) | 690 (83.3%) | 1 | ||
Female | 220 (29.1%) | 537 (70.9%) | <0.001 | 0.488 | 0.384–0.621 |
Occupation | |||||
Housewives | 78(28.3%) | 198(71.7%) | <0.001 | 3.008 | 1.889–5.051 |
Daily wages | 17(26.2%) | 48 (73.8%) | 0.004 | 2.777 | 1.390–5.549 |
Students | 171(24.9%) | 517(75.1%) | <0.001 | 2.593 | 1.652–4.070 |
Farmers | 67(20.0%) | 268(80.0%) | 0.008 | 1.960 | 1.195–3.215 |
Other [business, job] | 25 (11.3%) | 196(88.7%) | 1 | ||
Education | |||||
Secondary level | 74(24.3%) | 231(75.7%) | 0.125 | 2.323 | 0.791–6.823 |
Primary level | 99(22.9%) | 334(77.1%) | 0.161 | 2.149 | 0.738–6.260 |
Higher secondary | 85(22.4%) | 295(77.6%) | 0.178 | 2.089 | 0.714–6.108 |
No education | 96(22.1%) | 338(77.9%) | 0.186 | 2.059 | 0.707–6.001 |
Graduate | 4(12.1%) | 29(87.9%) | 1 | ||
Age Group | |||||
1–10 Years | 61(22.7%) | 208(77.3%) | 0.046 | 2.236 | 1.015–4.929 |
11–20 | 80(26.3%) | 224(73.7%) | 0.012 | 2.723 | 1.248–5.940 |
21–30 | 62(21.5%) | 226(78.5%) | 0.067 | 2.092 | 0.951–4.603 |
31–40 | 53 (22.6%) | 181(77.4%) | 0.049 | 2.233 | 1.005–4.959 |
41–50 | 39(22.0%) | 138(78.0%) | 0.066 | 2.155 | 0.951–4.884 |
51–60 | 45 (28.5%) | 113(71.5%) | 0.007 | 3.037 | 1.345–6.853 |
61–70 | 10(11.6%) | 76(88.4%) | 0.995 | 1.003 | 0.373–2.697 |
71 and above | 8 (11.6%) | 61(88.4%) | 1 | ||
Seasonal variation | |||||
Spring | 3 (2.3%) | 130(97.7%) | 1 | ||
Winter | 10(7.5%) | 124(92.5%) | 0.062 | 3.495 | 0.940–12.996 |
Fall/Autumn | 236(24.9%) | 713(75.1%) | <0.001 | 14.343 | 4.523–45.480 |
Summer | 109(29.5%) | 260(70.5%) | <0.001 | 18.167 | 5.660–58.312 |
Residential location | |||||
Rural | 279 (23.8%) | 892 (76.2%) | 0.048 | 1.326 | 1.003–1.754 |
Urban | 79 (19.1%) | 335 (80.9%) | 1 | ||
Type of house | |||||
Cemented floor | 84 (20.0%) | 336 (80.0%) | 1 | ||
No cemented floor | 274 (23.5%) | 891 (76.5%) | 0.140 | 0.813 | 0.618–1.070 |
House near grassland | |||||
Yes | 303 (25.4%) | 891 (74.6%) | <0.001 | 2.078 | 1.518–2.842 |
No | 55 (14.1%) | 336 (85.9%) | 1 | ||
Piling weeds in house | |||||
Yes | 63 (23.8%) | 202 (76.2%) | 0.613 | 1.084 | 0.794–1.479 |
No | 295 (22.3%) | 1025(77.7%) | 1 | ||
Piling weeds on the yard | |||||
Yes | 239(41.8%) | 333(58.2%) | <0.001 | 5.392 | 4.185–6.947 |
No | 119(11.7%) | 894(88.3%) | 1 | ||
Presence of mice | |||||
Yes | 268(42.3%) | 365(57.7%) | <0.001 | 7.032 | 5.377–9.197 |
No | 90(9.5%) | 862(90.5%) | 1 | ||
Working in the field | |||||
Yes | 237(43.8%) | 304(56.2%) | <0.001 | 5.947 | 4.611–7.670 |
No | 121 (11.6%) | 923(88.4%) | 1 |
Clinical Characteristics | Number (%) |
---|---|
Fever | 358 (100) |
Nausea | 181 (50.6) |
Headache | 180 (50.3) |
Shortness of breath | 105 (29.3) |
Abdominal pain | 67 (18.7) |
Tachypnea | 60 (16.8) |
Ventilation support | 52 (14.5) |
Jaundice | 42 (11.7) |
Hypertension | 21 (5.9) |
Seizure | 17 (4.7) |
COPD | 15 (4.2) |
Diabetes | 13 (3.6) |
Hypotension | 13 (3.6) |
Eschar | 11 (3.1) |
Pregnancy | 5 (1.4) |
Laboratory Parameters | Value | Number (%) |
---|---|---|
Hemoglobin | <11.0 gm/dL | 163 (45.3) |
>11.0 gm/dL | 196 (54.7) | |
Total leucocyte count | <4000 cumm | 35 (9.8) |
4000–11,000 cumm | 238 (66.5) | |
>11,000 cumm | 85 (23.7) | |
Platelet count | <150,000/µL | 265 (74.09) |
150,000–450,000/µL | 93 (26.0) | |
Urea | >45 mg/dL | 48 (13.4) |
<45 mg/dL | 310 (86.6) | |
Creatinine | >1.4 mg/dl | 67 (18.7) |
<1.4 mg/dl | 291 (81.3) | |
Bilirubin(total) | >1.2 mg/dL | 87 (24.3) |
Up to 1.2 mg/dL | 271 (75.7) | |
Bilirubin(direct) | >0.4 mg/dL | 115 (32.1) |
Up to 0.4 mg/dL | 243 (67.9) | |
AST | >45 mg/dL | 255 (71.2) |
Up to 45 mg/dL | 103 (28.8) | |
ALT | >40 mg/dL | 277 (77.4) |
Up to 40 mg/dL | 81 (22.6) | |
ALP | >192.0 U/L | 115 (32.1) |
<192.0 U/L | 243 (67.9) | |
Protein | >6.0 mg/dL | 276 (77.1) |
Up to 6.0 mg/dL | 82 (22.9) | |
Albumin | >3.5 mg/dL | 119 (33.2) |
Up to 3.5 mg/dL | 239 (66.8) |
Number (%) | |
---|---|
Doxycycline | 154 (43.0) |
Doxycycline/Ciprofloxacin/Azithromycin | 64 (17.9) |
Doxycycline/Azithromycin | 57 (15.9) |
Ceftriaxone/Azithromycin | 20 (5.6) |
Azithromycin | 18 (5.0) |
Piperacillin/Tazobactum | 16 (4.5) |
Amikacin IV | 13 (3.6) |
Levofloxacin/Ceftazidime | 9 (2.5) |
Ceftriaxone IV | 7 (2.0) |
Variables | ELISA Report | p-Value | Adjusted Odds Ratio | 95% Confidence Interval | |
---|---|---|---|---|---|
Positive | Negative | ||||
Sex | |||||
Male | 138 (16.7%) | 690 (83.3%) | 1 | ||
Female | 220 (29.1%) | 537 (70.9%) | <0.001 | 1.976 | 1.417–2.756 |
Occupation | |||||
Housewives | 83(28.3%) | 210(71.7%) | 0.033 | 2.054 | 1.060–3.982 |
Daily wages | 16(25.8%) | 46(74.2%) | 0.092 | 2.115 | 0.886–5.049 |
Students | 173(24.6%) | 531(75.4%) | 0.014 | 2.231 | 1.174–4.238 |
Farmers | 66(19.2%) | 277(80.8%) | 0.105 | 1.704 | 0.895–3.245 |
Other [business, job] | 20(10.9%) | 163(89.1%) | 1 | ||
Age groups | |||||
1–10 Years | 61(22.7%) | 208(77.3%) | 0.171 | 2.042 | 0.736–5.667 |
11–20 | 80(26.3%) | 224(73.7%) | 0.329 | 1.690 | 0.589–4.848 |
21–30 | 62(21.5%) | 226(78.5%) | 0.381 | 1.557 | 0.578–4.191 |
31–40 | 53 (22.6%) | 181(77.4%) | 0.406 | 1.504 | 0.575–3.934 |
41–50 | 39(22.0%) | 138(78.0%) | 0.387 | 1.537 | 0.580–4.075 |
51–60 | 45 (28.5%) | 113(71.5%) | 0.077 | 2.403 | 0.908–6.357 |
61–70 | 10(11.6%) | 76(88.4%) | 0.665 | 0.773 | 0.240–2.485 |
71 and Above | 8(11.6%) | 61(88.4%) | 1 | ||
Season | |||||
Spring | 3 (2.3%) | 130(97.7%) | 1 | ||
Winter | 10(7.5%) | 124(92.5%) | 0.004 | 7.877 | 1.967–31.538 |
Fall autumn | 236(24.9%) | 713(75.1%) | <0.001 | 25.141 | 7.528–83.970 |
Summer | 109(29.5%) | 260(70.5%) | <0.001 | 17.879 | 5.303–60.276 |
Residential location | |||||
Rural | 279 (23.8%) | 892 (76.2%) | 0.001 | 1.32 | 1.245–1.675 |
Urban | 79 (19.1%) | 335 (80.9%) | 1 | ||
House near grassland | |||||
Yes | 303 (25.4%) | 891 (74.6%) | <0.001 | 3.288 | 1.935–5.587 |
No | 55 (14.1%) | 336 (85.9%) | 1 | ||
Piling weeds in yard | |||||
Yes | 239(41.8%) | 333(58.2%) | 0.409 | 0.517 | 0.108–2.480 |
No | 119(11.7%) | 894(88.3%) | 1 | ||
Presence of mice | |||||
Yes | 268(42.3%) | 365(57.7%) | <0.001 | 5.504 | 4.074–7.435 |
No | 90(9.5%) | 862(90.5%) | 1 | ||
Working in the field | |||||
Yes | 237(43.8%) | 304(56.2%) | 0.004 | 9.764 | 2.059–46.315 |
No | 121 (11.6%) | 923(88.4%) | 1 |
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Gautam, R.; Parajuli, K.; Sherchand, J.B. Epidemiology, Risk Factors and Seasonal Variation of Scrub Typhus Fever in Central Nepal. Trop. Med. Infect. Dis. 2019, 4, 27. https://doi.org/10.3390/tropicalmed4010027
Gautam R, Parajuli K, Sherchand JB. Epidemiology, Risk Factors and Seasonal Variation of Scrub Typhus Fever in Central Nepal. Tropical Medicine and Infectious Disease. 2019; 4(1):27. https://doi.org/10.3390/tropicalmed4010027
Chicago/Turabian StyleGautam, Rajendra, Keshab Parajuli, and Jeevan Bahadur Sherchand. 2019. "Epidemiology, Risk Factors and Seasonal Variation of Scrub Typhus Fever in Central Nepal" Tropical Medicine and Infectious Disease 4, no. 1: 27. https://doi.org/10.3390/tropicalmed4010027