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A city park as a potential epidemic site of scrub typhus: a case¿control study of an outbreak in Guangzhou, China.
[scrub typhus]
BackgroundScrub
typhus
is
an
important
public
health
problem
in
China
,
especially
in
Guangzhou
city
.
Typical
outbreaks
of
scrub
typhus
have
been
previously
reported
in
rural
areas
,
affecting
mainly
farmers
.
We
describe
an
atypical
outbreak
of
the
disease
with
case
fatalities
,
from
a
park
in
Haizhu
District
,
Guangzhou
,
that
could
turn
out
to
be
a
potential
scrub
typhus
epidemic
site
.
MethodsFrom
May
2012
to
June
2012
,
a
case
¿
control
study
was
conducted
to
identify
source
and
risk
factors
of
this
outbreak
.
Reported
cases
of
scrub
typhus
in
Xiaogang
Park
were
confirmed
by
Weil
¿
Felix
test
or
a
nested
polymerase
chain
reaction
(
NPCR
)
.
Controls
were
matched
with
their
neighbors
by
gender
and
age
.
Multivariate
conditional
logistic
regression
was
used
to
identify
risk
factors
and
protective
factors
.
ResultsA
total
of
29
cases
were
confirmed
by
Weil
¿
Felix
test
,
including
4
deaths
by
both
Weil
¿
Felix
test
and
NPCR
.
All
patients
presented
with
fever
(
100
%
)
,
while
28
(
96
.
6
%
)
cases
had
eschars
,
10
(
34
.
5
%
)
headache
,
10
(
34
.
5
%
)
chills
,
6
(
20
.
7
%
)
lymphadenopathy
,
5
(
17
.
2
%
)
rash
,
2
(
6
.
9
%
)
vomiting
and
1
(
3
.
5
%
)
presented
with
conjunctival
congestion
.
The
proportion
of
cases
with
activity
history
in
Xiaogang
Park
was
much
higher
than
the
control
group
(
72
.
4
%
vs
24
.
1
%
,
P
¿
<
¿
0
.
001
)
,
and
morning
exercise
in
park
or
field
was
also
as
a
risk
factor
for
scrub
typhus
(
adjusted
OR
=
3
.
0
,
95
%
CI
:
1
.
1
-
8
.
2
)
.
Four
factors
were
significantly
associated
with
the
risk
of
developing
scrub
typhus
:
sitting
on
the
lawn
(
adjusted
OR
=
8
.
0
,
95
%
CI
:
1
.
4
-
44
.
5
)
,
close
contact
with
rats
(
adjusted
OR
=
3
.
3
,
95
%
CI
:
1
.
2
-
9
.
6
)
,
sitting
near
the
rat
holes
(
OR
=
6
.
8
,
95
%
CI
:
1
.
2
-
38
.
1
)
and
wearing
long
-sleeved
clothing
when
outside
(
adjusted
OR
=
0
.
3
,
95
%
CI
:
0
.
1
-
0
.
7
)
.
ConclusionsWe
confirmed
an
atypical
outbreak
of
scrub
typhus
in
a
park
in
Guangzhou
city
,
which
has
the
potential
to
develop
into
an
important
epidemic
site
.
This
public
health
risk
should
not
be
neglected
and
requires
more
attention
from
authorities
.
Diseases
Validation
Diseases presenting
"lymphadenopathy"
symptom
adrenal incidentaloma
allergic bronchopulmonary aspergillosis
carcinoma of the gallbladder
congenital toxoplasmosis
erdheim-chester disease
focal myositis
hodgkin lymphoma, classical
liposarcoma
lymphangioleiomyomatosis
oculocutaneous albinism
omenn syndrome
primary effusion lymphoma
scrub typhus
severe combined immunodeficiency
typhoid
waldenström macroglobulinemia
wiskott-aldrich syndrome
This symptom has already been validated