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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
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated