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Endoscopic Abnormalities not Correlated with Presence, Absence of Scrub Typhus-Related GI Symptoms

Issue: Premier Issue 2014

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WASHINGTON, D.C. — The presence or absence of scrub typhus-associated gastrointestinal symptoms was not indicative of endoscopic findings, but symptom severity was correlated with the presence of endoscopic abnormalities, according to data presented at ICAAC 2014.

“Gastrointestinal symptoms occur in up to 76.4% of scrub typhus patients,” the researchers wrote, citing erosion and ulcers as major endoscopic findings. “Our study documents that the presence or absence of gastrointestinal symptoms is not reflected in endoscopic findings, even though the severity of symptoms and the presence of endoscopic abnormalities are correlated.”

The researchers prospectively studied 127 Korean scrub typhus patients from 2006 to 2008 to investigate involvement of the GI tract, identify the relationship between clinical severity and severity of disease-associated endoscopic findings, and to determine the utility of screening for endoscopy. They recommended esophagogastroduodenoscopy (EGD) to all possible patients regardless of GI symptoms and categorized endoscopic findings as: normal (I), mucosal hyperemia (II), mucosal erosion (III) or ulcer and/or active bleeding (IV). They also evaluated organ involvement and ICU admissions to categorize clinical severity as mild, moderate or severe.

Dyspepsia (49.6%), nausea (44.1%), abdominal pain (23.6%), vomiting (14.2%), diarrhea (11%), melena or hematemesis (7.1%) were the most common scrub typhus-associated GI symptoms. Endoscopic findings included erythema, erosion and ulcers, and 20.4% of patients were categorized as having grade I endoscopic findings; 16.2%, grade II; 29%, grade III; and 34.4%, grade IV. Sixty-three percent of patients had erosions or ulcers; most were found in the antrum.

In terms of clinical severity, 65 patients were categorized as mild, 50 moderate, and 12 severe. GI symptoms and grade of endoscopic findings were not correlated (P=.995), but clinical severity and endoscopic findings were (P=.001).

“Scrub typhus patients may have significant endoscopy abnormalities even in the absence of gastrointestinal symptoms,” the researchers concluded. “Our study confirmed that the presence or absence of gastrointestinal symptoms did not reflect the need for endoscopy.”

The researchers said their study was the first to present an association between esophageal candidiasis and scrub typhus.

For more information:

Kim D. Abstract P-1127. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 5-9, 2014; Washington, D.C.

Disclosure: The researchers report no relevant financial disclosures.