{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T22:57:30Z","timestamp":1773788250118,"version":"3.50.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2019,3,27]],"date-time":"2019-03-27T00:00:00Z","timestamp":1553644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Infection plays a major role in the development of autoimmune diseases. In this study, we investigated the relationship between scrub typhus and systemic autoimmune diseases. We enrolled 6,928 hospitalized patients with scrub typhus between 2000 and 2012 from the Taiwan National Health Insurance Research Database, and we compared them with 27,712 selected inpatients who had never been diagnosed with scrub typhus (1:4 ratio, matched by age, sex, and index year) in relation to the risk of developing autoimmune diseases. Cox proportional hazards regression analysis was used to analyze the risk of autoimmune diseases by sex, age, and comorbidities, with hazard ratios and 95% confidence intervals. The adjusted hazard ratio for autoimmune diseases for the scrub typhus group was 2.4 (95% confidence interval: 1.66, 3.48, P &lt; 0.0001) compared with the control group. Subgroup analysis showed that women aged &lt;40 years had a significant higher risk of autoimmune diseases. The risk was significantly higher within 3 years after scrub typhus infection. In conclusion, a higher risk of autoimmune diseases was found among the scrub typhus group, especially for female patients, those aged &lt;40 years, and within the first 3 years after getting scrub typhus.<\/jats:p>","DOI":"10.1093\/aje\/kwz074","type":"journal-article","created":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T08:10:37Z","timestamp":1553501437000},"page":"1311-1318","source":"Crossref","is-referenced-by-count":10,"title":["Association of Scrub Typhus With the Risk of Autoimmune Diseases: A Population-Based Cohort Study"],"prefix":"10.1093","volume":"188","author":[{"given":"Kuo-An","family":"Chu","sequence":"first","affiliation":[{"name":"Authors affiliations: Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan"},{"name":"Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan"},{"name":"School of Medicine, National Yang Ming University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weishan","family":"Chen","sequence":"additional","affiliation":[{"name":"Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan"},{"name":"College of Medicine, China Medical University, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chung Y","family":"Hsu","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao-Min","family":"Hung","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang Ming University, Taipei, Taiwan"},{"name":"Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan"},{"name":"Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James Cheng-Chung","family":"Wei","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan"},{"name":"Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,3,27]]},"reference":[{"issue":"9","key":"2019070110025530800_kwz074C1","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.2105\/AJPH.90.9.1463","article-title":"Autoimmune diseases: a leading cause of death among young and middle-aged women in the United States","volume":"90","author":"Walsh","year":"2000","journal-title":"Am J Public Health"},{"issue":"3","key":"2019070110025530800_kwz074C2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/S1568-9972(03)00006-5","article-title":"The epidemiology of autoimmune diseases","volume":"2","author":"Cooper","year":"2003","journal-title":"Autoimmun Rev"},{"key":"2019070110025530800_kwz074C3","doi-asserted-by":"crossref","first-page":"728574","DOI":"10.1155\/2013\/728574","article-title":"Systemic autoimmune diseases","volume":"2013","author":"Shi","year":"2013","journal-title":"Clin Dev Immunol"},{"issue":"5","key":"2019070110025530800_kwz074C4","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1056\/NEJM200108023450506","article-title":"Autoimmune diseases","volume":"345","author":"Davidson","year":"2001","journal-title":"N Engl J Med"},{"issue":"12","key":"2019070110025530800_kwz074C5","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1056\/NEJMra020100","article-title":"The effect of infections on susceptibility to autoimmune and allergic diseases","volume":"347","author":"Bach","year":"2002","journal-title":"N Engl J Med"},{"issue":"6","key":"2019070110025530800_kwz074C6","doi-asserted-by":"crossref","first-page":"2228","DOI":"10.1172\/JCI78088","article-title":"Mechanisms of human autoimmunity","volume":"125","author":"Rosenblum","year":"2015","journal-title":"J Clin Invest"},{"issue":"1","key":"2019070110025530800_kwz074C7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2249.2008.03834.x","article-title":"The role of infections in autoimmune diseases","volume":"155","author":"Ercolini","year":"2009","journal-title":"Clin Exp Immunol"},{"key":"2019070110025530800_kwz074C8","doi-asserted-by":"crossref","first-page":"967852","DOI":"10.1155\/2012\/967852","article-title":"New insight into immunity and immunopathology of rickettsial diseases","volume":"2012","author":"Mansueto","year":"2012","journal-title":"Clin Dev Immunol"},{"issue":"2","key":"2019070110025530800_kwz074C9","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1111\/j.1469-185X.2010.00151.x","article-title":"Rickettsial evolution in the light of comparative genomics","volume":"86","author":"Merhej","year":"2011","journal-title":"Biol Rev Camb Philos Soc"},{"issue":"1","key":"2019070110025530800_kwz074C10","doi-asserted-by":"crossref","first-page":"pii:E19","DOI":"10.3390\/tropicalmed3010019","article-title":"Hemophagocytic lymphohistiocytosis associated with scrub typhus: systematic review and comparison between pediatric and adult cases","volume":"3","author":"Naoi","year":"2018","journal-title":"Trop Med Infect Dis"},{"issue":"1","key":"2019070110025530800_kwz074C11","doi-asserted-by":"crossref","first-page":"pii:E8","DOI":"10.3390\/tropicalmed3010008","article-title":"A review of scrub typhus (Orientia tsutsugamushi and related organisms): then, now, and tomorrow","volume":"3","author":"Luce-Fedrow","year":"2018","journal-title":"Trop Med Infect Dis"},{"key":"2019070110025530800_kwz074C12","author":"Taiwan Centers for Disease Control"},{"issue":"4","key":"2019070110025530800_kwz074C13","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1128\/JCM.01784-09","article-title":"Scrub typhus in previously unrecognized areas of endemicity in China","volume":"48","author":"Zhang","year":"2010","journal-title":"J Clin Microbiol"},{"issue":"5","key":"2019070110025530800_kwz074C14","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1007\/BF01645364","article-title":"Arthritis in Mediterranean spotted fever","volume":"19","author":"Pedro-Botet","year":"1991","journal-title":"Infection"},{"issue":"4\u20135","key":"2019070110025530800_kwz074C15","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s10067-003-0730-5","article-title":"Unusual causes of reactive arthritis: Leptospira and Coxiella burnetii","volume":"22","author":"Pappas","year":"2003","journal-title":"Clin Rheumatol"},{"issue":"5","key":"2019070110025530800_kwz074C16","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/MAJ.0b013e318295c788","article-title":"Atypical Rocky Mountain spotted fever with polyarticular arthritis","volume":"346","author":"Chaudhry","year":"2013","journal-title":"Am J Med Sci"},{"key":"2019070110025530800_kwz074C17","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1196\/annals.1374.008","article-title":"Rickettsioses in Australia","volume":"1078","author":"Graves","year":"2006","journal-title":"Ann N Y Acad Sci"},{"key":"2019070110025530800_kwz074C18","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1471-2334-13-191","article-title":"Scrub typhus islands in the Taiwan area and the association between scrub typhus disease and forest land use and farmer population density: geographically weighted regression","volume":"13","author":"Tsai","year":"2013","journal-title":"BMC Infect Dis"},{"key":"2019070110025530800_kwz074C19","author":"Database NHIR"},{"issue":"1","key":"2019070110025530800_kwz074C20","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/BF02918552","article-title":"Molecular mimicry as a mechanism for virus-induced autoimmunity","volume":"8","author":"Fujinami","year":"1989","journal-title":"Immunol Res"},{"issue":"2","key":"2019070110025530800_kwz074C21","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/0092-8674(91)90164-T","article-title":"Ablation of \u201ctolerance\u201d and induction of diabetes by virus infection in viral antigen transgenic mice","volume":"65","author":"Ohashi","year":"1991","journal-title":"Cell"},{"issue":"13","key":"2019070110025530800_kwz074C22","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1096\/fasebj.12.13.1255","article-title":"Molecular mimicry and immune-mediated diseases","volume":"12","author":"Oldstone","year":"1998","journal-title":"FASEB J"},{"key":"2019070110025530800_kwz074C23","doi-asserted-by":"crossref","first-page":"986789","DOI":"10.1155\/2013\/986789","article-title":"Th17 cells in immunity and autoimmunity","volume":"2013","author":"Bedoya","year":"2013","journal-title":"Clin Dev Immunol"},{"issue":"2","key":"2019070110025530800_kwz074C24","doi-asserted-by":"crossref","first-page":"e0005404","DOI":"10.1371\/journal.pntd.0005404","article-title":"Cytotoxic effector functions of T cells are not required for protective immunity against fatal Rickettsia typhi infection in a murine model of infection: role of TH1 and TH17 cytokines in protection and pathology","volume":"11","author":"Moderzynski","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"2019070110025530800_kwz074C25","first-page":"85","article-title":"GFPuv-expressing recombinant Rickettsia typhi: a useful tool for the study of pathogenesis and CD8+ T cell immunology in R. typhi infection","author":"Hauptmann","year":"2017","journal-title":"Infect Immun"},{"key":"2019070110025530800_kwz074C26","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1196\/annals.1386.043","article-title":"Estrogens and autoimmune diseases","volume":"1089","author":"Cutolo","year":"2006","journal-title":"Ann N Y Acad Sci"},{"issue":"3","key":"2019070110025530800_kwz074C27","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1002\/art.23291","article-title":"Interleukin-17-producing T cells are enriched in the joints of children with arthritis, but have a reciprocal relationship to regulatory T cell numbers","volume":"58","author":"Nistala","year":"2008","journal-title":"Arthritis Rheum"},{"issue":"7","key":"2019070110025530800_kwz074C28","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1038\/nrrheum.2011.68","article-title":"Pathogenesis of systemic juvenile idiopathic arthritis: some answers, more questions","volume":"7","author":"Mellins","year":"2011","journal-title":"Nat Rev Rheumatol"},{"key":"2019070110025530800_kwz074C29","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/1741-7015-11-94","article-title":"Age-related autoimmunity","volume":"11","author":"Vadasz","year":"2013","journal-title":"BMC Med"},{"issue":"23","key":"2019070110025530800_kwz074C30","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1136\/heartjnl-2014-306181","article-title":"Scrub typhus increases the risk of developing acute coronary syndrome: a nationwide cohort study","volume":"100","author":"Chung","year":"2014","journal-title":"Heart"},{"key":"2019070110025530800_kwz074C31","doi-asserted-by":"crossref","first-page":"i262","DOI":"10.1136\/bmj.i262","article-title":"Rheumatoid arthritis, anti-tumour necrosis factor treatment, and risk of squamous cell and basal cell skin cancer: cohort study based on nationwide prospectively recorded data from Sweden","volume":"352","author":"Raaschou","year":"2016","journal-title":"BMJ"},{"issue":"8","key":"2019070110025530800_kwz074C32","doi-asserted-by":"crossref","first-page":"e103078","DOI":"10.1371\/journal.pone.0103078","article-title":"Increased risk of dementia in patients exposed to nitrogen dioxide and carbon monoxide: a population-based retrospective cohort study","volume":"9","author":"Chang","year":"2014","journal-title":"PLoS One"}],"container-title":["American Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwz074\/28736436\/kwz074.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/aje\/article-pdf\/188\/7\/1311\/28890458\/kwz074.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T10:03:52Z","timestamp":1561975432000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/aje\/article\/188\/7\/1311\/5421029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,27]]},"references-count":32,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,3,27]]},"published-print":{"date-parts":[[2019,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/aje\/kwz074","relation":{},"ISSN":["0002-9262","1476-6256"],"issn-type":[{"value":"0002-9262","type":"print"},{"value":"1476-6256","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,7]]},"published":{"date-parts":[[2019,3,27]]}}}