{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:37:52Z","timestamp":1790689072979,"version":"4.1.0"},"reference-count":42,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,11,1]]},"abstract":"<jats:p>\n                    We prospectively evaluated severity predictors in terms of host, microorganism, and treatment factors in 153 eschar-positive scrub typhus patients. Severity was assessed with the Acute Physiology and Chronic Health Evaluation (APACHE) II score (&lt; 10 versus \u2265 10) and predefined criteria of severe complications. Genotypes of\n                    <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                    were determined. Independent risk factors for severity (APACHE II score \u2265 10) were old age, diabetes mellitus, serum osteopontin &gt; 100 ng\/mL, and a group of underlying diseases (congestive heart failure, cerebrovascular disease, chronic liver disease, bronchial asthma, and chronic obstructive lung diseases). Anemia (\u2264 10 g\/dL) and C-reactive protein &gt; 10 mg\/dL were indicators of current severity. Neither the delay in antibiotics administration nor strain types (Boryong, Taguchi, or Kanda\/Kawasaki) contributed to the severity. The risk factors for severe complications were similar. Serum osteopontin &gt; 100 ng\/mL had a negative predictive value of 96% for severe complications. This marker can be used to rule out severe disease status.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.2011.11-0134","type":"journal-article","created":{"date-parts":[[2011,11,2]],"date-time":"2011-11-02T17:52:54Z","timestamp":1320256374000},"page":"924-930","source":"Crossref","is-referenced-by-count":29,"title":["Severity Predictors in Eschar-Positive Scrub Typhus and Role of Serum Osteopontin"],"prefix":"10.4269","volume":"85","author":[{"given":"Sang-Won","family":"Park","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Seop","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi Kug","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yee Gyung","family":"Kwak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chisook","family":"Moon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baek-Nam","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eu Suk","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Myung","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myoung-don","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"R1","series-title":"Principles and Practice of Infectious Diseases","first-page":"2529","author":"Raoult","year":"2010"},{"key":"R2","series-title":"Ann N Y Acad Sci","first-page":"564","article-title":"Detection of Rickettsia tsutsugamushi by gene amplification using polymerase chain reaction techniques","volume":"590","author":"Kelly","year":"1990"},{"key":"R3","series-title":"J Korean Med Sci","first-page":"343","article-title":"Acute respiratory distress syndrome associated with scrub typhus: diffuse alveolar damage without pulmonary vasculitis","volume":"15","author":"Park","year":"2000"},{"key":"R4","series-title":"Southeast Asian J Trop Med Public Health","first-page":"780","article-title":"Septic shock secondary to scrub typhus: characteristics and complications","volume":"33","author":"Thap","year":"2002"},{"key":"R5","series-title":"Trop Doct","first-page":"129","article-title":"Scrub typhus: an unrecognized threat in South India - 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Immun","first-page":"1265","article-title":"Expression of chemokine genes in human dermal microvascular endothelial cell lines infected with Orientia tsutsugamushi","volume":"69","author":"Cho","year":"2001"},{"key":"R32","series-title":"Clin Infect Dis","first-page":"624","article-title":"Life-threatening scrub typhus in a traveler returning from Thailand","volume":"18","author":"Watt","year":"1994"},{"key":"R33","series-title":"Microbiol Immunol","first-page":"439","article-title":"Epidemiological survey of Orientia tsutsugamushi distribution in field rodents in Saitama prefecture, Japan, and discovery of a new type","volume":"45","author":"Tamura","year":"2001"},{"key":"R34","series-title":"Lancet","first-page":"1236","article-title":"Fulminant Rickettsia tsutsugamushi infection associated with hemophagocytic syndrome","volume":"343","author":"Iwasaki","year":"1994"},{"key":"R35","series-title":"J Clin Microbiol","first-page":"3320","article-title":"Increased levels of macrophage colony-stimulating factor, gamma interferon, and tumor necrosis factor alpha in sera of patients with Orientia tsutsugamushi infection","volume":"35","author":"Iwasaki","year":"1997"},{"key":"R36","series-title":"Int J Infect Dis","first-page":"e328","article-title":"Correlation between the concentrations of tumor necrosis factor-alpha and the severity of disease in patients infected with Orientia tsutsugamushi","volume":"14","author":"Iwasaki","year":"2010"},{"key":"R37","series-title":"J Infect","first-page":"44","article-title":"Kinetics of inflammatory cytokines in patients with scrub typhus receiving doxycycline treatment","volume":"56","author":"Chung","year":"2008"},{"key":"R38","series-title":"Science","first-page":"860","article-title":"Eta-1 (osteopontin): an early component of type-1 (cell-mediated) immunity","volume":"287","author":"Ashkar","year":"2000"},{"key":"R39","series-title":"Infect Immun","first-page":"4223","article-title":"Attenuated host resistance against Mycobacterium bovis BCG infection in mice lacking osteopontin","volume":"67","author":"Nau","year":"1999"},{"key":"R40","series-title":"Acta Trop","first-page":"305","article-title":"Osteopontin is involved in Th1-mediated immunity against Plasmodium falciparum infection in a holoendemic malaria region in Vietnam","volume":"98","author":"Maeno","year":"2006"},{"key":"R41","series-title":"Mod Pathol","first-page":"752","article-title":"Identification of the target cells of Orientia tsutsugamushi in human cases of scrub typhus","volume":"14","author":"Moron","year":"2001"},{"key":"R42","series-title":"Clin Infect Dis","first-page":"1329","article-title":"A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus","volume":"39","author":"Kim","year":"2004"}],"container-title":["The American Society of Tropical Medicine and 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