{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:22:08Z","timestamp":1788283328539,"version":"build-2803163510"},"reference-count":54,"publisher":"American Society of Tropical Medicine and Hygiene","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Scrub typhus, caused by\n                    <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                    , is a mite-borne febrile illness endemic to the Asia-Pacific region. Although most patients respond promptly to appropriate antibiotic therapy, a subset exhibits delayed defervescence, the clinical significance and predictors of which remain insufficiently understood. In the present study, the authors aimed to identify clinical, laboratory, and radiological factors associated with delayed defervescence in patients with scrub typhus. In this retrospective cohort study, scrub typhus patients who were hospitalized at Chosun University Hospital, Gwangju, South Korea, between November 2005 and November 2008 were assessed. Demographic characteristics, clinical manifestations, laboratory values, and radiological findings were compared. Multivariate logistic regression was used to identify independent predictors. During the study period, 413 patients were recorded initially. Among 160 confirmed scrub typhus patients, 22 (13.8%) experienced delayed defervescence. Compared with patients with early defervescence, those with delayed defervescence had significantly lower hemoglobin levels (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.045), higher rates of anemia (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.006) and leukocytosis (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.017), and elevated C-reactive protein levels (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.034). Pneumonia was also more common in the delayed group. In multivariate logistic regression analysis, anemia (odds ratio [OR]: 2.79; 95% CI: 1.00\u20137.79) and pneumonia (OR: 2.86; 95% CI: 1.07\u20137.59) were the strongest independent predictors of delayed defervescence. Delayed defervescence may reflect ongoing systemic inflammation and greater disease severity. Pneumonia and anemia could help identify patients at risk of a more severe clinical course or complications despite appropriate treatment, underscoring the importance of close monitoring.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.26-0157","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:09:53Z","timestamp":1788282593000},"source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Delayed Defervescence in Scrub Typhus: A Retrospective Cohort Analysis"],"prefix":"10.4269","author":[{"given":"Sadia","family":"Tamanna","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Min","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choon-Mee","family":"Kim","sequence":"additional","affiliation":[{"name":"Premedical Science, Chosun University College of Medicine, Gwangju, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You-Mi","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Won","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na-Ra","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"3","key":"b1","series-title":"J Med Entomol","first-page":"237","article-title":"The ecology of chigger-borne rickettsiosis (scrub typhus)","volume":"11","author":"Traub","year":"1974"},{"issue":"1","key":"b2","series-title":"Trop Med Infect Dis","first-page":"8","article-title":"A review of scrub typhus (Orientia tsutsugamushi and related organisms): Then, now, and tomorrow","volume":"3","author":"Luce-Fedrow","year":"2018"},{"issue":"11","key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e0006062","article-title":"A review of the global epidemiology of scrub typhus","volume":"11","author":"Xu","year":"2017"},{"issue":"1","key":"b4","series-title":"Trop Med Infect Dis","first-page":"11","article-title":"Scrub typhus: No longer restricted to the tsutsugamushi triangle","volume":"3","author":"Jiang","year":"2018"},{"issue":"11","key":"b5","series-title":"PLoS Negl Trop Dis","first-page":"e0010952","article-title":"Neurological manifestations of scrub typhus infection: A systematic review and meta-analysis of clinical features and case fatality","volume":"16","author":"Alam","year":"2022"},{"issue":"3","key":"b6","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"},{"issue":"1","key":"b7","series-title":"BMC Infect Dis","first-page":"884","article-title":"Doxycycline vs azithromycin in patients with scrub typhus: A systematic review of literature and meta-analysis","volume":"23","author":"Gupta","year":"2023"},{"issue":"9020","key":"b8","series-title":"Lancet","first-page":"86","article-title":"Scrub typhus infections poorly responsive to antibiotics in northern Thailand","volume":"348","author":"Watt","year":"1996"},{"issue":"9235","key":"b9","series-title":"Lancet","first-page":"1057","article-title":"Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: A randomised trial","volume":"356","author":"Watt","year":"2000"},{"issue":"3","key":"b10","series-title":"Am J Trop Med Hyg","first-page":"451","article-title":"Rickettsial infections in Southeast Asia: Implications for local populace and febrile returned travelers","volume":"91","author":"Aung","year":"2014"},{"key":"b11","series-title":"Int J Infect Dis","first-page":"132","article-title":"Prompt defervescence after initiation of treatment for rickettsial infections\u2013Time to dispense with the dogma?","volume":"102","author":"Stewart","year":"2021"},{"issue":"2","key":"b12","series-title":"Infect Chemother","first-page":"161","article-title":"Clinical and laboratory predictors associated with complicated scrub typhus","volume":"51","author":"Kim","year":"2019"},{"issue":"5","key":"b13","series-title":"J Trop Pediatr","first-page":"fmab087","article-title":"Prospective study to assess the response to therapy and its predictors in children with scrub typhus","volume":"67","author":"Arun Babu","year":"2021"},{"issue":"4","key":"b14","series-title":"Indian J Crit Care Med","first-page":"208","article-title":"Scrub typhus: Clinical spectrum and outcome","volume":"19","author":"Venkategowda","year":"2015"},{"issue":"1","key":"b15","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"},{"issue":"3","key":"b16","series-title":"Am J Trop Med Hyg","first-page":"441","article-title":"Clinical characteristics of acute Q fever, scrub typhus, and murine typhus with delayed defervescence despite doxycycline treatment","volume":"79","author":"Lai","year":"2008"},{"issue":"1","key":"b17","series-title":"BMC Infect Dis","first-page":"283","article-title":"Indicators of severe prognosis of scrub typhus: Prognostic factors of scrub typhus severity","volume":"19","author":"Kim","year":"2019"},{"issue":"6","key":"b18","series-title":"Antimicrob Agents Chemother","first-page":"2011","article-title":"Controlled trial of a 5-day course of telithromycin versus doxycycline for treatment of mild to moderate scrub typhus","volume":"51","author":"Kim","year":"2007"},{"issue":"4","key":"b19","series-title":"Clin Infect Dis","first-page":"600","article-title":"Effects of rifampin and doxycycline treatments in patients with uncomplicated scrub typhus: An open-label, randomized, controlled trial","volume":"67","author":"Kim","year":"2018"},{"issue":"1","key":"b20","series-title":"Emerg Microbes Infect","first-page":"909","article-title":"The scrub typhus in mainland China: Spatiotemporal expansion and risk prediction underpinned by complex factors","volume":"8","author":"Yao","year":"2019"},{"issue":"6","key":"b21","series-title":"Emerg Infect Dis","first-page":"1091","article-title":"Epidemiologic changes of scrub typhus in China, 1952\u20132016","volume":"26","author":"Li","year":"2020"},{"issue":"22","key":"b22","series-title":"Glob Chang Biol","first-page":"6618","article-title":"Climate drives the spatiotemporal dynamics of scrub typhus in China","volume":"28","author":"Ding","year":"2022"},{"issue":"5","key":"b23","series-title":"J Microbiol Immunol Infect","first-page":"769","article-title":"Clinicoepidemiologic characteristics of scrub typhus and murine typhus: A multi-center study in southern Taiwan","volume":"52","author":"Chang","year":"2019"},{"issue":"1","key":"b24","series-title":"J Vector Borne Dis","first-page":"33","article-title":"Prospective study to assess the treatment modalities and fever defervescence in patients with scrub typhus from a tertiary care centre in South India","volume":"58","author":"Barnabas","year":"2021"},{"issue":"8","key":"b25","series-title":"Indian J Crit Care Med","first-page":"480","article-title":"Acute respiratory failure in scrub typhus patients","volume":"20","author":"Sahoo","year":"2016"},{"key":"b26","series-title":"Risk Manag Healthc Policy","first-page":"43","article-title":"Clinical indicators for severe prognosis of scrub typhus","volume":"6","author":"Sriwongpan","year":"2013"},{"issue":"1","key":"b27","series-title":"BMC Infect Dis","first-page":"334","article-title":"Serum C-reactive protein and procalcitonin values in acute Q fever, scrub typhus, and murine typhus","volume":"20","author":"Lin","year":"2020"},{"issue":"3","key":"b1","series-title":"J Med Entomol","first-page":"237","article-title":"The ecology of chigger-borne rickettsiosis (scrub typhus)","volume":"11","author":"Traub","year":"1974"},{"issue":"1","key":"b2","series-title":"Trop Med Infect Dis","first-page":"8","article-title":"A review of scrub typhus (Orientia tsutsugamushi and related organisms): Then, now, and tomorrow","volume":"3","author":"Luce-Fedrow","year":"2018"},{"issue":"11","key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e0006062","article-title":"A review of the global epidemiology of scrub typhus","volume":"11","author":"Xu","year":"2017"},{"issue":"1","key":"b4","series-title":"Trop Med Infect Dis","first-page":"11","article-title":"Scrub typhus: No longer restricted to the tsutsugamushi triangle","volume":"3","author":"Jiang","year":"2018"},{"issue":"11","key":"b5","series-title":"PLoS Negl Trop Dis","first-page":"e0010952","article-title":"Neurological manifestations of scrub typhus infection: A systematic review and meta-analysis of clinical features and case fatality","volume":"16","author":"Alam","year":"2022"},{"issue":"3","key":"b6","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"},{"issue":"1","key":"b7","series-title":"BMC Infect Dis","first-page":"884","article-title":"Doxycycline vs azithromycin in patients with scrub typhus: A systematic review of literature and meta-analysis","volume":"23","author":"Gupta","year":"2023"},{"issue":"9020","key":"b8","series-title":"Lancet","first-page":"86","article-title":"Scrub typhus infections poorly responsive to antibiotics in northern Thailand","volume":"348","author":"Watt","year":"1996"},{"issue":"9235","key":"b9","series-title":"Lancet","first-page":"1057","article-title":"Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: A randomised trial","volume":"356","author":"Watt","year":"2000"},{"issue":"3","key":"b10","series-title":"Am J Trop Med Hyg","first-page":"451","article-title":"Rickettsial infections in Southeast Asia: Implications for local populace and febrile returned travelers","volume":"91","author":"Aung","year":"2014"},{"key":"b11","series-title":"Int J Infect Dis","first-page":"132","article-title":"Prompt defervescence after initiation of treatment for rickettsial infections\u2013Time to dispense with the dogma?","volume":"102","author":"Stewart","year":"2021"},{"issue":"2","key":"b12","series-title":"Infect Chemother","first-page":"161","article-title":"Clinical and laboratory predictors associated with complicated scrub typhus","volume":"51","author":"Kim","year":"2019"},{"issue":"5","key":"b13","series-title":"J Trop Pediatr","first-page":"fmab087","article-title":"Prospective study to assess the response to therapy and its predictors in children with scrub typhus","volume":"67","author":"Arun Babu","year":"2021"},{"issue":"4","key":"b14","series-title":"Indian J Crit Care Med","first-page":"208","article-title":"Scrub typhus: Clinical spectrum and outcome","volume":"19","author":"Venkategowda","year":"2015"},{"issue":"1","key":"b15","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"},{"issue":"3","key":"b16","series-title":"Am J Trop Med Hyg","first-page":"441","article-title":"Clinical characteristics of acute Q fever, scrub typhus, and murine typhus with delayed defervescence despite doxycycline treatment","volume":"79","author":"Lai","year":"2008"},{"issue":"1","key":"b17","series-title":"BMC Infect Dis","first-page":"283","article-title":"Indicators of severe prognosis of scrub typhus: Prognostic factors of scrub typhus severity","volume":"19","author":"Kim","year":"2019"},{"issue":"6","key":"b18","series-title":"Antimicrob Agents Chemother","first-page":"2011","article-title":"Controlled trial of a 5-day course of telithromycin versus doxycycline for treatment of mild to moderate scrub typhus","volume":"51","author":"Kim","year":"2007"},{"issue":"4","key":"b19","series-title":"Clin Infect Dis","first-page":"600","article-title":"Effects of rifampin and doxycycline treatments in patients with uncomplicated scrub typhus: An open-label, randomized, controlled trial","volume":"67","author":"Kim","year":"2018"},{"issue":"1","key":"b20","series-title":"Emerg Microbes Infect","first-page":"909","article-title":"The scrub typhus in mainland China: Spatiotemporal expansion and risk prediction underpinned by complex factors","volume":"8","author":"Yao","year":"2019"},{"issue":"6","key":"b21","series-title":"Emerg Infect Dis","first-page":"1091","article-title":"Epidemiologic changes of scrub typhus in China, 1952\u20132016","volume":"26","author":"Li","year":"2020"},{"issue":"22","key":"b22","series-title":"Glob Chang Biol","first-page":"6618","article-title":"Climate drives the spatiotemporal dynamics of scrub typhus in China","volume":"28","author":"Ding","year":"2022"},{"issue":"5","key":"b23","series-title":"J Microbiol Immunol Infect","first-page":"769","article-title":"Clinicoepidemiologic characteristics of scrub typhus and murine typhus: A multi-center study in southern Taiwan","volume":"52","author":"Chang","year":"2019"},{"issue":"1","key":"b24","series-title":"J Vector Borne Dis","first-page":"33","article-title":"Prospective study to assess the treatment modalities and fever defervescence in patients with scrub typhus from a tertiary care centre in South India","volume":"58","author":"Barnabas","year":"2021"},{"issue":"8","key":"b25","series-title":"Indian J Crit Care Med","first-page":"480","article-title":"Acute respiratory failure in scrub typhus patients","volume":"20","author":"Sahoo","year":"2016"},{"key":"b26","series-title":"Risk Manag Healthc Policy","first-page":"43","article-title":"Clinical indicators for severe prognosis of scrub typhus","volume":"6","author":"Sriwongpan","year":"2013"},{"issue":"1","key":"b27","series-title":"BMC Infect Dis","first-page":"334","article-title":"Serum C-reactive protein and procalcitonin values in acute Q fever, scrub typhus, and murine typhus","volume":"20","author":"Lin","year":"2020"}],"container-title":["The American Journal of Tropical Medicine and 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