Coagulation and inflammation in scrub typhus and murine typhus—a prospective comparative study from Laos D.H. Paris, V. Chansamouth, P. Nawtaisong, E.C.

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Presentation transcript:

Coagulation and inflammation in scrub typhus and murine typhus—a prospective comparative study from Laos D.H. Paris, V. Chansamouth, P. Nawtaisong, E.C. Löwenberg, R. Phetsouvanh, S.D. Blacksell, S.J. Lee, A.M. Dondorp, P.N. Newton, T. van der Poll, P.N. Newton, M. Levi, N. P.J. Day Clinical Microbiology and Infection Volume 18, Issue 12, Pages 1221-1228 (December 2012) DOI: 10.1111/j.1469-0691.2011.03717.x Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 1 Markers of coagulation. Levels of thrombin-antithrombin (TAT) complexes and soluble tissue factor (sTF) were significantly higher in patients with scrub typhus (ST), murine typhus (MT) and scrub and murine typhus combined (SMT) than in febrile controls (FC) or healthy controls (HC). On comparison of ST and MT, TAT complexes and sTF levels were significantly higher in ST. Data are expressed as mean and interquartile range (grey boxes) and upper and lower adjacent values (whiskers) of admission samples. *Odds ratios (95% CIs): TAT complexes, 0.24 (0.13-0.44); sTF, 0.89 (0.78-1.01). Clinical Microbiology and Infection 2012 18, 1221-1228DOI: (10.1111/j.1469-0691.2011.03717.x) Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 2 Anticoagulant factors. On admission, anticoagulant pathways were inhibited in patients with scrub typhus (ST), murine typhus (MT) and scrub and murine typhus combined (SMT) as compared with controls. Antithrombin (AT) levels were significantly decreased in ST but not in MT, whereas protein C (PC) levels were significantly lower in MT, but not in ST, than in healthy controls (HC). Data are depicted as mean and interquartile range (grey boxes) and upper and lower adjacent values (whiskers). *Odds ratios (95% CI): AT, 1.17 (1.1-1.24); PC, 0.80 (0.73-0.87). FC, febrile controls. Clinical Microbiology and Infection 2012 18, 1221-1228DOI: (10.1111/j.1469-0691.2011.03717.x) Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 3 Markers of fibrinolytic activity. Although, on admission, levels of tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) were significantly raised, overall plasminogen activator activity (PAA) was significantly lower in patients with murine typhus (MT) than in those with scrub typhus (ST). Data are expressed as mean and interquartile range (grey boxes) and upper and lower adjacent values (whiskers). *Odds ratios (95% CIs): tPA, 1.69 (1.39-2.05); PAI-1, 1.39 (1.23-1.57); PAA, 0.78 (0.71-0.86). FC, febrile controls; HC, healthy controls; SMT, scrub and murine typhus combined. Clinical Microbiology and Infection 2012 18, 1221-1228DOI: (10.1111/j.1469-0691.2011.03717.x) Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 4 Markers of endothelial cell perturbation. On admission, plasma concentrations of endothelium-derived soluble thrombomodulin (sTM) and von Willebrand factor (VWF) were significantly higher in patients with murine typhus (MT) than in those with scrub typhus (ST). Data are depicted as mean and interquartile range (grey boxes) and upper and lower adjacent values (whiskers). *Odds ratios (95% CIs): VWF and sTM, 1.03 (1.02-1.04). FC, febrile controls; HC, healthy controls; SMT, scrub and murine typhus combined. Clinical Microbiology and Infection 2012 18, 1221-1228DOI: (10.1111/j.1469-0691.2011.03717.x) Copyright © 2012 European Society of Clinical Infectious Diseases Terms and Conditions