Therefore , in total, 382 patients were included in this study, with etiology of acute undifferentiated fever determined in 250 (65. 4%) cases (Figure 1). == Physique 1 . of illness during an outbreak period (two points), myalgia (one point), and eschar (two points). Thecstatistic was 0. 977 (95% confidence interval = 0. 9600. 994). At a cutoff value 4, the sensitivity and specificity were 92. 7% (79. 098. 1%) and 90. 9% (86. 094. 3%), respectively. Scrub typhus, the 3rd leading cause of acute undifferentiated fever in our region, can be identified early using the prediction rule. == Introduction == A variety of etiologies have been reported in patients presenting with acute undifferentiated fever in tropical areas. 13Malaria, dengue fever, scrub typhus, other rickettsioses, leptospirosis, and enteric fever are common causes of acute undifferentiated fever, causing considerable morbidity, mortality, and economic burden. However , the etiologic spectrum of acute undifferentiated fever continues to be poorly characterized in non-tropical areas. The incidence of scrub typhus, one of the potentially life-threatening reasons for acute undifferentiated fever, offers continuously increased in Korea, a non-tropical endemic area. 4Delayed treatment in patients with scrub typhus might increase morbidity and mortality. 57Therefore, early treatment with doxycycline or azithromycin is warranted in patients who also are suspected of having scrub typhus. However , clinical suspicion of scrub typhus is often difficult in patients showing with acute undifferentiated fever in acute healthcare settings, leading to misdiagnosis or overdiagnosis of scrub typhus. three or more The diagnosis of scrub typhus is based on (+)-DHMEQ history of exposure, clinical features, and results of serologic screening. Other than eschar, which is characteristic but not usually detectable, clinical features of scrub typhus are notoriously non-specific. 8Based on clinical features (except eschar), it is almost impossible for clinicians to differentiate scrub typhus from other etiologies of acute undifferentiated fever. Currently, indirect immunofluorescence assay (IFA) is the gold standard reference test for the diagnosis of scrub typhus. 9However, IFA requires acute and convalescent paired sera as well as technical experience and gear. As a result, IFA is not useful in the early diagnosis of scrub typhus in the acute healthcare setting, such as emergency departments or outpatient clinics. To get rapid diagnosis of scrub typhus, several point-of-care tests have been developed, albeit with reduce sensitivity. 10, 11For these reasons, we sought to develop a clinical prediction rule consisting of demographic, clinical, or laboratory parameters at the time of initial presentation to facilitate early detection of suspected cases of scrub typhus in patients with acute undifferentiated fever. (+)-DHMEQ In this study, we investigated the etiologic spectrum in adult patients showing with acute undifferentiated fever at the emergency department in a non-tropical scrub typhus-endemic area. In addition , we tried to develop a prediction rule to identify suspected cases of scrub typhus in patients with acute undifferentiated fever using predictors derived from a multiple regression model. == Methods == == Design. == This cross-sectional study was conducted at a 550-bed suburban university (+)-DHMEQ hospital located in the western part of Kangwon Province, Republic of Korea. On average, 30, 000 patients present at (+)-DHMEQ our emergency department each year. Of these patients, 11. 7% have a fever or history of a fever. == Subjects. == Information from all patients who presented with fever or history of a fever at the emergency department from January of 2009 to December of 2013 was retrieved from the administrative registry. From these data, adult patients ( 18 years old) who were hospitalized with acute undifferentiated fever were included in this study. Acute undifferentiated fever was defined as any febrile illness (tympanic IL24 membrane heat 37. 8C) with a duration of 14 days without evidence of localized infection by history, physical examination, total blood count number, chemistry profile, urinalysis, or chest radiography at the time of initial presentation at the emergency department. 2Patients who were receiving cancer chemotherapy or immunosuppressive therapy, had human being immunodeficiency disease (HIV) contamination, had been hospitalized.