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A positive diagnosis of scrub typhus was defined by a titre of passive haemagglutination assay (PHA) against O.?tsutsugamushi of ��1?:?80 in a single serum sample or by a four-fold or greater increase of titre in the follow-up [11�C13]. PHA was performed selleck kinase inhibitor at the NeoDIN Medical Institute in Seoul, Korea, using Genedia Tsutsu PHA ?II test kits; Genedia Tsutsu PHA ?II is a test kit for the qualitative and quantitative detection of antibodies against O.?tsutsugamushi in human serum based on the PHA. Sheep erythrocytes sensitized by the Karp and Gilliam strains, including the Boryong strain found in Korea, were used with the test kit [14,15]. Diagnosis of cirrhosis was made on the basis of the clinical findings of at least two of the following: (i) gastro-oesophageal varices on endoscopy; (ii) serum albumin ��3.4?g/dL, prothrombin time (International Normalized Ratio) ��1.3, or serum bilirubin ��2?mg/dL; and (iii) radiological imaging (ultrasonography or computed tomography) suggesting portal hypertension resulting from cirrhosis [16]. Central nervous system (CNS) involvement was defined by the presence of CNS-related illnesses such as confusion, seizure, or coma. Involvement of the respiratory system (RS) was defined by the presence of symptoms, signs and investigation results supporting evidence of pulmonary oedema, interstitial pneumonia, pleural effusion, or the need for artificial ventilation. Selleck PD98059 Cardiovascular system (CS) involvement was defined by the presence of symptoms, signs and investigation results supporting pericardial effusion, new onset of atrial fibrillation, and ischaemic heart disease. New onset of atrial fibrillation was defined as such when the symptoms improved with clinical recovery from scrub typhus. Gastrointestinal system (GS) involvement was defined by the presence of symptoms, signs and investigation results supporting peptic ulcer, pancreatitis, and upper gastrointestinal bleeding. Acute renal failure (ARF) was defined as such when at least 50% reduction Carnitine palmitoyltransferase II was seen in glomerular filtration rate (GFR) using the abbreviated modified diet in renal disease equation, namely: GFR (mL/min/1.73?m2) =?186Scr?1.154?��?age?0.203?��?(1.212 if black)?��?(0.742 if female)[17]. Septic shock was defined as sepsis with hypotension (systolic arterial blood pressure