Case of scrub typhus complicated by severe disseminated intravascular coagulation and death

Ono, Yuko; Ikegami, Yukihiro; Tasaki, Kazuhiro; Abe, Masahumi; Tase, Choichiro

doi:10.1111/j.1742-6723.2012.01600.x

Cited by 22 publications

(13 citation statements)

References 5 publications

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“…Nearly one-fourth of our patients presented with altered sensorium, similar to other studies. [12][13][14][15][16][17][18][19][20][21][22] The pathognomonic eschar was present in 14% patients (Table 3), a figure considerably higher than a previous study from the Himalayan region (9.5% patients), but lesser than that reported from south India (43.5%) and Jeju Island in South Korea (75.8%). 26,28,29 This variation in the presence of eschar may be explained by the geographic distribution of different strains of the organism.…”

Section: Discussioncontrasting

confidence: 50%

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Scrub Typhus in a Tertiary Care Hospital in North India

Sharma

Biswal

Kumar

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Scrub typhus, a zoonotic disease caused by the bacterium Orientia tsutsugamushi, has become endemic in many parts of India. We studied the clinical profile of this infection in 228 patients that reported to this tertiary care center from July 2013 to December 2014. The median age of patients was 35 years (interquartile range = 24.5-48.5 years), and 111 were males and 117 females. A high-grade fever occurred in 85%, breathlessness in 42%, jaundice in 32%, abdominal pain in 28%, renal failure in 11%, diarrhea in 10%, rashes in 9%, and seizures in 7%. Common laboratory abnormalities at presentation were a deranged hepatic function in 61%, anemia in 54%, leukopenia in 15%, and thrombocytopenia in 90% of our patients. Acute kidney injury (32%), acute respiratory distress syndrome (ARDS) (25%), and disseminated intravascular coagulation (DIC) (16%) were the commonest complications. A hepatorenal syndrome was seen in 38% and multiple organ dysfunction syndrome (MODS) in 20% patients. The overall case fatality rate was 13.6%. In univariate analysis, ARDS requiring mechanical ventilation, acute kidney injury requiring hemodialysis, hypotension requiring inotropic support, central nervous system dysfunction at presentation, and MODS were inversely associated with survival.

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Section: Discussioncontrasting

confidence: 50%

“…13 Multiple organ dysfunction syndrome (MODS) was confined to acutely ill patients presenting with features of two or more altered organ system functioning. 14 The antigen used to coat the wells was a recombinant 56-kDa type-specific antigen. The absorbance was read at 450 nm and an optical density of > 0.5 was considered positive.…”

Section: Methodsmentioning

confidence: 99%

Scrub Typhus in a Tertiary Care Hospital in North India

Sharma

Biswal

Kumar

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…Corresponding to this pathologic finding, hemorrhages in various organs, such as atraumatic hemoperitoneum or massive GI bleeding, and acute myocardial infarction or splenic infarctions have been reported as possible complications in scrub typhus patients. 3,4 Endothelial cell dysfunction and disseminated intravascular coagulation may occur in response to endothelial cell injury by O. tsutsugamushi in scrub typhus patients, 5,6 even though actual mechanism is not fully understood. According to the definition of disseminated intravascular coagulation (DIC) based on the criteria presented by the Scientific Subcommittee on DIC of the International Society of Thrombosis and Hemostasis (ISTH), overt DIC and thrombocytopenia were observed in two of the three patients with a cerebral vascular accident (CVA) in this study.…”

Section: Discussionmentioning

confidence: 99%

Scrub Typhus and Cerebrovascular Injury: A Phenomenon of Delayed Treatment?

Chung¹,

Yun²,

Kim³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Three patients diagnosed with scrub typhus through serology and polymerase chain reaction tests, experienced delayed administration of effective antibiotics after the appearance of symptoms, presented with subdural hemorrhage, intracerebral hemorrhage, or cerebral infarction in the late acute phase. Orientia tsutsugamushi should be considered as a causal or provoking factor for cerebrovascular accidents in regions where scrub typhus is endemic, especially in those who receive delayed treatment.

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“…Complications of scrub typhus infection include pneumonia [33] , acute respiratory distress syndrome (ARDS) like picture [34,35] , Peter JV et al . Scrub typhus infection myocarditis [36] , encephalitis [37] , hepatitis [38] , DIC [39] , hemophagocytic syndrome [40] , acute kidney injury [41] , acute pancreatitis [42] , transient adrenal insufficiency [43] , subacute painful thyroiditis [44] and presentation as an acute abdomen [45] . Several neurological manifestations have been observed in the setting of scrub typhus infection.…”

Section: Clinical Featuresmentioning

confidence: 99%

Severe scrub typhus infection: Clinical features, diagnostic challenges and management

Peter

Sudarsan

Prakash

et al. 2015

WJCCM

139

121

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Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay (IFA) for the detection of IgM antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%.

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Case of scrub typhus complicated by severe disseminated intravascular coagulation and death

Cited by 22 publications

References 5 publications

Scrub Typhus in a Tertiary Care Hospital in North India

Scrub Typhus in a Tertiary Care Hospital in North India

Scrub Typhus and Cerebrovascular Injury: A Phenomenon of Delayed Treatment?

Severe scrub typhus infection: Clinical features, diagnostic challenges and management

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