Clinical profile and risk factors associated with severe scrub typhus infection among non-ICU patients in semi-urban south India

Premraj, Sarah; Mayilananthi, Kaliannan; Krishnan, Durga; Padmanabhan, K.; Rajasekaran, D

doi:10.4103/0972-9062.234626

Cited by 25 publications

(26 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Serum creatinine was a predictor in our study as in Kim et al [24]. Age and absence of an eschar were risk factors for severe disease in studies by Premraj et al and Kim et al, while these factors were not predictive in our study [24,28]. TNF-α was used to predict the severity of scrub typhus by Lee Kim et al [26] APACHE II scores were used by Lee Kim et al and Griffith et al, which we could not perform due to arterial blood gases (ABG) data being unavailable in many patients.…”

Section: Discussionsupporting

confidence: 55%

“…However, platelet indices have not been used previously to predict MODS in scrub typhus. Our patients were of a similar age to that present in the Chennai study, [28] but younger than that of Korean patients [24,26]. We had a larger patient cohort comparable to Kim et al (189 vs. 208).…”

Section: Discussionsupporting

confidence: 53%

“…There are a few studies wherein severe scrub typhus has been studied with regard to predictors of severity and mortality [ 24 , 26 – 28 ]. However, platelet indices have not been used previously to predict MODS in scrub typhus.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Utility of Platelet Indices in Predicting Multiorgan Dysfunction in Scrub Typhus

Vijayakumar

Viswanathan

Jain

2020

Interdisciplinary Perspectives on Infectious Diseases

View full text Add to dashboard Cite

Platelet indices have been used to diagnose and prognosticate infections such as tuberculosis, malaria, dengue, and septic shock. Platelet indices have previously not been used in the prediction of multiorgan dysfunction (MODS) in patients with scrub typhus. A three-year retrospective review of patient charts was performed. Patients with and without MODS were compared. Platelet indices and other clinical and laboratory variables were used in logistic regression analysis to determine significant predictors. A ROC curve was generated with the platelet indices to predict MODS. Of 189 patients, 106 were male. Respiratory rate, serum creatinine, liver function tests, platelet count, thrombocytopenia <150 × 109/L, mean platelet volume (MPV) > 7.3 fL, and plateletcrit ≤0.19% varied significantly between patients with MODS and those without. Platelet indices are inexpensive and easily available. Only thrombocytopenia along with creatinine, alanine transaminase, and abnormal chest radiograph could significantly predict MODS in patients with scrub typhus.

show abstract

Section: Discussionsupporting

confidence: 55%

Section: Discussionsupporting

confidence: 53%

See 1 more Smart Citation

The Utility of Platelet Indices in Predicting Multiorgan Dysfunction in Scrub Typhus

Vijayakumar

Viswanathan

Jain

2020

Interdisciplinary Perspectives on Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…The complications were defined if it showed dysfunction of the following organ systems: 1) Cardiovascular system - presence of any of the following: systolic blood pressure <90 mmHg, myocarditis (defined as elevated creatine kinase-myocardial band isoenzyme above baseline), or abnormal cardiac arrhythmia with no previous history of atrial fibrillation, supraventricular tachycardia, or frequent premature ventricular tachycardia; 2) Respiratory system - presence of any of the following: presence of acute respiratory distress syndrome, defined as the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO 2 /FiO 2 ) <200 mmHg, with bilateral interstitial infiltration on chest film, or pneumonia with parenchymal lung lesion on chest radiograph; 3) Central nervous system - presence of any of the following: Glasgow Coma Scale ≤12 without other causes, seizure without other causes, or meningoencephalitis; 4) Hematological system - platelet count ≤20×10 9 /L; 5) Urinary system - presence of acute kidney injury, defined as creatinine ≥2 mg/dL or creatinine change of >0.5 mg/dL/day; 6) Gastrointestinal and hepatobiliary system - presence of any of the following: presence of hepatitis, defined as elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) more than fivefold normal levels or increase in serum total bilirubin >2 mg/dL, or gastrointestinal bleeding [478].…”

Section: Methodsmentioning

confidence: 99%

Clinical and Laboratory Predictors associated with Complicated Scrub Typhus

Kim

Choi

et al. 2019

Infect Chemother

View full text Add to dashboard Cite

Background Scrub typhus, a mite-borne disease caused by bites of Orientia tsutsugamushi -infected chiggers, is endemic in Asia-Pacific countries. In Korea, it is a seasonal disease prevalent in autumn and one of the important causes of acute undifferentiated febrile illness. The purpose of this study was to identify the risk factors for the prediction of the severe clinical course of scrub typhus and to investigate the differences in the clinical and laboratory findings of hospitalized elderly and non-elderly patients with scrub typhus. Materials and Methods This study retrospectively reviewed the medical records of patients diagnosed with scrub typhus. Results A total of 710 patients were enrolled and 43.9% of them were elderly patients. The number of patients with complicated scrub typhus was 168 (23.7%) and the most common complication of severe scrub typhus was hepatic dysfunction (10.7%) followed by pneumonia (7.2%), acute kidney injury (4.9%) and shock (2.4%). Blood urea nitrogen ≥20 mg/dL, adenosine deaminase (ADA) ≥100 IU/L, pulmonary edema or pleural effusion, lactate dehydrogenase ≥500 U/L, alkaline phosphatase ≥400 IU/L, ferritin ≥500 ng/mL and absence of skin rash were independently associated with severe scrub typhus. There was no significant difference in the incidence of complicated scrub typhus between elderly and non-elderly patients. Absence of skin rash, pulmonary edema, pleural effusion, serum creatinine ≥1.5 mg/dL, total bilirubin ≥1.5 mg/dL, ADA ≥100 IU/L and ferritin ≥500 ng/mL were significantly associated with a longer hospitalization (≥10 days). Conclusion The several independent predictors of complicated scrub typhus were identified in this study. Absence of skin rash, the increased levels of serum ADA and ferritin were identified as the predictors of complicated scrub typhus, which were also associated with a prolonged hospitalization.

show abstract

“…Recently, several outbreaks reported from all parts of India, notably, during the rainy season (June to December) in south India and winter (September to January) in north India. 1,12,11,[13][14][15] Majority of the cases presented with prolonged fever and non-specific signs and symptoms of acute undifferentiated fever.…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory profile of pediatric scrub typhus in a tertiary care teaching hospital in Southern India

Lakshmanan

Sagayaraj

Sujatha

et al. 2018

Int J Contemp Pediatr

View full text Add to dashboard Cite

Background: Scrub typhus is a common aetiology for an acute undifferentiated fever among children. Early recognition and prompt management help to reduce morbidity and mortality.Methods: All children who visited our pediatric out-patient department between January 2016 and February 2018, admitted with clinical suspicion of scrub typhus and having positive serum IgM by ELISA were included in the study.Results: A total of 83 cases were enrolled during the study period. Of these 55 were boys and 28 girls. The average age of presentation was seven years, and the youngest was just five months old. Majority of these patients were from rural areas (86%). Roughly, two-thirds (77%) of the study group practiced open defecation. A maximum number of cases (65;78.3%) were reported during monsoon season (between September and January).Prolonged fever (100%), gastrointestinal symptoms (76%) such as vomiting, diarrhoea and abdominal pain, lymphadenopathy (96%) and hepatosplenomegaly (61%) were common signs and symptoms of pediatric scrub typhus. Only six patients had severe illnesses. The diagnosis was based on the positive serum IgM for scrub typhus. All the patients were IgM positive. Out of these 83 patients, eschar was seen in 50 (60%) patients. Weil Felix test was positive in 15 cases out of 33 tested cases. Six children had co-infection with 2 cases of malaria and four dengue fever cases.Conclusions: Scrub typhus is one of the common causes for acute undifferentiated fever among children. A high index of clinical suspicion and a lookout for an eschar shall facilitate an early diagnosis of scrub typhus.

show abstract

Clinical profile and risk factors associated with severe scrub typhus infection among non-ICU patients in semi-urban south India

Abstract: Severe scrub typhus infection among non-ICU patients is more likely to occur in elderly patients and in those with longer duration of illness prior to presentation. The subset of patients without eschar might be more prone to develop complications.

Cited by 25 publications

References 1 publication

The Utility of Platelet Indices in Predicting Multiorgan Dysfunction in Scrub Typhus

The Utility of Platelet Indices in Predicting Multiorgan Dysfunction in Scrub Typhus

Clinical and Laboratory Predictors associated with Complicated Scrub Typhus

Clinical and laboratory profile of pediatric scrub typhus in a tertiary care teaching hospital in Southern India

Contact Info

Product

Resources

About