Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India

Abstract

Introduction Scrub typhus is a resurging zoonotic infection prevalent in South Asia with many recent outbreaks in India. It can mimic other tropical infections and the disease spectrum ranges from subclinical illness to life-threatening disease with multiorgan dysfunction. This study was conducted to study the pattern of hepatic and renal injury. Methods A retrospective study was done on 176 patients diagnosed by detecting IgM antibodies using an enzyme-linked immunosorbent assay (ELISA) over a period of three years at a tertiary center in Chandigarh, India. They were treated with doxycycline (azithromycin if pregnant) and supportive therapies. The patterns of hepatic and renal functions, along with the need of renal replacement therapy, were recorded and evaluated. The values were expressed as mean ± SD, and p values were calculated to establish statistical significance. Results Most of the cases were from the state of Haryana (37.5%), followed by Punjab (33.5%), Himachal Pradesh (13.6%), Uttar Pradesh (10.2%) and Chandigarh (5%). 30% of the study population was engaged in agriculture. The mean age was 32.3 ± 13.5 years with range of 13-65 years. A peak in the incidence was observed during monsoon months. Approximately 13% of the patients died. Urea, creatinine, bilirubin and aspartate transaminase were found to be higher in mortality group with statistical significance (p < 0.05). Alanine transaminase was higher and albumin was lower in the mortality group but without statistical significance. 27.8% had acute kidney injury, 90.9% had liver dysfunction and one patient had acute liver failure. All the pregnant patients had fetal loss. Conclusion Renal and liver dysfunctions are common in scrub typhus, and their occurrence adversely affects the outcome.

A Cross-Sectional Study to Evaluate Acute Kidney Injury in Scrub Typhus Patients

“…A similar female majority has been reported in previous studies [7][8][9][10]. However, male preponderance also been reported in few studies [5,6,11].…”

“…Kumar et al [5] found that average age of the scrub typhus cases was found to be34.16. Gaba et al [6] reported that the mean age at the time of diagnosis of scrubtyphus cases was found to be 32.3±13. A study carried out in SriLanka [7] also found that the mean age of scrub typhus cases was reported as 34.6.…”

An Overview of the Clinical Profile and Risk Factors Associated with Severe Scrub Typhus Infection: A Hospital Based Study in Coimbatore

“…Higher female dominance is attributed to greater involvement of women in agricultural and outdoor activities [20] . A study in south India in Telangana also found that 24.1% of patients had a history of exposure to vegetation and agricultural works [5] . Similarly, about 34% of the current study participants were involved in agricultural activities.…”

“…It is an acute zoonotic infection caused by a mite-borne bacterium called Orientia tsutsugamushi, which is transmitted via insect bites [3] . The arthropod responsible for this transmission, which also serves as a reservoir for this bacterium, is the Leptotrombidium mite [4][5][6][7][8] . O. tsutsugamushi is a Gram negative, obligate, intracellular organism [4,7] .…”

Case report of atypical scrub typhus in pregnancy coexistent with HELLP syndrome mimicking pregnancy specific liver disease (P-sLD): A management dilemma

“…There is evidence for the deposition of O. tsutsugamushi in endothelial cells which is supported by positive immunohistochemistry for its antigen. Almost 30% of the individuals go on to develop one organ dysfunction if untreated and the most common being AKI or acute hepatic failure (AHF) [7,[11][12][13][14][15].…”