Scrub typhus-associated acute kidney injury: A study from a South Indian Tertiary Care Hospital

Jayaprakash, Varadharajan; Vamsikrishna, M; Indhumathi, Elayaperumal; Jayakumar, M

doi:10.4103/1319-2442.265464

Cited by 18 publications

(15 citation statements)

References 27 publications

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“…In general, HA is associated with complications and mortality in patients with acute infectious diseases. HA is also frequently observed in scrub typhus with a rate of 25-69% [14,22], and the association between HA and scrub typhus-related complications have been reported in previous studies [14,15]. These findings were also observed in our study, where patients with HA experienced various complications more frequently in comparison to the NA group.…”

Section: Discussionsupporting

confidence: 90%

“…Hypoalbuminemia (HA) is known to be associated with complications and mortality in patients with acute infectious diseases [11] and has been correlated with an increased risk of AKI occurrence [12,13]. Previous studies have shown that HA in scrub typhus was closely related to the frequency of various complications including AKI [14,15]. However, the sample size of previous studies was relatively small, and there was no literature on whether hypoalbuminemia correlated with AKI severity based on the RIFLE criteria.…”

Section: Introductionmentioning

confidence: 99%

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Clinical significance of hypoalbuminemia in patients with scrub typhus complicated by acute kidney injury

Lim

Cho

et al. 2021

PLoS ONE

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Background This study aimed to investigate the clinical significance of hypoalbuminemia (HA) in patients with scrub typhus complicated by acute kidney injury (AKI). Methods From 2009 to 2018, 611 patients were diagnosed with scrub typhus. We divided the patients into two groups [normoalbuminemia (NA) vs. HA] based on the serum albumin level of 3.0 g/dL and compared the incidence, clinical characteristics, and severity of AKI based on the RIFLE classification between the two groups. Results Of the total 611 patients, 78 (12.8%) were categorized into the HA group. Compared to patients in the NA group, patients in the HA group were older (73 ± 9 vs. 62 ± 14 years, P<0.001). The HA group had a significantly longer hospital stay (9.6 ± 6.2 vs 6.2 ± 3.1 days, p<0.001) and a higher incidence of complications in respiratory and cardiovascular systems. Furthermore, AKI developed significantly more in patients in the HA group (58% vs. 18%, p<0.001) as compared to the NA group. The overall incidence of AKI was 23.1%; of which, 14.9%, 7.0%, and 1.2% of cases were classified as Risk, Injury, and Failure, respectively. The serum albumin level correlated with AKI severity (3.4 ± 0.5 vs 3.0 ± 0.5 vs 2.6 ± 0.3, p<0.05). In a multivariate logistic regression analysis for predicting AKI, age, presence of co-morbidities such as chronic kidney disease, total bilirubin, leukocytosis, and hypoalbuminemia were significant predictors for AKI. Conclusion Serum albumin level is helpful to predict the development and severity of scrub typhus-associated AKI.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Clinical significance of hypoalbuminemia in patients with scrub typhus complicated by acute kidney injury

Lim

Cho

et al. 2021

PLoS ONE

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“…also observed that mean age of affected population was 45.7 ± 15 years with female to male ratio of 1.68:1. [ 10 ] So, studies suggest that any febrile young patient from rural background should always be evaluated for Scrub typhus.…”

Section: Discussionmentioning

confidence: 99%

Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India

Verma

Gupta

Arya

et al. 2021

Journal of Family Medicine and Primary Care

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Background: Scrub typhus is a neglected rickettsial disease in India. Every year, we are facing outbreaks of Scrub typhus after Monsoon season. Patients present with a wide clinical spectrum ranging from pyrexia of unknown origin to multiple organ dysfunction. Some of these clinical features overlap with presentation of other tropical infections prevalent in Indian subcontinent, which leads to diagnostic dilemma and delay in diagnosis. Hence, we planned this study to know the demographic, clinical and biochemical profile of scrub typhus patients. Methods: This was an observational study conducted in department of Medicine, King George's Medical University Lucknow, India a leading tertiary care hospital of Northern India. All scrub typhus patients were evaluated by detailed history, examination and laboratory tests. Results: We enrolled 52 patients in our study. The mean age of the patients was 35.17 ± 16.90 years with majority (82.7%) of patients from rural background. All the patients had fever with an average duration of 9.6 ± 2 days. Most of the patients developed hepatitis (69.2%) followed by acute encephalitis syndrome (47%), acute kidney injury (23.1%) and acute respiratory failure (19.2%). Eschar was found in 11 patients (21.2%). Conclusion: Scrub typhus is often misdiagnosed or diagnosed late due to its wide clinical spectrum overlapping with clinical presentation of other commonly prevalent tropical diseases. One should always consider the differential diagnosis of scrub typhus while evaluating a young febrile patient of rural background, with features of single or multiple organ dysfunction and laboratory findings of leucocytosis, thrombocytopenia and elevation of transaminases.

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“…69 Scrub typhus has recently been documented to be an important cause of acute febrile illness in India and is being seen in increasing numbers. 21,[70][71][72] AKI is common in scrub typhus, with frequency ranging from 36-82%, 21,73 and is an independent predictor of mortality. 21 Pathogenetic factors include impaired renal perfusion secondary to volume depletion or increased vascular permeability, direct tubular toxicity, rhabdomyolysis, interstitial nephritis, immune mediated glomerular injury and thrombotic microangiopathy.…”

Section: Scrub Typhusmentioning

confidence: 99%

Community-Acquired AKI in Asia: An Update

Kumar

Jha

2020

Seminars in Nephrology

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Scrub typhus-associated acute kidney injury: A study from a South Indian Tertiary Care Hospital

Cited by 18 publications

References 27 publications

Clinical significance of hypoalbuminemia in patients with scrub typhus complicated by acute kidney injury

Clinical significance of hypoalbuminemia in patients with scrub typhus complicated by acute kidney injury

Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India

Community-Acquired AKI in Asia: An Update

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