Scrub typhus complicated by acute respiratory distress syndrome and multiorgan failure; an unrecognized alarming entity in central India: A report of two cases

Abstract

Scrub typhus is an acute infectious illness, distributed throughout the Asia Pacific rim. In India, it has been reported from northern, eastern, and southern India. However, cases of scrub typhus have not been well-documented from Vidarbha, an eastern region of Maharashtra state in central India. We report two cases of complicated scrub typhus from Vidarbha region. These cases admitted in unconscious state with 8-10 days history of fever, body ache, cough, and progressive breathlessness. The diagnosis in both cases was based on presence of eschar, a positive Weil-Felix test, and a positive rapid diagnostic test (immunochromatographic assay). Both cases were complicated by acute respiratory distress syndrome (ARDS) and multiorgan failure. Both of them presented in their 2nd week of illness and died during the hospital course in spite of intensive supportive care. The main cause of mortality was delayed referral leading to delay in diagnosis and treatment.

Scrub Typhus in a Tertiary Care Hospital in North India

“…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.…”

“…The patients with bilateral chest infiltrates on a chest X-ray, a ratio of partial pressure of arterial oxygen and fraction of inspired oxygen (PaO 2 /FIO 2 ) < 300 in the absence of heart failure were defined as ARDS. 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.…”

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

“…Five to eight days after the onset of fever, a macular or maculopapular rash may appear on the trunk and later extend to the arms and the legs in a small proportion of patients [31] . 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] .…”

Scrub typhus: a case report

“…6 Scrub typhus can be complicated by encephalitis, acute renal failure, myocarditis, pneumonia, acute respiratory distress syndrome and multiple organ dysfunction syndrome. 7 Scrub typhus is difficult to recognize because the symptoms and signs are often nonspecific. The nonspecific presentation and lack of the characteristic eschar leads to misdiagnosis and underreporting.…”