Scrub Typhus in a Tertiary Care Hospital in North India

Sharma, Navneet; Biswal, Manisha; Kumar, Abhay; Zaman, Kamran; Jain, Sanjay; Bhalla, Ashish

doi:10.4269/ajtmh.16-0086

Cited by 72 publications

(68 citation statements)

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“…The male-to-female ratio was 1.4:1 in our study which is similar to other studies from South India. [ 14 15 16 17 18 19 ] A similar male preponderance has also been seen in other studies from the Asia-Pacific region outside India except South Korea (male-to-female ratio of 1:1.6), a trend that may be influenced by the prevailing socioeconomic culture of females occupied with farming. [ 20 21 22 23 24 ]…”

Section: Discussionsupporting

confidence: 63%

Critical illness scoring systems: Sequential organ failure assessment, Acute Physiology and Chronic Health Evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions

Balasubramanian

Sharma

Biswal

et al. 2018

Indian Journal of Critical Care Medicine

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Background and Aim:Scrub typhus (ST) is an acute infectious disease of variable severity caused by Orientia (formerly Rickettsia) tsutsugamushi. The disease can be complicated by organ dysfunctions and the case fatality rate (CFR) is approximately 15%, which further rises with the development of severe complications. We studied the clinical features of the ST and the performance of critical illness scoring systems (CISSs) – Acute Physiology and Chronic Health Evaluation (APACHE) II, sequential organ failure assessment (SOFA), and quick SOFA (qSOFA) in predicting the clinical outcomes in complicated ST (cST) patients admitted to the emergency department.Study Design and Methods:A prospective observational study was done in 50 patients diagnosed to have cST with one or more organ dysfunctions. Clinical features and laboratory parameters were recorded and the patients were followed up until the end of their stay in the hospital. APACHE II, SOFA, and qSOFA scores at admission were calculated and were analyzed in predicting the clinical outcomes.Results:The median SOFA, APACHE II, and qSOFA scores of the cohort were 7 (interquartile range [IQR] = 13–22), 8 (IQR = 5–11), and 2 (IQR = 1–3), respectively. The median duration of in-hospital stay was 9 (IQR 5–11) days and overall CFR was 8%. On bivariate analysis, both SOFA (P = 0.031) and qSOFA (P = 0.001) predicted mortality. However, only SOFA score correlated with the in-hospital stay duration (Pearson's correlation = 0.311, P = 0.028).Conclusion:Among the three CISSs studied, the SOFA score correlated with in-hospital stay duration and mortality, whereas the qSOFA score formed a simple as well as a convenient tool in predicting the mortality in patients of cST with organ dysfunction.

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Section: Discussionsupporting

confidence: 63%

Critical illness scoring systems: Sequential organ failure assessment, Acute Physiology and Chronic Health Evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions

Balasubramanian

Sharma

Biswal

et al. 2018

Indian Journal of Critical Care Medicine

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“…(16) Classically known as a post monsoon disease, this seasonal occurrence of scrub typhus was a prolonged one, extending well into the month of December. (17) During our study also period of highest incidence was found to be in post monsoon season (August to November). Eschar at the site of attachment of the larval mite/chigger is considered highly suggestive of scrub typhus, but occurs in a variable proportion of patients in different studies.…”

Section: Discussionsupporting

confidence: 62%

Scrub Typhus in a Tertiary Care Hospital in Visakhapatnam

Shankar¹,

Roopalatha²,

Lakshmi³

2019

jemds

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BACKGROUND Scrub typhus is a serious public health problem in the Asia-Pacific area including, India. It is a zoonotic disease and usually presents with acute febrile illness along with multi-organ involvement caused by Orientia tsutsugamushi. It is transmitted to humans by the bite of the larvae of trombiculid mites (Chiggers) which feed on forest and rural rodents. The mites are both vector and natural reservoir. Human infection follows a chigger bite. Incubation period is 6-21 days. Onset of scrub typhus is characterised by fever, headache, myalgia, cough and gastrointestinal symptoms. A primary lesion which later crusts to form a flat black eschar may be present which is pathognomonic feature of scrub typhus. If the condition is not treated, serious complications may occur involving various organ systems. Owing to potential for severe complications, diagnosis and decision to initiate treatment should be based on clinical suspicion and confirmed by serological tests. The recommended treatment for scrub typhus is doxycycline. Our aim was to study the magnitude of scrub typhus antibodies among febrile patients for a period of one year in a tertiary care hospital and to assess clinical features and outcomes of serologically positive patients. METHODS Blood was collected aseptically from 131 patients with request for investigation of scrub typhus from various departments. Screening for scrub typhus was done by rapid Immunochromatographic test to identify antibodies. RESULTS During the 1-year study period, a total of 131 serum samples presenting with fever were tested for scrub typhus. Of these, 46 samples were found seropositive. Among these patients, Eschar was found only in 4.3% of cases. In one patient tuberculosis and in 3 patients dengue was found as co-infection. Seasonally the highest number of cases were observed in the cooler months of the year. Male to female ratio was not significant. The percentage of patients positive for scrub typhus was highest (17.6%) in the age group 16-25 years followed by (15.4%) in 26-35 year. None among the age group of 0-15 year was positive. CONCLUSIONS Prompt diagnosis, timely antimicrobial therapy and intensive supportive care are important to prevent life-threatening complications. Scrub typhus detected by immunochromatography can be utilized as part of initial investigation to guide the clinicians. In the present study we found that our results highlight that scrub typhus infection is an important cause of fever and active surveillance is necessary to access exact magnitude and distribution of the disease.

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“…Fever of >12 days, presence of eschar, ICU admission, shock needing ionotropes, CNS dysfunction etc. have also been proven to be predictors of mortality [ 5 , 14 , 35 ]. These give valuable hints to the impending fatal outcome and may help the clinicians to initiate the intensive management.…”

Section: Discussionmentioning

confidence: 99%

Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India

et al. 2016

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BackgroundIndia is an integral component of “tsutsugamushi triangle” which depicts a part of the globe endemic to scrub typhus. Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is described as a re-emerging infectious disease in India. The present study aimed to study the clinical and paraclinical profile, complications and predictors of outcome among 90 cases of scrub typhus diagnosed in a hospital of north-eastern India from Sept 2011 to Aug 2012.MethodsA longitudinal study was conducted in a hospital of Meghalaya, India between Sept 2011 and Aug 2012. Diagnosis of scrub typhus was arrived by SD BIOLINE tsutsugamushi (solid phase immunochromatographic assay) rapid diagnostic test for antibodies (IgM, IgG or IgA). Descriptive analyses of age, gender, geographic area, symptoms and signs, treatment, laboratory findings, complications, and outcome were conducted. Relative risk (RR) with 95 % confidence interval (CI) was computed for Multiple Organ Dysfunction Syndrome (MODS) and mortality. Binary logistic regression was applied to the significant correlates (P < 0.05) on univariate analysis to identify the predictors of MODS and mortality in scrub typhus.ResultsAs many as 662 clinically suspected scrub typhus patients were tested and 90 (13.6 %) were diagnosed to have scrub typhus. Out of 90 patients, 52.2 % (n = 47) were males and their mean (SD) age was 36.29 (13.38) years. Fever of <7 days (n = 75, 83.3 %), myalgia (n = 56, 62.2 %), pain abdomen (n = 24, 26.7 %), headache (n = 24, 26.7 %), nausea/vomiting (n = 21, 23.3 %), dry cough (n = 21, 23.3 %), hepatomegaly (n = 24, 26.7 %), splenomegaly (n = 22, 24.4 %), and lymphadenopathy (n = 20, 22.2 %) were the predominant clinical features. Eschar was seen in 10 patients (11.1 %). One third (n = 30) of the patients developed at least one systemic complication. Acute hepatitis (n = 15, 16.7 %), pneumonitis (n = 14, 15.6 %), and acute kidney injury (n = 11, 12.2 %) were the common complications. MODS was seen in 14.4 % (n = 13) and 38.5 % (n = 5) of the patients with MODS died. Overall, case fatality rate was 5.15 % (n = 5). On univariate analysis, platelets <100 000/mm3, serum creatinine >1.5 mg/dl, and transaminase (AST, ALT or both) >500 U/L were associated with MODS (P < 0.001) and mortality (P < 0.05). In addition, serum bilirubin >3 mg/dl was also associated with MODS (P < 0.001). On applying binary logistic regression, serum creatinine >1.5 mg/dl was a predictor of MODS (OR: 76.1, 95 % CI: 4.9–1175.6) and mortality (OR: 18.03, 95 % CI: 1.38–235.1).ConclusionIn this study setting, approximately one-seventh (13.6 %) of the acute undifferentiated febrile illness were due to scrub typhus. Systemic complications were common (33.3 %). Serum creatinine >1.5 mg/dl was a predictor of MODS and mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0186-x) contains supplementary material, which is available to authorized users.

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Scrub Typhus in a Tertiary Care Hospital in North India

Cited by 72 publications

References 32 publications

Critical illness scoring systems: Sequential organ failure assessment, Acute Physiology and Chronic Health Evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions

Critical illness scoring systems: Sequential organ failure assessment, Acute Physiology and Chronic Health Evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions

Scrub Typhus in a Tertiary Care Hospital in Visakhapatnam

Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India

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