Acute Respiratory Distress Syndrome in Scrub Typhus

Abstract

Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi. Acute respiratory distress syndrome (ARDS) is a serious complication of scrub typhus. This study retrospectively reviewed the medical records of 72 patients diagnosed with scrub typhus from January 1998 to August 2006 in Kaohsiung Chang Gung Memorial Hospital in Taiwan. Eight of 72 scrub typhus patients with ARDS were included in the study; the other patients without ARDS were used as controls. The mortality rate for the scrub typhus patients with ARDS was 25%. The eight patients seldom had underlying diseases. Initial presentations of dyspnea and cough, white blood cell count, hematocrit, total bilirubin, and delayed used of appropriate antibiotics use were significant predictors of ARDS. Multivariate analysis showed that albumin, prothrombin time, and delayed use of appropriate antibiotics were independent predictors of ARDS. Identification of these relative risk factors may help clinicians evaluate clinical cases of scrub typhus with ARDS.

Does the presence of an eschar correlate with severity of scrub typhus infection?

“…Previous studies from India show an incidence of acute respiratory distress syndrome of 8-25% with majority of them requiring invasive ventilation. [7,12,13] Tsay and Chang reported no association between the presence of an eschar and pulmonary involvement. [13] In our study 8.2% of patients overall required invasive ventilation with no difference noticed between the two groups.…”

A gender based comparative analysis of laboratory investigations in scrub typhus patients at tertiary care teaching hospital of Southern Rajasthan, India

“…Similar mortality rates were reported by other studies too. 3,[14][15][16][17] Mortality has been reported from 0% to 30%. The reason for this much of range of mortality can be due to patient's age, region of infection, missed or delayed diagnosis etc.…”

Rickettsial Infections in Southeast Asia: Implications for Local Populace and Febrile Returned Travelers

“…11,66 Pulmonary involvement occurs in up to 50% of patients 28,65 but clinical manifestation of acute respiratory distress syndrome is rare. [67][68][69][70] Mortality rates can be up to 25% and scrub typhus could be potentially mistaken for melioidosis or leptospirosis, which are more common in the region. 69,70 Atypical clinical features and absence of eschar may result in delayed diagnosis, complications, or death.…”

“…[67][68][69][70] Mortality rates can be up to 25% and scrub typhus could be potentially mistaken for melioidosis or leptospirosis, which are more common in the region. 69,70 Atypical clinical features and absence of eschar may result in delayed diagnosis, complications, or death. 47,[66][67][68] Laboratory abnormalities of scrub typhus may include leukopenia or mild leukocytosis and thrombocytopenia.…”