Acute respiratory failure in scrub typhus patients

Abstract

Respiratory failure is a serious complication of scrub typhus. In this prospective study, all patients with a diagnosis of scrub typhus were included from a single center Intensive Care Unit (ICU). Demographic, clinical characteristics, laboratory, and imaging parameters of these patients at the time of ICU admission were compared. Of the 55 scrub typhus patients, 27 (49%) had an acute respiratory failure. Seventeen patients had acute respiratory distress syndrome, and ten had cardiogenic pulmonary edema. Respiratory supported patients were older had significant chronic lungs disease and high severity illness scores (Acute Physiology and Chronic Health Evaluation-II and Sequential Organ Failure Assessment score). At ICU admission, these patients presented with more deranged laboratory markers, including high bilirubin, high creatine kinase, high lactate, metabolic acidosis, low serum albumin, and presence of ascites. The average ICU and hospital stay were 4.27 ± 2.74 and 6.53 ± 3.52 days, respectively, in the respiratory supported group. Three patients died in respiratory failure group, while only one patient died in nonrespiratory failure group.

Scrub Typhus Pathogenesis: Innate Immune Response and Lung Injury During Orientia tsutsugamushi Infection

“…Despite these differences, certain risk factors appear to be important for ARDS development during scrub typhus: septic shock, hypoalbuminemia, high circulating white blood cell counts, delayed antibiotic treatment, and advanced age (Tsay and Chang, 2002; Jayasimha et al, 2017). Scrub typhus patients that developed ARDS presented with many clinical features, including pleural effusion, peribronchial thickening, hyaline membrane formation, and occasionally, pulmonary edema (Hsu and Chen, 2008; Abhilash et al, 2016; Sahoo et al, 2016).…”

Higher Acid-Base Imbalance Associated with Respiratory Failure Could Decrease the Survival of Patients with Scrub Typhus during Intensive Care Unit Stay: A Gene Set Enrichment Analysis

“…Critically ill patients with severe infection may require intensive care due to severe disease complications. The mortality rate of the intensive care unit (ICU) due to scrub typhus varies from 3.5% to 30.3%, depending on subjects of previous studies [10,11,12,13]. Among patients requiring intensive care, the major complication is ARF leading to the requirement for mechanical ventilation (MV).…”

Acute respiratory failure in scrub typhus patients

“…published in August 2016 issue of Indian Journal of Critical Care Medicine with great interest. [1] Delay in diagnosis of scrub typhus or late treatment with doxycycline can increase morbidity and mortality. Having suspicion about scrub typhus in patients with fever, thrombocytopenia, and polyserositis and early treatment is the key for successful outcome.…”

“…Finally, it has been mentioned in results that out of 55 patients in the prospective observational study, 29 patients required respiratory support for the neurological cause (Glasgow coma scale <8). However, the Table 1[1] highlights that 27 patients required respiratory support for ARF and two patients for nonrespiratory failure.…”