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

Abstract

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.

Prevalence of Scrub typhus among Patients attending a Tertiary Care Hospital - A Prospective and Retrospective study

“…The current study showed that females were more affected as compared to males. This is concordant with the study done by Verma et al 5 Our study showed patients belonging to the age group of 41-70 years were more affected (37%) followed by patients belonging to the age group of 1-18 years (33%). This correlates with a study done by George et al where the age group of 51-60 years were affected more than other age groups.…”

“…These observations were found to be consistent with various studies. 5,6 Though the signs and symptoms of scrub typhus are common for many other infections like rickettsiosis and tularaemia, early diagnosis and treatment will bring down the in-patient burden in hospitals. 10 In our study, 5% of the patients had dengue as a co-infection.…”

An Overview of the Clinical Profile and Risk Factors Associated with Severe Scrub Typhus Infection: A Hospital Based Study in Coimbatore

“…[8] . This could be due to the fact that people in this age group are actively involved in various occupations and frequently venture out [8,18,20] . Some studies have noted a slight female preponderance for ST, with a female to male ratio ranging from 1.16:1 (F:M) to 2.8:1…”

“…(F:M) [20,21] . In the present study, a marginal male predilection was observed (51.1%, 24 of 47 patients).…”

“…While Varghese et al (2016) [8] found an equal gender distribution, Grover and Mehalingam (2021) in their study found a male preponderance (60.52%) [22] . Higher female dominance is attributed to greater involvement of women in agricultural and outdoor activities [20] . A study in south India in Telangana also found that 24.1% of patients had a history of exposure to vegetation and agricultural works [5] .…”