Clinical Manifestation and Complications of Scrub Typhus Cases: A Hospital-based Observational Study from Rural Part of West Bengal

Abstract

Introduction: Scrub typhus is very common re-emerging Rickettsia infection in India and many other South East Asian countries. The unplanned urbanization, deforestation and easy transportation leads to changes of place of occurrence of scrub typhus from hilly and forest terrains to plan land with different clinical manifestation. Aim: This study was conducted to identify the regional characteristic of clinical sign, symptom and treatment outcome of scrub typhus patients admitted in a tertiary level hospital of Murshidabad district of West Bengal. Methods: An observational cross sectional study was conducted among 82 hospitalized scrub typhus patients during September, 2019 to March, 2020. Patients were selected by purposive sampling procedure. Data were analyzed in descriptive statistic. Results: All study participants presented with acute febrile illness with other symptoms like headache, cough, dyspnea, nausea, generalized weakness, abdominal pain and myalgia. On examination, patients had hepatosplenomegaly (21%), lymphadenopathy (7%), pedal edema (14%), Icterus (12%) and eschar (4%). On investigation, elevated ALT (37%), elevated AST (36%), Low platelet count (25%), low Hb% (52%), elevated WBC count (37%) levels were the most common findings. Interestingly few patients diagnosed with co-morbid infections eg: enteric fever (12%), Urinary tract infection (12%), respiratory tract infection (27%), dengue fever (5%) and malaria (2%). Low mortality rate (4%) was observed due to tertiary level health care services and increased awareness among local medical fraternities on scrub typhus apart from lower virulence or indigenous resistance as host or environment factor. Conclusion: Scrub typhus is an important zoonotic disease of variable presentation with low fatality if diagnosed and treated early. It is necessary to include scrub typhus serology test as routine blood test for all acute febrile illness patients for this area.

Seroprevalence of Scrub typhus in a rural tertiary care hospital of Eastern India

“…16,17,18 Fever is the most common symptom reported by the different patients which is similar to other studies. 3,9,19 No mortality was found in the study and all the patients recovered fully from the infection probably because of early diagnosis and increased use of the drug Doxycycline for the treatment of the infection.…”

Acute Pancreatitis - A Rare Manifestation in Scrub Typhus

“…Evidence of eschar highly favours the diagnosis. 8 The disease should be aggressively treated as early as possible because late recognition and treatment are associated with multiple complications and high mortality. Acute pancreatitis itself is a very rare complication encountered in scrub typhus and earlier studies have shown high mortality associated with it.…”

Outbreak prone communicable diseases of public health importance in the northern districts of West Bengal – Current status & the way forward

“…Scrub typhus has re-emerged and is brazenly challenging the public health professionals with newer and varied clinical presentations, elusive epidemiology and its expansion and presence in areas not known for its endemicity 51 . The recent years has seen an increase in the number of cases of ST in the entire State including the North Bengal districts which possibly is due to enhanced awareness of ST as an important cause of AES and AFI among the medical practitioners 52 . The large number of reported outbreaks of AES and AFIs over the last decade, coupled with the increased access to testing facilities for ST in at least tertiary level hospitals has contributed substantially to an enhanced awareness amongst all stakeholders.…”