Clinical profile and improving mortality trend of scrub typhus in South India

Varghese, George M.; Trowbridge, Paul; Janardhanan, Jeshina; Thomas, Kurien; Peter, John Victor; Mathews, Prasad; Abraham, Ooriapadickal Cherian; Kavitha, M.

doi:10.1016/j.ijid.2014.02.009

Cited by 164 publications

(247 citation statements)

References 20 publications

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“…A study from south India has reported MODS in 34% of their cases. 23 ARDS occurred in 25% in our study, whereas earlier studies have reported ARDS in 8-34%. 23,27,28 An intensive care unit (ICU) study from south India has shown ARDS (96%) as the most common indication among scrub typhus patients requiring admission to their ICU.…”

Section: Discussioncontrasting

confidence: 81%

“…30,31 A maculopapular rash, as a presenting feature, was seen in 9% of our patients, as compared with 22% patients from Vellore, 20% patients from the Himalayan region of north India, 30% patients in Thailand, and 55.7% patients from Jeju Islands, South Korea. [23][24][25][26][27][28][29][30][31][32] In the present study, splenomegaly was present in 45% of patients. Another study from north India has reported a higher splenomegaly rate of 59%.…”

Section: Discussionmentioning

confidence: 61%

“…Vomiting and diarrhea occurred in 60% and 10% cases in a previous study from our institute, and in 54% and 30% cases in a study from south India. 9,23 This highlights the fact that febrile patients of scrub typhus can also present with prominent gastrointestinal symptoms.…”

Section: Discussionmentioning

confidence: 96%

“…5 In recent years, scrub typhus has rapidly remerged to become the major cause of AFI in many parts of India, especially during the monsoon and postmonsoon seasons. Of the 29 states in India, 23 have reported the presence of scrub typhus. [6][7][8][9] The clinical presentation of scrub typhus ranges from subclinical disease to multiorgan failure and death.…”

Section: Introductionmentioning

confidence: 99%

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Scrub Typhus in a Tertiary Care Hospital in North India

Sharma

Biswal

Kumar

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Scrub typhus, a zoonotic disease caused by the bacterium Orientia tsutsugamushi, has become endemic in many parts of India. We studied the clinical profile of this infection in 228 patients that reported to this tertiary care center from July 2013 to December 2014. The median age of patients was 35 years (interquartile range = 24.5-48.5 years), and 111 were males and 117 females. A high-grade fever occurred in 85%, breathlessness in 42%, jaundice in 32%, abdominal pain in 28%, renal failure in 11%, diarrhea in 10%, rashes in 9%, and seizures in 7%. Common laboratory abnormalities at presentation were a deranged hepatic function in 61%, anemia in 54%, leukopenia in 15%, and thrombocytopenia in 90% of our patients. Acute kidney injury (32%), acute respiratory distress syndrome (ARDS) (25%), and disseminated intravascular coagulation (DIC) (16%) were the commonest complications. A hepatorenal syndrome was seen in 38% and multiple organ dysfunction syndrome (MODS) in 20% patients. The overall case fatality rate was 13.6%. In univariate analysis, ARDS requiring mechanical ventilation, acute kidney injury requiring hemodialysis, hypotension requiring inotropic support, central nervous system dysfunction at presentation, and MODS were inversely associated with survival.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Scrub Typhus in a Tertiary Care Hospital in North India

Sharma

Biswal

Kumar

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…[3,4] It is a clinically important disease because it is associated with many serious complications and has a mortality rate of 14-20%. [5][6][7] Its incidence in certain parts of India reaches endemic proportions and accounts for up to 50% of undifferentiated febrile illness in those areas during cooler months of the year. [3,7] The clinical finding of a pathognomonic eschar in a patient with febrile illness is the most important clue to the diagnosis of ST.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Background & Materials and Methods:In scrub typhus (ST) the correlation of disease severity to the presence or absence of eschar is not known. We describe the differences between patients with an eschar and those without. Results: In the 193 patients, 105 (56%) had an eschar. Patients with an eschar had a higher incidence of renal failure (18.1% vs. 5.7%; P = 0.01), respiratory system involvement (30.5% vs. 13.6%; P = 0.01) and cardiovascular system (CVS) involvement (21.9% vs. 10.2%; P = 0.03). Involvement of the central nervous system, hematological system and gastro-intestinal tract were not statistically significant between the two groups. ST patients with an eschar had significantly higher requirement for noninvasive ventilation (9.1% vs. 1.9%; P = 0.04). Requirement of invasive ventilation and inotropic supports were the same in both groups. Conclusion: The presence of an eschar in patients with ST is associated with a higher incidence of renal dysfunction, CVS and respiratory system involvement and a greater requirement of noninvasive ventilatory support.

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CNS Manifestations in Orientia tsutsugamushi Disease (Scrub Typhus) in North India

2016

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This communication highlights that variable central nervous system (CNS) involvement is not uncommon in patients with scrub typhus with high mortality. CSF and neuro-radiology findings are nonspecific as these are also observed in patients with aseptic meningitis or encephalitis. Early suspection and institution of appropriate therapy without delay will lead to substantial reduction in the morbidity and mortality.

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Clinical profile and improving mortality trend of scrub typhus in South India

Abstract: Scrub typhus can manifest with potentially life-threatening complications such as lung injury, shock, and meningoencephalitis. MODS occurred in a third of our patients. The overall case-fatality rate was 9%, with shock, renal failure, and CNS associated with a higher mortality.

Cited by 164 publications

References 20 publications

Scrub Typhus in a Tertiary Care Hospital in North India

Scrub Typhus in a Tertiary Care Hospital in North India

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

CNS Manifestations in Orientia tsutsugamushi Disease (Scrub Typhus) in North India

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