Eschar in scrub typhus

Kundavaram, Abhilash; Jonathan, Ashish; Nathaniel, S D; Varghese, George M.

doi:10.4103/0022-3859.118033

Cited by 69 publications

(54 citation statements)

References 4 publications

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“…In this study, it was found that the eschar was mainly confined to the trunk, inguinal, genital and axially areas of the patients. Similar pattern distribution was observed in studies carried out in India [9] which also revealed a significant difference in the distribution of eschars between males and females. While the location of eschars is common on the chest and abdomen among females, the axilla, groin and genitalia areas were more common in males.…”

Section: Discussionsupporting

confidence: 88%

Emerging scrub typhus infection in the northern region of Sri Lanka

2014

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BackgroundThere is an increasing trend in rickettsioses or typhus fevers in the island of Sri Lanka. The seroepidemiological mapping previously published did not include the northern region of the island. This study was conducted to demonstrate the presence of scrub typhus (ST) and to characterise the clinical presentation of ST in this region.FindingsSerum samples from patients (n = 64) with clinical symptoms suspected of typhus fever following exclusion of other common febrile illnesses commonly seen in the northern region of Sri Lanka were selected and screened for ST using specific IgM and IgG ELISA (ImBios, USA). ST was confirmed by serology in 54 patients, with typical eschar being found in 49 of cases positive for ST. Fever was the sole presenting complaint of these patients with the duration of febrile illness varying from 2–14 days. Of these patients 44.4% had regional lymphadenopathy, 18.5% hepatomegaly, 12.9% pneumonitis and 9.3% splenomegaly. None of the patients had a rash.ConclusionsThis study confirms the presence of high numbers of patients with ST in northern Sri Lanka. It was found that 84.4% of the patients presenting with clinical features of rickettsioses (54 of the 64) were seropositive for ST with a significant majority having a typical eschar. This data provided will enable clinicians to be vigilant of ST in this region and provide appropriate therapy and also facilitate planning for preventive measures aimed at reducing the burden of ST.

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Section: Discussionsupporting

confidence: 88%

Emerging scrub typhus infection in the northern region of Sri Lanka

2014

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“…12 A necrotic eschar which is considered as most useful diagnostic clue for scrub typhus was present in 46(45%) cases of our study population similar to a study done in Taiwan though it was reported as high as 86.3% in some study and also as low as 5%. [13][14][15] In our present study the commonest site of eschar was inguinal region 18%, followed by trunk and axilla, similar to the study by Jamil. 16 Few patients had eschar in the inframammary region and one had penile eschar.…”

Section: Discussionsupporting

confidence: 78%

A study on demographic, clinical profile and outcome of scrub typhus

2016

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“…In females it was primarily present in the chest and abdomen (42.3%), while in males it was present in the axilla, groin and genitalia (55.8%). Unusual sites of eschar were reported to be in the cheek, ear lobe and dorsum of the feet [32] . Five to eight days after the onset of fever, a macular or maculopapular rash may appear on the trunk and later extend to the arms and the legs in a small proportion of patients [31] .…”

Section: Clinical Featuresmentioning

confidence: 99%

“…In a large retrospective analysis of 418 patients with confirmed scrub typhus and an eschar, a significant difference in the distribution of eschar was noted between males and females [32] . In females it was primarily present in the chest and abdomen (42.3%), while in males it was present in the axilla, groin and genitalia (55.8%).…”

Section: Clinical Featuresmentioning

confidence: 99%

Severe scrub typhus infection: Clinical features, diagnostic challenges and management

Peter

Sudarsan

Prakash

et al. 2015

WJCCM

133

121

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Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay (IFA) for the detection of IgM antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%.

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Eschar in scrub typhus

Abstract: The eschar is the most useful diagnostic clue in patients with acute febrile illness in areas endemic for Scrub typhus and therefore should be thoroughly examined for its presence especially over the covered areas such as the groin, genitalia, infra-mammary area and axilla.

Cited by 69 publications

References 4 publications

Emerging scrub typhus infection in the northern region of Sri Lanka

Emerging scrub typhus infection in the northern region of Sri Lanka

A study on demographic, clinical profile and outcome of scrub typhus

Severe scrub typhus infection: Clinical features, diagnostic challenges and management

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