Hepatic Impairment Induced by Scrub Typhus is Associated with New Onset of Renal Dysfunction

Abstract

Background: Scrub typhus is a potentially fatal infectious disease caused by Orientia tsutsugamushi. There is little attention given to hepatic impairment in the adults with scrub typhus. This study investigated the incidence and the prognostic implications of hepatic impairment in patients with scrub typhus. Methods: We retrospectively reviewed a total of 143 adult patients with scrub typhus who were admitted between January 1999 and December 2010 in Guangdong province, China. The patients were divided into three groups, e.g., normal, mild, and moderate to severe groups based on the elevated serum ALT and/or total bilirubin levels. Furthermore, clinical characteristics and prognosis of the patient groups were compared. Results: 109 patients (76.2%) had abnormal liver function. Among the patients with hepatic impairment 45 cases (31.4%), 54 cases (37.8%), and 10 cases (7.0%) had mild, moderate, and severe hepatic damage, respectively. The moderate to severe hepatic impairment group had higher levels of serum creatinine compared with that of normal hepatic function. The incidence of new onset of renal dysfunction -defined as peak serum creatinine ≥ 176 µmol/L during hospital stay with no evidence of renal disease prior hospitalization -was 0% in the mild hepatic impairment group, 8.9% in the moderate hepatic impairment group, and 21.9% in the severe hepatic impairment group, (p = 0.005 for trend). Additionally, the patients with hepatic impairment (n = 109) had higher incidences of episodes of thrombocytopenia (45.9% vs. 8.82%, p < 0.001), hypoalbuminemia (50.5% vs. 11.8%, p < 0.001), new onset of renal dysfunction (16.5% vs. 0.0%, p = 0.011), and electrocardiogram abnormality (28.4% vs. 8.82%, p = 0.019) than the patients without hepatic impairment. Conclusions: The degree of hepatic impairment induced by scrub typhus is associated with new onset of renal dysfunction. (Clin. Lab. 2014;60:xx-xx.

IL-33-Dependent Endothelial Activation Contributes to Apoptosis and Renal Injury in Orientia tsutsugamushi-Infected Mice

“…Infection-induced renal dysfunction, as well as acute kidney injury, has often been described in moderate-to-severe scrub typhus [ 13 – 18 ]. The severity of disease is often correlated with the extent of renal dysfunction [ 13 , 17 , 19 , 20 ]; however, the molecular mechanism that accounts for such renal dysfunction is poorly understood.…”

Scrub typhus-related hepatotoxicity: The Indian scenario

“…There was no sign of cholestasis or apoptosis of hepatocytes. 9 61 61 (100%) North-eastern India Sinha et al 10 42 38 (94.7%) North-western India Takhar et al 11 66 32 (48.5%) North-western India Varghese et al 7 623 542 (87%) Southern India Premraj et al 12 50 41 (82%) Southern India Sharma et al 13 228 139 (61%) Northern India Kumar et al 14 330 234 (70.9%) Northern India Bhise et al 15 96 69 (72%) Central India Liang et al 16 143 109 (76.2%) Guangdong, China Yang et al 17 47 36 (77%) Taipei, China Chanta et al 18 54 52 (96.29%) Thailand…”