Hypoalbuminemia and Multi Organ Dysfunction in a Case of Scrub Typhus

Sridevi, S.; Mythili, SV; Aj, Manjula Devi; Shanthi, B.; Vs, Kalai Selvi

doi:10.17659/01.2013.0043

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…Patients with ARDS had more deranged liver parameters and raised serum creatinine, LDH, creatinine phosphokinase (CPK), and serum lactate. 20,21 It is essential to make the rapid diagnostic kit available to all the district level hospitals. It is also important to conduct large prospective studies to validate our findings, so that clinicians can manage the cases more effectively.…”

Section: 12mentioning

confidence: 99%

Scrub typhus an emerging public health threat in Eastern Nepal: an analysis from a tertiary centre during two years outbreak

Yadav

Dharel

Shah

et al. 2018

Int J Contemp Pediatr

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Background: Scrub typhus is an emerging disease in the eastern part of Nepal. Varied clinical presentation and lack of laboratory resources make diagnosis difficult. Epidemic outbreaks have been reported from different parts of Nepal. The objective of this study was to describe the clinical presentation, complications, laboratory profile and outcome of admitted cases with scrub typhus.Methods: The cases (1 month to 15 years) admitted in paediatric ward or intensive care with confirmed serological diagnosis of scrub typhus over a period of two years 2015 and 2016, were retrospectively evaluated from the maintained records. All the clinical and laboratory parameters along with intervention and outcome were analysed by descriptive statistics.Results: There were 52 cases of scrub typhus of which 30 were female and 22 males. The youngest case was 2.5 months old and the median age was 3.6 years, mode being 14 years (7 cases). Majority (>71%) of cases were from the hilly districts. Mean duration of illness at presentation was 7.8±2.7 days and ≥94% of the cases had temperature of ≥102°F. More than half of the cases had hepatomegaly (78%), splenomegaly (53.8%), respiratory symptoms (53.8%) and the classical eschar (55.8%). The mean haemoglobin of the cases was below 10 g/dl and the mean platelet count was below 70,000/cu mm, along with hyponatremia, hypoalbuminemia and elevated liver enzymes. X-rays showing variable infiltrates were seen in 59.6%. Respiratory complications like pneumonia and acute respiratory distress syndrome (ARDS) were seen in 46%, encephalopathy in 12%, myocarditis in 40.2%and acute kidney injury in 7.6%. Twenty percent of the cases required intensive care management. There was 15.4% mortality, and all the cases who succumbed had ARDS and myocarditis.Conclusions: In this study the main clinical features were hepatomegaly, splenomegaly, respiratory symptoms and the classical eschar. Mortality was 15.4%. ARDS and myocarditis were present in all cases who died.

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