Pancreatitis and MODS Due to Scrub Typhus and Dengue Co-Infection

Iqbal, Nayyar; Viswanathan, Stalin; Remalayam, Bhavith; Muthu, Vivekanandan; George, Tarun K

doi:10.2149/tmh.2012-07

Cited by 30 publications

(25 citation statements)

References 7 publications

(8 reference statements)

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“…The differential diagnoses of scrub typhus in our setting include enteric fever, dengue, leptospirosis and malaria [22] all of which had been ruled out in our patients save one, who had a co-infection with dengue [18]. Clinical diagnosis is often made/confirmed by the presence of an eschar and clinical improvement following doxycycline therapy [22].…”

Section: Discussionmentioning

confidence: 85%

“…The first subject also had a posterior pericardial effusion. There was one woman (28 y) with 28 weeks' gestation, one case of acute pancreatitis following co-infection with dengue [18], one man with a papular rash, one woman (38 y) admitted under surgery for an acute abdomen and another woman (53 y) on antiretroviral therapy. HIV testing performed for lymphocytic meningitis was negative in all the 17 patients.…”

Section: Resultsmentioning

confidence: 99%

“…In our setting hepatomegaly and hepatic dysfunction were seen in 41.8% and 24.6% of subjects respectively while CXR abnormalities were observed in 20(30.8%) patients. Unusual manifestations include ARDS, myocarditis, pancreatitis, hemophagocytic syndrome, disseminated intravascular coagulation (DIC) and meningoencephalitis [25],[18]. Myocarditis, pleural effusion and gastrointestinal (GI) hemorrhage are more common with winter scrub typhus [12].…”

Section: Discussionmentioning

confidence: 99%

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Scrub Typhus Meningitis in South India — A Retrospective Study

et al. 2013

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BackgroundScrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reportsMethodsA retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness- a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits.ResultsSixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol.ConclusionMeningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.

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Section: Discussionmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Scrub Typhus Meningitis in South India — A Retrospective Study

et al. 2013

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“…Scrub typhus has been reported as a co-infection with viruses, bacteria and malarial parasites. The viruses include HIV [5], dengue [6] and H1N1 [7], while the bacterial group includes leptospira [8], Mycoplasma pneumoniae [9] and Arsenophonus nasoniae [10]. Co-infections can lead to persistent fever despite adequate therapy, atypical symptoms or signs that are not attributable to the primary illness (like in our case), and worsening of common symptoms (e.g., headache due to both varicella meningitis and scrub typhus).…”

Section: Discussionmentioning

confidence: 73%

Lost in a haystack: The importance of physical re-examination

Jain

Viswanathan

Shanmugam

2014

Journal of Infection and Public Health

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We report an unusual case of varicella zoster in a 19-year-old, who presented with persisting fever even after her lesions began forming scabs. Fever workup for secondary complications was negative. A re-examination revealed an axillary eschar. She recovered completely with doxycycline. This report suggests the importance of keeping in mind, epidemiological data of common diseases in the locality, as well as the significance of a thorough physical examination in patients with fever.

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“…Pancreatitis has been reported as a rare complication presenting in <3% of cases as per various case reports 1. Pancreatitis in coinfection of scrub typhus and dengue is also reported 18. Hyperamylasaemia and hyperlipasaemia associated with multiorgan failure and lasting for around 10 months is also reported in a patient with scrub typhus 13…”

Section: Discussionmentioning

confidence: 93%

Pancreatitis in scrub typhus: a rare complication

Dhakal

Bhandari

2014

BMJ Case Reports

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Scrub typhus is a zoonosis transmitted by a trombiculid mite which introduces bacteria of Orientia tsutsugamushi by its bite. The acute febrile illness is characterised by eschar at the site of the bite with maculopapular rashes and local and/or generalised lymphadenopathy. The disease is endemic in the tsutsugamushi triangle. Sikkim, a small Himalayan north-eastern state, is also not unaffected where outbreaks of the disease have been reported. The clinical spectrum of the disease ranges from mild to fatal depending on the virulence of the bacterial strain, susceptibility of the host and promptness of the treatment. In severe cases, there can be multiple organ involvement. Pancreatitis is a serious and unusual complication of this disease, which was seen in our presentation. A 22-year-old man, diagnosed to have scrub typhus, developed pancreatitis in the second week of the illness and responded well to medical treatment.

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Pancreatitis and MODS Due to Scrub Typhus and Dengue Co-Infection

Cited by 30 publications

References 7 publications

Scrub Typhus Meningitis in South India — A Retrospective Study

Scrub Typhus Meningitis in South India — A Retrospective Study

Lost in a haystack: The importance of physical re-examination

Pancreatitis in scrub typhus: a rare complication

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