Scrub typhus: a reemerging infection

John, Rebecca; Varghese, George M.

doi:10.1097/qco.0000000000000664

Cited by 29 publications

(30 citation statements)

References 55 publications

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“…[ 2 12 ] In a review done by John R and Varghese GM, the incidence of AKI among patients with scrub typhus admitted to a tertiary care teaching hospital in south India was found to be 18%. [ 13 ] The incidence of AKI in our study is close to these studies. Electrolyte abnormalities in the form of hyponatremia and hypokalemia are seen in some patients with AKI.…”

Section: Discussionsupporting

confidence: 87%

Acute kidney injury and electrolyte abnormalities in patients with scrub typhus admitted to a tertiary care hospital in southern India

Grover

Mehalingam

2021

Journal of Family Medicine and Primary Care

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Introduction: Scrub typhus is an acute febrile illness that is seen in many parts of India. Acute kidney injury (AKI) can occur in patients with scrub typhus who are not diagnosed and treated in the early stage of the disease. Such patients can have associated electrolyte abnormalities also. Objectives: This study was done to find out the incidence of occurrence of AKI and electrolyte abnormalities among patients with scrub typhus and correlate the latter with the severity of AKI. Methods: This prospective, observational study included 38 patients with scrub typhus admitted to a tertiary care hospital in south India. Serum sodium and serum potassium levels of all the patients were measured at hospital admission. Also, serum creatinine levels of patients on all days of the hospital stay was measured along with other parameters like hemoglobin, leucocyte count, and platelet count. Results: The incidence of AKI among patients with scrub typhus was 13.16%. However, electrolyte abnormalities though seen in the patients did not correlate with AKI. Conclusion: AKI is not an uncommon phenomenon in patients with scrub typhus. Electrolyte abnormalities in these patients did not correlate with the severity of AKI.

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Section: Discussionsupporting

confidence: 87%

Acute kidney injury and electrolyte abnormalities in patients with scrub typhus admitted to a tertiary care hospital in southern India

Grover

Mehalingam

2021

Journal of Family Medicine and Primary Care

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“…The case fatality rate in those with ARDS was 18% [ 6 ]. In a recent review on scrub typhus, John and Varghese reported that pneumonia progressing to ARDS was seen in more than one-third of patients requiring hospitalization and was one of the common complications [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

A Study of the Profile of Scrub Typhus in a Tertiary Care Hospital in Jharkhand: An Underestimated Problem

Kamath¹,

Kumari²,

Sunder³

2022

Cureus

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Background and objectiveScrub typhus (ST) is a rickettsial infection caused by Orientia tsutsugamushi, which is transmitted by the bite of the larval stage (chiggers) of trombiculid mites. Although it presents as an acute undifferentiated febrile illness (AUFI), its course can be complicated with acute respiratory distress syndrome, acute kidney injury (AKI), myocarditis, meningoencephalitis, hepatitis, multi-organ dysfunction syndrome (MODS), and ultimately death. This study aimed to evaluate the epidemiological features, clinical profile, laboratory features, and clinical outcomes of cases of scrub typhus and identify the predictors of disease severity. Methods and materialsThis study is a retrospective observational study that included confirmed cases of scrub typhus admitted in the medical wards and critical care unit (CCU) of Tata Main Hospital (TMH) from January 1, 2019, to December 31, 2021. The case records of patients were analyzed for demographic characteristics, clinical features, treatment, and outcomes, which included length of stay (LOS), complications, and mortality. The required odds ratio (OR) was calculated, univariate and binary regression analyses were done, and a p-value of <0.05 was considered statistically significant. ResultsOf the 42 confirmed cases, 38.1% were males and 61.9% were females. The average age of male patients was 12.6 ± 11.2 years, while that of females was 22 ± 19.3 years. Of the patients, 64.3% were in the age group of 1-20 years. The clinical manifestations in descending order were fever (71.2%), skin rash (19.1%), cough (16.7%), vomiting (28.6%), altered sensorium (23.8%), abdominal pain (23.8%), loose stools (14.3%), seizures (14.3%), anasarca (9.7%), breathlessness (9.7%), and melena (7.1%). Eschar was noted in 38.1% of patients. Swelling of the body (6.7%) and lymphadenopathy (10%) were seen exclusively in children. The common laboratory abnormalities observed were leukocytosis in 34.3% of cases; thrombocytopenia in 68.8% of cases, of which 25% of patients had platelets < 50,000/mm 3 ; and transaminitis in 87.5% of cases. The ratio of AST/ALT of more than one was seen in 89.3% of patients, while it was less than one in 10.7% of patients. The average C-reactive protein (CRP) level was 10.9 ± 6.3 mg/dL. The complications noted were acute respiratory distress syndrome (ARDS) (16.7%), meningoencephalitis (21.4%), septic shock (14.3%), capillary leak syndrome (26.2%), thrombocytopenia (68.8%), transaminitis (87.5%), myocarditis (4.8%), disseminated intravascular coagulation (2.4%), and hypocalcemia (11.9%). The average length of stay (LOS) was 8.1 ± 4.2 days. Twenty-four (57.2%) patients required transfer to the critical care unit (CCU) for managing various complications. There was no mortality in this series, giving rise to the case fatality ratio (CFR) of 0. ConclusionScrub typhus is a reemerging cause of acute febrile illness. The highest number of cases were found during the post-monsoon period and in those with rural backgrounds. It presents with varying clinical mani...

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“…Scrub typhus, a potentially life-threatening disease with an enormous incidence in the Asia–Pacific Rim, remains remarkably neglected [ 12 ]. Outdoor work is the high-risk occupation associated with scrub typhus [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

mNGS helped diagnose scrub typhus presenting as a urinary tract infection with high D-dimer levels: a case report

Liu

et al. 2021

BMC Infect Dis

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Background Scrub typhus is caused by O. tsutsugamushi and spreads through mite larvae biting the skin. Classic symptoms of the disease are eschar and lymphadenopathy. Previous reports have revealed clinical manifestations of scrub typhus, including gastrointestinal symptoms, meningoencephalitis, ocular flutter, pneumonitis, acute respiratory distress syndrome, and acute kidney injury. However, cases of scrub typhus presenting as a urinary tract infection (UTI) with high D-dimer levels could be easily misdiagnosed when clinical attention is insufficient, resulting in difficulty in making a timely diagnosis of the infection. Metagenomics next-generation sequencing (mNGS) is a revolutionary and highly sensitive method that may help in diagnosing atypical cases, even when trace amounts of pathogens are present. Case presentation A 52-year-old female presented with a 10-day history of fever, chills, headache and myalgia. She was initially diagnosed with influenza at a local clinic. Various antibacterials were used on the 2nd–12th day onwards; however, her symptoms persisted and were followed by increased urination duration, frequency, urgency and dysuria for 2 days. Orientia tsutsugamushi was confirmed as the pathogen responsible for the infection through mNGS analysis of her blood samples from Day 13 onwards. The patient’s temperature changed remarkably 24 h after the initiation of doxycycline. Over the next 48 h (i.e., Day 15 onwards), the patient showed clinical improvement. She recovered and was discharged from the hospital. Conclusions Scrub typhus can present atypical clinical symptoms, such as UTIs, in a febrile patient. mNGS may be a useful method for identifying O. tsutsugamushi infection in patients with atypical clinical manifestations.

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Scrub typhus: a reemerging infection

Cited by 29 publications

References 55 publications

Acute kidney injury and electrolyte abnormalities in patients with scrub typhus admitted to a tertiary care hospital in southern India

Acute kidney injury and electrolyte abnormalities in patients with scrub typhus admitted to a tertiary care hospital in southern India

A Study of the Profile of Scrub Typhus in a Tertiary Care Hospital in Jharkhand: An Underestimated Problem

mNGS helped diagnose scrub typhus presenting as a urinary tract infection with high D-dimer levels: a case report

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