Scrub Typhus Cases in a Teaching Hospital in Penghu, Taiwan, 2006–2010

Wang, Ying-Chuan; Chen, Po-Chuan; Lee, Kwai-Fong; Wu, Yi–Chang; Chiu, Chong‐Chi

doi:10.1089/vbz.2012.1059

Cited by 18 publications

(17 citation statements)

References 15 publications

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“…This finding is similar to those of other studies, where the rural population appears to be more susceptible to rickettsial infections [19,20]. The seasonal determinants of rickettsial infection depend on the climate, temperature, and degree of rainfall in that region [18].…”

Section: Discussionsupporting

confidence: 91%

Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

Thomas

Puranik

Kalal

et al. 2016

J Infect Dev Ctries

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Introduction: Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management. Methodology: Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data. Results: Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive WeilFelix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Overall mortality among hospitalised children was 1.9%. Conclusions: This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.

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Section: Discussionsupporting

confidence: 91%

Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

Thomas

Puranik

Kalal

et al. 2016

J Infect Dev Ctries

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“…In our study, most patients were from the rural areas Karnataka, Andhra Pradesh, and Tamil Nadu. This finding is similar to those of other studies, where the rural population appears to be more susceptible to rickettsial infections [19,20]. The seasonal determinants of rickettsial infection depend on the climate, temperature, and degree of rainfall in that region [18].…”

Section: Discussionsupporting

confidence: 91%

Five - Year Analysis of Rickettsial Fevers in Children in South India: Clinical Manifestations and Complications

Thomas¹,

Puranik²,

Kalal³

et al. 2013

Pediatric Oncall

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Introduction: Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management. Methodology: Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data. Results: Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive Weil-Felix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Overall mortality among hospitalised children was 1.9%. Conclusions: This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.

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“…We did not note any geographic clustering. The condition was also seen in urban residents,who are traditionally considered to be at low risk [28], [29]. Whether this is related to environment, host, pathogen or vector related factors needs further studies.…”

Section: Discussionmentioning

confidence: 96%

Scrub Typhus Is an Under-recognized Cause of Acute Febrile Illness with Acute Kidney Injury in India

Kumar

Yadav

et al. 2014

PLoS Negl Trop Dis

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BackgroundInfection-related acute kidney injury (AKI) is an important preventable cause of morbidity and mortality in the tropical region. The prevalence and outcome of kidney involvement, especially AKI, in scrub typhus is not known. We investigated all patients with undiagnosed fever and multisystem involvement for scrub typhus and present the pattern of renal involvement seen.MethodsFrom September 2011 to November 2012, blood samples of all the patients with unexplained acute febrile illness and/or varying organ involvement were evaluated for evidence of scrub typhus. A confirmed case of scrub typhus was defined as one with detectable Orientia tsutsugamushi deoxyribonucleic acid (DNA) in patient's blood sample by nested polymerase chain reaction (PCR) targeting the gene encoding 56-kDa antigen and without any alternative etiological diagnosis. Renal involvement was defined by demonstration of abnormal urinalysis and/or reduced glomerular filtration rate. AKI was defined as per Kidney Disease: Improving Global Outcomes (KDIGO) definition.ResultsOut of 201 patients tested during this period, 49 were positive by nested PCR for scrub typhus. Mean age of study population was 34.1±14.4 (range 11–65) years. Majority were males and a seasonal trend was evident with most cases following the rainy season. Overall, renal abnormalities were seen in 82% patients, 53% of patients had AKI (stage 1, 2 and 3 in 10%, 8% and 35%, respectively). The urinalysis was abnormal in 61%, with dipstick positive albuminuria (55%) and microscopic hematuria (16%) being most common. Acute respiratory distress syndrome (ARDS) and shock were seen in 57% and 16% of patients, respectively. Hyperbilirubinemia was associated with AKI (p = 0.013). A total of 8 patients (including three with dialysis dependent AKI) expired whereas rest all made uneventful recovery. Jaundice, oliguria, ARDS and AKI were associated with mortality. However, after multivariate analysis, only oliguric AKI remained a significant predictor of mortality (p = 0.002).ConclusionsScrub typhus was diagnosed in 24% of patients presenting with unexplained febrile illness according to a strict case definition not previously used in this region. Renal abnormalities were seen in almost 82% of all patients with evidence of AKI in 53%. Our finding is contrary to current perception that scrub typhus rarely causes renal dysfunction. We suggest that all patients with unexplained febrile illness be investigated for scrub typhus and AKI looked for in scrub typhus patients.

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Scrub Typhus Cases in a Teaching Hospital in Penghu, Taiwan, 2006–2010

Cited by 18 publications

References 15 publications

Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications

Five - Year Analysis of Rickettsial Fevers in Children in South India: Clinical Manifestations and Complications

Scrub Typhus Is an Under-recognized Cause of Acute Febrile Illness with Acute Kidney Injury in India

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