Scrub typhus in North India: clinical spectrum, laboratory parameters and treatment outcome in tertiary care teaching hospital

Abstract

Background: Scrub typhus is an acute febrile illness causing serious complications leading to significant mortality especially if there is delay in diagnosis and treatment. It is caused by Orentia tsutsugamushi a gram negative bacterium and transmitted by the bite of the trombiculid mite (chigger). This study was undertaken to document the clinical manifestations, laboratory parameters and treatment outcomes of scrub typhus cases.Methods: This retrospective study was done in a tertiary care teaching hospital which included 40 confirmed cases of scrub typhus. The diagnosis was confirmed by positive IgM ELISA. Clinical spectrum and manifestations, laboratory parameters and course in hospital with outcomes were evaluated. Factors associated with complications and mortality were analyzed.Results: The mean age of the patients was 40 ±15 yrs with almost equal proportion of males and females (47.5 vs 52.5%). The most common presenting symptoms were Fever (100%), shortness of breath (40%), altered sensorium (22.5%), nausea/vomiting (10%), and diarrhea (7.5%). Mean duration of fever before presentation to hospital was 11.1±4.9 days. Eschar was seen in 15% of patients. Common laboratory abnormalities documented was thrombocytopenia (85%), elevated transaminases (57%) leukocytosis (45%), and leucopenia (15%). About 37.5% of patients developed multiple organ dysfunction syndrome (MODS) with case fatality rate was 10%. Acute renal failure, acute hepatitis, need of ventilator support and CNS dysfunction was higher among patient with MODS.Conclusions: Scrub typhus patients can have a wide range of manifestation ranging from mild illness to serious and life threatening complications like acute respiratory distress syndrome, acute renal failure, and acute hepatitis and CNS dysfunction. High index of suspicion with early recognition and treatment is key for good outcome. Use of empirical doxycycline may be lifesaving.