CLINICAL SPECTRUM OF SCRUB TYPHUS IN A TERTIARY CARE HOSPITAL AT EASTERN INDIA
Â Objective: Our hospital, tertiary care hospital in the capital of the state of Odisha, had been witnessing pyrexia of unknown origin, associated with breathlessness, renal, and liver impairment, which did not respond to high antibiotics but to doxycycline; therefore, the present study was undertaken to identify whether scrub typhus is the etiological agent, and thereafter, their characteristic features were further evaluated as an effort in supporting its diagnoses and treating patients accordingly.
Methods: A total of 65 adult patients (age >15 years) admitted with pyrexia between April 2015 and October 2017 were evaluated. Immunoglobulin M (IgM) scrub typhus test was done in all these patients. IgM scrub typhus test positive samples were included in the study and various clinical parameters analyzed.
Results: Of the 65 patients included in the study, all were found to be positive for IgM antibodies against Orientia tsutsugamushi. The cases were seen mainly in the months between September and November. The common symptoms found were fever, myalgia, breathlessness, rash, and abdominal pain and rarely altered sensorium. The diagnostic features like eschar were found in 23% patients. Nearly, two-thirds of patients had fever more than 7 days and myalgia (76.92%), headache (58.46%). The most common complications were renal failure (20%) followed by pneumonia (10.76%). Laboratory findings of high C-reacting protein (89.23%) and leukocytosis are found in 35.38%.
Conclusion: Our results showed that scrub typhus should be considered in the differential diagnosis of pyrexia of unknown origin associated with breathlessness, myalgia, rash, gastrointestinal symptoms, hepatorenal syndrome, or acute respiratory distress syndrome. Empirical treatment with doxycycline may be given in the cases with strong suspicion of scrub typhus.
2. Groves MG, Harrington KS. Scrub typhus. In: Beran GW, editor. Handbook of Zoonoses. 2nd ed. Florida: CRC Press; 1994. p. 663e-8.
3. Allen AC, Spitz S. A comparative study of the pathology of scrub typhus (Tsutsugamushi disease) and other Rickettsial diseases. Am J Pathol 1945;21:603.
4. Park K. Epidemiology of communicable diseases. In: Parkâ€™s Textbook of Preventive and Social Medicine. 15th ed. Jabalpur, India: Banarsidas Bhanot Publishers; 1998. p. 228e-9.
5. Kelly DJ, Fuerst PA, Ching WM, Richards AL. Scrub typhus: The geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis 2009;48 Suppl 3:S203-30.
6. Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India 2010;58:24e-8.
7. Mahajan SK. Scrub typhus. Clinical manifestations, laboratory findings and complications of pediatric scrub typhus in eastern Taiwan. J Assoc Physicians India 2005;53:954e-8.
8. Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, et al. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci 2003;990:359e-64.
9. Kulkarni A, Vaidya S, Kulkarni P, Bidri LH, Padwal S. Rickettsial disease-an experience. Pediatr Infect Dis 2009;1:118-24.
10. Murali N, Pillai S, Cherian T, Raghupathy P, Padmini V, Mathai E. Rickettsial infections in South India-how to spot the spotted fever. Indian Pediatr 2001;38:1393-6.
11. Sirisanthan V, Puthanakit T, Sirisanthana T. Epidemiological, clinical and laboratory features of scrub typhus in thirty Thai children. Pediatr Infect Dis J 2003;22:341-5.
12. Wei Y, Huang Y, Luo L, Xiao X, Liu L, Yang Z. Rapid increase of scrub typhus: An epidemiology and spatial-temporal cluster analysis in Guangzhou city, Southern China, 2006-2012. PLoS One 2014;9:101976.
13. Bhat NK, Dhar M, Mittal G, Shirazi N, Rawat A, Kalra BP, et al. Scrub typhus in children at a tertiary hospital in North India: Clinical profile and complications. Iranian J Pediatr 2014;24:387.
14. Pattnaik S, Ray B, Sinha S, Mohanty A, Sahu S. Outbreak of scrub typhus in odisha-an emerging threat. Intensive Care Med Exp 2015;1:A355.
15. Trowbridge P, Premkumar PD, Varghese P. Prevalence and risk factors for scrub typhus in South India. Trop Med Int Health 2017;22:576-82.
16. Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S. Scrub typhus in children at a tertiary hospital in southern India: Clinical profile and complications. J Infect Public Health 2012;5:82-8.
17. Jim WT, Chiu NC, Chan WT, Ho CS, Chang JH, Huang SY, et al. Clinical manifestations, laboratory findings and complications of pediatric scrub typhus in eastern Taiwan. Pediatr Neonatol 2009;50:96-101.
18. Varghese GM, Janardhanan J, Trowbridge P, Peter JV, Prakash JA, Sathyendra S, et al. Scrub typhus in South India: Clinical and laboratory manifestations, genetic variability, and outcome. Int J Infect Dis 2013;30:e981-7.
19. Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P. Clinical profile of scrub typhus in children. Indian J Pediatr 2012;79:1459-62.
20. Digra SK, Saini GS, Singh V, Sharma SD, Kaul R. Scrub typhus in children: Jammu experience. JK Sci 2010;12:95-7.
21. Liu YX, Jia N, Suo JJ, Xing YB, Liu G, Xiao HJ, et al. Characteristics of pediatric scrub typhus in a new endemic region of northern China. Pediatr Infect Dis J 2009;28:1111-4.
22. Prakash JA, Abraham OC, Mathai E. Evaluation of tests for serological diagnosis of scrub typhus. Trop Doct 2006;36:212-3.
23. Damodharan N, Manimaran V, Sravanthi B. Formulation development and evaluation of delayed release doxycycline tablets. Int J Pharm Pharm Sci 2010;2:116-9.
24. Moorthi C, Paul R, Grandhi R, Dhanunjayarao G, Sivaraman K, Mohamed AE. Irrational use of over-the-counter drugs: A pilot study at community pharmacies research article. Int J Pharm Pharm Sci 2012;4:292-5.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.