TITLE:
In Search of Scrub Typhus: A Prospective Analysis of Clinical and Epidemiological Profile of Patients from a Tertiary Care Hospital in New Delhi
AUTHORS:
Nitin Gupta, Rama Chaudhry, Sushil K. Kabra, Rakesh Lodha, Bijay R. Mirdha, Bimal K. Das, Naveet Wig, Vishnubhatla Sreenivas
KEYWORDS:
Scrub Typhus, India, Epidemiology
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.5 No.4,
November
23,
2015
ABSTRACT: Introduction: Scrub typhus
is a febrile illness caused by Orientia
tsutsugamushi which is
transmitted by the larval stage of trombiculid mites. It has varied
manifestations ranging from mild disease to fatal illness. The classical
manifestations include fever, rash, lymphadenopathy and eschar. Serology is the
preferred diagnostic tool with indirect immunofluorescence assay (IFA) as the
current gold standard. Material & Methods: A total of 229 clinically
suspected cases of Scrub typhus from 15th of October 2013 to 15th of October 2015 were enrolled in the
study. Clinical, epidemiological and laboratory data of the patients were
collected and analysed. The method for diagnosis was IgM immunofluorescence
assay. Results: A total of 33 cases (14.4%) of scrub typhus were detected. Most
of the cases (87%) presented in the months of September to November. Fever of >39°C was seen in all 33 cases. Rash and
eschar were seen in 24.2% and 18.2% cases, respectively. Lymphadenopathy
(18.2%), hepatomegaly (48.5%),
splenomegaly (21.2%) and icterus (15.2%) were seen in some cases. Pulmonary
manifestations were noted in 69.7% of cases. Acute kidney injury (18.2%),
encephalitis (21.2%), and myocarditis (15.15%) were the other complications
observed. Common haematological abnormalities noted in patients of scrub typhus
were anaemia (45.6%), leucocytosis
(45.6%), thrombocytopenia (48.5%) and transaminitis (54.5%). 10 cases were treated by azithromycin while doxycycline
was used for treatment in 28 cases. Conclusion: The nonspecific symptoms and
lack of classical manifestations make the diagnosis of scrub typhus difficult.
There is a definite need to increase awareness and heighten the suspicion,
especially in the light of increasing number of patients presenting with
atypical manifestations.