scholarly journals Comparative Study of Chikungunya Only and Chikungunya-Scrub Typhus Coinfection in Children: Findings from a Hospital-Based Observational Study from Central Nepal

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Santosh Pathak ◽  
Nagendra Chaudhary ◽  
Prativa Dhakal ◽  
Sanjay Ray Yadav ◽  
Binod Kumar Gupta ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Observational Study ◽  
Comparative Study ◽  
Falciparum Malaria ◽  
Scrub Typhus ◽  
Clinical Manifestations ◽  
Clinical Profile ◽  
Shortness Of Breath ◽  
Central Nepal ◽  
Igm Elisa

Objectives. Chikungunya and scrub typhus infection are important causes of undifferentiated fever in tropical zones. The clinical manifestations in both conditions are nonspecific and often overlap. This study compares the clinical manifestations and the outcome of chikungunya with chikungunya-scrub typhus coinfection in children. Methods. A hospital-based observational study was conducted in children below 15 years of age over 16-month duration in 2017-2018. Chikungunya was diagnosed by IgM ELISA. All positive chikungunya cases were subjected to scrub typhus testing, dengue testing, leptospira testing, and malaria testing. Clinical manifestations and outcomes of all patients were recorded. Results. Out of the 382 admitted cases with fever, 11% ( n = 42 ) were diagnosed with chikungunya, and the majority ( n = 30 , 71.4%) were male. Among the 42 chikungunya cases, 17 (40.5%) tested positive for scrub typhus and one positive for falciparum malaria. Out of a total of 42 chikungunya cases, myalgia, nausea/vomiting, headache, abdominal pain, lymphadenopathy, hepatomegaly, splenomegaly, and edema were 81%, 73.8%, 66.7%, 64.3%, 59.5%, 52.4%, 40.5%, and 38.1%, respectively. Besides, altered sensorium (31%), jaundice (26.2%), dry cough (21.4%), shortness of breath (19%), and seizures (16.7%) were other clinical manifestations present in this group of children. Patients with chikungunya-scrub typhus coinfection reported headaches, pain in the abdomen, dry cough, shortness of breath, seizures, and splenomegaly, significantly more ( p value < 0.05) compared to those with chikungunya only. Thirteen (31%) children developed shock, five in the chikungunya group and eight in the chikungunya-scrub typhus coinfection group. Six children in the coinfection group received inotrope. Among the chikungunya-only cases, 22 recovered and one died, whereas in the chikungunya-scrub typhus coinfection group, fourteen recovered and three died. Conclusions. Both the chikungunya and scrub typhus coinfection groups shared many similar clinical manifestations. In children, coinfection with scrub typhus often leads to modification of the clinical profile, complications, and chikungunya outcome.

scholarly journals Clinical profile and seroepidemiology of scrub typhus and its concurrent infections associated with other tropical fevers: a two-year study from a tertiary care centre in North India

2020 ◽  
Vol 7 (11) ◽  
pp. 4440
Author(s):  
Monika Matlani ◽  
Supriya Maheshwari ◽  
Neha Dubey ◽  
Shyam S. Mina ◽  
Vinita Dogra
Keyword(s):  
Clinical Presentation ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Clinical Profile ◽  
North India ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Igm Elisa ◽  
Concurrent Infections

Background: The study showed epidemiological aspects, clinical profile and laboratory features of patients presenting with scrub typhus alone and scrub typhus along with concurrent infections namely typhoid, malaria, leptospira, chikungunya and dengue.Methods: A total of 383 suspected cases of Scrub typhus were tested by IgM ELISA from January 2017 to October 2018. Appropriates tests were performed to determine the coinfections of scrub typhus with dengue, chikungunya, malaria, leptospirosis and typhoid fever.Results: Of the 383 samples received, 68 were positive for scrub typhus. Commonest clinical manifestations were fever, shortness of breath, myalgia, headache and jaundice. Maximum number of co infection cases were observed along with dengue.Conclusions: With the rapidly changing epidemiology of scrub typhus, it is very important to become familiar with its clinical presentation when presenting alone and as a concurrent infection with other acute febrile infections. 

scholarly journals Clinical profile, complications and outcome of scrub typhus in children: A hospital based observational study in central Nepal

PLoS ONE ◽  
2019 ◽  
Vol 14 (8) ◽  
pp. e0220905 ◽  
Author(s):  
Santosh Pathak ◽  
Nagendra Chaudhary ◽  
Prativa Dhakal ◽  
Disuja Shakya ◽  
Prativa Dhungel ◽  
...  
Keyword(s):  
Observational Study ◽  
Scrub Typhus ◽  
Clinical Profile ◽  
Central Nepal

Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

2016 ◽  
Vol 5 (09) ◽  
pp. 4896
Author(s):  
Sripriya C.S.* ◽  
Shanthi B. ◽  
Arockia Doss S. ◽  
Antonie Raj I. ◽  
Mohana Priya
Keyword(s):  
Scrub Typhus ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
The Past ◽  
Igm Elisa ◽  
The Mean ◽  
Specific Symptoms ◽  
Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45. 

scholarly journals Diagnostic evaluation of IgM ELISA and IgM Immunofluorescence assay for the diagnosis of Acute Scrub Typhus in central Nepal

2020 ◽  
Author(s):  
Rajendra Gautam ◽  
Keshab Parajuli ◽  
Tshokey Tshokey ◽  
John Stenos ◽  
Jeevan Bahadur Sherchand
Keyword(s):  
Likelihood Ratio ◽  
Predictive Value ◽  
Gold Standard ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Immunofluorescence Assay ◽  
Acute Febrile Illness ◽  
Central Nepal ◽  
Igm Elisa ◽  
Typhus Fever

Abstract Introduction Scrub typhus is an acute febrile illness caused by the obligate intracellular bacterium,Orientia tsutsugamushi. Given their affordability and ease of use, antibody based diagnostic assays can be important diagnostic tools for early detection of scrub typhus fever in resource poor countries like Nepal. Immunochromatography (ICT) and IgM ELISA are two of the routinely employed antibody based assays for diagnosis of Scrub typhus fever in Nepal, although the recommended gold standard diagnostic test is IgM Immunofluorescence assay (IFA). This study evaluated the InBios Scrub Typhus Detect™ Immunoglobulin M (IgM) ELISA and IgM Immunofluorescence assays in single serum sample at the time of admission. Methodology Study participants (1585 suspected cases), were enrolled based on acute febrile illness with suspected scrub typhus cases in central Nepal from April 2017 to March 2018. Blood sample was collected from the suspected patients of scrub typhus, presenting with acute febrile illness. IgM antibody to Orientia tsusugamushi was detected by using Scrub Typhus Detect™ Kit (In Bios International, USA) and an in-house IgM IFA (Australian Rickettsial Reference Laboratory, Geelong, Australia. The IFA assay was performed with the Gilliam, Karp, Kato strains and O. chuto antigens following the ARRL protocol. Result Statistical analysis of ELISA IgM results when compared to reference test, IgM IFA results demonstrated the following characteristics, sensitivity 84.0% (95%CI: 79.73%-87.68%), specificity 94.82% (95% CI: 93.43%-95.99%), positive likelihood ratio 16.21% (95% CI: 12.71%-20.67%), negative likelihood ratio 0.17% (95% CI: 0.13-0.21%), disease prevalence 22.08% (95% CI: 20.06%-24.21%), positive predictive value 82.12% (95% CI: 78.28-85.42%) and negative predictive value 95.44% (95% CI: 94.27%-96.38%) respectively. Conclusion The study indicated that the IgM ELISA has the sensitivity 84.0% (95% CI: 79.73%-87.68%) and specificity 94.82% (95% CI: 93.43%-95.99%). Although IgM IFA is considered the gold standard test for the diagnosis of scrub typhus cases, it is relatively expensive, requires trained personal and a microscope with fluorescence filters. Scrub typhus IgM ELISA with appropriate OD cut–off values may be the best alternative test and possible viable option for resource limited endemic countries like Nepal.

scholarly journals Clinical presentation of scrub typhus during a major outbreak in central Nepal

2017 ◽  
Vol 8 (4) ◽  
pp. 27-31 ◽  
Author(s):  
Arun Sedhain ◽  
Gandhi R. Bhattarai
Keyword(s):  
Acute Kidney Injury ◽  
Scrub Typhus ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Continuous Variables ◽  
Neurologic Manifestation ◽  
Igm Elisa ◽  
Clinical Presentations ◽  
Tertiary Teaching ◽  
Major Outbreak

Background: Scrub typhus, an emerging rickettsial disease caused by the organism Orientiatsutsugamushi, is associated with multi-organ involvement. We prospectively studied the clinical manifestations of the disease during a major outbreak in central part of Nepal.Aims and Objective: This study was carried out with an aim to analyze the clinical presentations, laboratory parameters, complications and outcomes of scrub typhus.Materials and Methods: A prospective observational study was conducted in the Department of Medicine in a tertiary teaching hospital. A total of 1398 patients admitted with acute febrile illness were subjected for Scrub Typhus Detect™ IgM ELISA test, among which 502 (35.90%) patients tested positive and were included in the study. Acute kidney injury was defined according to KDIGO guideline. Statistical analysis was done with SAS University Studio package using t-test for continuous variables and chi-square test for categorical variables.Results: Mean age of the patients was 30.37±18.81 years with 26.29% in the pediatric age group (<14 years). Females comprised of 55.98% of the patients. Majority (97.98%) of the patients were seen between July to November. Clinical presentations in the descending order of frequency were anorexia (55.18%), headache (53.39%), lymphadenopathy (15.73%), jaundice (13.35) and eschar (6.57%). Mean scrub typhus IgM ELISA value was 2.17. Leukocytosis was seen in 5.78% and thrombocytopenia in 66.73% of patients. Transaminitis was found in 80.68% of patients. Urinary abnormalities were recorded in 42.3% of patients. Acute kidney injury (AKI) was seen in 35.8% of patients followed by acute respiratory distress syndrome (24.1%), pneumonia (22.1%), shock (14.74%), neurologic manifestation (6.37%) and cardiac manifestations (4.38%). ICU admission was required for 18.73% of patients and 8.57% required ventilator support. Mortality rate was 1.79%.Conclusion: Scrub typhus, being an emerging vector borne infectious disease in Nepalese context, is associated with multiple organ involvement.Asian Journal of Medical Sciences Vol.8(4) 2017 27-31

Seroprevalence and clinical profile of scrub typhus in patients presenting with undifferentiated acute febrile illness in a tertiary care centre

2021 ◽  
Vol 12 (4) ◽  
pp. 54-60
Author(s):  
Reena Anie Jose ◽  
Hyma Jose ◽  
Anjali Anne Jacob ◽  
Pramod Thomas ◽  
Renu Mathew ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Laboratory Finding ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Febrile Illness ◽  
Clinical Profile ◽  
Bivariate Analysis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Rickettsial Infections ◽  
Igm Elisa

Background: Scrub typhus (ST) is a common Rickettsial infection which has been increasingly reported from the various states of southern part of India. Aims and Objective: With very few reports from Central Kerala, we aimed to study the seroprevalence of scrub typhus and its clinical profile. Materials and Methods: Patients presenting with acute undifferentiated febrile illness and other symptoms and signs of Rickettsial infections during a period of two years were included in this prospective study. Serodiagnosis of ST was based on a positive Scrub typhus IgM Enzyme Linked Immunosorbent Assay (ELISA) and/or agglutination for OXK in Weil Felix test. The cut-off for ELISA was calculated. The clinical and laboratory details of the positive patients were obtained and bivariate analysis was performed. Results: The cut-off for ST IgM ELISA was calculated and found to be 0.38. Of the 636 samples screened, 34 (5.3%) were positive for ST IgM ELISA. Out of the 34 positive samples, only 5 (0.8%) were positive by Weil Felix test. Most of the ST patients presented during the months of May to January. Rashes were observed in 8.8% of the ST patients and none had signs of eschar. The commonest clinical features included fever, myalgia (52.9%), nausea & vomiting (32.4%), headache (29.4%) and hepatosplenomegaly (29.4%). The commonest abnormal laboratory finding and complication observed were elevated serum transaminases (52.9%) and acute respiratory distress syndrome (17.6%) respectively. Conclusion: The seroprevalence of ST in Central Kerala was 5.3% using Weil Felix test and ST IgM ELISA.

scholarly journals Diagnostic evaluation of IgM ELISA and IgM Immunofluorescence assay for the diagnosis of Acute Scrub Typhus in central Nepal

2019 ◽  
Author(s):  
Rajendra Gautam ◽  
Keshab Parajuli ◽  
Tshokey Tshokey ◽  
John Stenos ◽  
Jeevan Bahadur Sherchand
Keyword(s):  
Likelihood Ratio ◽  
Predictive Value ◽  
Gold Standard ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Immunofluorescence Assay ◽  
Acute Febrile Illness ◽  
Central Nepal ◽  
Igm Elisa ◽  
Typhus Fever

Abstract Introduction Scrub typhus is an acute febrile illness caused by the obligate intracellular bacterium,Orientia tsutsugamushi. Given their affordability and ease of use, antibody based diagnostic assays can be important diagnostic tools for early detection of scrub typhus fever in resource poor countries like Nepal. Immunochromatography (ICT) and IgM ELISA are two of the routinely employed antibody based assays for diagnosis of Scrub typhus fever in Nepal, although the recommended gold standard diagnostic test is IgM Immunofluorescence assay (IFA). This study evaluated the InBios Scrub Typhus Detect™ Immunoglobulin M (IgM) ELISA and IgM Immunofluorescence assays in single serum sample at the time of admission. Methodology Study participants (1585 suspected cases), were enrolled based on acute febrile illness with suspected scrub typhus cases in central Nepal from April 2017 to March 2018. Blood sample was collected from the suspected patients of scrub typhus, presenting with acute febrile illness. IgM antibody to Orientia tsusugamushi was detected by using Scrub Typhus Detect™ Kit (In Bios International, USA) and an in-house IgM IFA (Australian Rickettsial Reference Laboratory, Geelong, Australia. The IFA assay was performed with the Gilliam, Karp, Kato strains and O. chuto antigens following the ARRL protocol. Result Statistical analysis of ELISA IgM results when compared to reference test, IgM IFA results demonstrated the following characteristics, sensitivity 84.0% (95%CI: 79.73%-87.68%), specificity 94.82% (95% CI: 93.43%-95.99%), positive likelihood ratio 16.21% (95% CI: 12.71%-20.67%), negative likelihood ratio 0.17% (95% CI: 0.13-0.21%), disease prevalence 22.08% (95% CI: 20.06%-24.21%), positive predictive value 82.12% (95% CI: 78.28-85.42%) and negative predictive value 95.44% (95% CI: 94.27%-96.38%) respectively. Conclusion The study indicated that the IgM ELISA has the sensitivity 84.0% (95% CI: 79.73%-87.68%) and specificity 94.82% (95% CI: 93.43%-95.99%). Although IgM IFA is considered the gold standard test for the diagnosis of scrub typhus cases, it is relatively expensive, requires trained personal and a microscope with fluorescence filters. Scrub typhus IgM ELISA with appropriate OD cut–off values may be the best alternative test and possible viable option for resource limited endemic countries like Nepal.

scholarly journals Clinical manifestations in calotropis poisoning: a prospective study in Government General Hospital Nalgonda, India

2019 ◽  
Vol 6 (4) ◽  
pp. 1314 ◽  
Author(s):  
C. Yadavendra Reddy
Keyword(s):  
Abdominal Pain ◽  
Observational Study ◽  
Prospective Study ◽  
Prospective Observational Study ◽  
Clinical Manifestations ◽  
Calotropis Procera ◽  
Common Symptom ◽  
Accidental Ingestion ◽  
Male And Female ◽  
A Prospective Study

Background: Calotropis procera commonly known as Madar is common shrub all over India. Its chemical component Calotropin, which is derived from latex is known to cause injury to eyes and oral mucosa. Toxic manifestations following accidental ingestion are mostly gastrointestinal. This study was aimed at studying the various clinical manifestations of Calotropis poisoning in patients admitted to GGH Nalgonda.Methods: This prospective observational study was done from Feb 2019 to May 2019.All patients both male and female admitted to GGH Nalgonda during this period were studied. Patients below 12 years, pregnant women and patients with earlier gastritis, hepatitis, stomatitis were excluded from the study. The study was carried out in all patients fulfilling the inclusion and exclusion criteria.Results: A total of 60 patients 45 females and 15 males presented during the study period. Most of the patients presented with abdominal pain 15 (25%), hepatitis 10 (16.6%), stomatitis 12 (20%), vomiting 8 (13.3%), diarrhea 6 (10%), hyperkalemia 3 (5%), tachycardia 5 (8.3%), convulsion 1 (1.6%).Conclusions: It was observed from the study that most of the patients had abdominal pain as the major symptom. Stomatitis was the second most common symptom. It was observed consumption of the toxin in lesser quantities produced these symptoms in large quantities produced tachycardia, hyperkalemia and convulsions.

scholarly journals Clinical manifestations, complications, and outcomes of patients with COVID-19 in Sudan: a multicenter observational study

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Elfatih A. Hasabo ◽  
Fatima A. Ayyad ◽  
Sara A. M. Alam Eldeen ◽  
Malaz K. Noureldaim ◽  
Tibyan A. Abdallah ◽  
...  
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Hospital Death ◽  
Shortness Of Breath ◽  
Multicenter Observational Study ◽  
Systemic Manifestations ◽  
Multiple Variables ◽  
The Mean

Abstract Background Coronavirus disease 2019 (COVID-19) is a pandemic caused by a newly discovered coronavirus. Although clinical manifestations of COVID-19 are mainly pulmonary, some patients have other systemic manifestations. This study aimed to describe the clinical finding and outcomes in Sudanese patients diagnosed with COVID-19. Methods This retrospective observational study is based on documented files that included patients diagnosed with COVID-19 in seven selected hospitals inside Khartoum. Clinical manifestations, complications and outcomes were extracted from patients’ records using an extraction form designed for this study. Results Data of 243 patients diagnosed with COVID-19 were analyzed. The mean (SD) age in years was 55.8 (18.4). Out of 116 participants, 27 of them (23.3%) had severe disease, 15 (12.9%) were critically ill. 67.5% of patients were admitted to the hospital within 7 days from onset of symptoms; most of them were admitted to the wards (n = 140,72.5%). Fever (83.2%), cough (70.7%), and shortness of breath (69.2%) were the most commonly recorded clinical manifestations. Sepsis (9.8%) and acidosis (7.8%) were the most frequently reported complications. Death was the final outcome in 21.4% (56/243). Older age and presence of diabetes were found significantly associated with in-hospital death. The laboratory results showed high CRP in 85.6% (119/139), high ferritin in 88.9% (24/27), lactate dehydrogenase had a median of 409.0 (359–760), D-dimer had a median of 3.3 (1.2–16. 6), and 53/105 (50.5%) had low albumin. Conclusions Fever was the most mentioned sign among the participants, followed by fatigue. Cough and shortness of breath were the most commonly recorded pulmonary symptoms manifested. Our study showed multiple variables were associated with in-hospital death. The mortality rate was high among severe and critically ill patients diagnosed with COVID-19.

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