scholarly journals Scrub typhus infection, not a benign disease: an experience from a tertiary care center in Northern India

2019 ◽  
Vol 92 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Deepak Jain ◽  
Nitya Nand ◽  
Kajaree Giri ◽  
Jaikrit Bhutani
Keyword(s):  
Scrub Typhus ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Febrile Illness ◽  
North India ◽  
Acute Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
Tertiary Care Centre ◽  
Function Tests

Introduction. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. It is characterised by fever, rash, myalgia and diffuse lymphadenopathy. Most common complications are sepsis, shock, acute respiratory distress syndrome (ARDS), hepatitis, pre renal azotemia and multi organ dysfunction syndrome (MODS). Mortality rates range from 7-30% in untreated cases. Scrub typhus is endemic to a part of the world known as ‘the tsutsugamushi triangle’. River banks, grassy areas generally harbour scrub typhus infection; however, recently there has been an increase in prevalence of infection from dry regions like Haryana. Objective. To assess the clinical spectrum and complications of scrub typhus infection at a tertiary care centre in North India. Material and methods. An observational study was conducted on patients >14 years old with acute febrile illness >7 days duration, admitted indoor from emergency department, from July to November 2017. Suspected cases were tested for specific IgM antibodies against Orientia tsutsugamushi by ELISA. Results. Among the 230 patients, screened for scrub typhus infection, 39 (16.95%) came out to be positive. Most common patient complaints were fever followed by cough and breathlessness, myalgia, nausea, vomiting and behavioral abnormality. 15% of patients required inotropic support initially and 48% had oxygen saturation of less than 90% at the time of presentation. Pleural effusion and crepitations were present in 41% of patients. Most common biochemical alterations were: abnormal liver function tests (95%), followed by thrombocytopenia, anemia, abnormal renal function tests, and hyponatremia. 12 patients (30.7%) were shifted to intensive care unit, 8 of which (20.5%) needed invasive mechanical ventilation and 4 patients (10.3%) underwent hemodialysis. Various complications were noted in 89.7% of cases, the most common being ARDS followed by sepsis, acute kidney injury (AKI) and meningitis. The mortality rate in this study was 18%. Conclusions. This study emphasizes that scrub typhus infection is on a rampant resurgence and it is associated with significant complications. High degree of suspicion as well as development of effective measures to treat, control and prevent is critical to lower the disease burden.

scholarly journals Scrub Typhus and Molecular Characterization of Orientia tsutsugamushi from Central Nepal

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 422
Author(s):  
Rajendra Gautam ◽  
Keshab Parajuli ◽  
Mythili Tadepalli ◽  
Stephen Graves ◽  
John Stenos ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Limited Information ◽  
Orientia Tsutsugamushi ◽  
Health Measures ◽  
Central Nepal ◽  
Vector Borne

Scrub typhus is a vector-borne, acute febrile illness caused by Orientia tsutsugamushi. Scrub typhus continues to be an important but neglected tropical disease in Nepal. Information on this pathogen in Nepal is limited to serological surveys with little information available on molecular methods to detect O. tsutsugamushi. Limited information exists on the genetic diversity of this pathogen. A total of 282 blood samples were obtained from patients with suspected scrub typhus from central Nepal and 84 (30%) were positive for O. tsutsugamushi by 16S rRNA qPCR. Positive samples were further subjected to 56 kDa and 47 kDa molecular typing and molecularly compared to other O. tsutsugamushi strains. Phylogenetic analysis revealed that Nepalese O. tsutsugamushi strains largely cluster together and cluster away from other O. tsutsugamushi strains from Asia and elsewhere. One exception was the sample of Nepal_1, with its partial 56 kDa sequence clustering more closely with non-Nepalese O. tsutsugamushi 56 kDa sequences, potentially indicating that homologous recombination may influence the genetic diversity of strains in this region. Knowledge on the circulating strains in Nepal is important to the development of diagnostic tests and vaccines to support public health measures to control scrub typhus in this country.

scholarly journals Differentiating Scrub Typhus, Dengue Fever and Typhoid Fever in Indian Children Presenting with Acute Febrile Illness

2020 ◽  
Vol 40 (2) ◽  
pp. 93-99
Author(s):  
Saheli Misra Chatterjee ◽  
Suman Mondal ◽  
Kaushik Mukhopadhyay ◽  
Niloy Kumar Das
Keyword(s):  
Dengue Fever ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Indian Children ◽  
Diagnostic Dilemma ◽  
Female Ratio ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

Introduction: The disease spectrum of dengue, scrub typhus and typhoid presenting as acute febrile illness is often a diagnostic dilemma to the clinician. The purpose of this study is to compare the clinical features and laboratory parameters of children suffering from typhoid, dengue and scrub typhus and use these parameters in early identification of scrub typhus before conclusion is made from serological diagnosis. Methods: A retrospective observational analytical study was conducted among children presenting with acute febrile illness in a tertiary care level hospital. Over the period of one year 113 cases were identified of which 39 were dengue, 44 were typhoid and 30 were scrub typhus. Results: The mean age of the children was 7.45 ± 2.98 years, median was eight with an interquartile range of six to ten years. The male to female ratio was 1.3:1. Symptoms of vomiting (61.54%), headache (46.15%) and hepatomegaly (47.37%) were significantly higher among children with dengue fever. A significantly higher number of children with scrub typhus fever had temperature above 40°C. The incidence of low haemoglobin, raised C reactive protein, raised ALT and low albumin levels were significantly higher in them. Children with acute febrile illness having temperature > 40°C, absolute neutrophil/lymphocyte ratio > 2 early in the illness were more likely to suffer from scrub typhus with relative probability ratio (RPR) of 25.68 and 10.57 respectively (p < 0.001). Children with WBC < 5000/mm3 were more likely to be suffering from dengue with RPR of 10.60 (p < 0.001). Conclusion: Children with acute febrile illness with temperature > 40°C and absolute neutrophil/lymphocyte ratio > 2 early in the illness were more likely to be suffering from scrub typhus.

scholarly journals Evaluation of loop-mediated isothermal amplification assay for detection of scrub typhus in patients with acute febrile illness presenting to a Tertiary Care Center in Puducherry, India

2019 ◽  
Vol 11 (01) ◽  
pp. 082-086 ◽  
Author(s):  
Patricia Anitha Karthikeyan ◽  
Sugeerappa Laxmanappa Hoti ◽  
Reba Kanungo
Keyword(s):  
Diagnostic Test ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Lamp Assay ◽  
Febrile Illness ◽  
Isothermal Amplification ◽  
Acute Febrile Illness ◽  
Loop Mediated Isothermal Amplification ◽  
Igm Antibodies ◽  
Two Samples

Abstract PURPOSE: Scrub typhus an acute febrile illness has diverse clinical manifestations, which overlap with other febrile illnesses. Due to this reason, it is misdiagnosed, leading to inappropriate treatment, sometimes resulting in fatality. Thus, accurate diagnosis of scrub typhus is important for appropriate treatment. This study evaluated the loop-mediated isothermal amplification (LAMP) assay as a diagnostic test for scrub typhus among patients with fever. MATERIALS AND METHODS: A total of 50 cases of acute febrile illness clinically resembling scrub typhus, with or without an eschar, or cases of pyrexia of unknown origin were included in the study. Blood samples collected from these cases were subjected to detection of IgM antibodies to Orientia tsutsugamushi by ELISA, conventional groEL polymerase chain reaction (PCR), and the LAMP assay. RESULTS: Twelve cases had fever for less than a week, and two had fever for more than 3 weeks. IgM antibodies to O. tsutsugamushi were detected in 37 out of 50 samples (74%). LAMP assay was positive in 33 samples (66%). groEL gene-based PCR detected 35 (70%) samples as positive. Two samples negative by LAMP assay were positive by this PCR. Twenty samples collected from patients with dengue, typhoid, and malaria tested by the LAMP assay were negative, indicating its good specificity. LAMP assay and the conventional groEL-based PCR could detect 72.7% and 74.3% of the samples, respectively before the 10th day after onset of fever, whereas IgM ELISA could detect only 40.5% of the 37 samples. CONCLUSION: This study suggests that LAMP assay could be a useful diagnostic test for detecting scrub typhus in the acute phase of the illness and a cheaper alternative to other molecular methods in resource poor settings.

A PROSPECTIVE DESCRIPTIVE STUDY OF REFERRED NEONATES ADMITTED TO A TERTIARY CARE CENTER OF NORTH INDIA

2021 ◽  
pp. 219-221
Author(s):  
Divya Mishra ◽  
Arun Kumar Thakur ◽  
Rashmi Kispotta ◽  
Neeraj Neeraj
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Observational Study ◽  
Care Center ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
North India ◽  
Tertiary Care Centre ◽  
Neonatal Transport ◽  
One Year

Objectives: The Study was conducted with an objective to analyze the important contributors of neonatal mortality and outcome of referred neonates admitted to intensive care unit of a tertiary care centre. Methods: In this prospective observational study conducted over one year period included extramural neonates only. Respiratory and hemodynamic status of all neonates at admission was assessed and outcome was evaluated. Results: At admission 80 % of neonates were hypothermic, hypoxic – 37 %, prolonged capillary lling time (CFT)- 85% and hypoglycemic – 28 %. Sepsis was the most common nal diagnosis followed by birth asphyxia and neonatal jaundice. 39% of neonates had poor outcome whereas 61% had good outcome. Culture positivity was 40 % for at risk neonates for sepsis. Among these, most common organism was klebsiella pneumoniae followed by Staph aureus. Conclusion: This prospective study reveals the need of better neonatal transport facility from labor room to intensive care unit and from periphery to tertiary centers.

Infection-Associated Opsoclonus: A Retrospective Case Record Analysis and Review of Literature

2020 ◽  
Vol 35 (7) ◽  
pp. 480-484 ◽  
Author(s):  
Lokesh Saini ◽  
Sumeet R. Dhawan ◽  
Priyanka Madaan ◽  
Renu Suthar ◽  
Arushi Gahlot Saini ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Subacute Sclerosing Panencephalitis ◽  
Acute Infection ◽  
Tertiary Care ◽  
Febrile Illness ◽  
North India ◽  
Brainstem Encephalitis ◽  
Case Record ◽  
Acute Cerebellitis

Opsoclonus, an uncommon clinical sign, and is often described in the context of opsoclonus myoclonus ataxia syndrome (OMAS). OMAS may be paraneoplastic or postinfectious. However, opsoclonus with or without OMAS may occur in association with a wide gamut of infections. Infection-associated opsoclonus/OMAS (IAO) needs recognition as a separate entity, since it demands relatively brief immunosuppression, symptomatic treatment, and has a better outcome. Case records of children, who presented with opsoclonus to a tertiary-care teaching hospital of North India over a period of 1 year (2017-2018), were reviewed. Those with opsoclonus in the setting of an acute infection/febrile illness (symptomatic opsoclonus; IAO) were included. Of 15 children with opsoclonus, 6 children [median age: 42 months (range: 8 months to 7 years); 2 boys] had opsoclonus associated with an infective or febrile illness. Additional clinical findings in these children included myoclonus (n = 2), ataxia (n = 4) and behavioral abnormalities (n = 4). All these patients had an associated neurologic or nonneurologic illness- scrub typhus (n = 1), tuberculous meningitis (n = 1), mumps encephalitis (n = 1), brainstem encephalitis (n = 1), acute cerebellitis (n = 1), and subacute sclerosing panencephalitis (SSPE, n = 1). Children with acute cerebellitis, brainstem encephalitis, and mumps encephalitis were treated with steroids while those with scrub typhus, tuberculosis, and SSPE were treated with antibiotics, antitubercular therapy, and Isoprinosine, respectively. None of them needed long-term maintenance immunotherapy. The evaluation for tumor was negative in all. Three of the 6 children are functionally normal at the last follow-up. Acute neuro infections may trigger opsoclonus. A careful analysis of clinical data and suitable investigations can help differentiate these children from those with OMAS. This distinction may avoid unwarranted long-term immunosuppression.

scholarly journals Scrub Typhus in Children

2018 ◽  
Vol 38 (1) ◽  
pp. 59-62
Author(s):  
Madiha Zainab ◽  
Atul Kumar Gupta ◽  
Suparna Guha
Keyword(s):  
Acute Kidney Injury ◽  
Scrub Typhus ◽  
Kidney Injury ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Common Complication ◽  
Orientia Tsutsugamushi ◽  
Pain Abdomen ◽  
One Year ◽  
High Index Of Suspicion

Introduction: Scrub typhus is an acute febrile illness caused by infection with rickettsial bacilli Orientia tsutsugamushi. This was a retrospective observational study to study the clinical profile of paediatric scrub typhus, its associated complications and response to treatmentMaterial and Methods: Record files of all patients diagnosed with positive Weil felix (OXK>1:80) and Scrub IgM positive over a period of one year were analysed. Total of 10 cases were diagnosed as scrub with median age of presentation 4.1 years.Results: Fever was present in all followed by pain abdomen (50%), rash. Anaemia (90%), lymphadenopathy (70%) hepatomegaly (100%), Leukopenia was present in those cases with fever <1 week while leucocytosis was found thereafter. Most common complication were hepatitis (100%) shock (50%), acute kidney injury (AKI) 30%, DIC in 20% cases. Secondary HLH was found in 20% and pancarditis in one case. All the cases showed dramatic response to doxycycline.Conclusion: So a high index of suspicion is required to diagnose scrub and early initiation of treatment is essential to prevent mortality from the disease.

scholarly journals Acute kidney injury in tropical acute febrile illness in a tertiary care centre--RIFLE criteria validation

2010 ◽  
Vol 26 (2) ◽  
pp. 524-531 ◽  
Author(s):  
G. Basu ◽  
A. Chrispal ◽  
H. Boorugu ◽  
K. G. Gopinath ◽  
S. Chandy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Rifle Criteria

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. 

Sign in / Sign up

Export Citation Format

Share Document