scholarly journals Scrub typhus, a rare of cause of fulminant hepatic failure: A common disease with uncommon presentation

2022 ◽  
pp. 526-528
Author(s):  
Subramani Jagadeesan ◽  
Pranav Patel ◽  
Ajay Jain

Scrub typhus (bush typhus) is a potentially lethal mite-borne, acute febrile infectious illness caused by Orientia tsutsugamushi, reported precipitating frequent outbreaks in the Asia-pacific belt. Usual presentation after a median incubation period of 10–14 days, stretches from pathognomonic eschar, high-grade fever, centrifugal skin rash, jaundice, regional lymphadenopathy to frontal headache, nevertheless complicated at times with myocarditis, acute respiratory distress syndrome, acute kidney injury, encephalitis, and shock. Although patients with scrub typhus invariably do display mild liver injury, fulminant hepatic failure (FHF) is rarely reported. We describe herein, a case of FHF in an elderly male that responded well to antibiotics. Early diagnosis and sensitive antibiotic administration aids in mortality prevention of the former.

2018 ◽  
Vol 29 (1) ◽  
pp. 45-47 ◽  
Author(s):  
Quazi Tarikul Islam ◽  
Homayra Tahseen Hossain ◽  
Md Abulkashem Khandaker ◽  
HAM Nazmul Ahasan ◽  
Maksudul Majumder ◽  
...  

Dengue fever is a mosquito borne viral infection found in tropic & sub-tropic regions. The symptomatic dengue infection follows an uncomplicated course; however, unusual manifestations of this disease are now being increasingly reported as expanded dengue syndrome which incorporates wide spectrum of uncommon presentation of this common disease which does not fall into either dengue shock syndrome or dengue hemorrhagic fever. We report a case of a 30 year old lady who presented with high grade fever, rash, diffuse abdominal pain & vomiting, who ultimately developed shock and features of multi organ failure. We diagnosed her as a case of expanded dengue syndrome with multi organ failure ( hepatitis with very high transaminase levels, pancreatitis, acalculous cholecystitis, coagulation failure & acute kidney injury) with septicaemia. With prompt diagnosis and aggressive management, this potentially fatal patient was cured.Bangladesh J Medicine Jan 2018; 29(1) : 45-47


2019 ◽  
Vol 9 (2) ◽  
pp. 136-139
Author(s):  
Akmat Ali ◽  
Richmond Ronald Gomes ◽  
Khadiza Begum

Leptospirosis is a zoonosis with protean manifestation caused by the spirochete, Leptospira interrogans. Here we report a 60-year-old male who presented with sudden onset of fever, rigors, myalgia and headache occasionally accompanied by nausea, vomiting and diarrhea. Later during the course of treatment he developed encephalopathy with fulminant hepatic failure and acute kidney injury and was diagnosed as a case of leptospirosis. A timely workup combined with early initiation of antibiotics and hemodialysis led to effective treatment for this patient. J Enam Med Col 2019; 9(2): 136-139


2017 ◽  
Vol 4 (3) ◽  
pp. 848
Author(s):  
J. Balaji ◽  
P. Punitha ◽  
B. Ramesh Babu ◽  
K. S. Kumaravel

Background: Rickettsial diseases including Scrub Typhus are emerging as an important cause of acute undifferentiated febrile illness throughout the Asia-Pacific region. The objectives of the study are to study the clinical profile, complications and outcome of Scrub Typhus cases admitted in rural medical college.Methods: This prospective descriptive study was done at Government Dharmapuri Medical College Hospital, Tamilnadu, between Jul’2015 and Jan’2016. The children who were positive for Scrub Typhus by IgM Elisa were analyzed.Results: During the study period, 151 children (40% of fever cases) were positive for Scrub Typhus. All the children were presented with fever. High-grade fever, chills, vomiting, cough, head ache, were seen in 83%, 41%, 57%, 56% and 32% respectively. 54% of children had lethargy and 10% children brought with convulsions to hospital. Eschar was seen in 68% of children. Lymphadenopathy (70%) and hepatosplenomegaly (more than 56%) were common findings. Shock, respiratory distress, pleural effusion and ascites were seen in 46%, 36%, 40% and 37% respectively. Anemia (74%) and thrombocytopenia (81%) were common lab findings. Shock (46%), ARDS (12%), Meningoencephalitis (10%) and MODS (1.3%) were complications reported. Doxycycline (53%), Azithromycin (11%) and both drugs (36%) were used. Along with fluids, Dopamine (38%), nor-adrenaline (12%), Oxygen through Jackson-Rees Circuit (28%), Non-invasive ventilation (9%) was needed to treat the complications.Conclusions: When a child presents with acute febrile illness, hepatospleenomegaly, lymphadenopathy, anemia with thrombocytopenia and features suggestive of capilary leak diagnosis of Scrub Typhus must be considered. Doxycycline or Azithromycin, proper fluid boluses, Inotropes and O2 through Jackson-Rees Circuit are life saving for scrub typhus and its complications.


2020 ◽  
Vol 7 (8) ◽  
pp. 1812
Author(s):  
Shreyasi Das ◽  
Rajendra Pandey ◽  
Sumit Roy

Scrub typhus is a multisystem disease, caused by genera orientia tsutsugamushi and is currently endemic in India. In children, the disease may vary from a mild to a severe form. Complications include encephalitis, myocarditis, disseminated intravascular coagulation, acute kidney injury, atypical pneumonia, etc. The pathophysiologic mechanisms of renal involvement in scrub typhus include prerenal failure, septic shock, vasculitis, acute tubular injury and direct renal invasion by rickettsia. Here, authors present the case of a previously well 5-year old female child who was admitted to our hospital with a history of high-grade fever and pain abdomen. IgM scrub typhus turned out to be positive and she was adequately treated with doxycycline. She turned afebrile but then gradually developed anasarca, hematuria, proteinuria and persistent stage 2 hypertension. Kidney biopsy was done which revealed focal segmental glomerulosclerosis (FSGS). Further workup of the patient by whole exome sequencing revealed missense mutations in TBX18, INF2 and NPHS1 genes. Mutations in INF2 gene is a recently discovered cause of autosomal dominant FSGS. In our case, the scrub typhus mediated kidney injury probably acted as a trigger in unmasking FSGS in the already genetically susceptible child.


2021 ◽  
Vol 8 (3) ◽  
pp. 545
Author(s):  
E. Kishore ◽  
S. V. S. Sreedhar

Background: Rickettsial diseases, including scrub typhus, are emerging across the Asia-Pacific region as a significant source of acute undifferentiated febrile disease. The purpose of the research is to study the clinical profile, symptoms, and results of cases of scrub typhus admitted to rural medical colleges.Methods: From November 2019 to August 2020, this prospective descriptive research was performed at Narayana Medical College, Nellore, Andhra Pradesh, India. Children who were scrub typhus-positive by immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) were tested.Results: 164 children (more than 40 percent of fever cases) were scrub typhus-positive during the study time. Many of the children had a fever. 84.15 percent, 49.40 percent, 37.20 percent, 56.10 percent, and 25 percent respectively saw high-grade fever, chills, vomiting, cough, and headache. In 63.41 percent of children, Eschar was shown. The typical findings were lymphadenopathy (68.30 percent) and hepatomegaly (more than 57 percent). In 47.56 percent, 25.60 percent, 39.63 percent, and 37.19 percent, shock, respiratory failure, pleural effusion, and ascites were observed. Popular lab results were anemia (70.12 percent) and thrombocytopenia (74.40 percent). Complications were recorded in shock (47.56 percent), ARDS (10.36 percent), meningoencephalitis (7.32 percent), and MODS (1.22 percent). The complications were treated with doxycycline (51.21 percent), azithromycin (12.80 percent), and both drugs (35.97 percent) were used to treat the complications.Conclusions: When a child presents with acute febrile illness, hepatosplenomegaly, lymphadenopathy, anemia with thrombocytopenia, and features suggestive of capillary leak diagnosis of scrub typhus must be considered. Doxycycline or azithromycin, proper fluid boluses, inotropes, and O2 through Jackson-Rees circuit are life-saving for scrub typhus and its complications.


2001 ◽  
Vol 120 (5) ◽  
pp. A257-A257
Author(s):  
N SHAMUGAM ◽  
R AMARO ◽  
E MOLINA ◽  
L RAEZ

2016 ◽  
Vol 22 ◽  
pp. 116
Author(s):  
Maha Sulieman ◽  
Delamo Isaac Bekele ◽  
Jennifer Marquita Carter ◽  
Rabia Cherqaoui ◽  
Vijaya Ganta ◽  
...  

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