scholarly journals Clinico-Laboratory Profile, Complications and Therapeutic Outcome of Scrub Typhus in Children

2020 ◽  
Vol 18 (2) ◽  
pp. 282-287
Author(s):  
Ram Hari Chapagain ◽  
Sumit Agrawal ◽  
Sunita Pokharel ◽  
Madhusudhan Kayastha ◽  
Susan Bhattrai ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Febrile Illness ◽  
Abdominal Distension ◽  
Therapeutic Outcome ◽  
Care Hospital ◽  
Middle Income ◽  
Increased Risk ◽  
Laboratory Profile

Background: Scrub typhus, an important cause of undifferentiated fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to describe the clinico-laboratory profile, drug used in treatment, predictor of PICU admission and therapeutic outcome of serologically confirmed scrub typhus among Nepalese children.Methods: A prospective observational study was carried out in children aged up to 14 years with serologically (IgM ELISA) diagnosed Scrub typhus, admitted in a tertiary care hospital of central Nepal between Jan 2019 to Dec 2019.Results: All 100 children with scrub typhus presented with fever. Other symptoms and sign were cough (29%), abdominal distension (22%) hepatomegaly (45%), splenomegaly (28%), crepitation (10%) and eschar (6%). Similarly, thrombocytopenia (72%), and increased liver enzymes SGPT (51%) and SGOT (62%) were found. Co-infection with dengue (5%) brucella (5%) and UTI (5%) were seen. Thirty six percent has some form of complication. Fifty eight percent of children were treated with azithromycin and 25% treated with doxycycline. The mean length of hospital stay was 6.68 ±2.97 days with a mean duration of defervescence being 30.07 ± 26.65 hours. The increased risk of PICU admission was found in those children with crepitation in chest (OR: 15.17, 95% CI: 3.4-66.8) during presentation and those children not getting azithromycin as treatment (OR: 3.8, 95% CI: 1.2-11.7)Conclusions: Scrub typhus should be considered as a differential diagnosis in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Sepsis, meningitis and pneumonia are important complications. Child having crepitation on presentation has an increased chance admission in critical care unit. The child receiving azithromycin has less chance to land in PICU.Keywords: Clinico-laboratory profile; complications; fever; scrub typhus.

scholarly journals Clinical and laboratory profile of Scrub typhus in paediatric age group

2020 ◽  
Vol 11 (6) ◽  
pp. 63-67
Author(s):  
Atindra Mishra ◽  
Rupa Thakur ◽  
Ruby Thakur
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Care Hospital ◽  
Age Group ◽  
Open Defecation ◽  
Laboratory Findings ◽  
Laboratory Profile

Background: Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, obligate intracellular organism. Incidence of Scrub typhus is increasing due to easy availability and decreased cost of diagnostic facility. This study was designed to study the clinical and laboratory profile of scrub typhus patient in department of paediatrics at National Medical College, Birgunj. Aims and Objectives: To study the clinical manifestations, laboratory findings and complications of Scrub typhus in Pediatric age group. Methods and Methods: A prospective observational study was carried out in children below the age of 15 years, admitted in paediatrics department of a tertiary care hospital of Nepal from June 2019 to May 2020. Clinical manifestations and laboratory findings were collected and recorded in predesigned data sheet. Scrub typhus was diagnosed with IgM ELISA. Results: A total of 52 patients were diagnosed as scrub typhus. All patients presented with fever and commonly had other symptoms such as headache (65.3%), vomiting (63.5%), cough (59.6%), breathing difficulty (57.7%), abdominal pain (53.9%), seizures (21.2%) and rashes (9.6%). Important clinical signs noticed were lymphadenopathy (84.6%), edema (76.4%), hepatomegaly (56.8%), splenomegaly (36.5%) jaundice (30.7%). About 12% (n = 9) had necrotic eschar. 54% of the admitted patient confirmed using open defecation. Myocarditis (67.3%) was the commonest complication followed by Acute Kidney Injury (65.4%). Conclusions: Scrub typhus must be considered in differential of tropical fever in children, especially in those residing in rural area and having open defecation. In our study, Fever was the ubiquitous symptom and Myocarditis was the commonest complication.

scholarly journals Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System

2020 ◽  
Vol 41 (S1) ◽  
pp. s397-s398
Author(s):  
Ayush Lohiya ◽  
Samarth Mittal ◽  
Vivek Trikha ◽  
Surbhi Khurana ◽  
Sonal Katyal ◽  
...  
Keyword(s):  
Surveillance System ◽  
Trauma Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Care Hospital ◽  
Middle Income ◽  
Predominant Pathogen ◽  
Level I

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

scholarly journals Incidence of scrub typhus in a tertiary care hospital in Kolkata, India

2020 ◽  
Vol 7 (5) ◽  
pp. 825
Author(s):  
Kausik Munsi ◽  
Sayonee Das ◽  
Ramiz Islam ◽  
Parvez Shahide Biswas ◽  
Satyabrata Ganguly ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Female Ratio ◽  
Gi Symptoms ◽  
Ns1 Antigen ◽  
Morbilliform Rash ◽  
Almost All

Background: Authors aimed to identify incidence of scrub typhus among patients of fever. Scrub typhus is an endemic disease in India caused by Orientia tsutsugamushi, transmitted by trombiculid mites. It is an important cause of acute febrile illness in India. Signs and symptoms include fever, headache, myalgia and GI symptoms and is generally associated with morbilliform rash (<40%), eschar (<50%) which is due to bite of the mite. Abnormal LFTs and lymphocytosis are commonly seen in early phase of illness. It’s often labelled as PUO. Early diagnosis and prompt administration of therapy mostly leads to complete recoveryMethods: Authors screened 100 patients presenting with fever, malaise, headache, with or without rash for more than a week from the month of May to December 2019. Routine blood investigations with fever profile (Dengue NS1 antigen, MP, MPDA, TyphidotM) and cultures were done. Patients in whom no cause of fever could be established, having lymphocytosis, hyponatremia and transaminitis, they were tested for Scrub typhus by using Indirect immunofluorescence & detection of IgM antibody.Results: Total 22 patients were found positive for scrub typhus by using the aforementioned method (22%). Male: Female ratio was 3:4 (9 vs 12). Patients were in the age group of 16-76 years. Lymphocytosis, hyponatremia and transaminitis were cardinal features seen in almost all patients diagnosed with Scrub Typhus.Conclusions: This study will help clinicians to have a stronger suspicion of scrub typhus in undiagnosed febrile patients.

scholarly journals Serological Detection and Epidemiological Factors Associated with Scrub Typhus among Undifferentiated Febrile Illness Patients in a Tertiary Care Hospital

2021 ◽  
Author(s):  
V.M. Somasunder ◽  
K. Akila ◽  
S. Sijimol ◽  
S. Senthamarai ◽  
S. Sivasankari ◽  
...  
Keyword(s):  
Rural Areas ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Laboratory Diagnosis ◽  
P Value ◽  
Care Hospital ◽  
Serum Samples ◽  
Serological Tests ◽  
Igm Elisa

Scrub typhus is an arthropod-borne zoonotic bacterial infection caused by Orientia tsutsugamushi. It presents clinically as a non-specific febrile illness that needs a high index of clinical suspicion for diagnosis. The mortality rate can be as high as 30% if not treated appropriately. Laboratory diagnosis is therefore important for confirming the cause of illness prior to initiating appropriate therapy. Hence we aimed to detect scrub typhus in serum samples of undifferentiated febrile illness patients and to correlate with the socioeconomic status of these individuals. We also aimed to study the seasonal variation associated with the disease. Serum samples from 143 febrile patients who were negative for other febrile illnesses were subjected to scrub typhus IgM ELISA. Scrub typhus IgM antibodies were found in 14 (9.8%) individuals of which 41-60 years being the most affected age group. Scrub typhus positivity was high during the months of October to December (P-value 0.0056) with the individuals from the rural areas being the most affected (P-value 0.027). To conclude, this study emphasises the importance of serological tests to detect scrub typhus and to include it as a differential diagnosis among undifferentiated febrile illnesses.

scholarly journals Burden of scrub typhus among patients with acute febrile illness attending tertiary care hospital in Chitwan, Nepal

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e034727
Author(s):  
Sangita Thapa ◽  
Pradip Hamal ◽  
Navin Kumar Chaudhary ◽  
Lokendra Bahadur Sapkota ◽  
Jaya Prasad Singh
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
College Teaching ◽  
Febrile Illness ◽  
Care Hospital ◽  
Acute Febrile Illness ◽  
Medical College ◽  
Igm Elisa ◽  
High Prevalence ◽  
And Control

ObjectivesScrub typhus is an emerging neglected tropical disease, reported from many parts of Asia including Nepal. This study aims to determine the seroepidemiology of scrub typhus among febrile patients attending Chitwan Medical College Teaching Hospital (CMC-TH), Bharatpur, Nepal.Study design and settingThis was a hospital laboratory-based prospective study conducted in CMC-TH (a 750-bed hospital) located in Bharatpur, Chitwan district of Nepal.ParticipantsA total of 1797 patients visiting CMC-TH with acute febrile illness (temperature more than 38°C) were enrolled in this study.MethodsA total of 1797 blood samples were collected from patients presenting with acute febrile illness. The samples were processed for detection of antibody for scrub typhus by ELISA for specific IgM antibody and Weil-Felix test.ResultsOut of 1797 serum sample of febrile patients, 524 (29.2%) were scrub typhus positive. Maximum seropositive cases were from Chitwan district, 271 (51.7%) with predominance among women, 314 (35.9%). Scrub typhus was common among age group 51–60 years (37.2%) and farmers, 182 (37.8%). Highest seropositivity was found in July, 60 (57.7%). Fever was common clinical symptom. Thrombocytopenia was seen in 386 (73.7%) and raised transaminase aspartate aminotransferase, 399 (76.1%) among seropositive cases. Weil-Felix test positive were 397 (22.1%) and IgM ELISA positive were 524 (29.2%). The correlation between IgM ELISA and Weil-Felix test showed statistically significant association (r=0.319, p<0.001).ConclusionHigh prevalence of scrub typhus implies that patients with acute febrile illness should be investigated for scrub typhus with high priority. There is utmost need of reliable diagnostic facilities at all levels of healthcare system in Nepal. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. More sustain and vigorous awareness programmes need to be promoted for early diagnosis, treatment and control.

scholarly journals A study on clinical profile of acute undifferentiated febrile illness in a tertiary care hospital

2020 ◽  
Vol 7 (3) ◽  
pp. 404
Author(s):  
Mariraj I. ◽  
Mohammed Adil ◽  
Ramkumar M. ◽  
Jagadeesan M. ◽  
Prasanna Karthik S. ◽  
...  
Keyword(s):  
Enteric Fever ◽  
Scrub Typhus ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Clinical Profile ◽  
Malarial Parasite ◽  
Care Hospital ◽  
Acute Febrile Illness ◽  
Function Test

Background: Acute febrile illness is very common among patients seeking hospital care in tropical country like India. This study was conducted to evaluate etiology and clinical profile of Acute Undifferentiated Febrile Illness (AUFI) in a tertiary care hospital.Methods: This study was conducted in 175 patients with acute febrile illness who were admitted in the medical wards and ICU from January 2018 to June 2019 in a tertiary care hospital. Clinical examination and investigations like complete hemogram, liver function test, renal function test, smear for malarial parasite, widal test, urine analysis blood and urine culture, antibody titters for dengue, Leptospirosis and imaging were done.Results: Out of 175, 94 (54%) were males and 81 (46%) were females. The commonest etiology was dengue (19%) followed by enteric fever (18%), scrub typhus (16%), malaria (14%), tuberculosis (6%) and leptospirosis (5%). 138 (79%) patients had less than 14 days of fever of which dengue was the most common and 37 (21%) patients had more than 14 days of fever with tuberculosis being predominate. Other common symptoms were chills/rigors, headache and myalgia seen in 77%, 71% and 42% respectively. Icterus was seen in malaria (42%) and leptospirosis (38%). Elevated transaminases levels were observed with dengue, leptospirosis, scrub typhus, enteric fever and malaria. ARDS was most common in scrub typhus.Conclusions: Among acute febrile illness, dengue and enteric fever were the most common in this study. A thorough and probing search for an eschar is very important in scrub typhus. The treating physician has to keep in mind the comprehensive list of differential diagnosis for patients with febrile illness and anticipating the complications.

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