Clinico-demographic profile of scrub typhus: A prospective study

Meenaxi Sharda; Sachin Shyoran; Prateek Jain; Bhimsain Goyal; Ankit Vijay; Nikhil Gandhi

Clinico-demographic profile of scrub typhus: A prospective study

Authors
Meenaxi Sharda, Sachin Shyoran, Prateek Jain, Bhimsain Goyal, Ankit Vijay, Nikhil Gandhi

Abstract
Background and Objectives: Scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi, is endemic in many parts of India including Rajasthan. We aim to study the clinico-demographical profile of scrub typhus and to identify the markers which may help in early diagnosis and predicting the severity of disease. Methods: A prospective study was conducted at Government Medical College, Kota including 100 IgM ELISA confirmed scrub typhus patients getting admitted between September 2019 and September 2020. Results: The mean age of 100 patients (60 females and 40 males) is 41.13±15.78 years. Farmers (65%) are mostly affected specially from rural areas (85%). Manifestations include fever (100%), myalgia (68%), headache (56%), breathlessness (48%), abdominal pain (48%), cough (46%), vomiting (41%), diarrhea (9%), altered sensorium (9%), convulsions (2%), hepatomegaly (64%), splenomegaly (36%), jaundice (34%), eschar (12%), lymphadenopathy (8%) and rashes (5%). 72% developed complications, such as hepatic dysfunction (52%), ARDS (32%), acute kidney injury (36%), multiple organ dysfunction (35%), encephalitis (7%), shock (7%), myocarditis (4%) and epididymo-orchitis (1%). Leucocytosis (p=0.009), thrombocytopenia (p=0.040), hypoalbuminemia (p=0.037), raised LDH (p=0.001) and hypertriglyceridemia (p=0.001) are significantly associated with complications. Mean length of hospital stay is 5.6 days with a mortality rate of 2%. Conclusion: Scrub typhus should be considered in the differential diagnosis of acute febrile illness associated with hepatosplenomegaly, thrombocytopenia, elevated liver enzymes, hypertriglyceridemia, renal dysfunction or ARDS, with or without the presence of eschar. A high index of suspicion is required for early diagnosis and treatment to prevent morbidity and mortality.

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