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Clinical Prevalence and Atypical Presentations in Scrub Typhus

Rayees Ahmed Sofi, Associate Consultant & Academic in-charge, Department of Emergency Medicine, The Mission Hospital, 219(P), Immon Kalyan Sarani, Sector 2C, Bidhannagar West Bengal 713212, India. , Sonika Dhillon , Rayees Ahmed Sofi , Parimal Tara , Balwant Kumar

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Indian Journal of Emergency Medicine 4(3):p 175-180, Jul-Sep, 2018. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4318.11

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Abstract

Study Objective: We studied and describe the clinical and Para clinical profile, complications and outcome among 17 cases of Scrub typhus diagnosed in The Mission Hospital, Durgapur from March 2017 to April 2018.

Methods: This was a cross-sectional study of clinical prevalence and presentations of Scrub Typhus at the Emergency Department at the Mission Hospital, Durgapur. We observed suspected cases presenting with high grade fever and recorded patient demographics, vital signs, pulse oximetry, findings on thorough physical examinations. Clinical features at admission, complications occurring during stay, treatment and outcome were recorded for all cases and descriptive statistics are presented in this study. All treatment decisions were at the discretion of the treating provider who was blinded to study measurements to simulate usual care. At the end of the study, provider and patients were assessed for treatment satisfaction. 

Results: We observed 17 patients (3 children and 14 adults) from all age groups. The most common clinical features included were high grade fever (100%), headache (47.05%), rash (29.41%), hepatomegaly (23.52%), lymphadenopathy (17.64%), skin hyperemia (11.76%), nausea / vomiting (17.64%), cold and dry cough (17.64%), pain abdomen (17.64%) and An Eschar was found in 41.17% which were the predominant clinical features. Complications noted in the patients were mainly of pulmonary pathology noted in 41.17 % of cases, liver enzymes were elevated in MODS which were seen in 11.76% but none of the patients with MODS died. Overall, Use of empiric treatment was considered to reduce the high mortality observed with the disease and resulted in high patient and provider satisfaction.

Conclusion: In this study, diagnosis of scrub typhus largely based on a high index of suspicion and careful clinical, laboratory, and epidemiological evaluation with early diagnosis, identifying the complications and predictors of outcome among the diagnosed cases of scrub typhus which led to better outcome with no mortality [4].
 

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4318.11

Keywords

Scrub Typhus; Tsutsugamushi Triangle; Eschar; Rickettsial Disease; Acute Undifferentiated Febrile Illness.

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