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Infectious Diseases of Poverty

, 5:91

First Online: 05 October 2016Received: 08 November 2015Accepted: 22 August 2016DOI: 10.1186-s40249-016-0186-x

Cite this article as: Sivarajan, S., Shivalli, S., Bhuyan, D. et al. Infect Dis Poverty 2016 5: 91. doi:10.1186-s40249-016-0186-x


BackgroundIndia is an integral component of -tsutsugamushi triangle- which depicts a part of the globe endemic to scrub typhus. Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is described as a re-emerging infectious disease in India. The present study aimed to study the clinical and paraclinical profile, complications and predictors of outcome among 90 cases of scrub typhus diagnosed in a hospital of north-eastern India from Sept 2011 to Aug 2012.

MethodsA longitudinal study was conducted in a hospital of Meghalaya, India between Sept 2011 and Aug 2012. Diagnosis of scrub typhus was arrived by SD BIOLINE tsutsugamushi solid phase immunochromatographic assay rapid diagnostic test for antibodies IgM, IgG or IgA. Descriptive analyses of age, gender, geographic area, symptoms and signs, treatment, laboratory findings, complications, and outcome were conducted. Relative risk RR with 95 % confidence interval CI was computed for Multiple Organ Dysfunction Syndrome MODS and mortality. Binary logistic regression was applied to the significant correlates P < 0.05 on univariate analysis to identify the predictors of MODS and mortality in scrub typhus.

ResultsAs many as 662 clinically suspected scrub typhus patients were tested and 90 13.6 % were diagnosed to have scrub typhus. Out of 90 patients, 52.2 % n = 47 were males and their mean SD age was 36.29 13.38 years. Fever of <7 days n = 75, 83.3 %, myalgia n = 56, 62.2 %, pain abdomen n = 24, 26.7 %, headache n = 24, 26.7 %, nausea-vomiting n = 21, 23.3 %, dry cough n = 21, 23.3 %, hepatomegaly n = 24, 26.7 %, splenomegaly n = 22, 24.4 %, and lymphadenopathy n = 20, 22.2 % were the predominant clinical features. Eschar was seen in 10 patients 11.1 %. One third n = 30 of the patients developed at least one systemic complication. Acute hepatitis n = 15, 16.7 %, pneumonitis n = 14, 15.6 %, and acute kidney injury n = 11, 12.2 % were the common complications. MODS was seen in 14.4 % n = 13 and 38.5 % n = 5 of the patients with MODS died. Overall, case fatality rate was 5.15 % n = 5. On univariate analysis, platelets <100 000-mm, serum creatinine >1.5 mg-dl, and transaminase AST, ALT or both >500 U-L were associated with MODS P < 0.001 and mortality P < 0.05. In addition, serum bilirubin >3 mg-dl was also associated with MODS P < 0.001. On applying binary logistic regression, serum creatinine >1.5 mg-dl was a predictor of MODS OR: 76.1, 95 % CI: 4.9–1175.6 and mortality OR: 18.03, 95 % CI: 1.38–235.1.

ConclusionIn this study setting, approximately one-seventh 13.6 % of the acute undifferentiated febrile illness were due to scrub typhus. Systemic complications were common 33.3 %. Serum creatinine >1.5 mg-dl was a predictor of MODS and mortality.

KeywordsHospital India Longitudinal Multiple Organ Dysfunction Syndrome MODS Mortality Scrub typhus AbbreviationsAKIAcute Kidney Injury

ALPAlkaline phosphatase

ALTAlanine aminotransferase

ARDSAcute respiratory distress syndrome

ASTAspartate aminotransferase AST

CSFCerebrospinal fluid

DICDisseminated intravascular coagulation

IQRInter Quartile range

MODSMultiple Organ Dysfunction Syndrome

SPSSStatistical Package for the Social Sciences

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s40249-016-0186-x contains supplementary material, which is available to authorized users.

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Autor: Sunuraj Sivarajan - Siddharudha Shivalli - Debomallya Bhuyan - Michael Mawlong - Rittwick Barman


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