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Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality.
Trop Doct 2010; 40(3):129-33TD

Abstract

Scrub typhus is an important cause of acute undifferentiated febrile illnesses in the Indian subcontinent. Delay in diagnosis and in the initiation of appropriate treatment can result in severe complications such as acute respiratory distress syndrome (ARDS), septic shock and multisystem organ failure culminating in death. We conducted a prospective, observational study to delineate the clinical profile and predictors of mortality in scrub typhus in adults admitted to the medical wards of a tertiary care, referral hospital in South India over a one-year period. The case fatality rate in this study was 12.2%. Metabolic acidosis (odds ratio [OR] 6.1), ARDS (OR 3.6), altered sensorium (OR 3.6) and shock (OR 3.1) were independent predictors of mortality. It appears that scrub typhus has four possible overlapping clinical presentations: mild disease; respiratory predominant disease; central nervous system predominant disease (meningoencephalitis); or sepsis syndrome. Given the telltale presence of an eschar (evident in 45.5%), the characteristic clinical profile and the dramatic therapeutic response to a cheap, yet effective, drug such as doxycycline, medical practitioners in the region should have ample opportunity to reach an early diagnosis and initiate treatment which could, potentially, reduce the mortality and morbidity associated with scrub typhus.

Authors+Show Affiliations

Department of Medicine Unit 2, Christian Medical College, Vellore 632004, Tamil Nadu, India. anugrahchrispal@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20360426

Citation

Chrispal, Anugrah, et al. "Scrub Typhus: an Unrecognized Threat in South India - Clinical Profile and Predictors of Mortality." Tropical Doctor, vol. 40, no. 3, 2010, pp. 129-33.
Chrispal A, Boorugu H, Gopinath KG, et al. Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Trop Doct. 2010;40(3):129-33.
Chrispal, A., Boorugu, H., Gopinath, K. G., Prakash, J. A., Chandy, S., Abraham, O. C., ... Thomas, K. (2010). Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Tropical Doctor, 40(3), pp. 129-33. doi:10.1258/td.2010.090452.
Chrispal A, et al. Scrub Typhus: an Unrecognized Threat in South India - Clinical Profile and Predictors of Mortality. Trop Doct. 2010;40(3):129-33. PubMed PMID: 20360426.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. AU - Chrispal,Anugrah, AU - Boorugu,Harikishan, AU - Gopinath,Kango Gopal, AU - Prakash,John Antony Jude, AU - Chandy,Sara, AU - Abraham,O C, AU - Abraham,Asha Mary, AU - Thomas,Kurien, Y1 - 2010/04/01/ PY - 2010/4/3/entrez PY - 2010/4/3/pubmed PY - 2010/8/4/medline SP - 129 EP - 33 JF - Tropical doctor JO - Trop Doct VL - 40 IS - 3 N2 - Scrub typhus is an important cause of acute undifferentiated febrile illnesses in the Indian subcontinent. Delay in diagnosis and in the initiation of appropriate treatment can result in severe complications such as acute respiratory distress syndrome (ARDS), septic shock and multisystem organ failure culminating in death. We conducted a prospective, observational study to delineate the clinical profile and predictors of mortality in scrub typhus in adults admitted to the medical wards of a tertiary care, referral hospital in South India over a one-year period. The case fatality rate in this study was 12.2%. Metabolic acidosis (odds ratio [OR] 6.1), ARDS (OR 3.6), altered sensorium (OR 3.6) and shock (OR 3.1) were independent predictors of mortality. It appears that scrub typhus has four possible overlapping clinical presentations: mild disease; respiratory predominant disease; central nervous system predominant disease (meningoencephalitis); or sepsis syndrome. Given the telltale presence of an eschar (evident in 45.5%), the characteristic clinical profile and the dramatic therapeutic response to a cheap, yet effective, drug such as doxycycline, medical practitioners in the region should have ample opportunity to reach an early diagnosis and initiate treatment which could, potentially, reduce the mortality and morbidity associated with scrub typhus. SN - 1758-1133 UR - https://www.unboundmedicine.com/medline/citation/20360426/Scrub_typhus:_an_unrecognized_threat_in_South_India___clinical_profile_and_predictors_of_mortality_ L2 - http://journals.sagepub.com/doi/full/10.1258/td.2010.090452?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -