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Pattern of Clinical Presentation, Laboratory Findings and Mortality Risk Among Patients of Scrub Typhus in Western Himalayas.
J Assoc Physicians India. 2016 03; 64(3):26-30.JA

Abstract

OBJECTIVE

To study the pattern of the clinical presentation, laboratory findings and mortality risk among patients infected by scrub typhus in Western Himalayan region of India.

METHODS

We studied all serologically confirmed cases of scrub typhus admitted to our hospital from July 2010 through December 2011. Presence of IgM antibodies to scrub typhus antigens by ELISA was considered as serological confirmation of the diagnosis. We observed the symptoms, signs, laboratory findings, risk factors for death from the time of admission till discharge/death. We performed bivariate and logistic regression analysis to look for independent risk factors for death.

RESULTS

Total 253 patients were studied. All patients came from rural areas. More than 2/3rd were women and below 50 years of age each. High grade fever (90%), chills and rigors (68%), conjunctival suffusion (50%), body aches (43%), headache (41%), myalgias (37%), abdominal pain (21%), lymphadenopathy (17%), splenomegaly (17%), cough (16%), altered sensorium (16%), vomiting (15%), hepatomegaly (13%) were main presenting features. Eschar was present in 112 (44%) patients. Transaminitis (49%); and abnormal renal functions (31%) were predominant biochemical abnormalities. All patients were empirically treated with doxycycline/azithromycin. Thirteen (5%) patients died.

CONCLUSIONS

In our region, rural women below 50 years of age presenting with high grade fever with or without eschar should be strongly suspected to be having scrub typhus. Renal dysfunction and altered sensorium are significant mortality risk factors (p < 0.05) and need to be identified at early stage to improve the treatment outcomes.

Authors+Show Affiliations

Mahajan SK
Department of Medicine.
Raina R
Department of Medicine.
Singh B
Assistant Professor cum Incharge, Epidemiology Unit, Department of Community Medicine.
Singh DV
Department of Microbiology.
Kanga A
Department of Microbiology.
Sharma A
Department of Medicine.
Kaushal SS
Principal, I. G. Medical College, Shimla, Himachal Pradesh.

MeSH

AdolescentAdultAgedAnti-Bacterial AgentsAzithromycinDoxycyclineEnzyme-Linked Immunosorbent AssayFemaleFeverHumansImmunoglobulin MIndiaMaleMiddle AgedOrientia tsutsugamushiRisk FactorsScrub TyphusYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27731554

Citation

Mahajan, Sanjay K., et al. "Pattern of Clinical Presentation, Laboratory Findings and Mortality Risk Among Patients of Scrub Typhus in Western Himalayas." The Journal of the Association of Physicians of India, vol. 64, no. 3, 2016, pp. 26-30.
Mahajan SK, Raina R, Singh B, et al. Pattern of Clinical Presentation, Laboratory Findings and Mortality Risk Among Patients of Scrub Typhus in Western Himalayas. J Assoc Physicians India. 2016;64(3):26-30.
Mahajan, S. K., Raina, R., Singh, B., Singh, D. V., Kanga, A., Sharma, A., & Kaushal, S. S. (2016). Pattern of Clinical Presentation, Laboratory Findings and Mortality Risk Among Patients of Scrub Typhus in Western Himalayas. The Journal of the Association of Physicians of India, 64(3), 26-30.
Mahajan SK, et al. Pattern of Clinical Presentation, Laboratory Findings and Mortality Risk Among Patients of Scrub Typhus in Western Himalayas. J Assoc Physicians India. 2016;64(3):26-30. PubMed PMID: 27731554.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pattern of Clinical Presentation, Laboratory Findings and Mortality Risk Among Patients of Scrub Typhus in Western Himalayas. AU - Mahajan,Sanjay K, AU - Raina,Rajiv, AU - Singh,Balraj, AU - Singh,Dig Vijay, AU - Kanga,Anil, AU - Sharma,Ashok, AU - Kaushal,Satinder S, PY - 2016/10/13/entrez PY - 2016/10/13/pubmed PY - 2018/10/20/medline SP - 26 EP - 30 JF - The Journal of the Association of Physicians of India JO - J Assoc Physicians India VL - 64 IS - 3 N2 - OBJECTIVE: To study the pattern of the clinical presentation, laboratory findings and mortality risk among patients infected by scrub typhus in Western Himalayan region of India. METHODS: We studied all serologically confirmed cases of scrub typhus admitted to our hospital from July 2010 through December 2011. Presence of IgM antibodies to scrub typhus antigens by ELISA was considered as serological confirmation of the diagnosis. We observed the symptoms, signs, laboratory findings, risk factors for death from the time of admission till discharge/death. We performed bivariate and logistic regression analysis to look for independent risk factors for death. RESULTS: Total 253 patients were studied. All patients came from rural areas. More than 2/3rd were women and below 50 years of age each. High grade fever (90%), chills and rigors (68%), conjunctival suffusion (50%), body aches (43%), headache (41%), myalgias (37%), abdominal pain (21%), lymphadenopathy (17%), splenomegaly (17%), cough (16%), altered sensorium (16%), vomiting (15%), hepatomegaly (13%) were main presenting features. Eschar was present in 112 (44%) patients. Transaminitis (49%); and abnormal renal functions (31%) were predominant biochemical abnormalities. All patients were empirically treated with doxycycline/azithromycin. Thirteen (5%) patients died. CONCLUSIONS: In our region, rural women below 50 years of age presenting with high grade fever with or without eschar should be strongly suspected to be having scrub typhus. Renal dysfunction and altered sensorium are significant mortality risk factors (p < 0.05) and need to be identified at early stage to improve the treatment outcomes. SN - 0004-5772 UR - https://www.unboundmedicine.com/medline/citation/27731554/Pattern_of_Clinical_Presentation_Laboratory_Findings_and_Mortality_Risk_Among_Patients_of_Scrub_Typhus_in_Western_Himalayas_ DB - PRIME DP - Unbound Medicine ER -