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Prospective study to assess the treatment modalities and fever defervescence in patients with scrub typhus from a tertiary care centre in South India.
J Vector Borne Dis. 2021 Jan-Mar; 58(1):33-38.JV

Abstract

BACKGROUND AND OBJECTIVES

Fever defervescence in scrub typhus, a zoonotic bacterial infection is used as a surrogate marker of disease resolution. Failure of fever defervescence prompts clinicians to suspect alternate diagnoses and treatment. In this observational study, various treatment regimens were correlated with clinical outcomes.

METHODS

All adult patients with a diagnosed scrub typhus were included; various antibiotic regimens used and clinical outcomes were studied. Data was analyzed using SPSS software for windows 16, with a 2-sided P-value of 0.05 or less was considered statistically significant.

RESULTS

In 177 hospitalized patients with scrub typhus, combination therapy (doxycycline and azithromycin) was used in 74 subjects with doxycycline and azithromycin used in 46 and 57 subjects, respectively. Incidence of delayed defervescence was seen in 31.6%, Combination therapy being preferred in sicker patients (SOFA score 8.82). Presence of respiratory dysfunction was associated with a delay in fever defervescence [risk ratio 2.50(1.18-5.3)]. Patients receiving doxycycline did better in terms of oxygen requirement and the presence of hypotension. The overall case fatality rate was 5.6%. The severity of illness rather than the choice of antibiotics predicted the outcome in scrub typhus.

INTERPRETATION & CONCLUSION

Combination therapy with doxycycline and azithromycin is the most common regimen used. Incidence of delayed defervescence (31.6%) is increasing despite therapy and the involvement of respiratory dysfunction is an independent predictor of delayed fever defervescence.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Barnabas R
Department of General Medicine, Christian Medical College, Vellore, India.
Abhilash K
Department of General Medicine, Christian Medical College, Vellore, India.
Varghese GM
Department of Infectious Disease, Christian Medical College, Vellore, India.
Shubanker M
Department of General Medicine, Christian Medical College, Vellore, India.
Ramya I
Department of General Medicine, Christian Medical College, Vellore, India.
Prakash J
Department of Microbiology, Christian Medical College, Vellore, India.

MeSH

AdultAnti-Bacterial AgentsAzithromycinDoxycyclineHumansIndiaProspective StudiesScrub TyphusTertiary Care Centers

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

34818861

Citation

Barnabas, Rohit, et al. "Prospective Study to Assess the Treatment Modalities and Fever Defervescence in Patients With Scrub Typhus From a Tertiary Care Centre in South India." Journal of Vector Borne Diseases, vol. 58, no. 1, 2021, pp. 33-38.
Barnabas R, Abhilash K, Varghese GM, et al. Prospective study to assess the treatment modalities and fever defervescence in patients with scrub typhus from a tertiary care centre in South India. J Vector Borne Dis. 2021;58(1):33-38.
Barnabas, R., Abhilash, K., Varghese, G. M., Shubanker, M., Ramya, I., & Prakash, J. (2021). Prospective study to assess the treatment modalities and fever defervescence in patients with scrub typhus from a tertiary care centre in South India. Journal of Vector Borne Diseases, 58(1), 33-38. https://doi.org/10.4103/0972-9062.321748
Barnabas R, et al. Prospective Study to Assess the Treatment Modalities and Fever Defervescence in Patients With Scrub Typhus From a Tertiary Care Centre in South India. J Vector Borne Dis. 2021 Jan-Mar;58(1):33-38. PubMed PMID: 34818861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective study to assess the treatment modalities and fever defervescence in patients with scrub typhus from a tertiary care centre in South India. AU - Barnabas,Rohit, AU - Abhilash,Kpp, AU - Varghese,George M, AU - Shubanker,M, AU - Ramya,I, AU - Prakash,Jaj, PY - 2021/11/25/entrez PY - 2021/11/26/pubmed PY - 2021/12/15/medline KW - Scrub typhus KW - azithromycin KW - combination therapy KW - delayed defervesce KW - doxycycline SP - 33 EP - 38 JF - Journal of vector borne diseases JO - J Vector Borne Dis VL - 58 IS - 1 N2 - BACKGROUND AND OBJECTIVES: Fever defervescence in scrub typhus, a zoonotic bacterial infection is used as a surrogate marker of disease resolution. Failure of fever defervescence prompts clinicians to suspect alternate diagnoses and treatment. In this observational study, various treatment regimens were correlated with clinical outcomes. METHODS: All adult patients with a diagnosed scrub typhus were included; various antibiotic regimens used and clinical outcomes were studied. Data was analyzed using SPSS software for windows 16, with a 2-sided P-value of 0.05 or less was considered statistically significant. RESULTS: In 177 hospitalized patients with scrub typhus, combination therapy (doxycycline and azithromycin) was used in 74 subjects with doxycycline and azithromycin used in 46 and 57 subjects, respectively. Incidence of delayed defervescence was seen in 31.6%, Combination therapy being preferred in sicker patients (SOFA score 8.82). Presence of respiratory dysfunction was associated with a delay in fever defervescence [risk ratio 2.50(1.18-5.3)]. Patients receiving doxycycline did better in terms of oxygen requirement and the presence of hypotension. The overall case fatality rate was 5.6%. The severity of illness rather than the choice of antibiotics predicted the outcome in scrub typhus. INTERPRETATION & CONCLUSION: Combination therapy with doxycycline and azithromycin is the most common regimen used. Incidence of delayed defervescence (31.6%) is increasing despite therapy and the involvement of respiratory dysfunction is an independent predictor of delayed fever defervescence. SN - 0972-9062 UR - https://www.unboundmedicine.com/medline/citation/34818861/Prospective_study_to_assess_the_treatment_modalities_and_fever_defervescence_in_patients_with_scrub_typhus_from_a_tertiary_care_centre_in_South_India_ DB - PRIME DP - Unbound Medicine ER -