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Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission.
[scrub typhus]
Scrub
typhus
,
a
zoonotic
rickettsial
infection
,
is
an
important
reason
for
intensive
care
unit
(
ICU
)
admission
in
the
Indian
subcontinent
.
We
describe
the
clinical
profile
,
organ
dysfunction
,
and
predictors
of
mortality
of
severe
scrub
typhus
infection
.
Retrospective
study
of
patients
admitted
with
scrub
typhus
infection
to
a
tertiary
care
university
affiliated
teaching
hospital
in
India
during
a
21
-
month
period
.
The
cohort
(
n
=
116
)
aged
40
.
0
±
15
.
2
years
(
mean
±
SD
)
,
presented
8
.
5
±
4
.
4
days
after
symptom
onset
.
Common
symptoms
included
fever
(
100
%
)
,
breathlessness
(
68
.
5
%
)
,
and
altered
mental
status
(
25
.
5
%
)
.
Forty
-
seven
(
41
.
6
%
)
patients
had
an
eschar
.
Admission
APACHE-
II
score
was
19
.
6
±
8
.
2
.
Ninety
-
one
(
85
.
2
%
)
patients
had
dysfunction
of
3
or
more
organ
systems
.
Respiratory
(
96
.
6
%
)
and
hematological
(
86
.
2
%
)
dysfunction
were
frequent
.
Mechanical
ventilation
was
required
in
102
(
87
.
9
%
)
patients
,
of
whom
14
(
12
.
1
%
)
were
solely
managed
with
non-invasive
ventilation
.
Thirteen
patients
(
11
.
2
%
)
required
dialysis
.
Duration
of
hospital
stay
was
10
.
7
±
9
.
7
days
.
Actual
hospital
mortality
(
24
.
1
%
)
was
less
than
predicted
APACHE-
II
mortality
(
36
%
;
95
%
Confidence
interval
32
-
41
)
.
APACHE-
II
score
and
duration
of
fever
were
independently
associated
with
mortality
on
logistic
regression
analysis
.
In
this
cohort
of
severe
scrub
typhus
infection
with
multi-organ
dysfunction
,
survival
was
good
despite
high
severity
of
illness
scores
.
APACHE-
II
score
and
duration
of
fever
independently
predicted
mortality
.
Diseases
Validation
Diseases presenting
"affiliated teaching hospital"
symptom
scrub typhus
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