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Clinical profile and improving mortality trend of scrub typhus in South India.
[scrub typhus]
Scrub
typhus
,
a
bacterial
zoonosis
caused
by
Orientia
tsutsugamushi
,
may
cause
multiorgan
dysfunction
syndrome
(
MODS
)
and
is
associated
with
significant
mortality
.
This
study
was
undertaken
to
document
the
clinical
and
laboratory
manifestations
and
complications
and
to
study
time
trends
and
factors
associated
with
mortality
in
patients
with
scrub
typhus
infection
.
This
retrospective
study
,
done
at
a
university
teaching
hospital
,
included
623
patients
admitted
between
2005
and
2010
with
scrub
typhus
.
The
diagnosis
was
established
by
a
positive
IgM
ELISA
and
/
or
pathognomonic
eschar
with
PCR
confirmation
where
feasible
.
The
clinical
and
laboratory
profile
,
course
in
hospital
,
and
outcome
were
documented
.
Factors
associated
with
mortality
were
analyzed
using
multivariate
logistic
regression
analysis
.
The
most
common
presenting
symptoms
were
fever
(
100
%
)
,
nausea
/
vomiting
(
54
%
)
,
shortness
of
breath
(
49
%
)
,
headache
(
46
%
)
,
cough
(
38
%
)
,
and
altered
sensorium
(
26
%
)
.
An
eschar
was
present
in
43
.
5
%
of
patients
.
Common
laboratory
findings
included
elevated
transaminases
(
87
%
)
,
thrombocytopenia
(
79
%
)
,
and
leukocytosis
(
46
%
)
.
MODS
was
seen
in
34
%
of
patients
.
The
overall
case-fatality
rate
was
9
.
0
%
.
Features
of
acute
lung
injury
were
observed
in
33
.
7
%
,
and
29
.
5
%
required
ventilatory
support
.
On
multivariate
analysis
,
shock
requiring
vasoactive
agents
(
relative
risk
(
RR
)
10
.
5
,
95
%
confidence
interval
(
CI
)
4
.
2
-
25
.
7
,
p
<
0
.
001
)
,
central
nervous
system
(
CNS
)
dysfunction
(
RR
5
.
1
,
95
%
CI
2
.
4
-
10
.
7
,
p
<
0
.
001
)
,
and
renal
failure
(
RR
3
.
6
,
95
%
CI
1
.
7
-
7
.
5
,
p
=
0
.
001
)
were
independent
predictors
of
mortality
.
Over
4
years
,
a
decreasing
trend
was
observed
in
the
mortality
rate
.
Scrub
typhus
can
manifest
with
potentially
life-threatening
complications
such
as
lung
injury
,
shock
,
and
meningoencephalitis
.
MODS
occurred
in
a
third
of
our
patients
.
The
overall
case-fatality
rate
was
9
%
,
with
shock
,
renal
failure
,
and
CNS
associated
with
a
higher
mortality
.
Diseases
Validation
Diseases presenting
"overall case-fatality rate"
symptom
scrub typhus
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