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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
"vomiting"
symptom
22q11.2 deletion syndrome
alexander disease
alpha-thalassemia
aromatase deficiency
benign recurrent intrahepatic cholestasis
cadasil
carcinoma of the gallbladder
child syndrome
cholangiocarcinoma
congenital toxoplasmosis
cutaneous mastocytosis
dedifferentiated liposarcoma
esophageal squamous cell carcinoma
homocystinuria without methylmalonic aciduria
kallmann syndrome
locked-in syndrome
megacystis-microcolon-intestinal hypoperistalsis syndrome
neonatal adrenoleukodystrophy
primary hyperoxaluria type 1
proteus syndrome
scrub typhus
severe combined immunodeficiency
systemic capillary leak syndrome
triple a syndrome
typhoid
von hippel-lindau disease
This symptom has already been validated