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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
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated