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Recent outbreak of scrub typhus in North Western part of India.
[scrub typhus]
Scrub
typhus
usually
affects
previously
healthy
active
persons
and
if
undiagnosed
or
diagnosed
late
,
may
prove
to
be
life-threatening
.
Diagnosis
of
scrub
typhus
should
be
largely
based
on
a
high
index
of
suspicion
and
careful
clinical
,
laboratory
and
epidemiological
evaluation
.
To
describe
the
diverse
clinical
and
laboratory
manifestations
of
scrub
typhus
diagnosed
in
Mahatma
Gandhi
Medical
College
and
Hospital
,
Jaipur
.
A
ll
cases
of
febrile
illness
diagnosed
as
scrub
typhus
over
a
period
of
3
months
were
analysed
.
Diagnosis
was
based
on
ELISA
test
for
antibody
detection
against
56
kDa
antigen
.
Forty
-
two
cases
of
scrub
typhus
were
seen
over
a
period
of
3
months
(
October
,
2012
-
December
,
2012
)
.
Common
symptoms
were
high
grade
fever
of
4
-
30
days
duration
,
cough
,
haemoptysis
and
breathlessness
.
Eschar
was
not
seen
even
in
a
single
patient
.
Liver
enzymes
were
elevated
in
nearly
all
cases
(
95
.
9
%
)
.
Multiple
organ
dysfunction
syndrome
(
MODS
)
was
present
in
16
.
66
%
of
our
patients
(
7
out
of
42
)
.
Hypotension
(
6
patients
,
14
.
2
%
)
,
renal
impairment
(
9
out
of
15
patients
,
60
%
)
,
acute
respiratory
distress
syndrome
(
4
patients
,
9
.
52
%
)
and
meningitis
(
4
patients
,
9
.
52
%
)
were
some
of
the
important
complications
.
There
was
a
dramatic
response
to
doxycycline
in
nearly
all
the
patients
,
but
initially
when
the
disease
was
not
diagnosed
,
seven
patients
had
died
.
Scrub
typhus
has
emerged
as
an
important
cause
of
febrile
illness
in
Jaipur
.
Empirical
treatment
with
doxycycline
is
justified
in
endemic
areas
.
Diseases
Validation
Diseases presenting
"liver enzymes"
symptom
aromatase deficiency
benign recurrent intrahepatic cholestasis
erythropoietic protoporphyria
neuralgic amyotrophy
pyomyositis
scrub typhus
werner syndrome
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