Complications Of Scrub Typhus Research Articles

Clinical and laboratory findings in scrub typhus associated Guillain-Barré syndrome in South Korea.

Scrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain-Barré syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus. Patients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS-associated clinical and electrophysiological characteristics, outcomes, and scrub typhus-associated features were collected. Of the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2-14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1-4) points. Patients with scrub typhus-associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS.

Liver dysfunction in children with scrub typhus: association with severity of illness and outcome

Background: Liver dysfunction is a common finding in children with scrub typhus. Adult literature has found a significant association between the extent of liver dysfunction and severity of illness and outcome. However, very few studies are available on children.Objectives: To study the extent of liver dysfunction in children with scrub typhus and its association with severity of illness and outcome.Method: It was a retrospective descriptive study conducted on children diagnosed with scrub typhus admitted to a tertiary care centre in south India from January 2016 to December 2020. Children from 1 month to 18 years of age were included. Demographic data, clinical details, laboratory parameters, course of illness and outcome data were collected and analysed. Results: Study population included 143 cases of scrub typhus. Mean age of the study population was 8.4 ± 4.4 years with a male: female ratio of 1.2:1. Fever was present in 100%, myalgia in 54.5%, decreased appetite in 54.5%, jaundice in 8.4% and hepatomegaly in 71.3% of children. Abnormal liver function tests were present in 75.5% children. Elevated aspartate transaminase (AST) was seen in 75.5%, elevated alanine transaminase (ALT) in 67.1%, hypoalbuminaemia in 47.5% and severe hypoalbuminaemia (<2.5g/dL) in 29.4%. Complications included meningitis (13.3%), shock (7.6%), meningoencephalitis (2.7%) and acute respiratory distress syndrome (2%). There were 2 (1.3%) deaths. Children with complications had higher AST (p <0.01), ALT (p = 0.018), low serum albumin (p<0.001) and prolonged international normalised ratio (INR) (p =0.003).Conclusions: Abnormal liver function tests were present in 75.5% of children with scrub typhus. Children with complications of scrub typhus had significantly higher median AST levels, ALT levels, low serum albumin levels and prolonged INR compared to children with no complications

Acute Onset Peripheral Neuropathy in a Patient with Scrub Typhus

The neurological complications of scrub typhus can have a wide spectrum of presentations involving both central and peripheral nervous system, meningoencephalitis and meningitis being the most common. Involvement of the peripheral nervous system in scrub infection is not commonly reported, here we present a case of A 70-year-old male diagnosed with scrub typhus fever and presented with peripheral neuropathy. Duloxetine and methyl cobalamin combination along with gabapentin were used for management and the patient was partially improved gradually over a period of six days. Keywords: scrub typhus, scrub infection, scrub typhus fever, orientia tsutsugamushi.

Splenic infarction secondary to probable scrub typhus

A mite‑borne infection, scrub typhus is endemic in India. It causes a myriad of complications with multisystemic involvement like meningoencephalitis, acute respiratory distress syndrome (ARDS), myocarditis and is also known to cause abdominal complications like hepatomegaly, gastrointestinal haemorrhage, acute pancreatitis, and acute renal failure. Among the abdominal organs, splenic involvement is considered to be very rare and the usual presentation in such cases is splenomegaly. Splenic infarcts are a lesser known complication of scrub typhus which has been sparsely reported in the literature. We report a case with a rare presentation of scrub typhus in a 39-year-old male who reported to our hospital with fever and gastrointestinal system related complaints and was ultimately diagnosed to have multiple splenic infarcts secondary to scrub typhus.

Clinical profile and predictors of severity in children with scrub typhus admitted to paediatric intensive care unit

Background: Scrub typhus accounts for a significant portion of morbidity and mortality related to tropical infectious diseases. This study is done to determine the factors associated with complications and outcome in children with scrub typhus. Methods: It is a retrospective descriptive study conducted on children diagnosed with scrub typhus (IgM) admitted to the paediatric intensive care unit at a tertiary care centre in south India during 1 year of study period. Clinical profile, laboratory parameters, course of illness and outcome data were collected and analysed. Results: The study population included 88 children with scrub typhus. 32 children required intensive care unit admission. Remaining 56 children were included in non-severe scrub typhus group. Complications of scrub typhus included hepatic dysfunction (100%), pneumonitis 16 (50 %), meningoencephalitis 12 (37.5%), shock 12 (37.5%), acute respiratory distress syndrome (ARDS) 4 (12.5%), myocarditis 4 (12.5%), acute kidney injury (AKI) 2 (6.25%), multiple organ dysfunction syndrome (MODS) 2 (6.25%) and purpura fulminans 1 (3.1%). Mortality was observed in 2 (1.3%) children. It was found that anaemia and leucocytosis were predominantly associated with the risk of severe scrub typhus (odds ratio of 6.43 and 30.4 respectively, p value <0.001). Among other laboratory parameters, C-reactive protein (CRP) of >30 and hypoalbuminemia were significantly associated with mortality (p value <0.001). The median CRP and AST levels were significantly high in the severe scrub typhus group (p value 0.02 and 0.012 respectively). Conclusions: Hepatic dysfunction was present in all children admitted to PICU. Children with scrub typhus had an increased risk of developing complications in the presence of anaemia, leucocytosis, CRP>30 mg/l and severe hypoalbuminemia.

Scrub typhus with complications of acute myocarditis and cardiac tamponade in metropolitan areas: two case reports

Scrub typhus is known as one of the most common seasonal infections in endemic rural areas, but life-threatening cardiac complications in cases of scrub typhus are very infrequent. In addition, scrub typhus infection has been rarely reported among workers assembling pallets using manufactured wood in metropolitan areas. Herein, we present two cases involving myocarditis and cardiac tamponade as complications of scrub typhus. One patient died and the other patient survived. These cases indicate that scrub typhus infection could be an environmental hazard in metropolitan areas, especially in locations with poor hygiene, and highlight the need for timely diagnosis and proper management of severe scrub typhus infections. Therefore, we present these two informative fatal cases of scrub typhus infection presenting with myocarditis and cardiac tamponade as an environmental hazard in metropolitan areas.

Coagulation Abnormalities in Severe Scrub Typhus and Their Association with Complications.

To describe coagulation abnormalities and their association with complications in patients with severe scrub typhus. A cohort study was conducted among all patients of severe scrub typhus [immunoglobulin M (IgM) positive] who reported to this facility from 1st August 2019 to 31st July 2020 and met our inclusion criteria. We estimated the incidence of severe thrombocytopenia (<50,000/µL) and overt disseminated intravascular coagulation (DIC) (DIC score of ≥5). We determined the association [risk (RR) ratios] of these abnormalities with complications of scrub typhus, namely-septic shock, multiple organ dysfunction syndrome (MODS), and septic shock with MODS. In total, 71 patients were studied with a mean age of 50 ± 15.5 years, of which 45 (63.4%) were females. On presentation, fever 70 (98.5%), myalgias 22 (31.0%), loose stools 13(18.3%), cough, vomiting, headache 11 (15.5%), altered sensorium 10(14.1%), and pain abdomen 9 (12.7%) were main symptoms. On examination, hypotension 31 (43.7%), eschar 25 (35.2%), icterus 17 (23.9%), and rash 16 (22.5%) were noted. The d-dimer (>0.5 µg/mL) levels were increased in all (100%) patients. Thrombocytopenia (91.5%) was the commonest hematological abnormality and 31 (43.6%) of them had severe thrombocytopenia, 25 (35.2%) patients had low fibrinogen levels (<200 mg/dL) and prothrombin time (PT >16.7 seconds) was prolonged in 20 (28.1%). A total of 42 (59.1%) patients developed MODS, 33 (46.4%) developed septic shock, 24 (33.8 %) had MODS with septic shock, 17 (23.9%) developed overt DIC, and eight (11.2%) died. Severe thrombocytopenia (p = -0.028) and overt DIC (p = 0.045) were significantly associated with septic shock development. In the patients admitted with severe scrub typhus; thrombocytopenia was the commonest hematological abnormality. The development of septic shock was significantly associated with severe thrombocytopenia and overt DIC.

Deep vein thrombosis as a rare complication of scrub typhus

Scrub typhus is a common re-emerging, acute febrile infectious disease, caused by orientia tsutsugamushi, transmitted by bite of chiggers of trombiculid mite. The clinical presentation of infection can vary from mild symptoms to severe multi organ failure, shock, encephalopathy, meningoencephalitis, DIC and various thromboembolic complications. We describe a rare hematological complication of deep vein thrombosis (DVT) caused by scrub typhus in a 61-year-old female. Vasculitis and perivasculitis with endothelial dysfunction could be considered as the main pathologic mechanism causing this complication.

An Emerging Infection “Scrub Typhus”– A Detailed Clinical Profile and Complications among Children in a Tertiary Hospital

Objectives: To study the clinical profile and complications of Scrub typhus in children.Methods: This descriptive study conducted in Siddhartha Medical college, Vijayawada, among children less than12 years for a period of one year(December 2020-November 2021).A total of 49 children who are serologically/clinically diagnosed cases of Scrub typhus.Results: Scrub typhus mainly occurred in school going children with male predominance. Fever being the singlemost clinical presentation in most of the cases(95.9%) associated with pallor, hepatosplenomegaly. Co infectionwas documented in 14.2% cases with 85.7% cases showing increased morbidity and mortality. Mortality rate ismore in infants.Conclusions: Among cases of Acute febrile illness, Scrub typhus accounts for 9.8% of cases. Main clinical featureswere persistent fever, hepatosplenomegaly, thrombocytopenia, anemia along with capillary leak signs like edemawith or without eschar.Infants are at high risk for complications and mortality.

POS-125 Revisiting kidney injury in scrub typhus infection: A novel cause of infection-related glomerulonephritis

Kidney injury related to infections is one of the important preventable causes of morbidity and mortality, especially in tropical regions. Kidney involvement in scrub typhus infection ranges from bland urinary sediments to the requirement of renal replacement therapy (RRT). Earlier studies have shown renal histopathological findings consistent with acute tubular necrosis, interstitial nephritis, and mild mesangial glomerulonephritis in patients with scrub typhus and renal injury. We investigated patients with complicated scrub typhus for the pattern of renal involvement.

Unraveling scrub encephalitis: A study on the clinical profile and investigations of scrub encephalitis

Introduction: Scrub encephalitis (SE) is one of the known causes of acute encephalitis syndrome (AES). Although central nervous system involvement is known in scrub typhus, its association with AES is less understood and lesser diagnosed. In the absence of a point of care test for scrub typhus, cases of SE can be easily missed. A clinical approach using detailed history and clinical profiling of SE will help to diagnose SE in our region, using minimum resources, within a reasonable period. Aims: To analyze the clinical spectrum in patients of SE and to evaluate the investigations required to diagnose SE. Methodology: This is a retrospective study that analyzed Scrub typhus patients over 2 years from January 2018 to December 2019. A total of 370 patients were screened and 23 patients who satisfied the study criteria were included in the study and analyzed. Results: Among the cases of scrub typhus admitted in the hospital, the prevalence of SE was 6%. The most common presenting complaint was fever in 21 patients (91%) followed by altered sensorium in 16 (70%) and seizures in 9 patients (39%). An eschar was noted in 66% of the cases. The mean Glasgow Coma scale was 11 among the cases with almost 70% of cases showing signs of meningeal irritation. Organ involvement was noted as thrombocytopenia in 21 patients (91%), 16 patients (69%) with jaundice, and 1 (4%) with acute kidney injury. Conclusion: SE is an AES which, if detected early, is easily treatable with no residual neurological sequelae. Hence, identification of this condition and prompt diagnosis of SE becomes crucial to the management of this complication of scrub typhus.

A case report of rare constellation of complications of scrub typhus

Scrub typhus is an acute febrile illness widely prevalent in the “Tsutsugamushi Triangle” region of the world. We present a case of a 52-year-old female patient with an atypical presentation of scrub typhus. This is an atypical presentation of scrub typhus because of unusual location of eschar, associated myocarditis, pancytopenia, and cerebellar involvement.

SCRUB TYPHUS PRESENTING AS ACUTE PANCREATITIS: A RARE CASE

Scrub typhus is an insect-borne disease caused by Orientia sutsugamushi which may cause disseminated vasculitis and perivascular inflammatory lesions resulting in significant vascular leakage and cause end organ damage. Scrub typhus can lead to severe complications such as acute respiratory distress syndrome (ARDS), myocarditis, hepatitis and meningoencephalitis. Some unusual presentations of scrub typhus are peritonitis, gastric ulceration, duodenal ulcer perforation and acalculous cholecystitis. But acute pancreatitis is a relatively rare complication of scrub typhus. Here we report a rare case of scrub typhus in the form of acute pancreatitis.

Presence of bilateral vocal cord palsy with stridor: A case study on an unusual complication of scrub typhus

Several studies have reported on developing neurological complications following scrub typhus, however vocal cord palsy (VCP) symptoms in this case have never been reported. This work reports on a case where a twelve-year-old male child has been presented to the emergency department with stridor due to bilateral vocal cord palsy as a complication of post-scrub typhus infection.

Mortality and complications of scrub typhus in the paediatric population: a systematic review and meta-analysis.

Scrub typhus is a leading cause of treatable febrile illness. It can produce complications and dysfunction of multiple organs in children and is associated with considerable mortality. We attempted to perform a systematic review of original articles published between 1990 to 2020 based on certain selection criteria to estimate the case fatality risk of this disease in children. We addressed the pattern of complications of this disease with its impact on mortality We calculated pooled prevalence with a random effects model (restricted maximum likelihood method) that assumed varying effect sizes between studies using R statistical software. We reported the case fatality rate and its 95% confidence intervals (CIs) in the pooled analysis. Thirty-seven articles with a total of 3329 children were identified for inclusion. The case fatality rate was 1.1% (CI 0.05 to 2, I2=58% and prediction interval 0-6%). The mortality rate showed a declining trend over the last 5y. Hepatitis (30.68% [95% CI 18.52 to 44.38]) remains the most common complication, followed by shock (14.45% [95% CI 7.71 to 22.85]), pneumonia (14.71% [95% CI 9.76 to 20.48]), acute kidney injury (13.72% [95% CI 8.49 to 19.97]) and meningitis/meningoencephalitis (11.57% [95% CI 7.83 to 15.92]). Multi-organ dysfunction syndrome was the main contributor to mortality.

Acute respiratory distress syndrome in paediatric scrub typhus.

Acute respiratory distress syndrome is a life-threatening complication of scrub typhus; we sought to describe its mortality and associated factors, namely eschar, hepatomegaly and severe thrombocytopenia, in a retrospective study in India of 65 children.

Typhus pneumonitis – A rare and life-threatening complication of scrub typhus

Typhus pneumonitis – A rare and life-threatening complication of scrub typhus

Scrub typhus meningoencephalitis in children: A single centre, observational study from Eastern India

Background: Scrub typhus is being reported from different parts of India. Meningitis or meningoencephalitis among various neurological complication seen in scrub typhus is not uncommon. Delay in diagnosis may cause higher mortality without prompt treatment. The aim of the study was to describe the various manifestations of scrub typhus meningoencephalitis and their outcome from eastern part of India. Subjects and Methods: A prospective observational study of scrub meningoencephalitis was carried out at Kalinga Institute of Medical Sciences, between October 2018 and August 2020.The diagnosis was made based on the compatible clinical features, positive Scrub Ig M by ELISA and cerebrospinal fluid lymphocytosis (>5 cell/cmm), after excluding other causes of meningoencephalitis. Results: Twenty-seven (12.38%) cases of scrub meningoencephalitis were included in the study with male (66.6%) predominance. All had presented with fever of mean duration of 8.5 days of illness. Altered sensorium and seizure was observed in 70.5% and 62.9% of our patients along with two patients who had sixth cranial nerve palsy. Eschar was found in 25.9% of our children. The mean CSF cell count, protein and glucose were 25 cells/cmm,84.2 mg/dL and 62.9 mg/dL respectively with lymphocytosis in all cases. There was no mortality in this study. Conclusion: Meningoencephalitis is an important complication of scrub typhus in children. Unlike most viral encephalitis cases, it has a definite treatment with good outcome, if treated early.

Splenic abscess: A rare complication of scrub typhus in a child

Background: Scrub typhus is endemic in the various parts of the world and especially in the Indian subcontinent. Splenic infarcts and abscess are largely unknown in scrub typhus. These can be a source of persistent abdominal pain in the left hypochondriac region. Clinical Description: A 9-year-old child presented with a 7-day history of fever, loose stools, respiratory distress, and abdominal pain. On examination, she was febrile, had tachypnea, tachycardia, pallor, and facial puffiness. Systemic examination showed pleural effusion and hepatomegaly. Acute febrile illness with third spacing led to differentials of tropical infections (dengue, scrub typhus, enteric fever, and malaria). Management: Dengue, enteric fever, and malaria were ruled out on investigations. Scrub IgM enzyme-linked immunosorbent assay was positive. Ultrasound of the abdomen showed multiple splenic anechoic lesions suggestive of abscesses. Contrast-enhanced computed tomography (CT) confirmed the findings. Ultrasonography-guided aspiration of the lesion revealed blood-stained pus. The gram stain was negative, and culture was sterile. The final diagnosis was scrub typhus with splenic abscess. Her symptoms resolved with doxycycline therapy. Conclusion: Involvement of the spleen resulting in infarct and abscess is a rare complication in scrub typhus and can lead to persisting abdominal symptoms. Splenic infarction is not a well-known complication in patients of scrub typhus; hence, it may lead to under diagnosis of the condition. An abdominal ultrasound or if required, CT scan of the abdomen might be needed in cases with persistent abdominal symptoms to rule out this rare complication.

Comparison of IgM enzyme linked immuno sorbent assay with Weil-felix agglutination test for diagnosis of Scrub typhus in South India

Introduction: Scrub typhus is a disease caused by Orientia (Rickettsia) tsutsugamushi which belongs to Rickettsiaeceae family. Early diagnosis of Scrub typhus is important because timely anti-microbial therapy may help an excellent response and prevent complications. Serology is widely used for diagnosis of scrub typhus. The Aim of this study isto detect the IgM antibodies by Capture Enzyme linked immuno sorbent assay (ELISA) and Weil –Felix agglutination test against Scrub typhus and to compare the results of IgM ELISA with Weil – Felix test. Materials and Methods:Total of 723 blood samples were collected from clinically suspected Scrub typhus patients. IgM ELISA (commercial) and Weil –Felix agglutination test for Scrub typhus were performed on all serum samples. Results: Among 723 patients, 31(4.2%) showed positive by Weil-Felix test against OX K antigen and 43 (6%) showed positive by IgM ELISA. Among 43samples which were positive by IgM ELISA, 13(1.8 %) showed negative by Weil-Felix test. Out of 31samples positive by Weil-Felix test, one sample showed negative by IgM ELISA. The sensitivity of IgM ELISA and Weil –Felix agglutination test is 96.77% and 69.76 % respectively. Conclusion:Early diagnosis and treatment will prevent complications of Scrub typhus. This study has found out the IgM ELISA is highly sensitive and dependable for diagnosis of scrub typhus than Weil –Felix agglutination test. Keywords: IgM Enzyme linked immuno sorbent assay, Scrub typhus, Weil Felix agglutination Test.