Rapsang Amy G, Bhattacharyya Prithwis
Department of Anesthesiology and Intensive Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) Campus, Shillong, Meghalaya, India.
Indian J Anaesth. 2013 Mar;57(2):127-34. doi: 10.4103/0019-5049.111835.
Scrub typhus is an acute febrile illness caused by orientia tsutsugamushi, transmitted to humans by the bite of the larva of trombiculid mites. It causes a disseminated vasculitic and perivascular inflammatory lesions resulting in significant vascular leakage and end-organ injury. It affects people of all ages and even though scrub typhus in pregnancy is uncommon, it is associated with increased foetal loss, preterm delivery, and small for gestational age infants. After an incubation period of 6-21 days, onset is characterized by fever, headache, myalgia, cough, and gastrointestinal symptoms. A primary papular lesion which later crusts to form a flat black eschar, may be present. If untreated, serious complications may occur involving various organs. Laboratory studies usually reveal leukopenia, thrombocytopenia, deranged hepatic and renal function, proteinuria and reticulonodular infiltrate. Owing to the potential for severe complications, diagnosis, and decision to initiate treatment should be based on clinical suspicion and confirmed by serologic tests. A therapeutic trial of tetracycline or chloramphenicol is indicated in patients in whom the diagnosis of scrub typhus is suspected. The recommended treatment regimen for scrub typhus is doxycycline. Alternative regimens include tetracycline, chloramphenicol, azithromycin, ciprofloxacin, rifampicin, and roxithromycin. Treatment of pregnant women with azithromycin was successfully done without relapse and with favorable pregnancy outcomes. Hence, early diagnosis and treatment are essential in order to reduce the mortality and the complications associated with the disease. We searched the English-language literature for reports of scrub typhus in children, pregnant women, and non-pregnant patients with scrub typhus, using the MEDLINE/PubMed database, which includes citations from 1945 to the present time. We used the search terms 'scrub typhus', 'scrub typhus' and 'pregnancy', 'scrub typhus' and 'children', 'scrub typhus' and 'complications', 'scrub typhus' and 'treatment'.
恙虫病是由恙虫病东方体引起的一种急性发热性疾病,通过恙螨幼虫叮咬传播给人类。它会引发弥漫性血管炎和血管周围炎性病变,导致严重的血管渗漏和终末器官损伤。该病影响所有年龄段的人群,尽管妊娠期间的恙虫病并不常见,但它与胎儿丢失增加、早产以及小于胎龄儿有关。在6至21天的潜伏期后,发病的特征为发热、头痛、肌痛、咳嗽和胃肠道症状。可能会出现原发性丘疹病变,随后结痂形成扁平的黑色焦痂。若不治疗,可能会发生涉及多个器官的严重并发症。实验室检查通常显示白细胞减少、血小板减少、肝肾功能紊乱、蛋白尿和网状结节状浸润。由于存在严重并发症的可能性,诊断及开始治疗的决策应基于临床怀疑,并通过血清学检测加以证实。对于疑似恙虫病的患者,建议进行四环素或氯霉素的治疗性试验。恙虫病的推荐治疗方案是多西环素。替代方案包括四环素、氯霉素、阿奇霉素、环丙沙星、利福平以及罗红霉素。用阿奇霉素治疗孕妇取得了成功,无复发且妊娠结局良好。因此,早期诊断和治疗对于降低该病相关的死亡率和并发症至关重要。我们使用MEDLINE/PubMed数据库检索了英文文献中有关儿童恙虫病、孕妇恙虫病以及非孕妇恙虫病患者的报告,该数据库涵盖了1945年至今的文献引用。我们使用了搜索词“恙虫病”、“恙虫病”和“妊娠”、“恙虫病”和“儿童”、“恙虫病”和“并发症”、“恙虫病”和“治疗”。