Venkategowda Pradeep M, Rao S Manimala, Mutkule Dnyaneshwar P, Rao Mallela V, Taggu Alai N
Department of Critical Care Medicine, Yashoda Multi-Speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
Department of General Medicine, Yashoda Multi-Speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
Indian J Crit Care Med. 2015 Apr;19(4):208-13. doi: 10.4103/0972-5229.154553.
Scrub typhus is one of the differential diagnoses for fever with thrombocytopenia. ARDS associated with Scrub typhus has high morbidity and mortality.
To evaluate clinical features, lab values, and outcome in patients with scrub typhus and comparison in patients with or without ARDS.
A prospective observational study was conducted on 109 patients with febrile illness and thrombocytopenia during a period of 12 months. All 109 patients were tested with both Immune-chromatography test and Weil felix test. Patients having either Immune-chromatography test/Weil felix test positive have been included and considered as scrub typhus positive whereas negative for both Immune-chromatography and Weil felix test were excluded. Clinical features, lab parameters, and outcome were evaluated in all patients with scrub typhus. Statistical analysis used in this study was T-test.
Among 58 patients who were included (After exclusion of 51 patients among total of 109 patients) 34 patients had no ARDS and 24 patients had ARDS. The clinical feature like dyspnoea, cough, low blood pressure (MAP<65 mmHg), IVC collapsibility (by ultrasound) and laboratory parameters like decreased Hemoglobin, Hematocrit, Serum albumin, and increased serum creatinine, serum total bilirubin, SGOT, SGPT, LDH, CPK, and serum lactate were statistically significant (P < 0.0001) in scrub typhus patients group with ARDS. The higher titers of Weil-felix can be correlated with more severe form of disease according to our observation. All 34 Scrub typhus patients without ARDS recovered completely. Among 24 Scrub typhus patients with ARDS, 22 patients recovered, and 2 patients died.
Scrub typhus is an important differential diagnosis in a patients having fever with thrombocytopenia. Scrub typhus associated with ARDS has high morbidity and mortality. Early diagnosis and treatment with doxycycline can prevent the occurrence of ARDS.
恙虫病是血小板减少伴发热的鉴别诊断之一。与恙虫病相关的急性呼吸窘迫综合征（ARDS）发病率和死亡率较高。
评估恙虫病患者的临床特征、实验室检查值及预后，并比较有无ARDS患者的情况。
对12个月内109例发热性疾病伴血小板减少的患者进行前瞻性观察研究。所有109例患者均进行了免疫层析试验和外斐试验。免疫层析试验/外斐试验任一项阳性的患者被纳入并视为恙虫病阳性，而免疫层析试验和外斐试验均为阴性的患者被排除。对所有恙虫病患者的临床特征、实验室参数及预后进行评估。本研究采用的统计分析方法为t检验。
纳入的58例患者（109例患者中排除51例后）中，34例无ARDS，24例有ARDS。在伴有ARDS的恙虫病患者组中，呼吸困难、咳嗽、低血压（平均动脉压<65mmHg）、下腔静脉塌陷（通过超声检查）等临床特征以及血红蛋白降低、血细胞比容降低、血清白蛋白降低、血清肌酐升高、血清总胆红素升高、谷草转氨酶升高、谷丙转氨酶升高、乳酸脱氢酶升高、肌酸磷酸激酶升高和血清乳酸升高等实验室参数具有统计学意义（P<0.0001）。根据我们的观察，外斐试验滴度越高，疾病形式越严重。所有34例无ARDS的恙虫病患者均完全康复。24例有ARDS的恙虫病患者中，22例康复，2例死亡。
恙虫病是血小板减少伴发热患者的重要鉴别诊断。与ARDS相关联的恙虫病发病率和死亡率较高。早期诊断并用多西环素治疗可预防ARDS的发生。
