Premraj Sarah S, Mayilananthi K, Krishnan Durga, Padmanabhan K, Rajasekaran D
Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India.
J Vector Borne Dis. 2018 Jan-Mar;55(1):47-51. doi: 10.4103/0972-9062.234626.
BACKGROUND & OBJECTIVES: Scrub typhus is as an emerging infectious disease that generally causes acute febrile illness, with disease spectrum ranging from mild illness to multiorgan dysfunction. This study was aimed to report the clinical profile, complications and risk factors associated with severe illness in patients with scrub typhus, outside the intensive care setting.
It was a prospective study, which involved recruitment of patients with acute febrile illness and diagnosed to have scrub typhus, who were admitted to the general medical wards of a tertiary care centre in Kanchipuram district, in semi-urban south India, over a 12 month period between June 2015 and May 2016. The diagnosis was established both clinically (with or without pathognomonic eschar) and by a positive test of IgM antibodies against scrub typhus by ELISA. The severity of scrub typhus was determined by the presence of organ dysfunction, and the factors associated with it were analyzed.
A total of 50 patients with mean age of 39.6±20.5 yr (mean ± SD) were admitted. The mean duration of illness before presentation was 9.10 ± 8.6 days. The mean duration of hospital stay was 7.7±3.6 days. The symptoms included fever, abdominal symptoms, headache, dysuria, breathlessness and altered sensorium. Most common findings on physical examination were eschar (58%), crepitations in the chest (36%), hepatomegaly (34%) and lymphadenopathy (30%). Thirty two percent had respiratory complications, 4% required mechanical ventilation, 24% had shock, 16% had acute kidney injury, and 6% had dysfunction of ≥2 organs. Age of >50 yr, longer duration of illness (>7 days), residence in a rural area and the absence of eschar were found to be independent risk factors for development of severe illness.
INTERPRETATION & CONCLUSION: Severe scrub typhus infection among non-ICU patients is more likely to occur in elderly patients and in those with longer duration of illness prior to presentation. The subset of patients without eschar might be more prone to develop complications.
恙虫病是一种新发传染病，通常引起急性发热性疾病，疾病谱范围从轻症到多器官功能障碍。本研究旨在报告在非重症监护环境下恙虫病患者的临床特征、并发症及与重症相关的危险因素。
这是一项前瞻性研究，纳入2015年6月至2016年5月期间在印度南部半城市金奈地区一家三级医疗中心普通内科病房住院的急性发热性疾病且诊断为恙虫病的患者。诊断通过临床诊断（有或无特征性焦痂）及酶联免疫吸附测定法检测抗恙虫病IgM抗体呈阳性来确定。根据是否存在器官功能障碍确定恙虫病的严重程度，并分析与之相关的因素。
共收治50例患者，平均年龄39.6±20.5岁（均值±标准差）。就诊前平均病程为9.10±8.6天。平均住院时间为7.7±3.6天。症状包括发热、腹部症状、头痛、排尿困难、呼吸急促和意识改变。体格检查最常见的表现为焦痂（58%）、肺部捻发音（36%）、肝肿大（34%）和淋巴结病（30%）。32%有呼吸系统并发症，4%需要机械通气，24%有休克，16%有急性肾损伤，6%有≥2个器官功能障碍。年龄>50岁、病程较长（>7天）、居住在农村地区及无焦痂被发现是发生重症的独立危险因素。
非重症监护病房患者中，重症恙虫病感染更可能发生在老年患者及就诊前病程较长的患者中。无焦痂的患者亚组可能更容易发生并发症。
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