Jain Deepak, Nand Nitya, Giri Kajaree, Bhutani Jaikrit
Internal Medicine Department, Pt. BD Sharma PGIMS, Rohtak, India.
Med Pharm Rep. 2019 Jan;92(1):36-42. doi: 10.15386/cjmed-1088. Epub 2019 Jan 15.
Scrub typhus is an acute febrile illness caused by . It is characterised by fever, rash, myalgia and diffuse lymphadenopathy. Most common complications are sepsis, shock, acute respiratory distress syndrome (ARDS), hepatitis, pre renal azotemia and multi organ dysfunction syndrome (MODS). Mortality rates range from 7-30% in untreated cases. Scrub typhus is endemic to a part of the world known as 'the tsutsugamushi triangle'. River banks, grassy areas generally harbour scrub typhus infection; however, recently there has been an increase in prevalence of infection from dry regions like Haryana.
To assess the clinical spectrum and complications of scrub typhus infection at a tertiary care centre in North India.
An observational study was conducted on patients >14 years old with acute febrile illness >7 days duration, admitted indoor from emergency department, from July to November 2017. Suspected cases were tested for specific IgM antibodies against by ELISA.
Among the 230 patients, screened for scrub typhus infection, 39 (16.95%) came out to be positive. Most common patient complaints were fever followed by cough and breathlessness, myalgia, nausea, vomiting and behavioral abnormality. 15% of patients required inotropic support initially and 48% had oxygen saturation of less than 90% at the time of presentation. Pleural effusion and crepitations were present in 41% of patients. Most common biochemical alterations were: abnormal liver function tests (95%), followed by thrombocytopenia, anemia, abnormal renal function tests, and hyponatremia. 12 patients (30.7%) were shifted to intensive care unit, 8 of which (20.5%) needed invasive mechanical ventilation and 4 patients (10.3%) underwent hemodialysis. Various complications were noted in 89.7% of cases, the most common being ARDS followed by sepsis, acute kidney injury (AKI) and meningitis. The mortality rate in this study was 18%.
This study emphasizes that scrub typhus infection is on a rampant resurgence and it is associated with significant complications. High degree of suspicion as well as development of effective measures to treat, control and prevent is critical to lower the disease burden.
恙虫病是由……引起的一种急性发热性疾病。其特征为发热、皮疹、肌痛和弥漫性淋巴结病。最常见的并发症是败血症、休克、急性呼吸窘迫综合征（ARDS）、肝炎、肾前性氮质血症和多器官功能障碍综合征（MODS）。未经治疗的病例死亡率在7%至30%之间。恙虫病在世界上被称为“恙虫病三角区”的部分地区流行。河岸、草地通常是恙虫病感染的滋生地；然而，最近像哈里亚纳邦这样的干旱地区感染率有所上升。
评估印度北部一家三级医疗中心恙虫病感染的临床谱和并发症。
对2017年7月至11月从急诊科收治入院、年龄大于14岁、急性发热病程超过7天的患者进行了一项观察性研究。疑似病例通过酶联免疫吸附测定（ELISA）检测针对……的特异性IgM抗体。
在筛查恙虫病感染的230名患者中，39名（16.95%）结果呈阳性。最常见的患者主诉是发热，其次是咳嗽、气促、肌痛、恶心、呕吐和行为异常。15%的患者最初需要使用血管活性药物支持，48%的患者就诊时血氧饱和度低于90%。41%的患者有胸腔积液和捻发音。最常见的生化改变为：肝功能检查异常（95%），其次是血小板减少、贫血、肾功能检查异常和低钠血症。12名患者（30.7%）被转入重症监护病房，其中8名（20.5%）需要有创机械通气，4名患者（10.3%）接受了血液透析。89.7%的病例出现了各种并发症，最常见的是ARDS，其次是败血症、急性肾损伤（AKI）和脑膜炎。本研究中的死亡率为18%。
本研究强调恙虫病感染正在猖獗复发，且与严重并发症相关。高度怀疑以及制定有效的治疗、控制和预防措施对于减轻疾病负担至关重要。
