Department of General Medicine, Government Medical College and Hospital, Chandigarh, India.
Department of Microbiology, Government Medical College and Hospital, Chandigarh, India.
J Vector Borne Dis. 2019 Oct-Dec;56(4):367-372. doi: 10.4103/0972-9062.302041.
BACKGROUND & OBJECTIVES: Scrub typhus is an under-reported rickettsial illness caused by Orientia tsutsugamushi which is transmitted by trombiculid mites. Serious complications are not uncommon and multiorgan dysfunction may develop leading to death. Paucity of data on the clinical spectrum and determinants of aftermath may be contributing to higher mortality in the region. A prospective study was done to describe the spectrum of organ dysfunction in serologically confirmed cases of scrub typhus and document predictors of adverse outcomes.
This prospective study was carried out in patients diagnosed to have scrub typhus by IgM ELISA. The clinical features, investigations and complications among survivors were statistically compared to those in the deceased. Fisher's exact test, t-test and logistic regression have been applied where appropriate.
The study population comprised of 123 patients. Majority of patients (62%) had one or more organ dysfunction. Ten patients (8.1%) did not survive. Complications documented were acute kidney injury (AKI) in 35%, hepatitis in 29.2%, acute respiratory distress syndrome (ARDS) in 26%, shock in 13%, meningitis in 5.7%, disseminated intravascular coagulation (DIC) in 2.6%, pancreatitis in 2.6% and myocarditis in 1.6%. Certain clinical features, biochemical parameters and complications had statistically significant correlation with the outcome. The mean SOFA score was considerably higher in those who did not survive. Interpretation &conclusion: Patients developing hepatic dysfunction, acute kidney injury and respiratory distress should be identified early and intensively monitored. The SOFA score can be utilized to assess the severity at admission and rapidly triage the sicker patients.
恙虫病是一种由恙虫东方体引起的、传播媒介为恙螨的、报告较少的立克次体病。恙虫病并不少见严重并发症，可能导致多器官功能障碍甚至死亡。该地区的死亡率较高，可能与缺乏关于临床谱和后遗症决定因素的数据有关。本前瞻性研究旨在描述血清学确诊恙虫病患者的器官功能障碍谱，并记录不良结局的预测因素。
本前瞻性研究纳入了通过 IgM ELISA 确诊为恙虫病的患者。对幸存者和死亡者的临床特征、检查和并发症进行统计学比较。在适当的情况下，应用 Fisher 确切检验、t 检验和逻辑回归进行分析。
研究人群包括 123 例患者。大多数患者（62%）存在一个或多个器官功能障碍。10 例患者（8.1%）死亡。记录的并发症包括急性肾损伤（AKI）35%、肝炎 29.2%、急性呼吸窘迫综合征（ARDS）26%、休克 13%、脑膜炎 5.7%、弥散性血管内凝血（DIC）2.6%、胰腺炎 2.6%和心肌炎 1.6%。某些临床特征、生化参数和并发症与结局具有统计学相关性。未存活者的平均 SOFA 评分明显更高。
应早期识别和密切监测出现肝肾功能障碍、急性肾损伤和呼吸窘迫的患者。SOFA 评分可用于评估入院时的严重程度，并快速对病情较重的患者进行分诊。
