Gautam Jeevan, Yadav Randhir S, Shrestha Shumneva, Singh Bishnu Mohan, Maharjan Renusha
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Department of Pediatrics, Tribhuvan University Institute of Medicine, Kathmandu, NPL.
Cureus. 2021 Sep 29;13(9):e18376. doi: 10.7759/cureus.18376. eCollection 2021 Sep.
Scrub typhus is endemic among farmers in the rural southern part of Nepal. It is grossly underdiagnosed due to a lack of clinical suspicion and inadequate testing facilities. The most common clinical features of the disease include fever, rashes, vomiting, myalgia, and eschar. The disease may present with ocular changes such as conjunctival injection, gastrointestinal features such as hepatitis and splenomegaly, acute kidney injury (AKI), or neurological findings in the form of meningoencephalitis. Herein, we present a report of three cases of scrub typhus from a rural part of South-west Nepal who failed to receive appropriate treatment initially. One of the patients recovered well with the treatment, the other developed AKI but recovered over the next few weeks. One of the patients died due to sepsis/multiorgan failure secondary to scrub typhus. While managing such cases in places with limited diagnostic facilities, the incorporation of early appropriate empirical therapy for scrub typhus after a careful clinical assessment prevents complications and saves lives.
恙虫病在尼泊尔南部农村地区的农民中呈地方性流行。由于缺乏临床怀疑和检测设施不足，该病严重漏诊。该病最常见的临床特征包括发热、皮疹、呕吐、肌痛和焦痂。该病可能表现为眼部改变，如结膜充血，胃肠道特征，如肝炎和脾肿大，急性肾损伤（AKI），或脑膜脑炎形式的神经系统表现。在此，我们报告3例来自尼泊尔西南部农村地区的恙虫病病例，这些病例最初未得到适当治疗。其中1例患者经治疗后恢复良好，另1例发展为急性肾损伤，但在接下来的几周内恢复。1例患者因恙虫病继发败血症/多器官衰竭死亡。在诊断设施有限的地方处理此类病例时，在仔细的临床评估后纳入早期适当的恙虫病经验性治疗可预防并发症并挽救生命。
