Shrestha Sanjeeb, Karn Mitesh, Regmi Sanjib Mani, Pradhan Shanti, Nagila Amar, Prajapati Rajesh
Department of Biochemistry, Gandaki Medical College Teaching Hospital, and Research Center, Pokhara, 33700, Nepal.
School of Medicine, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, 33700, Nepal.
Ann Med Surg (Lond). 2022 Nov 15;84:104903. doi: 10.1016/j.amsu.2022.104903. eCollection 2022 Dec.
Scrub Typhus (ST) is an acute febrile illness caused by obligate intracellular bacteria of the family Rickettsia. It is often unrecognized and neglected but prevalent in tropical regions of endemic areas. The tragedy behind this diagnostic dilemma is non-specific clinical signs and symptoms, limited awareness, unavailability of diagnostic facilities, and low index of suspicion among the physicians. To address the knowledge gap, we tried to find out a proper panel of laboratory investigations to diagnose the disease and predict its progression because of the uncertainty of the course of the disease in a tertiary care hospital in western Nepal.
This is a hospital laboratory-based prospective study conducted at Gandaki Medical College- Teaching Hospital (GMC-TH) for a period of two years. Among 988 cases of acute febrile illness, 40 seropositive cases of ST were enrolled in the study. We excluded those who did not give consent for the participation, those who were under 17 years of age, and those who had preexisting liver dysfunctions and other co-morbidities and dual seropositive with other infectious etiologies. We used descriptive statistics to analyze the data in terms of demography, clinical features, and laboratory parameters.
Out of 988 febrile patients, we included 40 confirmed cases of ST aged between 17 and 70 years during the study-period. Maximum seropositive cases were from Tanahun district 14 (35%), with predominance among the women (70%). The cases were prevalent in the age group 30-60 years, 19 (47.5%), and in the month of October 15 (37.5%). The commonest complaints were fever in 40 (100%), headache in 20 (50%), eschar in 11 (27.5%). Laboratory parameters showed anemia in 22 (55%), hypoalbuminemia in 11 (27.5%), leukopenia in 5 (12.5%), leukocytosis in 9 (22.5%), thrombocytopenia in 13 (32.5%), raised transaminase levels, SGPT in 21 (52.5%) and SGOT in 14 (26%) ST patients.
We found clinical and laboratory profiles in patients with ST were varied and nonspecific. However, knowledge of these findings may evoke the recognition of ST and give a clue to the progression of the disease.
恙虫病是由立克次氏体科专性细胞内细菌引起的急性发热性疾病。它常常未被识别和忽视，但在流行地区的热带区域很普遍。这种诊断困境背后的悲剧在于临床症状和体征不具特异性、认识有限、缺乏诊断设施以及医生的怀疑指数较低。为了填补知识空白，由于尼泊尔西部一家三级护理医院中该病病程的不确定性，我们试图找出一组合适的实验室检查方法来诊断该病并预测其进展情况。
这是一项基于医院实验室的前瞻性研究，在甘达基医学院教学医院（GMC-TH）进行，为期两年。在988例急性发热性疾病病例中，40例恙虫病血清学阳性病例被纳入研究。我们排除了那些不同意参与的人、17岁以下的人、有既往肝功能障碍和其他合并症的人以及与其他感染病因双重血清学阳性的人。我们使用描述性统计方法来分析人口统计学、临床特征和实验室参数方面的数据。
在988例发热患者中，我们在研究期间纳入了40例确诊的恙虫病病例，年龄在17至70岁之间。血清学阳性病例最多的是塔纳胡恩区，有14例（35%），女性占多数（70%）。病例在30至60岁年龄组中最为普遍，有19例（47.5%），在10月份最为常见，有15例（37.5%）。最常见的症状是发热40例（100%）、头痛20例（50%）、焦痂11例（27.5%）。实验室参数显示，22例（55%）有贫血、11例（27.5%）有低蛋白血症、5例（12.5%）有白细胞减少、9例（22.5%）有白细胞增多、13例（32.5%）有血小板减少、21例（52.5%）恙虫病患者转氨酶水平升高，谷丙转氨酶升高，14例（26%）谷草转氨酶升高。
我们发现恙虫病患者的临床和实验室特征各不相同且不具特异性。然而，了解这些发现可能会唤起对恙虫病的认识，并为疾病的进展提供线索。
