Gupta Nitin, Kumar Tirlangi Praveen, Boodman Carl, Fontaine Kim, Bottieau Emmanuel
Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
University of Antwerp, Antwerp, Belgium.
Infez Med. 2024 Sep 1;32(3):312-322. doi: 10.53854/liim-3203-5. eCollection 2024.
Scrub typhus is a mite-borne tropical febrile illness with high mortality if untreated. The presence of eschar is pathognomonic, but a wide range of frequencies of eschar positivity has been reported in Indian patients. Therefore, this systematic review and meta-analysis aimed to ascertain the frequency (overall and geographic region-wise) and anatomical distribution of eschar in scrub typhus in India.
We searched articles in two databases using: [(scrub OR typhus OR Orientia) AND (eschar) AND (India)]. The articles were independently screened and critically appraised by two authors. The frequency and distribution of eschar in patients with scrub typhus were pooled using a random-effect model.
After the title-abstract and full-text screening, 107 articles (34002 cases of scrub typhus) were finally included. The overall pooled proportion of eschar positivity was 28.5% (95% CI: 24.1 to 32.9%). The pooled eschar positivity varied from ≤12% in Haryana, Rajasthan, Madhya Pradesh, Punjab, and Meghalaya to ≥46% in Tamil Nadu and Tripura. The pooled proportion of eschar positivity in the 'trunk' (39.3%), 'groin' (23.8%), and 'axilla' (16.5%) was higher than in the 'limbs' (9.9%) and 'head' (11.3%).
Eschar is reported in less than a third of the patients with scrub typhus in India. Most eschars were in the groin, axilla, and the trunk. There is a need to create awareness amongst physicians of the need for thorough physical examination.
恙虫病是一种由螨虫传播的热带发热性疾病，若不治疗死亡率很高。焦痂的出现具有诊断意义，但印度患者中焦痂阳性的频率报道范围很广。因此，本系统评价和荟萃分析旨在确定印度恙虫病患者焦痂的出现频率（总体及按地理区域划分）和解剖分布。
我们在两个数据库中搜索文章，搜索词为：[（恙虫病或斑疹伤寒或东方体）且（焦痂）且（印度）]。文章由两位作者独立筛选并严格评估。采用随机效应模型汇总恙虫病患者焦痂的出现频率和分布情况。
经过标题摘要和全文筛选，最终纳入107篇文章（34002例恙虫病病例）。焦痂阳性的总体汇总比例为28.5%（95%置信区间：24.1%至32.9%）。焦痂阳性的汇总比例在哈里亚纳邦、拉贾斯坦邦、中央邦、旁遮普邦和梅加拉亚邦≤12%，在泰米尔纳德邦和特里普拉邦≥46%。“躯干”（39.3%）、“腹股沟”（23.8%）和“腋窝”（16.5%）部位焦痂阳性的汇总比例高于“四肢”（9.9%）和“头部”（11.3%）。
在印度，不到三分之一的恙虫病患者有焦痂。大多数焦痂出现在腹股沟、腋窝和躯干。有必要提高医生对全面体格检查必要性的认识。
