Saheed Shazia Zahara, Goswami Debajyoti, Niyas Vettakkara Kandy Muhammed, Ananthanaryanan Rajalakshmi
Department of Internal Medicine, KIMSHEALTH, Thiruvananthapuram, Kerala, India.
Department of Infectious Diseases, KIMSHEALTH, Thiruvananthapuram, Kerala, India.
Infez Med. 2025 Mar 1;33(1):106-113. doi: 10.53854/liim-3301-10. eCollection 2025.
Scrub typhus, a mite-borne infection caused by , is endemic in South and Southeast Asia, including India. Although increasing awareness and improved healthcare access have reduced mortality, the disease remains a significant public health concern. Kerala, a southern Indian state, has reported scrub typhus cases for decades; however, comprehensive data on its clinical profile and severity indicators are limited. This study aimed to describe the clinical characteristics of scrub typhus and identify predictors of intensive care unit (ICU) admission.
A retrospective study was conducted on scrub typhus cases diagnosed at KIMSHEALTH, Thiruvananthapuram, India, from 2015 to 2021 using electronic medical records (EMR). Scrub typhus was defined as an acute febrile disease with positive IgM ELISA. Patients with other diagnoses explaining the febrile illness or those with incomplete data were excluded. Demographic characteristics, clinical features, laboratory findings, and patient outcomes were analyzed. ICU admission was the primary outcome. Binary logistic regression was used to identify independent predictors of ICU admission.
A total of 241 patients were included in the study, of whom 74 (30.7%) required ICU admission. Most cases occurred between September and January, with a peak in December. The median age was 45 years (IQR: 24.5-60.5), and 122 (50.6%) were female. Fever lasting >7 days was present in 46.1% of patients. Common symptoms included headache (38.2%), myalgia (37.3%), vomiting (31.5%), and breathlessness (19.5%). Hepatomegaly and splenomegaly were observed in 33.2% and 28.6% of cases, respectively, while eschar was noted in 20.3%. Most patients received doxycycline (82.6%), with some receiving azithromycin (7.1%) or both (10.4%). In multivariable analysis using binary logistic regression, altered sensorium (adjusted odds ratio [aOR]: 6.63, 95% CI: 1.83-24.12, p=0.004) and breathlessness (aOR: 5.02, 95% CI: 2.31-10.90, p<0.001) were independent predictors of ICU admission.
Scrub typhus in Kerala exhibits seasonal variation, peaking from September to January. Breathlessness and altered sensorium present at admission were the strongest predictors of ICU admission The lower mortality in our study (2.1%) compared to national estimates may be attributed to improved healthcare access, early diagnosis, and prompt treatment. Further multicenter prospective studies are needed to validate these findings and improve risk stratification for severe disease.
恙虫病是一种由[恙虫病东方体]引起的螨传感染病，在包括印度在内的南亚和东南亚地区呈地方性流行。尽管人们的认识有所提高且医疗保健可及性有所改善，降低了死亡率，但该疾病仍然是一个重大的公共卫生问题。印度南部的喀拉拉邦数十年来一直有恙虫病病例报告；然而，关于其临床特征和严重程度指标的全面数据有限。本研究旨在描述恙虫病的临床特征并确定重症监护病房（ICU）收治的预测因素。
对2015年至2021年在印度特里凡得琅的KIMSHEALTH诊断的恙虫病病例进行回顾性研究，使用电子病历（EMR）。恙虫病被定义为IgM酶联免疫吸附测定（ELISA）呈阳性的急性发热性疾病。排除有其他诊断可解释发热性疾病的患者或数据不完整的患者。分析人口统计学特征、临床特征、实验室检查结果和患者结局。ICU收治是主要结局。采用二元逻辑回归确定ICU收治的独立预测因素。
本研究共纳入241例患者，其中74例（30.7%）需要入住ICU。大多数病例发生在9月至1月之间，12月达到高峰。中位年龄为45岁（四分位间距：24.5 - 60.5），女性122例（50.6%）。46.1%的患者发热持续超过7天。常见症状包括头痛（38.2%）、肌痛（37.3%）、呕吐（31.5%）和呼吸急促（19.5%）。分别有33.2%和28.6%的病例观察到肝肿大和脾肿大，20.3%的病例发现焦痂。大多数患者接受了多西环素治疗（82.6%），一些患者接受了阿奇霉素治疗（7.1%）或两者联合治疗（10.4%）。在使用二元逻辑回归的多变量分析中，意识改变（调整优势比[aOR]：6.63，95%置信区间：1.83 - 24.12，p = 0.004）和呼吸急促（aOR：5.02，95%置信区间：2.31 - 10.90，p < 0.001）是ICU收治的独立预测因素。
喀拉拉邦的恙虫病呈现季节性变化，9月至1月达到高峰。入院时出现的呼吸急促和意识改变是ICU收治的最强预测因素。与全国估计值相比，本研究中较低的死亡率（2.1%）可能归因于医疗保健可及性的改善、早期诊断和及时治疗。需要进一步开展多中心前瞻性研究来验证这些发现并改善重症疾病的风险分层。
