Key result
Scrub typhus infection in South India caused multi-organ dysfunction in 38.3% of patients and carried a 7.8% fatality rate, with hypotension independently predicting mortality (p<0.001).
Observational (n=154)
No
Scrub typhus in South India frequently presents with non-specific symptoms but can lead to severe multi-organ dysfunction and carries a 7.8% mortality rate, with hypotension being a key predictor of death.
Alerts clinicians to hypotension risk in scrub typhus; leaves open need for prospective interventional trials in endemic areas.
OBJECTIVES: This study sought to document the clinical and laboratory manifestations, genetic variability, and outcomes of scrub typhus, an often severe infection caused by Orientia tsutsugamushi, in South India. METHODS: Patients admitted to a large teaching hospital with IgM ELISA-confirmed scrub typhus were evaluated. Clinical examination with a thorough search for an eschar, laboratory testing, chest X-ray, and outcome were documented and analyzed. Additionally, a 410-bp region of the 56-kDa type-specific antigen gene of O. tsutsugamushi was sequenced and compared with isolates from other regions of Asia. RESULTS: Most of the 154 patients evaluated presented with fever and non-specific symptoms. An eschar was found in 86 (55%) patients. Mild hepatic involvement was seen in most, with other organ involvement including respiratory, cardiovascular, and renal. Multi-organ dysfunction was noted in 59 (38.3%), and the fatality rate was 7.8%. Hypotension requiring vasoactive agents was found to be an independent predictor of mortality (p<0.001). The phylogeny of 26 samples showed 17 (65%) clustering with the Kato-like group and eight (31%) with the Karp-like group. CONCLUSIONS: The presentation of scrub typhus can be variable, often non-specific, but with potentially severe multi-organ dysfunction. Prompt recognition is key to specific treatment and good outcomes. Further study of the circulating strains is essential for the development of a successful vaccine and sensitive point-of-care testing.
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Varghese et al. (2013) conducted an observational in Scrub typhus (n=154). Scrub typhus infection was evaluated on Fatality rate. Scrub typhus infection in South India caused multi-organ dysfunction in 38.3% of patients and carried a 7.8% fatality rate, with hypotension independently predicting mortality (p<0.001).
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