Key result
Age >50, illness >7 days, rural residence, and absent eschar linked to severe scrub typhus.
Why the study?
What are the clinical profile and risk factors associated with severe scrub typhus infection among non-ICU patients?
Observational (n=50)
No
What are the clinical profile and risk factors associated with severe scrub typhus infection among non-ICU patients?
In non-ICU patients with scrub typhus, older age, longer illness duration, rural residence, and absence of eschar are independent risk factors for developing severe illness.
Answers are grounded in this paper and cite their sources.
May guide closer monitoring of non-ICU scrub typhus patients; hypothesis-generating pending prospective validation.
BACKGROUND & OBJECTIVES: Scrub typhus is as an emerging infectious disease that generally causes acute febrile illness, with disease spectrum ranging from mild illness to multiorgan dysfunction. This study was aimed to report the clinical profile, complications and risk factors associated with severe illness in patients with scrub typhus, outside the intensive care setting. METHODS: It was a prospective study, which involved recruitment of patients with acute febrile illness and diagnosed to have scrub typhus, who were admitted to the general medical wards of a tertiary care centre in Kanchipuram district, in semi-urban south India, over a 12 month period between June 2015 and May 2016. The diagnosis was established both clinically (with or without pathognomonic eschar) and by a positive test of IgM antibodies against scrub typhus by ELISA. The severity of scrub typhus was determined by the presence of organ dysfunction, and the factors associated with it were analyzed. RESULTS: A total of 50 patients with mean age of 39.6±20.5 yr (mean ± SD) were admitted. The mean duration of illness before presentation was 9.10 ± 8.6 days. The mean duration of hospital stay was 7.7±3.6 days. The symptoms included fever, abdominal symptoms, headache, dysuria, breathlessness and altered sensorium. Most common findings on physical examination were eschar (58%), crepitations in the chest (36%), hepatomegaly (34%) and lymphadenopathy (30%). Thirty two percent had respiratory complications, 4% required mechanical ventilation, 24% had shock, 16% had acute kidney injury, and 6% had dysfunction of ≥2 organs. Age of >50 yr, longer duration of illness (>7 days), residence in a rural area and the absence of eschar were found to be independent risk factors for development of severe illness. INTERPRETATION & CONCLUSION: Severe scrub typhus infection among non-ICU patients is more likely to occur in elderly patients and in those with longer duration of illness prior to presentation. The subset of patients without eschar might be more prone to develop complications.
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Premraj et al. (2018) conducted an observational in Scrub typhus (n=50). Risk factors (age >50 years, illness >7 days, rural residence, absence of eschar) vs. Absence of these risk factors was evaluated on Development of severe illness (presence of organ dysfunction). Age >50 years, illness duration >7 days, rural residence, and absence of eschar were identified as independent risk factors for the development of severe scrub typhus illness.
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