Study of Clinical Profile and Treatment Pattern of Scrub Typhus Patients in Tertiary Care Hospital

Abstract

To assess the clinical features, complications and treatment of scrub typhus patients in tertiary care hospital. A total of 100 patients with scrub typhus, aged >12 years admitted in medicine wards and intensive care units of Government Medical College, Nagpur, were included in the study. A detailed history was taken; clinical examination, all relevant investigations, and IgM ELISA test were done for the diagnosis of scrub typhus. The most common presenting symptoms were high-grade fever with chills (80%). The most common complication was lung involvement (35%), liver damage (28%), and acute kidney injury (27%) with six cases requiring renal replacement therapy. Multisystem organ dysfunction syndrome was seen in 19% of cases. About 27% of patients had acute respiratory distress syndrome of which 16 cases needed mechanical ventilation. Of 100 patients included, 82 (82%) cases survived and were discharged, while 18 (18%) patients succumbed during hospital admission. Among the risk factor studied, systemic hypertension was associated with an increase in mortality (P = 0.014). There was a statistically significant increase in mortality (P = 0.006) in patients having electrocardiogram abnormalities in the forms of low-voltage complexes and tachycardia. Early diagnosis and rapid treatment with doxycycline (93.90%) and ceftriaxone (87.80%) were found to be associated with more survival rate. Scrub typhus is a significant disease in this part of the country; therefore, it should be kept in mind as a possible diagnosis in undifferentiated fevers even though an eschar is not found. An early diagnosis and timely antibiotic therapy may prevent further complications.