Dysregulation of cytokine profiles plays a crucial role in the pathogenesis of Scrub typhus associated acute kidney injury.

Abstract

Background objectives: Scrub typhus (ST) is a serious mite-borne disease which is recently considered as under-recognized cause of acute kidney injury (AKI). The current study was undertaken to elucidate in finer details the role of inflammatory response in the pathophysiology of Scrub typhus associated AKI (STAKI).

Methods: This prospective study was carried out on patients admitted to the Department of Nephrology, SCB Medical College and Hospital, Cuttack, a tertiary care hospital of the state. All sera were tested for O. tsutsugamushi using IgM ELISA kit (In Bios International, Inc., Seattle, WA, USA) and PCR assay. The serum level cytokines were detected by using commercially available ELISA kits.

Results: The study reveals that 31.4% of the hospitalized AKI samples were positive for scrub typhus. IL-33, IL-17, TNF-α, IFN-γ and Angio-2were significantly high in both scrub typhus associated febrile patients and STAKI patients. However, IL-17, TNF-α and Ang-2 were found to be significantly high in STAKI patients in comparison to scrub typhus associated febrile patients. However, significantly high expression of IL-10 was observed in both groups of scrub typhus patients with and without AKI.

Interpretation conclusion: Significantly high levels of IL-17, TNF-α and Ang-2 levels in STAKI patients showed the dysregulated inflammatory response during pathogenesis and can be used as potential biomarkers for monitoring disease progression. However, more studies are needed to shed light on delineating the mechanism which will help in developing future therapeutic target for the management of this neglected tropical disease.