Cardiovascular Manifestations and Outcomes in Patients with Scrub Typhus Admitted to a Tertiary Care Center in the Coastal Karnataka Region in India.

IF 3 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
Mugula Sudhakar Rao, Jyothi Samanth, Swathi Poojary, Krishnananda Nayak, Shubha Srinivas, Thrupthi Naik
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引用次数: 0

Abstract

Introduction: Scrub typhus is a mite-borne infectious disease caused by "Orientia tsutsugamushi", a bacterium that was formerly classified under the genus Rickettsia. It is transmitted to humans through the bites of infected chigger mites (larval trombiculid mites). However, clinical data on the cardiac manifestations of scrub typhus and their outcomes remain limited. Methods: This research was retrospectively conducted at a tertiary care hospital in South India. The study included all patients admitted from January 2016 to September 2021 who fulfilled the clinical criteria for a diagnosis of scrub typhus. Data were collected for 426 patients. Patients with previously diagnosed heart disease and mixed infections (leptospirosis, dengue fever, blood culture positivity, and COVID-19 positivity) were excluded. Comprehensive assessments of clinical presentation, electrocardiography (ECG), 2D echocardiography, and outcomes, including all-cause mortality and probable myocarditis, were performed. Multivariate regression analysis was performed to identify independent predictors of all-cause mortality and probable myocarditis. Results: Out of 426 patients, 200 (46.9%) were male and 226 (53.1%) were female. The mean age at presentation was 49.29 ± 14.43 years. A total of 108 (25.4%) patients had diabetes and 82 (19.25%) had hypertension. Sinus tachycardia (29.3%) was the most frequent ECG finding. Echocardiographic evidence of probable myocarditis was observed in 20 (4.7%) patients, while 6 (1.4%) patients had isolated RV dysfunction, 4 (0.9%) had biventricular dysfunction, 7 (1.6%) had significant pulmonary hypertension, and 40 (9.4%) had trivial pericardial effusion. A total of 78 (18.3%) patients had acute respiratory distress syndrome. All-cause mortality was observed in 12 (2.8%) patients. A total of 56 (13.1%) patients developed multiorgan dysfunction syndrome (MODS) during their hospitalization. A total of 78 (18.3%) patients were documented to have acute kidney injury (AKI), and 22 (5.2%) patients underwent hemodialysis. Multivariable binary logistic regression analysis revealed that probable myocarditis and MODS were independent predictors of mortality among patients with scrub typhus, and age, female gender, and LV systolic dysfunction were identified as predictors of overall complications, including mortality, probable myocarditis, congestive heart failure, MODS, AKI, and the need for hemodialysis. Conclusions: Probable myocarditis was the most frequent cardiac manifestation noted in patients with scrub typhus, and in addition to MODS, probable myocarditis was an independent predictor of mortality in this cohort. Thus, it is crucial to maintain clinical vigilance regarding the cardiac status of such patients.

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印度卡纳塔克沿海地区三级医疗中心收治的恙虫病患者的心血管表现和预后
简介:恙虫病是一种由恙虫病东方体引起的螨媒传染病,恙虫病东方体是一种以前归类为立克次体属的细菌。它通过受感染恙螨(恙螨幼虫)的叮咬传播给人类。然而,关于恙虫病的心脏表现及其结果的临床资料仍然有限。方法:本研究回顾性地在印度南部的一家三级医院进行。该研究纳入了2016年1月至2021年9月期间符合恙虫病诊断临床标准的所有住院患者。收集了426例患者的数据。排除既往诊断为心脏病和混合感染(钩端螺旋体病、登革热、血培养阳性和COVID-19阳性)的患者。对临床表现、心电图(ECG)、二维超声心动图和结局(包括全因死亡率和可能的心肌炎)进行综合评估。进行多因素回归分析以确定全因死亡率和可能的心肌炎的独立预测因素。结果:426例患者中,男性200例(46.9%),女性226例(53.1%)。平均发病年龄49.29±14.43岁。其中糖尿病108例(25.4%),高血压82例(19.25%)。窦性心动过速(29.3%)是最常见的心电图表现。20例(4.7%)患者有疑似心肌炎的超声心动图证据,6例(1.4%)患者有孤立性右室功能障碍,4例(0.9%)患者有双室功能障碍,7例(1.6%)患者有明显肺动脉高压,40例(9.4%)患者有少量心包积液。78例(18.3%)患者出现急性呼吸窘迫综合征。12例(2.8%)患者全因死亡。56例(13.1%)患者在住院期间出现多器官功能障碍综合征(MODS)。共有78例(18.3%)患者被记录为急性肾损伤(AKI), 22例(5.2%)患者接受了血液透析。多变量二元logistic回归分析显示,可能的心肌炎和MODS是恙虫病患者死亡率的独立预测因子,年龄、女性性别和左室收缩功能障碍被确定为总并发症的预测因子,包括死亡率、可能的心肌炎、充血性心力衰竭、MODS、AKI和血液透析需求。结论:可能的心肌炎是恙虫病患者最常见的心脏表现,除MODS外,可能的心肌炎是该队列中死亡率的独立预测因子。因此,对这类患者的心脏状态保持临床警惕是至关重要的。
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