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

Abstract

Objectives: To assess the clinical features, complications and treatment of scrub typhus patients in tertiary care hospital. Material and Methods: 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. Results: 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. Conclusion: 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.