Neeraj Dodake, Jain AP and Mansee Bhagat
Background: Scrub Typhus is among the commonest causes of Acute Undifferentiated Fever during the monsoon in central India but there is a gap in knowledge regarding the data of the clinical profile in tropical rural area.
Objective: To study the clinical profile of adult patients admitted with scrub typhus during the monsoon in rural central India.
Material and methods: A Hospital based retrospective study was carried out in the 125 patients admitted to Medicine department of MGIMS during the monsoon period of June to September 2017. The History, clinical features, Lab profile, Treatment, complications and outcomes were studied closely. The data was retrieved from the Hospital Information System. The Outcome was studied in association with the severity of presentation, complications and treatment given. Diagnosis depended on recognizing the syndrome of non-specific symptoms of fever and cough, while diagnosis was confirmed using the IgM Scrub Typhus Rapid Chromatographic Test, which was considered as a Gold Standard in our study. Statistical analysis was done by descriptive and inferential statistics using chi-square test and software SPSS 22.0 version, EPI Info version 7 and Graph Pad Prism 6.0 version.
Results: The clinical illness was characterized by Fever with chills (60.8%) and Cough (68.8%). The Disease was mostly acute (97%) presenting with a history of less than 10 days. The most characteristic physical sign was fever which was present in almost 60 percent of cases and the traditionally mentioned rash called Eschar was found in only 38 percent of patients. ARDS, nephropathy, Liver failure and Multi organ dysfunction occurred in 16%, 20%, 20% and 13.6% respectively. Though Scrub typhus occurs secondary to a chigger bite, only 6 patients out of 125 gave the actual history of insect bite. 9 patients out of 125 (7.2%) succumbed to death. Early treatment with Doxycycline shortened the duration of illness. No relapses
occurred in those patients who received Doxycycline or Azithromycin for at least 7 days.
Conclusion: Serious complications can occur if Scrub typhus is not recognized promptly. Early institution of Doxycycline can save lives in the patients of acute undifferentiated fever pending investigations. General physicians should be Scrub typhus minded to suspect and accurately treat the patients of fever.