Scrub typhus: emerging as a co-infection of acute undifferentiated febrile illness in children in a district hospital of Eastern India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20231502Keywords:
Scrub typhus, Co-infection, Thrombocytopenia, Eschar, IgM ELISAAbstract
Scrub typhus, a zoonosis, caused by Orientia tsuttsutgamushi is transmitted to man through bite of infected tromboculid mite. It is endemic in India as other other South-east Asia countries of Tsuttsutgamuhi triangle and affects children as well. It generally presents as an acute febrile illness with non-specific features like headache rash, lymphadenopathy resembling many other commonly prevalent febrile infections. An eschar, though pathognomonic of Scrub typhus, is often missed clinically. Therefore, a high index of clinical suspicion is essential to establish a diagnosis of Scrub typhus and hence it remains usually under-diagnosed in any undifferentiated febrile illness. In this case series including three cases, we decided to rule out Scrub typhus as a co-infection when there was persistence of fever associated with thrombocytopenia even after ongoing treatment of the primarily diagnosed infection. An eschar was incidentally detected in one case only.
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Kelly DJ, Fuerst PA, Ching WM, Richards AL. Scrub typhus: The geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis. 2009;48(3):S203‑30.
Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. 2003;16:429‑36.
Weitzel T, Dittrich S, Lo´pez J, Phuklia W, Martinez-Valdebenito C, Vela´squez K et al. Endemic scrub typhus in South America. N Engl J Med. 2016;375:954-61.
Park K. Epidemiology of communicable diseases. In: Park K, editor. Park’s Textbook of Preventive and Social Medicine. 20th ed. Jabalpur: Banarsidas Bhanot. 2009;262.
Sharma A, Mahajan S, Gupta ML, Kanga A, Sharma V. Investigation of an outbreak of scrub typhus in the himalayan region of India. Jpn J Infect Dis. 2005;58:208‑10.
Peter JV, Sudarsan TI, Prakash JA, Varghese GM. Severe scrub typhus infection: clinical features, diagnostic challenges and management. World J. Crit. Care Med. 2015;4:244-50.
Xu G, Walker DH, Jupiter D, Melby PC, Arcari CM. A review of the global epidemiology of scrub typhus. PLoS Negl Trop Dis. 2017;11:e0006062.
Ogawa M, Hagiwara T, Kishimoto T. Scrub typhus in Japan: epidemiology and clinical features of cases reported in1998. Am J Trop Med Hyg. 2002;67(2):162-5.
Kim DM, Won KJ, Park CY, Yu KD, Kim HS, Yang TY et al. Distribution of eschars on the body of scrub typhus patients: a prospective study. Am J Trop Med Hyg. 2007;76:806-9.
Silpapojakul K, Chupupakkarn S, Yuthasompob S, Varachit B, Chaipak D, Borkerd T et al. Scrub and murine typhus in children with obscure fever in the tropics. Pediatr Infect Dis J. 1991;10:200-3.
Somashekar HR, Moses PD, Pavithran S, Mathew LG, Agarwal I, Rolain JM et al. Magnitude and features of scrub typhus and spotted fever in children in India. J Trop Pediatr. 2005;16:228-9.
Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India. 2010;58:24-8.
DHR-ICMR. Guidelines of diagnosis and management of Rickettsisl diseases in India. DHR-ICMR. 2015.
Comprehensive Guideline for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. Revised and expanded edition. WHO Regional Office for South-East Asia. Available at: https://apps.who.int/iris/handle/10665/204894. Accessed on 22nd December 2022.
Simmons CP, Farrar JJ, Nguyen vV, Wills B. Dengue. N Engl J Med. 2012;366(15):1423-32.
Ralapanawa U, Alawattegama ATM, Gunrathne M, Tennakoon S, Kularatne SAM, Jayalath T. Value of peripheral blood count for dengue severity prediction. BMC Res Notes. 2018;11(1):400.
Ananda Rao A, U RR, Gosavi S, Menon S. Dengue Fever: Prognostic Insights From a Complete Blood Count. Cureus. 2020;12(11):e11594.
Jairajpuri ZS, Rana S, Hassan MJ, Nabi F, Jetley S. An Analysis of Hematological Parameters as a Diagnostic test for Malaria in Patients with Acute Febrile Illness: An Institutional Experience. Oman Med J. 2014;29(1):12-7.
Lathia TB, Joshi R. Can hematological parameters discriminate malaria from nonmalarious acute febrile illness in the tropics? Indian J Med Sci. 2004;58(6):239-44.
McKenzie FE, Prudhomme WA, Magill AJ, Forney JR, Permpanich B, Lucas C et al. White blood cell counts and malaria. J Infect Dis. 2005;192(2):323-30.
Abro AH, Abdou AM, Gangwani JL, Ustadi AM, Younis NJ, Hussaini HS. Hematological and biochemical changes in typhoid fever. Pak J Med Sci. 2009;25:166-71.
Khosla SN, Anand A, Singh U, Khosla A. Haematological profile in typhoid fever. Trop Doct. 1995;25(4):156-8.
Uplaonkar SV, Kauser SH, Tengli MB, Haematological profile in typhoid fever. Indian J Pathol Oncol 2017;4(2):263-5.
Verma SK, Gupta KK, Arya RK, Kumar V, Reddy DH, Chaudhary SC et al. Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India. J Family Med Prim Care. 2021;10(3):1459-1465.
Shajahan N, Sahana KS. Clinical profile of scrub typhus in children at a tertiary care hospital in South India. Karnataka Pediatr J. 2022;37:46-50.
Kim DM, Kim SW, Choi SH, Yun NR. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis. 2010;10:108.
Musso D, La Scola B. Laboratory diagnosis of leptospirosis: a challenge. J Microbiol Immunol Infect. 2013;46(4):245-52.
Ahmad SN, Shah S, Ahmad FM. Laboratory diagnosis of leptospirosis. J Postgrad Med. 2005;51(3):195-200.
Holla R, Darshan B, Pandey L, Unnikrishnan B, Kumar N, Thapar R et al. Leptospirosis in Coastal South India: A Facility Based Study. Biomed Res Int. 2018;2018:1759125.
Samanta J, Sharma V. Dengue and its effects on liver. World J Clin Cases. 2015;3(2):125-31.
China RS, Omesh G, Chhina DK, Goyal P, Kumar R, Puri S. Liver Function Tests in Patients with Dengue Viral Infection. Dengue Bulletin. 2008;32.
Anjum MU, Khan H, Shah SH. Typhoid fever with jaundice; a clinical study in Abbottabad. Professional Med J. 2015;22(4):439-42.
Ahmed A, Ahmed B. Jaundice in typhoid patients: differentiation from other common causes of fever and jaundice in the tropics. Ann Afr Med. 2010;9(3):135-40.
Lee VJ, Chow A, Zheng X, Carrasco LR, Cook AR, Lye DC et al. Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. PLoS Negl Trop Dis. 2012;6(9):e1786.
World Health Organization. Regional Office for South-East Asia. (2008). Guidelines on clinical management of chikungunya fever. WHO Regional Office for South-East Asia. Available at: https://apps.who.int/iris/handle/10665/205178. Accessed on 22nd December 2022.
National guideline for Clinical Management of Chikungunya. Government of India. 2016.
Oliveira JF, Burdmann EA. Dengue-associated acute kidney injury. Clin Kidney J. 2015;8(6):681-5.
Bignardi PR, Pinto GR, Boscarioli MLN, Lima RAA, Delfino VDA. Acute kidney injury associated with dengue virus infection: a review. J Bras Nefrol. 2022;44(2):232-237.
Grover R, Mehalingam V. Acute kidney injury and electrolyte abnormalities in patients with scrub typhus admitted to a tertiary care hospital in southern India. J Family Med Prim Care. 2021;10(1):187-91.
Jayaprakash V, Vamsikrishna M, Indhumathi E, Jayakumar M. Scrub typhus-associated acute kidney injury: A study from a South Indian Tertiary Care Hospital. Saudi J Kidney Dis Transpl. 201930(4):883-90.