Scrub typhus in a tertiary care hospital in the eastern part of Odisha

AimOur hospital, tertiary care hospital in the capital of the State of Odisha, had been witnessing pyrexia of unknown origin, associated with breathlessness, renal and liver impairment, which did not respond to high antibiotics like Carbapenems but to Doxycycline therefore, the present study was undertaken to identify whether scrub typhus is the aetiological agent and thereafter their characteristic features were further evaluated as an effort in supporting its diagnoses and treating patients accordingly.Methods150 Adult patients (age >12 yrs) admitted with pyrexia of unknown origin between April 2011 and October 2013, were evaluated. Weil Felix test was done in all these patients. Weil Felix positive samples were tested for Scrub Typhus IgM ELISA.ResultsOf the 150 patients included in the study 50 (33.33%) were found to be positive for IgM antibodies against Orientia Tsutsugamushi. The cases were seen mainly in the months between September and November. The common symptoms found were fever, myalgia, breathlessness, rash and abdominal pain and clouding of memory. The diagnostic features like eschar were found in 32% patients. Nearly two thirds of patients had fever >30 days and myalgia (62.5%), breathlessness (64%). Most common complications was ARDS (62.5%) followed by liver and renal failure (50%).ConclusionOur results showed that Scrub typhus should be considered in the differential diagnosis of POU associated with breathlessness, myalgia, rash, gastrointestinal symptoms, hepatorenal syndrome or ARDS. Empirical treatment with Doxycycline may be given in the cases with strong suspicion of Scrub typhus.