A study of complications of scrub typhus in a tertiary health care institute of Uttarakhand, India

S. P. Singh, Ragini Singh, Niaz Ahmad


Background: Scrub typhus or tsutsugamushi disease is a febrile illness caused by Orientia tsutsugamushi. Uttarakhand State in the northern region of India has been witnessing increased incidence of this fever. There is paucity of data on this topic from this region. The present study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from scrub typhus in a tertiary health care institute of Uttarakhand, India.

Methods: The study was performed at SGRR Institute of Medical & Health Sciences, Dehradun, which is a tertiary health care institute Uttrakhand. The study period was of 1year from December 2012 to November 2013. Patients of 12 years of age or above it who were IgM antibody positive by ELISA technique were included in the study. All such patients underwent detailed clinical examination and investigation.

Results: 47 patients were found to be suffering from scrub typhus. The common symptoms noted fever, myalgias, headache, vomiting, diarrhoea, breathlessness, petechiae and jaundice. Common complications noticed were hepatitis (78.7%) acute respiratory distress syndrome (19.2%), thrombocytopenia (46.8%) and acute renal failure (31.9%), Mortality was seen in 3 (6.4%) patients.

Conclusions: Scrub typhus is an important cause of mortality and morbidity in Uttarakhand. High index of suspicion, early diagnosis, monitoring of the clinical and laboratory parameters and prompt intervention may help in reducing the mortality.



Scrub typhus, Complications, Orientia tsutsugamushi, Uttarakhand

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Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. 2003;16(5):429-36.

Park K. Epidemiology of Communicable Diseases. In: Park K, eds. Park’s Textbook of Preventive and Social Medicine. 20th ed. Jabalpur: Banarsidas Bhanot; 2009: 262.

Willet HP. Sterilization and Disinfection. In: Joklik WK, Willet HP, Amos DB, Wilfert CM, eds. Zinsser microbiology. 20th ed. Orwalk, Conn: Appleton & Lange; 1992:700-718.

Chogle AR. Diagnosis and treatment of scrub typhus - the Indian scenario. J Assoc Physicians India 2010;58:11-2.

Watt G. Scrub typhus. In: Warrell DA, Cox TM, Firth JD, eds. Oxford, Textbook of Medicine. 5th ed. USA: Oxford University Press; 2010: 919-924.

Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavita ML et al. Scrub typhus among hospitalized patients with febrile illness in South India: magnitude and clinical predictors. J Infect 2006;52:56-60.

Kamarasu K, Malathi M, Rajagopal V, Subramani K, Jagadeeshramasamy D, Mathai E. Serological evidence for wide wide distribution of spotted fevers and typhus fever in Tamil Nadu. Indian J Med Res 2007;126:128-30.

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.

Somashekar HR, Prabhakar DM, Sreeja P, Elizabeth M, Didier R, Jean MR. Magnitude and features of scrub typhus and spotted fever in children in India. J Trop Pediatr 2006;52:22.

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.

Mahajan SK. Scrub typhus. J Assoc Physicians India 2005;53:954-8.

Jain N, Jain V. Study on Clinico - Laboratory Profi le of Children with Scrub Typhus. J Nepal Paediatr Soc 2012;32(2):187-92.

Rapmund G. Rickettsial diseases of the Far East: a new perspective. J Infect Dis 1984;149:330-8.

Mehta SR, Dham SK, Jetley V, Sahane AG. Scrub typhus - a report of six cases. MJAFI 1993;49:279-81.

Fang CT, Fergn WF, Hwang JJ, Yu CJ, Chen YC, Wang MH, Chang SC, Hsieh WC. Life‐threatening scrub typhus with meningoencephalitis and acute respiratory distress syndrome. J Formos Med Assoc1997;96:213-16.

Lee WS, Wang FD, Wang LS, Wong WW, Young D, Fung CP, Liu Y. Scrub typhus complicating acute respiratory distress syndrome: A report of two cases. Chin Med J (Taipei) 1995;56:205-10.

Chi WC, Huang JJ, Sung JM, Lan RR, Ko WC, Chen FF. Scrub typhus associated with multi‐organ failure: a case report. Scand J Infect Dis 1997;29:634-5.

Narvencar KPS, Rodrigues S, Nevrekar RP, Dias L, Dias A, Vaz M, Gomez E. Scrub typhus in patients reporting with acute febrile illnessat a tertiary health care institution in Goa. Indian J Med Res 2012;136:1020-4.

Mahajan SK, Rolain JM, Sankhyan N, Kaushal RK, Raoult D. 8. Pediatric scrub typhus in Indian Himalayas. Indian J Pediatr 2008;75:947-9.

Mahajan SK, Kashyap R, Kanga A, Sharma V, Prasher BS, Pal LS. Relevance of Weil -Felix test in diagnosis of scrub typhus in India. J Asssoc Physicians India 2006;54:619-21.

Aung-thu, Supanaranond W, Phumiratanaprapin W, Phonrat B, Chinprasatsak S, Ratanajaratroj N. Gastrointestinal manifestations of septic patients with scrub typhus in Maharat Nakhon Ratchasima Hospital. Southeast Asian J Trop Med Public Health 2004;35:845-51.

Sanjeev Kumar Digra, Ghan Shyam Saini, Virender Singh, Sunil Dutt Sharma, Rajesh Kaul, Scrub Typhus in Children: Jammu Experience; JK Science 2012;12(2):95.

Kim DM, Kim SW, Choi SH, Yun NR. Clinical and laboratory findings associated with severe Scrub typhus. BMC Infect Dis 2010;10:108.

Lee CS, Hwang JH, Lee HB, Kwon KS. Risk factors leading to fatal outcome in Scrub typhus patients. Am J Trop Med Hyg 2009;81:484-8.

Kim DM, Kang DW, Kim JO, Chung JH, Kim HL, Park CY et al. Acute renal failure due to acute tubular necrosis caused by direct invasion of Orientia tsutsugamushi. J Clin Microbiol 2008;46:1548-50.

Sonthayanon P, Chierakul W, Wuthiekanun V, Phimda K, Pukrittayakamee S, Day NP et al. Association of high Orientia tsutsugamushi DNA loads with disease of greater severity in adults with scrub typhus. J Clin Microbiol 2009;47:430-4.

Saah AJ. Orientia Tsutsugamushi (Scrub typhus). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious disease. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000: 2056-2057.

Levine HD. Pathologic study of thirty-one cases of Scrub typhus fever with especial reference to the cardiovascular system. Am Heart J 1946;31:314-28.

Seong S, Choi M, Kim I. Orientia tsutsugamushi infection: overview and immune responses. Microbes & Infection 2001;3(1):11-21.

Yen TH, Chang CT, Lin JL, Jiang JR, Lee KF. Scrub typhus: a frequently overlooked cause of acute renal failure. Ren Failure 2003;25:397-410.

Sanjay K Mahajan, Sharath Babu NM, et al. Scrub typhus presenting as acute abdomen. Trop D. 2011 Oct;41(3):185-6.

Mahajan SK, Rolain J-M, Kanga A, Raoult D. Scrub typhus involving central nervous system, India, 2004-2006. Emerg Infect Dis 2010 October;16(10):1641-3.