Abstract

Objective: We undertook this study in view of sudden outbreak of acute febrile illness, with associated thrombocytopenia and multiorgan failure, to assess the underlying etiological agent in these cases occurring in the district of Haryana, Northern India.

Methods: Adult patients with acute febrile illness who visited out-patient and emergency department, from July to November 2012 were examined. Suspected cases were tested for specific IgM antibodies against Orientia tsutsugamushi.

Results: Among 25 seropositive cases, 22 (88%) presented from July to September, while 3 (12%) during October and November. Mostly patients presented with fever (88%), hypotension (40%), maculopapular rash (28%) mostly on face and trunk, eschar (12%) predominantly over lower limbs and pleural effusion (12%). Abnormal liver function tests were seen in the form of elevated transaminases (84%) and serum alkaline phosphatase (72%). Anemia (36%), leukocytosis (32%) and thrombocytopenia (72%) were also detected. Proteinuria was found in 64% of patients while 40% had increased blood urea on presentation. The most common complications were shock in 32% and acute respiratory distress syndrome (ARDS) in 20% of the patients, eventually requiring ventilator support. Patients were treated with doxycycline 100 mg bid for 12-14 days. Three patients could not recover despite the addition of azithromycin and injectable chloramphenicol apart from doxycycline, and succumbed to the illness giving a mortality rate of 12%.

Conclusions: Scrub typhus forms one of the most differentials in patients of acute febrile illness presenting with thrombocytopenia, shock, abnormal liver function tests, renal dysfunction, ARDS and multiorgan dysfunction. Measures avoiding direct contact with infected mites and reducing the time of contact of mites with the body coupled with early diagnosis and treatment should be considered to prevent the development of fatal complications.