Key wordsscrub typhus, acute kidney injury, acute respiratory distress syndrome, shock. Such high mortality rate might be due to the delayed arrival in hospitals. Those who had been treated as scrub typhus but in whom the clinical notes were not convincing were excluded from the study. Scrub typhus should be part of the differential diagnosis of acute febrile illness with aki. Scrub typhus, or tsutsugamushi disease is a febrile illness caused by bacteria of the family rickettsiaceae and named orientia tsutsugamushi. We show that scrub typhus is responsible for about 24% of all patients presenting with unexplained febrile illness andor multisystem involvement. Scrub typhus is an underrecognized cause of acute febrile illness. Aki in scrub typhus is usually mild, nonoliguric, and renal recovery occurs in most patients. Scrub typhus, which is caused by orientia tsutsugamushi and is transmitted by chigger bite, is an acute febrile disease that can involve many vital organs including the kidneys. The incidence of acute kidney injury aki in scrub typhus has been reported to range from 21 to. A retrospective study was conducted on 120 patients with serum elisa igm positive for scrub typhus optical density. Scrub typhus is considered as one of the neglected diseases in the world, including nepal 5, 11, with median case fatality rate of 1. Results during the study period, 510 patients were diagnosed with scrub typhus and the incidence of aki was 35. Scrub typhus in patients with acute febrile illness.
The prevalence and outcome of kidney involvement, especially aki, in scrub typhus is not known. This disease was first described by the chinese in the third century, but the first description of its classic features did not appear in the western literature until the end of the nineteenth century. Scrub typhus is considered as an uncommon cause of aki even in. The causative organism is transmitted by the bite of sixlegged larval form chigger of trombiculid mite leptotrombidium. Walker, in tropical infectious diseases third edition, 2011. Considering the reemergence of scrub typhus in india, patients presenting with fever and acute kidney injury. Scrub typhus with a rare presentation in a child a case. Diagnosis and treatment of scrub typhus the indian. Mar 15, 2017 the mortality from scrub typhus in endemic areas in india is 212.
The incidence of acute kidney injury aki in scrub typhus has been reported to range from 21 to 43% 46, and old age and comorbidity are associated with the development of aki. It is also known as tsutsugamushi disease or chigger borne typhus. Scrub typhus is caused by orientia tsutsugamushi and humans are typically infected by a bite of an infected chigger trombiculid mite larva. It is spread and maintained by the larvae of mites. Scrub typhus is an underrecognized cause of acute febrile. Acute kidney injury in tropical acute febrile illness in a tertiary care. Patients were followed up until renal recovery or for at least 3 months after discharge. We were able to identify 25 patients with scrub typhus over the fouryear study period. Kumar v, kumar v, yadav ak, iyengar s, bhalla a, et al. Scrub typhus does not find a mention in most descriptions of tropical community acquired aki. Clinical characteristics of acute kidney injury in patients with scrub. Predictors of mortality in scrub typhus infection requiring.
Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called orientia tsutsugamushi. This study aimed to explore the predictors of mortality from scrub typhus infection in patients requiring intensive care unit icu admission. A suspected case of scrub typhus was defined as a patient presenting with acute onset of fever temperature 38c for aki with leukocytosis scrub typhus should always be ruled out because it is a fairly treatable condition and significantly under diagnosed. Scrub typhus disease pdf science tech ias mains topics. Typhus is a disease caused by infection with one or more rickettsial bacteria. Scrub typhus definition of scrub typhus by medical dictionary. Scrub typhus is a rare etiology of acute cholecystitis. Scrub typhus is spread to people through bites of infected chiggers larval mites. Acute kidney injury in scrub typhus mahe digital repository. Immunostaining procedures can also be performed on formalinfixed tissue samples. To report the clinical profile of acute kidney injury aki associated with scrub typhus. Clinical characteristics of acute kidney injury in.
Introduction scrub typhus is an acute, febrile, infectious illness that is caused by orientia formerly rickettsia tsutsugamushi. Typhus is a collective name given to a group of diseases caused by the rickettsia species. Thrombocytopenia and intensive care requirement are significant predictors of aki in scrub typhus. Kidney injury in tropical infections association of physician of india. A prospective case recordbased study of scrub typhus was carried out from january 2009 to december 2010 in a tertiary hospital in south india. The possible mechanisms of aki associated with scrub typhus include prerenal failure, septic.
Fleas, mites chiggers, lice, or ticks transmit it when they bite you. Hypotension, pulmonary involvement, cns involvement, and mods predict renal involvement. Scrub typhus leading to acute encephalitis syndrome, assam, india. Scrub typhus, also known as bush typhus because the mites leptotrombidium deliense, commonly known as trombiculid mite that cause it reside in vegetation predominantly comprising small shrubs, is an infectious disease with symptoms similar to any viral fever. Scrub typhus is an acute febrile illness in the tsutsugamushi triangle, transmitted by chiggers that can be treated effectively if detected early. Results the duration of fever with which these patients were admitted to the hospital varied. May 04, 2009 scrub typhus is transmitted by trombiculid mites and is endemic to east and southeast asia and northern australia. One study conducted in adult thai patients have suggested that orientia tsutsugamushi induces a type 1 immune response, associated with elevation of interferonalpha, il18 and il15 levels. The disease is distributed equally in all races and ages and in both sexes. Many complications have been reported in patients with scrub typhus including pneumonia, aki, ards, meningoencephalitis, shock, and myocarditis 28. Infectionrelated acute kidney injury aki is an important preventable cause of.
First, because jev is the predominant etiologic agent of aes in the northeastern region, especially in assam, health providers generally do not suspect other etiologic factors, including scrub typhus. Conclusion scrub typhus is an important cause of acute febrile illness which causes multiple organ dysfunction syndrome and it is easily treatable but most ignored disease. Scrub typhus definition of scrub typhus by medical. Open access research incidence, risk factors and clinical. The mortality from scrub typhus in endemic areas in india is 212. Clinical profile of scrub typhus meningoencephalitis among. Scrub typhus as a cause of acute encephalitis syndrome.
Scrub typhus or tsutsugamushi disease is an acute febrile disease prevalent in eastern asia, and the western pacific ocean. Scrub typhus or bush typhus is a form of typhus caused by the intracellular parasite orientia tsutsugamushi, a gramnegative. Scrub typhus associated acute kidney injurya study. The development of these complications is associated with prolonged hospitalization and higher medical. Scrub typhus associated acute kidney injury a study from a tertiary care hospital from western himalayan state of india article pdf available in renal failure 3510 august 20 with 391 reads. Scrub typhus infectious diseases msd manual professional. Scrub typhus played a major role during world war ii in the pacific theater. Scrub typhus, acute infectious disease in humans that is caused by the parasite rickettsia tsutsugamushi and is transmitted to humans by the bite of certain kinds of trombiculid mites, or chiggers. Infectionrelated acute kidney injury aki is an important preventable cause of morbidity and mortality in the tropical region. However, scrub typhus occurs in different geographic areas asiapacific area bounded by japan, korea, china, india, and northern australia, and frequently, an eschar develops with satellite adenopathy. In cases of scrub typhusassociated aki, antirickettsia agent and supportive care are very important.
Most cases of scrub typhus occur in rural areas of. Aki development in patients of scrub typhus may predict grave prognosis. Definition scrub typhus is an infectious disease that is transmitted to humans from field mice and rats through the bite of mites that live on the animals. Scrub typhus is manifested clinically by high fever, intense generalized headache, diffuse myalgias, and, in many patients, rash and an eschar at the site of the chigger bite. A total of 7 subjects were identified as having scrub typhus com. The prevalence and outcome of kidney involvement, especially aki. Ticks, scrub typhus rct and scrub typhus igm and igg rapid immunochromatographic assay panbio, brisbane, australia and multies dipsticks scrub recombinant assay integrated diagnostics, baltimore, maryland, usa have appeared in the market but are still far from the reach of most of the developing countries due to their high cost. Pdf scrub typhus associated acute kidney injury a study from a.
Information for health care providers typhus fevers cdc. Scrub typhus complicated by pneumonia and acute kidney injury. In comparison with the non aki group, the aki group was older 73. The disease scrub typhus disease pdf science tech ias mains topics. Renal involvement and acute kidney injury aki are common clinical manifestations seen in scrub typhus, a vectorborne tropical disease.
The possible mechanisms of aki associated with scrub typhus include prerenal failure, septic shock, vasculitis, rhabdomyolysis, and direct renal invasion of o. Manifestations of scrub typhus are similar to those of rocky mountain spotted fever and epidemic typhus. Scrub typhus is considered as an uncommon cause of aki even in endemic areas. It is a zoonotic disease, transmitted by arthropod vector trombiculid mite. The incidence of acute kidney injury aki in scrub typhus has been reported to range from 21 to 43% 4 5 6, and old age and comorbidity are associated with the development of aki 6. A patient presenting with the features of acute cholecystitis who does not respond to standard treatment should be screened for scrub typhus in a typhus endemic region. Outbreaks of acute encephalitis syndrome aes have been occurring in gorakhpur division, uttar pradesh, india, for several years.
Scrub typhus is endemic to a geographically distinct region, the socalled tsutsugamushi triangle, which includes japan, taiwan, china, and south. Scrub typhus is a febrile illness and can present with manifestations ranging from subclinical symptoms to multiorgan failure and death. On the other hand, enteric fever is an acute systemic illness characterized by fever, headache, and abdominal pain. The diagnosis is suggested by the clinical history including visit to an endemic area and physical findings and confirmed by serologic testing or biopsy of an eschar. The most common symptoms of scrub typhus include fever, headache, body aches, and sometimes rash. Typhus is caused by rickettsiae whereas typhoid is caused by salmonella typhi and paratyphi. The rodents on which these mites larval forms normally feed act as a primary host, while human beings are accidental host. Pdf scrub typhus is an acute febrile illness caused by orientia tsutsugamushi, transmitted to humans by the bite of the larva of trombiculid mites. Our findings revealed a high proportion of aes cases with orientia tsutsugamushi igm and igg, indicating that scrub typhus is a cause of aes. Aki is seen in over 50% cases, and is an important predictor of mortality. Scrub typhus etiology, epidemiology, symptoms, pathogenesis. See also overview of rickettsial and related infections. Our findings revealed a high proportion of aes cases with orientia tsutsugamushi igm and igg, indicating that scrub typhus is.
Scrub typhus should be considered as a diffe rential in cases presenting with fever and aki, in both adults and children, especially in endemic regions. The most rapid and specific diagnostic assays for scrub typhus rely on molecular methods like polymerase chain reaction pcr, which can detect dna in a whole blood, eschar swab pdf icon pdf 1 page, or tissue sample. Age and comorbidity are significant predictors of aki in scrub typhus. The clinical syndrome classically consists of a fever, rash, and eschar, but scrub typhus also commonly presents as an undifferentiated fever that requires laboratory confirmation of the diagnosis, usually by indirect fluorescent. The causative agent of scrub typhus, the bacterium r. The first record of apparent scrub typhus was described in china in ad 3. Aug 15, 2019 scrub typhus may disseminate into multiple organs through endothelial cells and macrophages, resulting in the development of fatal complications.
Scrub typhus is not found endemically in the united states, but it has been found in travelers from endemic areas. The clinical manifestations of scrub typhus in children are nonspecific and are likely to be misdiagnosed. Scrub typhus, also called tsutsugamushi disease, acute infectious disease in humans that is caused by the parasite rickettsia tsutsugamushi and is transmitted to humans by the bite of certain kinds of trombiculid mites, or chiggers. Scrub typhus should be considered as a differential in cases presenting with fever and aki. Scrub typhus with a rare presentation in a child a case report. In tropical region any short duration fever with pneumonia, aki with leukocytosis scrub typhus should be kept in differential as it is a fairly treatable. Although cases of aki in scrub typhus have been reported previously, there is a paucity of literature on the incidence and clinical characteristics of scrub typhus associated aki. Acute severe calculous cholecystitis with multiorgan. Considering the reemergence of scrub typhus in india, patients. Incidence, risk factors and clinical outcomes of acute.
Overall, mortality rate in our study was 20%, which is lower than that reported by a similar study in india 24. Renal manifestation in scrub typhus during a major outbreak in. Scrub typhus causes, symptoms, diagnosis, treatment. Scrub typhus or miteborne typhus is an infectious disease caused by a specific type of bacteria called orientia tsutsugamushi. Scrub typhus or bushtyphus is a form oftyphus caused by theintracellular parasiteorientia tsutsugamushi,a gramnegative. The main symptoms of the disease are fever, a wound at the site of the bite, a spotted rash on the trunk, and swelling of the lymph glands.
Scrub typhus leading to acute encephalitis syndrome. Symptoms are fever, a primary lesion, a macular rash, and lymphadenopathy. The incidence of aki in patient with scrub typhus is 21%. Mahajan sk, rolain jm, kashyap r, bakshi d, sharma v, et al. We studied the urinary abnormalities and acute kidney injury aki as per rifle criteria in scrub typhus.
Scrub typhus is an acute febrile illness caused by obligate intracellular gramnegative bacterium orientia tsutsugamushi. A prospective case recordbased study of scrub typhus was carried out. It is caused by orientia formerly rickettsia tsutsugamushi, an obligate intracellular gramnegative bacterium, which was first isolated in japan in 1930. Clinical significance of ngal and kim1 for acute kidney. A total of 1,733 reports were searched in pubmed n 1,710 and website of the korean journal of internal medicine n 23. We also show that the renal involvement is fairly common in scrub typhus. We investigated the incidence and clinical characteristics of scrub typhus associated aki using the rifle criteria. Scrub typhus is a zoonotic reemerging disease of the day caused by orientia tsutsugamushi o. Clinical diagnosis is unreliable for identifying scrub typhus, unless a tick eschar is present which is almost pathognomonic for the disease in southeast asia. Renal manifestations of scrub typhus in a tertiary care. Clinical characteristics of acute kidney injury in patients. All patients with suspected scrub typhus were recruited after taking written informed consent. The etiologic agent is an obligate intracellular parasite.