A retrospective study was conducted on 120 patients with serum elisa igm positive for scrub typhus optical density. Clinical characteristics of acute kidney injury in. Incidence, risk factors and clinical outcomes of acute kidney. 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 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. Scrub typhus or bush typhus is a form of typhus caused by the intracellular parasite orientia tsutsugamushi, a gramnegative. Such high mortality rate might be due to the delayed arrival in hospitals. Considering the reemergence of scrub typhus in india, patients. Mar 15, 2017 the mortality from scrub typhus in endemic areas in india is 212. Scrub typhus is considered as one of the neglected diseases in the world, including nepal 5, 11, with median case fatality rate of 1.
Infectionrelated acute kidney injury aki is an important preventable cause of morbidity and mortality in the tropical region. Hypotension, pulmonary involvement, cns involvement, and mods predict renal involvement. Clinical significance of ngal and kim1 for acute kidney. Scrub typhus is a febrile illness and can present with manifestations ranging from subclinical symptoms to multiorgan failure and death. The prevalence and outcome of kidney involvement, especially aki, in scrub typhus is not known. Scrub typhus leading to acute encephalitis syndrome. Thrombocytopenia and intensive care requirement are significant predictors of aki in scrub typhus. Scrub typhus or miteborne typhus is an infectious disease caused by a specific type of bacteria called orientia tsutsugamushi. The incidence of acute kidney injury aki in scrub typhus has been reported to range from 21 to. It is also known as tsutsugamushi disease or chigger borne typhus. The possible mechanisms of aki associated with scrub typhus include prerenal failure, septic.
Many complications have been reported in patients with scrub typhus including pneumonia, aki, ards, meningoencephalitis, shock, and myocarditis 28. Scrub typhus played a major role during world war ii in the pacific theater. Scrub typhus is a zoonotic reemerging disease of the day caused by orientia tsutsugamushi o. 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. It is caused by orientia formerly rickettsia tsutsugamushi, an obligate intracellular gramnegative bacterium, which was first isolated in japan in 1930.
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. Typhus is a collective name given to a group of diseases caused by the rickettsia species. Aki in scrub typhus is usually mild, nonoliguric, and renal recovery occurs in most patients. 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. Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called orientia tsutsugamushi.
Clinical characteristics of acute kidney injury in patients with scrub. 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. Diagnosis and treatment of scrub typhus the indian. The most common symptoms of scrub typhus include fever, headache, body aches, and sometimes rash. Scrub typhus causes, symptoms, diagnosis, treatment. Symptoms are fever, a primary lesion, a macular rash, and lymphadenopathy. Scrub typhus is a rare etiology of acute cholecystitis. Our findings revealed a high proportion of aes cases with orientia tsutsugamushi igm and igg, indicating that scrub typhus is. Scrub typhus does not find a mention in most descriptions of tropical community acquired aki. 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. A total of 7 subjects were identified as having scrub typhus com. In comparison with the non aki group, the aki group was older 73.
The disease is distributed equally in all races and ages and in both sexes. Predictors of mortality in scrub typhus infection requiring. Scrub typhus is spread to people through bites of infected chiggers larval mites. Pdf scrub typhus associated acute kidney injury a study from a. Key wordsscrub typhus, acute kidney injury, acute respiratory distress syndrome, shock. Scrub typhus is an acute febrile illness caused by obligate intracellular gramnegative bacterium orientia tsutsugamushi. Patients were followed up until renal recovery or for at least 3 months after discharge. A prospective case recordbased study of scrub typhus was carried out. The prevalence and outcome of kidney involvement, especially aki. May 04, 2009 scrub typhus is transmitted by trombiculid mites and is endemic to east and southeast asia and northern australia. Scrub typhus complicated by pneumonia and acute kidney injury. 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. Immunostaining procedures can also be performed on formalinfixed tissue samples.
To report the clinical profile of acute kidney injury aki associated with scrub typhus. Scrub typhus or bushtyphus is a form oftyphus caused by theintracellular parasiteorientia tsutsugamushi,a gramnegative. Incidence, risk factors and clinical outcomes of acute. The clinical manifestations of scrub typhus in children are nonspecific and are likely to be misdiagnosed. 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. Mahajan sk, rolain jm, kashyap r, bakshi d, sharma v, et al. Scrub typhus is caused by orientia tsutsugamushi and humans are typically infected by a bite of an infected chigger trombiculid mite larva. A total of 1,733 reports were searched in pubmed n 1,710 and website of the korean journal of internal medicine n 23. 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. 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. Results the duration of fever with which these patients were admitted to the hospital varied.
Most cases of scrub typhus occur in rural areas of. Scrub typhus associated acute kidney injurya study. 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 scrub typhus disease pdf science tech ias mains topics. Scrub typhus is an acute febrile illness in the tsutsugamushi triangle, transmitted by chiggers that can be treated effectively if detected early. We studied the urinary abnormalities and acute kidney injury aki as per rifle criteria in scrub typhus. Scrub typhus is an underrecognized cause of acute febrile illness. Aki is seen in over 50% cases, and is an important predictor of mortality. The first record of apparent scrub typhus was described in china in ad 3. Our findings revealed a high proportion of aes cases with orientia tsutsugamushi igm and igg, indicating that scrub typhus is a cause of aes.
Acute kidney injury in scrub typhus mahe digital repository. This study aimed to explore the predictors of mortality from scrub typhus infection in patients requiring intensive care unit icu admission. The etiologic agent is an obligate intracellular parasite. 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 prospective case recordbased study of scrub typhus was carried out from january 2009 to december 2010 in a tertiary hospital in south india. The incidence of aki in the common tropic al acute febrile illnesses in our study such as scrub typhus, falciparum malaria, enteric fever. Scrub typhus is considered as an uncommon cause of aki even in. 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 as a cause of acute encephalitis syndrome. 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. Manifestations of scrub typhus are similar to those of rocky mountain spotted fever and epidemic typhus. Introduction scrub typhus is an acute, febrile, infectious illness that is caused by orientia formerly rickettsia tsutsugamushi. Scrub typhus should be considered as a differential in cases presenting with fever and aki. 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. Clinical diagnosis is unreliable for identifying scrub typhus, unless a tick eschar is present which is almost pathognomonic for the disease in southeast asia. We also show that the renal involvement is fairly common in scrub typhus. Those who had been treated as scrub typhus but in whom the clinical notes were not convincing were excluded from the study. In cases of scrub typhusassociated aki, antirickettsia agent and supportive care are very important.
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. Scrub typhus definition of scrub typhus by medical. Diagnosis and treatment of scrub typhus the indian scenario. Renal involvement and acute kidney injury aki are common clinical manifestations seen in scrub typhus, a vectorborne tropical disease. Typhus is a disease caused by infection with one or more rickettsial bacteria. Results during the study period, 510 patients were diagnosed with scrub typhus and the incidence of aki was 35. Scrub typhus should be part of the differential diagnosis of acute febrile illness with aki.
Aki development in patients of scrub typhus may predict grave prognosis. Scrub typhus leading to acute encephalitis syndrome, assam, india. Outbreaks of acute encephalitis syndrome aes have been occurring in gorakhpur division, uttar pradesh, india, for several years. Scrub typhus infectious diseases msd manual professional. Scrub typhus is an underrecognized cause of acute febrile. Pdf scrub typhus is an underrecognized cause of acute. It is spread and maintained by the larvae of mites. Introduction 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. Scrub typhus is a miteborne infectious disease caused by orientia tsutsugamushi previously called rickettsia tsutsugamushi. Kidney injury in tropical infections association of physician of india.
Scrub typhus etiology, epidemiology, symptoms, pathogenesis. 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. Aug 15, 2019 scrub typhus may disseminate into multiple organs through endothelial cells and macrophages, resulting in the development of fatal complications. Clinical profile of scrub typhus meningoencephalitis among. Walker, in tropical infectious diseases third edition, 2011. Acute severe calculous cholecystitis with multiorgan. The development of these complications is associated with prolonged hospitalization and higher medical. Renal failure associated with scrub typhus semantic scholar. The incidence of aki in patient with scrub typhus is 21%. The causative organism is transmitted by the bite of sixlegged larval form chigger of trombiculid mite leptotrombidium. Considering the reemergence of scrub typhus in india, patients presenting with fever and acute kidney injury. Scrub typhus or tsutsugamushi disease is an acute febrile disease prevalent in eastern asia, and the western pacific ocean. Overall, mortality rate in our study was 20%, which is lower than that reported by a similar study in india 24. 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.
Typhus is caused by rickettsiae whereas typhoid is caused by salmonella typhi and paratyphi. 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. Renal manifestations of scrub typhus in a tertiary care. The causative agent of scrub typhus, the bacterium r. Scrub typhus, or tsutsugamushi disease is a febrile illness caused by bacteria of the family rickettsiaceae and named orientia tsutsugamushi. The rodents on which these mites larval forms normally feed act as a primary host, while human beings are accidental host. Scrub typhus with a rare presentation in a child a case report.
Infectionrelated acute kidney injury aki is an important preventable cause of. Scrub typhus with a rare presentation in a child a case. Retrospective study of hospitalized patients of acute febrile illness who were diagnosed scrub typhus and had aki. Scrub typhus is endemic to a geographically distinct region, the socalled tsutsugamushi triangle, which includes japan, taiwan, china, and south. Fleas, mites chiggers, lice, or ticks transmit it when they bite you. 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. Renal manifestation in scrub typhus during a major outbreak in. 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. On the other hand, enteric fever is an acute systemic illness characterized by fever, headache, and abdominal pain. Scrub typhus disease pdf science tech ias mains topics.
We show that scrub typhus is responsible for about 24% of all patients presenting with unexplained febrile illness andor multisystem involvement. Open access research incidence, risk factors and clinical. See also overview of rickettsial and related infections. Scrub typhus definition of scrub typhus by medical dictionary. The mortality from scrub typhus in endemic areas in india is 212. Scrub typhus is an acute, febrile, infectious illness that was first described in china in 3 ad. 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. Scrub typhus in patients with acute febrile illness. Scrub typhus is considered as an uncommon cause of aki even in endemic areas. Pdf scrub typhus is an acute febrile illness caused by orientia tsutsugamushi, transmitted to humans by the bite of the larva of trombiculid mites.
Clinical characteristics of acute kidney injury in patients. 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. We investigated the incidence and clinical characteristics of scrub typhus associated aki using the rifle criteria. Acute kidney injury in tropical acute febrile illness in a tertiary care. Scrub typhus is a miteborne disease caused by orientia tsutsugamushi formerly rickettsia tsutsugamushi. Scrub typhus is not found endemically in the united states, but it has been found in travelers from endemic areas. It is a zoonotic disease, transmitted by arthropod vector trombiculid mite.