Septic shock secondary to scrub typhus: characteristics and complications.
Scrub typhus is an acute febrile illness caused by infection with Orientia tsutsugamushi transmitted by the bite of larval trombiculid mites (chiggers). A prospective study was conducted in septic shock patients in Maharat Hospital, Nakhon Ratchasima Province, Thailand, from 12 November 2001 to 5 January 2002. Of the 51 septic shock patients studied during the 7 week period, 18 (35.3%) were found to have evidence of scrub typhus infection; 3 patients (16.7%) died. In this study, septic shock caused by Orientia tsutsugamushi is the most prominent (35.3%) in endemic area of scrub typhus. Scrub typhus with septic shock patients results in organ failure: respiratory failure, DIC were predominant, followed by renal and hepatic involvement. Two deaths were due to respiratory failure and one death was as a result of combined respiratory and renal failure. Fever was the most common symptom, followed by headache, myalgia and dyspnea; lymphadenophathy and eschar are common signs. Laboratory findings revealed that almost all of the patients had a mild leukocytosis, reduced hematocrit and thrombocytopenia; SGOT, ALP, direct bilirubin (DB), total billirubin (TB), BUN, Cr were elevated; hypoalbuminemia was noted. Urinalysis showed that 88.9% of the patients had albuminuria. 77.8% of patients had abnormal chest X-rays.
Thap
Lon Chan
LC
Malaria National Center, Phnom Penh, Cambodia. lonchanthap@yahoo.com
Supanaranond
Wichai
W
Treeprasertsuk
Sombat
S
Kitvatanachai
Sirima
S
Chinprasatsak
Soontorn
S
Phonrat
Benjaluck
B
D000328:Adult; D000368:Aged; D000818:Animals; D001096:Arachnid Vectors / Q000382:microbiology; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D004211:Disseminated Intravascular Coagulation / Q000382:microbiology; D004417:Dyspnea / Q000382:microbiology; D019353:Endemic Diseases / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000382:microbiology; D006261:Headache / Q000382:microbiology; D006400:Hematocrit; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D034141:Hypoalbuminemia / Q000382:microbiology; D007964:Leukocytosis / Q000382:microbiology; D008206:Lymphatic Diseases / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D008925:Mites / Q000382:microbiology; D009102:Multiple Organ Failure / Q000382:microbiology; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000382:microbiology; D012612:Scrub Typhus / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D013785:Thailand / Q000453:epidemiology; D013921:Thrombocytopenia / Q000382:microbiology
D003404:Creatinine; D001219:Aspartate Aminotransferases; D001663:Bilirubin