title: Outbreak of scrub typhus in Pondicherry.
abstract: OBJECTIVE
  To describe the diverse clinical and laboratory manifestations of scrub typhus diagnosed in Pondicherry Institute of Medical Sciences, Pondicherry.
  
  
  METHODS
  All cases of febrile illness diagnosed as scrub typhus over a period of 2 years were analysed. Diagnosis was based on the presence of the eschar and/or positive Weil Felix test with a titre of > 1:80.
  
  
  RESULTS
  Fifty cases of scrub typhus were seen over a period of 2 years (April 2006 and April 2008). Common symptoms were high grade fever of 7-14 days duration, nausea, vomiting, headache, myalgia, cough and breathlessness. Eschar was seen in 23 cases (46%) and the common sites were axilla, breast and groin. Weil Felix test was positive in 39 cases (78%). Liver enzymes were elevated in nearly all cases (95.9%). Multiple Organ Dysfunction Syndrome (MODS) was present in one third of our patients (17 out of 50, 34%). Hypotension (8 patients, 16%), renal impairment (6 patients, 12%), ARDS (4 patients, 8%) and meningitis (7 patients, 14%) were some of the important complications. There was a dramatic response to doxycycline in nearly all the patients.
  
  
  CONCLUSIONS
  Scrub typhus has emerged as an important cause of febrile illness in Pondicherry. Empirical treatment with doxycycline is justified in endemic areas.
authors.affiliation: Department of Medicine & Microbiology, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry - 605 014.
authors.forename: M
authors.initials: M
authors.lastname: Vivekanandan
authors.forename: Anna
authors.initials: A
authors.lastname: Mani
authors.forename: Yamini Sundara
authors.initials: YS
authors.lastname: Priya
authors.forename: Ajai Pratap
authors.initials: AP
authors.lastname: Singh
authors.forename: Samuel
authors.initials: S
authors.lastname: Jayakumar
authors.forename: Shashikala
authors.initials: S
authors.lastname: Purty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000372:Agglutination Tests; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004196:Disease Outbreaks; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007075:Immunoglobulin M; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications; D012285:Orientia tsutsugamushi / Q000276:immunology*; D012612:Scrub Typhus / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D007075:Immunoglobulin M; D004318:Doxycycline