title: Scrub typhus in patients reporting with acute febrile illness at a tertiary health care institution in Goa.
abstract: OBJECTIVE
  Scrub typhus is one of the differential diagnoses of haemorrhagic fevers especially if associated with jaundice and/or renal failure. Goa State in the western region of India has been witnessing increased incidence of such fevers, therefore, the present study was undertaken to identify whether scrub typhus is the aetiological agent.
  
  
  METHODS
  Adult patients presenting with undiagnosed febrile illness between June 2009 to October 2010, were evaluated. Testing was done using a commercial ELISA kit for specific IgM antibodies against Orientia tsutsugamushi.
  
  
  RESULTS
  Of the 44 patients included in the study, 15 (34%) were found to be positive for IGM antibodies against O. tsutsugamushi. The cases were seen mainly in the months between July to November. The common symptoms noted were fever, myalgias, gastrointestinal complaints, followed by breathlessness, rash and jaundice. The pathognomonic features such as eschar and lymphadenopathy were seen only in two patients. Nearly two third of the patients had leukocytosis (67%) and low serum albumin (60%). The most common complication noticed was hepatitis (80%) followed by acute respiratory distress syndrome (ARDS) (60%), thrombocytopenia (40%) and acute renal failure (33%). Five patients died in the course of illness.
  
  
  CONCLUSIONS
  Our results showed that scrub typhus should be considered in the differential diagnosis of acute febrile illness associated with gastrointestinal symptoms, rash, myalgia , including those with organ dysfunctions such as hepatorenal syndrome, coagulopathy or ARDS. Empirical treatment with doxycycline or macrolides may be given in cases with strong suspicion of scrub typhus.
authors: Department of Medicine, Goa Medical College, Goa, India. kedarnarvenkar@yahoo.com
authors: Kedareshwar P S
authors: KP
authors: Narvencar
authors: Savio
authors: S
authors: Rodrigues
authors: Ramnath P
authors: RP
authors: Nevrekar
authors: Lydia
authors: L
authors: Dias
authors: Amit
authors: A
authors: Dias
authors: Marina
authors: M
authors: Vaz
authors: E
authors: E
authors: Gomes
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012285:Orientia tsutsugamushi / Q000276:immunology*; D012612:Scrub Typhus / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*
chemical_list: D007075:Immunoglobulin M; D004318:Doxycycline
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