title: Scrub typhus: Clinical spectrum and outcome.
abstract: BACKGROUND
  Scrub typhus is one of the differential diagnoses for fever with thrombocytopenia. ARDS associated with Scrub typhus has high morbidity and mortality.
  
  
  OBJECTIVE
  To evaluate clinical features, lab values, and outcome in patients with scrub typhus and comparison in patients with or without ARDS.
  
  
  METHODS
  A prospective observational study was conducted on 109 patients with febrile illness and thrombocytopenia during a period of 12 months. All 109 patients were tested with both Immune-chromatography test and Weil felix test. Patients having either Immune-chromatography test/Weil felix test positive have been included and considered as scrub typhus positive whereas negative for both Immune-chromatography and Weil felix test were excluded. Clinical features, lab parameters, and outcome were evaluated in all patients with scrub typhus. Statistical analysis used in this study was T-test.
  
  
  RESULTS
  Among 58 patients who were included (After exclusion of 51 patients among total of 109 patients) 34 patients had no ARDS and 24 patients had ARDS. The clinical feature like dyspnoea, cough, low blood pressure (MAP<65 mmHg), IVC collapsibility (by ultrasound) and laboratory parameters like decreased Hemoglobin, Hematocrit, Serum albumin, and increased serum creatinine, serum total bilirubin, SGOT, SGPT, LDH, CPK, and serum lactate were statistically significant (P < 0.0001) in scrub typhus patients group with ARDS. The higher titers of Weil-felix can be correlated with more severe form of disease according to our observation. All 34 Scrub typhus patients without ARDS recovered completely. Among 24 Scrub typhus patients with ARDS, 22 patients recovered, and 2 patients died.
  
  
  CONCLUSIONS
  Scrub typhus is an important differential diagnosis in a patients having fever with thrombocytopenia. Scrub typhus associated with ARDS has high morbidity and mortality. Early diagnosis and treatment with doxycycline can prevent the occurrence of ARDS.
authors: Department of Critical Care Medicine, Yashoda Multi-Speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors: Pradeep M
authors: PM
authors: Venkategowda
authors: Department of General Medicine, Yashoda Multi-Speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors: S Manimala
authors: SM
authors: Rao
authors: Department of Critical Care Medicine, Yashoda Multi-Speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors: Dnyaneshwar P
authors: DP
authors: Mutkule
authors: Department of Critical Care Medicine, Yashoda Multi-Speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors: Mallela V
authors: MV
authors: Rao
authors: Department of Critical Care Medicine, Yashoda Multi-Speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors: Alai N
authors: AN
authors: Taggu
keywords: Acute respiratory distress syndrome; Weil-Felix test; immunochromatography test; screening criteria; scrub typhus; thrombocytopenia