Case Report Acute febrile illness with skin rash with multiorgan affection presented as scrub typhus: Scrub Typhus
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Nitin Rathod, ANDREA JANICE FONSECA, Ruchika Gupta, Aayush JayswalFiles
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Published in Vol. 66 No. 3 (2024) of Bombay Hospital Journal.
Bombay Hospital Journal (BHJ) is a peer-reviewed quarterly published Print and Online journal. It is an official Journal of Bombay Hospital institute of medical sciences. The aim of BHJ is to improve medical care by publishing sound scientific articles (both research and practice papers) and focusing on topics that are of great importance to its readership.
Editor-in-Chief- Dr Satish Vasant Khadilkar
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Abstract :
Aim: To diagnose and treat the patient with acute febrile illness and multiorgan failure affection who presented as scrub typhus
Background: Scrub typhus fever is a disease caused by Orientia Tsutsugamushi
Case Description: Adult male patient who has gone for picnic at hilly area and who presented after 5 days with acute febrile illness and deteriorated with skin rash and multi organ affection. His tropical fever panel investigations were normal and found to have high titre of Weil Felix test and PCR for rickettsia was positive. He responded well with doxycycline injection and was discharged.
Conclusion: Scrub typhus is characterized by skin rash initially maculopapular, progressing to petechial and spreading centripetally in patient with high fever, myalgia, and headache with supportive epidemiologic or exposure history .Classical triad includes Morbilliform eruption plus fever plus necrotic papule (eschar at the tick bite site) should prompt diagnosis of scrub typhus infection.
Clinical significance: With prompt diagnosis and identifying the main characteristic features of scrub typhus such as Eschar is important to identify so that the appropriate treatment can be started. Doxycycline is the mainstay treatment
References
References:
Warrell Clare E., et. al.: Imported rickettsial infections to the United Kingdom, 2015–2020. Journal of Infection 2023; 86.5: pp. 446-452.
Richards Allen L., Jiang Ju: Scrub typhus: historic perspective and current status of the worldwide presence of Orientia species. Tropical medicine and infectious disease 2020; 5.2: pp. 49.
Zeng B.S., Zeng B.Y., Hung C.M., Kuo H.C., Chen Y.W., Suen M.W., Shiue Y.L., Tseng P.T., Chen CH.: The efficacy and tolerability of antibiotics in scrub typhus: an updated network meta-analysis of randomized controlled trials. Int J Infect Dis 2022 Sep; 122: pp. 461-468.
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