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VOLUME 18 , ISSUE 8 ( August, 2014 ) > List of Articles

RESEARCH ARTICLE

Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission

Kishore Pichamuthu, John Victor Peter, Gunasekaran Karthik, Kartik Ramakrishna, John Antony Jude Prakash, George M. Varghese, Mathew Griffith, Rajamanickam C. Kalki, Anugragh Chrispal, Ramya Iyyadurai, Ooriapadickal Cherian Abraham

Keywords : Intensive care, organ dysfunction, outcome, rickettsia, ventilation

Citation Information : Pichamuthu K, Peter JV, Karthik G, Ramakrishna K, Prakash JA, Varghese GM, Griffith M, Kalki RC, Chrispal A, Iyyadurai R, Abraham OC. Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission. Indian J Crit Care Med 2014; 18 (8):497-502.

DOI: 10.4103/0972-5229.138145

License: CC BY-ND 3.0

Published Online: 01-08-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and Aims: Scrub typhus, a zoonotic rickettsial infection, is an important reason for intensive care unit (ICU) admission in the Indian subcontinent. We describe the clinical profile, organ dysfunction, and predictors of mortality of severe scrub typhus infection. Materials and Methods: Retrospective study of patients admitted with scrub typhus infection to a tertiary care university affiliated teaching hospital in India during a 21-month period. Results: The cohort (n = 116) aged 40.0 ± 15.2 years (mean ± SD), presented 8.5 ± 4.4 days after symptom onset. Common symptoms included fever (100%), breathlessness (68.5%), and altered mental status (25.5%). Forty-seven (41.6%) patients had an eschar. Admission APACHE-II score was 19.6 ± 8.2. Ninety-one (85.2%) patients had dysfunction of 3 or more organ systems. Respiratory (96.6%) and hematological (86.2%) dysfunction were frequent. Mechanical ventilation was required in 102 (87.9%) patients, of whom 14 (12.1%) were solely managed with non-invasive ventilation. Thirteen patients (11.2%) required dialysis. Duration of hospital stay was 10.7 ± 9.7 days. Actual hospital mortality (24.1%) was less than predicted APACHE-II mortality (36%; 95% Confidence interval 32-41). APACHE-II score and duration of fever were independently associated with mortality on logistic regression analysis. Conclusions: In this cohort of severe scrub typhus infection with multi-organ dysfunction, survival was good despite high severity of illness scores. APACHE-II score and duration of fever independently predicted mortality.


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  1. Jeong YJ, Kim S, Wook YD, Lee JW, Kim KI, Lee SH. Scrub typhus: Clinical, pathologic, and imaging findings. Radiographics 2007;27:161-72.
  2. Chen PH, Hung KH, Cheng SJ, Hsu KN. Scrub typhus-associated acute disseminated encephalomyelitis. Acta Neurol Taiwan 2006;15:251-4.
  3. Kim DE, Lee SH, Park KI, Chang KH, Roh JK. Scrub typhus encephalomyelitis with prominent focal neurologic signs. Arch Neurol 2000;57:1770-2.
  4. Premaratna R, Chandrasena TG, Dassayake AS, Loftis AD, Dasch GA, de Silva HJ. Acute hearing loss due to scrub typhus: A forgotten complication of a reemerging disease. Clin Infect Dis 2006;42:e6-8.
  5. Aronoff DM, Watt G. Prevalence of relative bradycardia in Orientia tsutsugamushi infection. Am J Trop Med Hyg 2003;68:477-9.
  6. Kim DM, Kang DW, Kim JO, Chung JH, Kim HL, Park CY, et al. Acute renal failure due to acute tubular necrosis caused by direct invasion of Orientia tsutsugamushi. J Clin Microbiol 2008;46:1548-50.
  7. Wang CC, Liu SF, Liu JW, Chung YH, Su MC, Lin MC. Acute respiratory distress syndrome in scrub typhus. Am J Trop Med Hyg 2007;76:1148-52.
  8. Young PC, Hae CC, Lee KH, Hoon CJ. Tsutsugamushi infection-associated acute rhabdomyolysis and acute renal failure. Korean J Intern Med 2003;18:248-50.
  9. Tsay RW, Chang FY. Acute respiratory distress syndrome in scrub typhus. QJM 2002;95:126-8.
  10. Tsay RW, Chang FY. Serious complications in scrub typhus. J Microbiol Immunol Infect 1998;31:240-4.
  11. Song SW, Kim KT, Ku YM, Park SH, Kim YS, Lee DG, et al. Clinical role of interstitial pneumonia in patients with scrub typhus: A possible marker of disease severity. J Korean Med Sci 2004;19:668-73.
  12. Ichimura K, Uchida Y, Arai K, Nakazawa K, Sasaki J, Kobayashi K, et al. Afebrile scrub typhus (Tsutsugamushi disease) with acute respiratory distress syndrome. Intern Med 2002;41:667-70.
  13. Hu ML, Liu JW, Wu KL, Lu SN, Chiou SS, Kuo CH, et al. Short report: Abnormal liver function in scrub typhus. Am J Trop Med Hyg 2005;73:667-8.
  14. Mahajan SK, Rolain JM, Kanga A, Raoult D. Scrub typhus involving central nervous system, India, 2004-2006. Emerg Infect Dis 2010;16:1641-3.
  15. Sayen JJ, Pond HS, et al. Scrub typhus in Assam and Burma: A clinical study of 616 cases. Medicine (Baltimore) 1946;25:155-214.
  16. Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, et al. Rapid increase of scrub typhus, South Korea, 2001-2006. Emerg Infect Dis 2009;15:1127-9.
  17. Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, Abraham OC, et al. Scrub typhus: An unrecognized threat in South India-clinical profile and predictors of mortality. Trop Doct 2010;40:129-33.
  18. Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, et al. Acute undifferentiated febrile illness in adult hospitalized patients: The disease spectrum and diagnostic predictors-an experience from a tertiary care hospital in South India. Trop Doct 2010;40:230-4.
  19. Kuo CC, Huang JL, Ko CY, Lee PF, Wang HC. Spatial analysis of scrub typhus infection and its association with environmental and socioeconomic factors in Taiwan. Acta Trop 2011;120:52-8.
  20. Kim J, Lee E, Rhee HC. Cost-benefit analysis of the tsutsugamushi disease prevention program in South Korea. Jpn J Infect Dis 2012;65:222-7.
  21. Faa AG, McBride WJ, Garstone G, Thompson RE, Holt P. Scrub typhus in the Torres Strait islands of north Queensland, Australia. Emerg Infect Dis 2003;9:480-2.
  22. Kim DM, Kim SW, Choi SH, Yun NR. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis 2010;10:108.
  23. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
  24. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 1996;22:707-10.
  25. Coleman RE, Sangkasuwan V, Suwanabun N, Eamsila C, Mungviriya S, Devine P, et al. Comparative evaluation of selected diagnostic assays for the detection of IgG and IgM antibody to Orientia tsutsugamushi in Thailand. Am J Trop Med Hyg 2002;67:497-503.
  26. Zhang L, He S, Wang S, Yu H, Li X, Zhang D, et al. Comparison of a rapid diagnostic test and microimmunofluorescence assay for detecting antibody to Orientia tsutsugamushi in scrub typhus patients in China. Asian Pac J Trop Med 2011;4:666-8.
  27. Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related problems of the ESICM. Intensive Care Med 1999;22:686-96.
  28. Choi YH, Kim SJ, Lee JY, Pai HJ, Lee KY, Lee YS. Scrub typhus: Radiological and clinical findings. Clin Radiol 2000;55:140-4.
  29. Marchick MR, Kline JA, Jones AE. The significance of non-sustained hypotension in emergency department patients with sepsis. Intensive Care Med 2009;35:1261-4.
  30. Varpula M, Tallgren M, Saukkonen K, Voipio-Pulkki LM, Pettila V. Hemodynamic variables related to outcome in septic shock. Intensive Care Med 2005;31:1066-71.
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