Volume 95, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Scrub typhus, a zoonotic disease caused by the bacterium , has become endemic in many parts of India. We studied the clinical profile of this infection in 228 patients that reported to this tertiary care center from July 2013 to December 2014. The median age of patients was 35 years (interquartile range = 24.5–48.5 years), and 111 were males and 117 females. A high-grade fever occurred in 85%, breathlessness in 42%, jaundice in 32%, abdominal pain in 28%, renal failure in 11%, diarrhea in 10%, rashes in 9%, and seizures in 7%. Common laboratory abnormalities at presentation were a deranged hepatic function in 61%, anemia in 54%, leukopenia in 15%, and thrombocytopenia in 90% of our patients. Acute kidney injury (32%), acute respiratory distress syndrome (ARDS) (25%), and disseminated intravascular coagulation (DIC) (16%) were the commonest complications. A hepatorenal syndrome was seen in 38% and multiple organ dysfunction syndrome (MODS) in 20% patients. The overall case fatality rate was 13.6%. In univariate analysis, ARDS requiring mechanical ventilation, acute kidney injury requiring hemodialysis, hypotension requiring inotropic support, central nervous system dysfunction at presentation, and MODS were inversely associated with survival. Survival was significantly higher in patients that presented with a duration of fever < 10 days compared with those that presented ≥ 12 days ( < 0.05) after onset. In conclusion, scrub typhus has become a leading infectious disease in north India and an important cause of infectious fever. An increasing awareness of this disease coupled with prompt management will go a long way in reducing both morbidity and mortality from this disease.


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  1. Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, Abraham AM, Abraham OC, Thomas K, , 2010. 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 40: 230234.[Crossref] [Google Scholar]
  2. Parola P, Paddock CD, Raoult D, , 2005. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. Clin Microbiol Rev 18: 719756.[Crossref] [Google Scholar]
  3. Kelly DJ, Fuerst PA, Ching WM, Richards AL, , 2009. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi . Clin Infect Dis 48 (Suppl 3): S203S230.[Crossref] [Google Scholar]
  4. Paris DH, Shelite TR, Day NP, Walker DH, , 2013. Unresolved problems related to scrub typhus: a seriously neglected life-threatening disease. Am J Trop Med Hyg 89: 301307.[Crossref] [Google Scholar]
  5. McDonald JC, MacLean JD, McDade JE, , 1988. Imported rickettsial disease: clinical and epidemiologic features. Am J Med 85: 799805.[Crossref] [Google Scholar]
  6. Kumar K, Saxena VK, Thomas TG, Lal S, , 2004. Outbreak investigation of scrub Typhus in Himachal Pradesh (India). J Commun Dis 36: 277283. [Google Scholar]
  7. Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S, , 2010. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India 58: 2428. [Google Scholar]
  8. Khan SA, Dutta P, Khan AM, Topno R, Borah J, Chowdhury P, Mahanta J, , 2012. Re-emergence of scrub typhus in northeast India. Int J Infect Dis 16: e889e890.[Crossref] [Google Scholar]
  9. Sethi S, Prasad A, Biswal M, Hallur VK, Mewara A, Gupta N, Galhotra S, Singh G, Sharma K, , 2014. Outbreak of scrub typhus in north India: a re-emerging epidemic. Trop Doct 44: 156159.[Crossref] [Google Scholar]
  10. Rathi NB, Rathi AN, Goodman MH, Aghai ZH, , 2011. Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatr 48: 867872.[Crossref] [Google Scholar]
  11. Sankhyan N, Saptharishi LG, Sasidaran K, Kanga A, Singhi SC, , 2014. Clinical profile of scrub typhus in children and its association with hemophagocytic lymphohistiocytosis. Indian Pediatr 51: 651653.[Crossref] [Google Scholar]
  12. Varghese GM, Janardhanan J, Trowbridge P, Peter JV, Prakash JA, Sathyendra S, Thomas K, David TS, Kavitha ML, Abraham OC, Mathai D, , 2013. Scrub typhus in south India: clinical and laboratory manifestations, genetic variability, and outcome. Int J Infect Dis 17: e981e987.[Crossref] [Google Scholar]
  13. Saxena A, Khiangte B, Tiewsoh I, , 2014. Scrub typhus complicated by acute respiratory distress syndrome and multiorgan failure; an unrecognized alarming entity in central India: a report of two cases. J Family Med Prim Care 3: 8083.[Crossref] [Google Scholar]
  14. Ono Y, Ikegami Y, Tasaki K, Abe M, Tase C, , 2012. Case of scrub typhus complicated by severe disseminated intravascular coagulation and death. Emerg Med Australas 24: 577580.[Crossref] [Google Scholar]
  15. Furuya Y, Yoshida Y, Katayama T, Yamamoto S, Kawamura A, Jr, 1993. Serotype-specific amplification of Rickettsia tsutsugamushi DNA by nested polymerase chain reaction. J Clin Microbiol 31: 16371640. [Google Scholar]
  16. Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, Lee SD, Im HK, Kwon JW, , 2009. A community-based case-control study of behavioral factors associated with scrub typhus during the autumn epidemic season in South Korea. Am J Trop Med Hyg 80: 442446. [Google Scholar]
  17. Prakash JA, Kavitha ML, Mathai E, , 2011. Nested polymerase chain reaction on blood clots for gene encoding 56 kDa antigen and serology for the diagnosis of scrub typhus. Int J Med Microbiol 29: 4750. [Google Scholar]
  18. Koraluru M, Bairy I, Varma M, Vidyasagar S, , 2015. Diagnostic validation of selected serological tests for detecting scrub typhus. Microbiol Immunol 59: 371374.[Crossref] [Google Scholar]
  19. Chang WH, Kang JS, Lee WK, Choi MS, Lee JH, , 1990. Serological classification by monoclonal antibodies of Rickettsia tsutsugamushi isolated in Korea. J Clin Microbiol 28: 685688. [Google Scholar]
  20. Sharma PK, Ramakrishnan R, Hutin YJ, Barui AK, Manickam P, Kakkar M, Mittal V, Gupte MD, , 2009. Scrub typhus in Darjeeling, India: opportunities for simple, practical prevention measures. Trans R Soc Trop Med Hyg 103: 11531158.[Crossref] [Google Scholar]
  21. Singh R, Singh SP, Ahmad N, , 2014. A study of etiological pattern in an epidemic of acute febrile illness during monsoon in a tertiary health care institute of Uttarakhand, India. J Clin Diagn Res 8: MC01MC03. [Google Scholar]
  22. Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, Mathai E, , 2006. Scrub typhus among hospitalised patients with febrile illness in south India: magnitude and clinical predictors. J Infect 52: 5660.[Crossref] [Google Scholar]
  23. Varghese GM, Trowbridge P, Janardhanan J, Thomas K, Peter JV, Mathews P, Abraham OC, Kavitha ML, , 2014. Clinical profile and improving mortality trend of scrub typhus in south India. Int J Infect Dis 23: 3943.[Crossref] [Google Scholar]
  24. Kumar V, Kumar V, Yadav AK, Iyengar S, Bhalla A, Sharma N, Aggarwal R, Jain S, Jha V, , 2014. Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India. PLoS Negl Trop Dis 8: e2605.[Crossref] [Google Scholar]
  25. Sinha P, Gupta S, Dawra R, Rijhawan P, , 2014. Recent outbreak of scrub typhus in north western part of India. Indian J Med Microbiol 32: 247250.[Crossref] [Google Scholar]
  26. Griffith M, Peter JV, Karthik G, Ramakrishna K, Prakash JA, Kalki RC, Varghese GM, Chrispal A, Pichamuthu K, Iyyadurai R, Abraham OC, , 2014. Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission. Indian J Crit Care Med 18: 497502.[Crossref] [Google Scholar]
  27. Jang MO, Kim JE, Kim UJ, Ahn JH, Kang SJ, Jang HC, Jung SI, Park KH, , 2014. Differences in the clinical presentation and the frequency of complications between elderly and non-elderly scrub typhus patients. Arch Gerontol Geriatr 58: 196200.[Crossref] [Google Scholar]
  28. Mahajan SK, Rolain JM, Kashyap R, Bakshi D, Sharma V, Prasher BS, Pal LS, Raoult D, , 2006. Scrub typhus in Himalayas. Emerg Infect Dis 12: 15901592.[Crossref] [Google Scholar]
  29. Yoo JR, Heo ST, Koh YS, Kim S, Kim S, , 2014. Unusual genotypic distribution of Orientia tsutsugamushi strains causing human infections on Jeju Island. Am J Trop Med Hyg 90: 507510.[Crossref] [Google Scholar]
  30. Nadjm B, Thuy PT, Trang VD, Dang Ha L, Kinh NV, Wertheim HF, , 2014. Scrub typhus in the northern provinces of Vietnam: an observational study of admissions to a national referral hospital. Trans R Soc Trop Med Hyg 108: 739740.[Crossref] [Google Scholar]
  31. Sirisanthana V, Puthanakit T, Sirisanthana T, , 2003. Epidemiologic, clinical and laboratory features of scrub typhus in thirty Thai children. Pediatr Infect Dis J 22: 341345. [Google Scholar]
  32. Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, Raoult D, , 2003. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci 990: 359364.[Crossref] [Google Scholar]
  33. Kumar Bhat N, Dhar M, Mittal G, Shirazi N, Rawat A, Prakash Kalra B, Chandar V, Ahmad S, , 2014. Scrub typhus in children at a tertiary hospital in north India: clinical profile and complications. Iran J Pediatr 24: 387392. [Google Scholar]
  34. Krishnamurthy S, Narayanan P, Prabha S, Mondal N, Mahadevan S, Biswal N, Srinivasan S, , 2013. Clinical profile of acute kidney injury in a pediatric intensive care unit from southern India: a prospective observational study. Indian J Crit Care Med 17: 207213.[Crossref] [Google Scholar]
  35. Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, Mathai E, , 2006. Scrub typhus among hospitalised patients with febrile illness in south India: magnitude and clinical predictors. J Infect 52: 5660.[Crossref] [Google Scholar]

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  • Received : 05 Feb 2016
  • Accepted : 30 Apr 2016
  • Published online : 03 Aug 2016

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