ABSTRACT
Background: Scrub typhus usually affects previously healthy active persons and if undiagnosed or diagnosed late, may prove to be life‑threatening. Diagnosis of scrub typhus should be largely based on a high index of suspicion and careful clinical, laboratory and epidemiological evaluation. Objective: To describe the diverse clinical and laboratory manifestations of scrub typhus diagnosed in Mahatma Gandhi Medical College and Hospital, Jaipur. Materials and Methods: All cases of febrile illness diagnosed as scrub typhus over a period of 3 months were analysed. Diagnosis was based on ELISA test for antibody detection against 56 kDa antigen. Results: Forty‑two cases of scrub typhus were seen over a period of 3 months (October, 2012‑December, 2012). Common symptoms were high grade fever of 4‑30 days duration, cough, haemoptysis and breathlessness. Eschar was not seen even in a single patient. Liver enzymes were elevated in nearly all cases (95.9%). Multiple organ dysfunction syndrome (MODS) was present in 16.66% of our patients (7 out of 42). Hypotension (6 patients, 14.2%), renal impairment (9 out of 15 patients, 60%), acute respiratory distress syndrome (4 patients, 9.52%) and meningitis (4 patients, 9.52%) were some of the important complications. There was a dramatic response to doxycycline in nearly all the patients, but initially when the disease was not diagnosed, seven patients had died. Conclusion: Scrub typhus has emerged as an important cause of febrile illness in Jaipur. Empirical treatment with doxycycline is justified in endemic areas.
ABSTRACT
Setting: Department of Tuberculosis and Chest Diseases, Tertiary Level tuberculosis (TB) institute in Delhi, India. Objective: To study the reasons for interruption of Anti-Tubercular Treatment (ATT) as reported by tuberculosis patients admitted at LRSI. Design: Retrospective cohort-based analysis. Results: A total of 201 patients were enrolled (179 of pulmonary tuberculosis, eight of extra-pulmonary tuberculosis and fourteen of both pulmonary as well as extra-pulmonary tuberculosis); who had interrupted treatment 327 times. Maximum interruptions (72.17%) were found to occur by third month of ATT. More than one reason was often reported for discontinuation of treatment. In all, 366 responses were obtained from 201 patients, in response to reasons for treatment interruption. The rate of treatment interruption was higher in the private health sector (56.27%), as compared to DOTS (34.25%) and other sources of treatment (9.48%). Early improvement (30.05%) and high cost of treatment (16.39%) were found to be the two most common reasons, leading to treatment interruption. Conclusion: Early improvement and high cost of treatment were found to be the two most common reasons, leading to treatment interruption. Continuous health education should be provided to all tubercular patients emphasizing the need to continue treatment despite early improvement in symptoms.