Epidemic of Scrub Typhus in Haroti Region of Rajasthan.

Scrub typhus is a rare form of disease caused by gram negative bacterium Orientia tsutsugamushi, of family Rickettsiaceae, transmitted by bite of infected trombiculid mite larva (chigger). The present prospective study is undertaken with the aim of the clinical manifestations, course, complications and outcome of scrub typhus in Haroti region of Rajasthan state during the recent epidemic. Method: This prospective study was conducted in indoor patients of MBS hospital and various private nursing homes in Kota city from August 2012 to November 2012. Twenty cases with positive Scrub typhus card test in the age group of 20 years to 60 years, comprising of 14 males and 06 females were included in the study group in clinically suspected cases with fever, rashes, cough with or without eschar and regional lymphadenopathy. Cases were studied in detail and followed up for improvement and any permanent damage or death. Results: Out of 20 patients, 16 patients improved and discharged from hospital in stable condition without any disability. 02 patients (10%) died because of late presentation and multiorgan involvement especially respiratory failure or meningoencephalitis. Conclusion: Haroti witnessed recent epidemic of Scrub typhus. Renal, respiratory and neurological complications were main cause of mortality and morbidity.

Impact on Morbidity & Mortality by Rodenticidal Poisoning.

Background : Rodenticidal poisoning is a very common clinical entity regularly encountered in outdoor & emergency department in various parts of India. This is the commonest type of poisoning. We present the prospective study of clinical profile, course, complication & outcome of various rodenticidal poisoning in 170 patients. Objectives : To determine the clinical symptoms, morbidity and mortality in various rodenticidal poisoning. To study the clinical profile & laboratory investigations. To study the course, complications & outcome. Methods : Study period was from 01 May 2011 to 30 April 2012. Historically and documented evidence of 170 patients of various rodenticidal poisoning admitted in the emergency, medical wards & I.C.U. under department of medicine, undergone for various laboratory investigations and imaging study. Statistical analysis was done in mean, range, standard deviation and percentage. Results : A total of 170 cases of various rodenticidal poisoning admitted in MBS hospital, Govt. Medical College, Kota were studied. The age of patients ranged from 10 to 65 years. Age groups were divided in four group, 10-18, 19-30, 31-45 & 45-65. Most common age group was ranged from 18-30 year. Most common gender was female (females 92 males 78). Mode of poisoning were suicidal, accidental & homicidal. Commonest mode of poisoning was suicidal uptake of poison. Route of poisoning was ingestion. Common presenting signs & symptoms were nausea & vomiting seen in 157(92.35%), Tachycardia in 156(91.7%), Tachypnoea in 137(80.62%), & Abdominal pain 129(75.8%). Few patients presented with Headache, Palpitation & Sweating. Deranged laboratory findings on day third of admission include Anemia in 21.76%, Leucocytosis in 20.59%, prolonged Prothrombin time (PT) in 16.47% & increased serum Bilirubin in 11.18%. Morbidity developed in 8 cases(4.71%), Of which four have Hemorrhagic complication ( e.g. Bleeding gums, Purpura Melena & Hematuria) by Dicoumarol , Bromadiolone and Brodifacoum. Three patients of Zinc phosphide poisoning produced cardiac insult and one patient of Barium carbonate poisoning developed cardiac arrhythmia. Transient arrhythmias and respiratory failure developed in other rodenticidal poisoning. All patients treated symptomatically and according to complications. Six cases of our study remained asymptomatic for two to three days then they developed delayed hemorrhagic complication ( Bleeding gums, Purpura, Melena & Hematuria). These patients had deranged liver function test (LFT) & prolonged Prothrombin time (PT). Mortality was seen in 1.76%( 3 cases). By Zinc phosphide in 2 patient and Barium carbonate in 1 patient. Conclusion : We concluded that bleeding, bruising & other hemorrhagic complications should be treated and monitored according to Prothrombin time (PT) & INR. Awareness should be increased especially for Zinc phosphide and arrhythmia produced by Barium carbonate.