Osteomielite maxilar associada ao COVID-19: mucormicose ou não? Uma série de casos / Maxillary osteomyelitis associated with COVID-19: mucormycosis or not? A series of cases

Aim: A series of cases have been presented involving the oral cavity focusing on the presentation, diagnosis and treatment of mucormycosis that can form a basis for successful therapy. Background: The management of severe coronavirus disease (COVID-19) in conjunction with comorbidities such as diabetes mellitus, hematological malignancies, organ transplants, and immunosuppression have led to a rise of mucormycosis which is an opportunistic infection. Cases Description: The various forms that have been enlisted till date are rhino-cerebral, rhino-orbital, gastrointestinal, cutaneous, and disseminated mucormycosis. From the dentistry and maxillofacial surgery perspective, the cases depicting extension of mucormycosis into the oral cavity have been less frequently recorded and thus, require a detailed study. The patients that reported to our private practice had non-tender swelling, draining sinuses and mobility of teeth. A similarity was observed in the clinical signs both in osteomyelitis and mucormycosis. Thus, a histopathological examination was used to establish the definitive diagnosis. Conclusion: Mucormycosis is a life threatening pathology that requires intervention by other branches to make an early diagnosis and commence the treatment. The characteristic ulceration or necrosis is often absent in the initial stage and thus, histopathological examination and radiographic assessment are required to formulate a definitive diagnosis. Early intervention is a necessity to avoid morbidity. The treatment involves surgical debridement of the necrotic infected tissue followed by systemic antifungal therapy. Mucormycosis has recently seen a spike in its prevalence, post the second-wave of coronavirus pandemic in India. It was seen commonly in patients with compromised immunity, diabetes mellitus, hematological malignancies, or on corticosteroid therapy. Mucormycosis invading the palate mostly via maxillary sinus has been less frequently described. In the post-COVID era the features associated with mucormycosis involving oral cavity, should warrant a possible differential diagnosis and managed appropriately. (AU)

Objetivo: Apresentar uma série de casos com enfâse na apresentação, diagnóstico e tratamento da mucormicose oral, assim como uma revisão sistemática que sirva como base para estabelecimento de terapias de sucesso. Introdução: A forma severa da infecção por coronavirus (COVID-19) associada a diabetes mellitus, doenças hematológicas malignas, transplante de órgãos e imunossupressão levaram a um aumento das infecções oportunistas de mucormicose. Descrição dos Casos: As diversas apresentações clínicas que foram descritas até o momento são a rinocerebral, rino-orbital, gastrointestinal, cutânea e mucormicose disseminada. No que concerne a odontologia e a cirurgia maxillofacial, os casos que apresentam extensão de mucormicose para cavidade oral tem sido menos reportados e assim requerem mais estudos. Os pacientes que compareceram a nossa clínica apresentavam aumento de volume endurecido, drenagem de fluidos dos seios maxilares e mobilidade dentária. Clinicamente tanto a osteomielite quanto a mucormicose apresentaram-se de forma semelhante. Assim, análise histopatológica foi utilizada para estabelecimento do diagnóstico definitivo. Conclusão: A mucormicose é uma patologia grave que requer intervenção precoce para estabelecimento do tratamento. A ulceração e necrose características usualmente estão ausentes nos estágios iniciais da lesão, assim análise histopatológica e radiográfica são necessárias para o diagnóstico final. Intervenção precoce é necessária para diminuir a morbidade. O tratamento envolve o debridamento cirúrgico da área necrosada seguida de terapia antifúngica sistêmica. Recentemente, houve um aumento nos casos de mucormicose, após a Segunda onda da pandemia de COVID-19 na índia. Os casos acometiam principalmente pacientes imunocomprometidos, com diabetes mellitus, doenças hematológicas malignas e em uso de corticosteróides. A mucormicose invadindo o palato pelos seios maxilares foi raramente descrita. Na era pós-COVID a mucormicose envolvendo a cavidade oral deve entrar no painel de diagnósticos diferenciais para que o tratamento adequado possa ser instituído precocemente.(AU)

Scrub Typhus with Multiple Cranial Nerve Palsy: A Rare Case Presentation

Scrub typhus, a rickettsial disease endemic in several parts of India, usually presents with acute symptoms. It is caused by small intracellular Gram-negative bacteria belonging to the Rickettsiaceae family. Optic neuritis and lateral rectus palsy may be associated with a range of autoimmune disorders, infectious diseases and raised intracranial tension. In this case, we report optic neuritis and lateral rectus palsy induced by Orientia tsutsugamushi. We report a case of a 23-year-old woman presenting with complaints of high-grade fever, vomiting and generalized swelling since 5 days. During this febrile period, on 4/10/2021, she complained of difficulty in vision and double vision. She was found to be positive for scrub typhus on 5/10/2021. Optic neuritis was diagnosed on the basis of ophthalmologic examination and magnetic resonance imaging (MRI) brain. Investigation was done to rule out autoimmune disorders (vasculitis and connective tissue diseases). Rickettsial optic neuritis was confirmed by detection of specific antibodies in serum and the negativity of other serologic tests. Fever, eschar, history of tick exposure and supportive diagnostic tests usually lead to the diagnosis. This case aims to raise awareness among the healthcare providers for this type of association. Scrub typhus should be included in the differential diagnosis when a patient presents with fever with or without eschar and isolated or multiple cranial nerve palsy

Diagnosis of 3 pediatric cases of scrub typhus without the eschar by metagenomics next-generation sequencing / 中华实用儿科临床杂志

Objective:To analyze the pathogen of 3 pediatric cases of scrub typhus without the eschar using metagenomics next-generation sequencing (mNGS), and the clinical application value of mNGS.Methods:Clinical data of 3 pediatric cases of severe scrub typhus without the eschar in the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University from June 2018 to October 2019 were analyzed retrospectively.Among them, 2 cases were 5-year-old males and 1 case was 6-year-old female.Peripheral blood samples of 3 children were detected via mNGS technology.Results:Through mNGS detection, all 3 children were diagnosed with Orientia tsutsugamushi infection and were not complicated with other pathogenic infections.Case 1 died, and case 2 and case 3 were cured.Conclusions:Early diagnosis of scrub typhus without the eschar is difficult.Clinical infectious diseases, especially complicated and critical infectious diseases are difficult to be diagnosed at an early stage, mNGS can provide fast and accurate pathogenic diagnosis support for precise treatment.

A new focus of spotted fever caused by Rickettsia parkeri in Brazil

ABSTRACT Spotted fever (SF) is a tick-borne zoonosis caused by bacteria of the genus Rickettsia . The disease varies in severity from mild clinical forms to severe cases. In Brazil, Rickettsia rickettsii SF is the most serious rickettsiosis and can result in death if not diagnosed and treated at the onset of symptoms. The SF mild form is caused by Rickettsia parkeri strain Atlantic Rainforest, and this etiological agent has been reported in the South, Southeast and Northeast regions of the country, in areas of preserved or little antropized Atlantic Rainforest. Amblyomma ovale is the proven vector and dogs are the hosts associated with the bioagent cycle. During a SF case investigation in Paraty municipality, Rio de Janeiro State, an Atlantic Rainforest biome area in Southeastern Brazil, the human pathogen R. parkeri strain Atlantic Rainforest was detected by PCR in a sample of human skin inoculation eschar and in a female A. ovale tick collected from a dog. These results expand the known area of occurrence of this mild form rickettsiosis in Brazil. In addition, the results of the present study indicate the importance of implementing programs to control canine ectoparasites and to raise awareness of the risks of infection, signs and symptoms of SF caused by R. parkeri strain Atlantic Rainforest.

Linfadenopatía transmitida por garrapata. Un caso pediátrico de rickettsiosis en atención primaria / Lymphadenopathy transmitted by tick. A pediatric case of rickettsiosis in primary care

La entidad llamada tick-borne lymphadenopathy, también conocida como dermacentor-borne necrosis eritema lymphadenopathy, se incluye dentro del diagnóstico diferencial de enfermedades transmitidas por garrapatas, que han aumentado considerablemente en los últimos años debido a una mayor observación clínica-epidemiológica y mejoría diagnóstica. Es una zoonosis causada por Rickettsia slovaca y transmitida por la picadura de la garrapata Dermacentor marginatus. Los pacientes afectados tienen una escara necrótica rodeada de un halo eritematoso en el cuero cabelludo y adenopatías regionales dolorosas. Se presenta a un varón de siete años que mostró, tras la extracción de una garrapata, una escara necrótica en el cuero cabelludo, con adenopatías y febrícula. La reacción en cadena de la polimerasa y el cultivo de la lesión confirmaron la presencia de Rickettsia slovaca. El paciente recibió azitromicina oral con buena respuesta. En Atención Primaria, es importante el seguimiento de las picaduras de garrapatas para detectar posibles enfermedades transmitidas por estas.

The entity called tick-borne lymphadenopathy, also known as dermacentor-borne necrosis eritema lymphadenopathy, is included in the differential diagnosis of diseases transmitted by ticks, which have increased considerably in recent years due to greater clinical-epidemiological observation and diagnostic improvement. It is a zoonosis caused by Rickettsia slovaca and transmitted by the bite of the Dermacentor marginatus tick. Affected patients have a necrotic eschar surrounded by an erythematous halo in the scalp, as well as painful regional lymphadenopathy. Linfadenopatía transmitida por garrapata. Un caso pediátrico de rickettsiosis en atención primaria Lymphadenopathy transmitted by tick. A pediatric case of rickettsiosis in primary care We present a seven-year-old male who shows, after the extraction of a tick, a necrotic eschar on the scalp, accompanied by lymphadenopathy and low-grade fever. The study of polymerase chain reaction and culture of the lesion confirm the presence of Rickettsia slovaca. The patient received oral azithromycin with a good response. In Primary Care, it is important to monitor the tick bites, to detect possible diseases transmitted by them.

A single-centre experience of scrub typhus in a tertiary care centre - a re-emerging infection

Background: Scrub typhus is a documented disease in Himachal Pradesh, but there have been few clinico-epidemiological studies in this area. The present study is done with IgM ELISA as a diagnostic test which has higher sensitivity and specificity as most of the previous studies had used Weil Felix test as a diagnostic test. Methodology: This was a prospective observational study. All the patients more than 18 years of age with positive IgM ELISA for scrub typhus with/without eschar were included. The clinical profile was observed. IgM scrub typhus was done by ELISA. Results: Total of 39 patients were observed between July 2016 to Dec 2016. Maximum patients were observed in August, September, and October. Fever with Headache was the most common presenting complaint. Eschar was present in 10 % patients. Complications were seen in 76.92 %. The mortality rate was 0 %. Conclusion: The varied presentations and high rate of complications require a high index of suspicion for Scrub Typhus. The general physicians should be sensitized for the early diagnosis and treatment to reduce morbidity and mortality.

Clinico-epidemiological analysis of scrub typhus in hospitalised patients presenting with acute undifferentiated febrile illness: A hospital-based study from Eastern India

Acute undifferentiated febrile illness (AUFI) constitutes the predominant cause of healthcare seeking in Odisha. This prospective study was conducted to analyse the clinical, epidemiological and laboratory profile of scrub typhus patients presenting with AUFI from January to December 2017. Four hundred and thirty-two samples were tested for dengue, malaria, scrub typhus and enteric fever. Scrub typhus was overall the most common cause of AUFI (26.3%, 114/432) followed by dengue (19.2%, 83/432). Eschar was seen in 6.1% of cases. Aetiologies of 38.6% of AUFI remained unidentified. In the present study, there was no mortality attributed to scrub typhus.

Clinical and laboratory predictors to differentiate severe dengue from scrub typhus in children

Background: Objective of study was to compare the clinical features and laboratory parameters at admission and differentiate severe dengue from scrub typhus in children.Methods: Retrospective analysis of case records and comparison of clinical and laboratory parameters at admission of all children with a diagnosis of severe dengue and scrub typhus was done.Results: A total of 72 children were included (severe dengue =40; scrub typhus =32) during the study period. The mean (SD) age of children with severe dengue and scrub typhus was 7.9(3.8) and 11.8(5.8) years, respectively. Majority of children with severe dengue presented with hypotension, 21(52.5%) vs 3(9.4%) in scrub typhus. Children with severe dengue had a relatively low ANC (2.6'1.97x103/mm3 vs 3.9'2.06x103/mm3), low platelet count (50.23'35.55x103/mm3 vs 140'95.0x103/mm3) and low mean ESR at 1hour (8.1'6.82mm vs 33.88'13.79mm) than scrub typhus.Conclusions: Compared to scrub typhus, severe dengue was significantly associated with hypotension, lower ANC, ESR and platelets.

Eschar and IgM ELISA in the diagnosis of scrub typhus

Scrub typhus is one of the leading causes of acute febrile illness in India. This study aimed to determine the best diagnostic tool for the identification of scrub typhus and study the possible association between diagnostics and clinical characteristics. Patients with fever of ?15 days admitted to the hospital satisfying the case definition of 47 kDa quantitative polymerase chain reaction (qPCR) positivity OR scrub typhus IgM ELISA positivity along with the presence of eschar OR Scrub typhus IgM ELISA positivity along with defervescence of fever within 72 h of initiation of specific therapy were recruited. Of the 116 patients satisfying the case definition, 47 kDa qPCR was positive in 43 (37%) patients, whereas IgM ELISA was positive in 104 (90%) patients and eschar was seen in 59 (51%) patients. The median duration of fever was 7.5 days (interquartile range 6� days). Multiorgan dysfunction syndrome (MODS) was described in 44 (37.9%) patients. Two patients (1.8%) succumbed to the illness. Presence of eschar and IgM ELISA positivity were detected in 106 (91%) cases. Scrub typhus, even with MODS, has low mortality because of immediate institution of specific therapy due to physician awareness. The presence of eschar and IgM ELISA positivity can be used to detect a majority of cases of scrub typhus.

Clinical characteristics and treatment of diabetic patients with superficial partial-thickness burn on feet / 中华烧伤杂志

Objective@#To analyze the characteristics and treatment of diabetic patients with superficial partial-thickness burn on feet.@*Methods@#Eighty-three patients with superficial partial-thickness burn on 119 feet were hospitalized in our unit from January 2011 to December 2017. The medical records of the patients with 46 men and 37 women, aged 60±11 were retrospectively analyzed. The patients were divided into diabetes group and non-diabetes group according to whether they had diabetes or not, with 41 patients (60 burn feet) in diabetes group and 42 patients (59 burn feet) in non-diabetes group. Patients in diabetes group and non-diabetes group were given systemic treatment and wound dressing change. Thirty-seven diabetic patients whose wounds deepened to deep partial-thickness were divided into eschar shaving group and non-eschar shaving group according to patients′ willingness and the treatment, with 14 patients in eschar shaving group and 23 patients in non-eschar shaving group. Patients in eschar shaving group were given eschar shaving operation at early stage, and patients in non-eschar shaving group were given wound dressing change. The length of hospital stay, hospitalization treatment expenses, pulse of arteria dorsal pedis and posterior tibial artery immediately after admission, deepening of wounds on feet during hospital stay, and rates of wound healing on feet of patients in diabetes group and non-diabetes group were observed and calculated. Pulses of arteria dorsal pedis and posterior tibial artery immediately after admission, deepening of wounds on feet during hospital stay, positive rates of bacteria and fungus in wounds on feet, and rates of wound healing on feet of patients in eschar shaving group and non-eschar shaving group were observed and calculated. Data were processed with chi-square test, t test, Fisher′s exact propability method, and Mann-Whitney U test.@*Results@#The length of hospital stay of patients in diabetes group was (29±20) d, which was significantly longer than that of patients in non-diabetes group [(19±13) d, t=2.730, P<0.01]. The hospitalization treatment expense of patients in diabetes group was (46 988±41 322) yuan, which was significantly more than that of patients in non-diabetes group [(29 106±24 813) yuan, t=2.396, P<0.05]. The pulses of arteria dorsal pedis and posterior tibial artery of patients in diabetes group were significantly weaker than those of patients in non-diabetes group (Z=3.278, 2.194, P<0.05 or P<0.01). The percentages of wounds on feet of patients in diabetes group deepening to deep partial-thickness burn, full-thickness skin defect with bone and tendon exposure were respectively 88.3% (53/60) and 23.3% (14/60), which were significantly higher than those of patients in non-diabetes group [47.5% (28/59) and 1.7% (1/59), χ2=22.867, 12.644, P<0.01]. Rate of wound healing on feet of patients in diabetes group was 78.3% (47/60), which was significantly lower than 100.0% (59/59) of patients in non-diabetes group ( χ2=14.351, P<0.01). There were respectively 21 and 32 feet in patients of eschar shaving group and non-eschar shaving group. There were no significantly statistical differences in pulses of arteria dorsal pedis and posterior tibial artery of patients between eschar shaving group and non-eschar shaving group (Z=0, 0.453, P>0.05). The percentage of wounds on feet of patients in non-eschar shaving group deepening to full-thickness skin defect with bone and tendon exposure was 43.8% (14/32), which was significantly higher than 0 of patients in eschar shaving group ( χ2=12.486, P<0.01). Positive rates of bacteria and fungus in wounds on feet of patients in eschar shaving group was significantly lower than that of patients in non-eschar shaving group (χ2=4.386, P<0.05 ). Rate of wound healing on feet of patients in non-eschar shaving group was 59.4% (19/32), which was significantly lower than that of patients in eschar shaving group [100.0% (21/21), P<0.01].@*Conclusions@#Diabetes patients with superficial partial-thickness burn wounds on feet has long length of hospital stay, high hospitalization treatment expenses. Wounds of the patients are easy to deepen, with low wound healing rate. Eschar shaving at early stage when the wounds deepened to deep partial-thickness burn is a good way to increase wound healing rate and prevent further deepening of wounds.

Use of eschar for the molecular diagnosis and genotypic characterisation of Orientia tsutsugamushi causing scrub typhus

Scrub typhus caused by Orientia tsutsugamushi presents as an acute febrile illness with a varied presentation from mild illness to fatal disease in the absence of appropriate antibiotic treatment. Performing polymerase chain reaction (PCR) on eschar sample acts a rapid diagnostic tool in the early stage of scrub typhus when blood is negative. A total of eight patients from whom both whole blood and eschar samples were collected and tested by nested PCR targeting 56 kDa trichostatin A (TSA) gene to detect O. tsutsugamushi DNA. All (100%) eschar samples and three whole blood samples tested positive. Genetic analysis of the 56 kDa TSA gene sequences showed that the majority were related to Karp reference strains, while one clustered with Kawasaki strain. When present, eschar should be favoured as a diagnostic sample over whole blood in the early phase of infection.

Scrub typhus: a case report

Scrub typhus is a rare rickettsial disease which is endemic in the state of Himachal Pradesh. It is caused by bacteria called Orentia tsutsugumasi and transmitted by larvae of Trombiculid mites. Though rarely seen in the plains, it should be kept as differential for a patient presenting as fever with seizure. Eschar may or may not be seen in all cases. We report a case of scrub typhus in a patient who presented with fever and seizures but no eschar.

Scrub Typhus in Children at a Tertiary Care Hospital in Odisha: A Study on Clinical, Laboratory Profile, Complications and Its Outcome.

Background: To study the clinical profile, laboratory parameters, complications and outcome of scrub typhus in children. Methods: One hundred children with undiagnosed febrile illness admitted to our hospital from Aug 2014 to Nov 2014 were included in the study. All children were tested for scrub typhus using a commercial ELISA kit for specific IgM antibodies against Orientia tsutsugamushi. Results: Out of 100 children admitted to our hospital, only 50(50%) patients had positive IgM antibodies against O. tsutsugamushi. 30(60%) cases had fever of 5 to 10 days duration and 20(40%) cases had fever of more than 10 days duration. Vomiting with abdominal pain was reported in 20 (40%) cases, Lymphadenopathy in 18 (36%), hepatosplenomegaly in 35 (70%), generalized edema in 18 (36%) patients. Eschar was seen in 25(50%) patients. Most common abnormal laboratory parameters were raised SGOT, thrombocytopenia, raised bilirubin, raised CRP, leukocytosis and anemia. Most common complications were shock and electrolyte disturbances. Conclusion: In children Scrub typhus should be considered in the differential diagnosis of acute febrile illness associated with gastrointestinal symptoms, hepatosplenomegaly and lymphadenopathy .Prompt antibiotic treatment for scrub typhus should be given in cases with strong clinical suspicion to prevent morbidity and mortality.

DHR-ICMR Guidelines for diagnosis & management of Rickettsial diseases in India.

Rickettsial diseases, caused by a variety of obligate intracellular, gram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma, belonging to the Alphaproteobacteria, are considered some of the most covert emerging and re-emerging diseases and are being increasingly recognized. Among the major groups of rickettsioses, commonly reported diseases in India are scrub typhus, murine flea-borne typhus, Indian tick typhus and Q fever. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45 per cent with multiple organ dysfunction, if not promptly diagnosed and appropriately treated. The vast variability and non-specific presentation of this infection have often made it difficult to diagnose clinically. Prompt antibiotic therapy shortens the course of the disease, lowers the risk of complications and in turn reduces morbidity and mortality due to rickettsial diseases. There is a distinct need for physicians and health care workers at all levels of care in India to be aware of the clinical features, available diagnostic tests and their interpretation, and the therapy of these infections. Therefore, a Task Force was constituted by the Indian Council of Medical Research (ICMR) to formulate guidelines for diagnosis and management of rickettsial diseases. These guidelines include presenting manifestations, case definition, laboratory criteria (specific and supportive investigations) and treatment.

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.

Scrub Typhus-An Emerging Entity: A Study From a Tertiary Care Hospital in North India.

Scrub typhus is a tropical febrile zoonotic disease caused by Orientia tsutsugamushi of the rickettsial family. These are obligate; intracellular Gram-negative coccobacilli transmitted by the bite of infected mites. It is usually underdiagnosed in India due to its varied and nonspecifi c clinical presentation, limited awareness, and low index of suspicion among clinicians and lack of diagnostic facilities. This study was planned to monitor the level of scrub typhus-specifi c antibodies among febrile patients in a tertiary care hospital over a period of 1 year for which a rapid qualitative immunochromatographic assay (Standard Diagnostics, Korea) was introduced for the detection of IgM, IgG and IgA antibodies to O. tsutsugamushi from the serum of suspected febrile patients. A total of 98 out of 772 fever patients (12.69%) tested positive for the presence of antibodies against O. tsutsugamushi. Persistent high-grade fever was the defi ning characteristic in all the cases with the presence of an eschar in only 10.2% (10/98) of cases. Three patients died during the study period while the rest responded to treatment with doxycycline.

Recent outbreak of scrub typhus in North Western part of India.

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.

Scrub typhus in patients reporting with acute febrile illness at a tertiary health care institution in Goa.

Background & objectives: Scrub typhus is one of the differential diagnoses of haemorrhagic fevers especially if associated with jaundice and/or renal failure. Goa State in the western region of India has been witnessing increased incidence of such fevers, therefore, the present study was undertaken to identify whether scrub typhus is the aetiological agent. Methods: Adult patients presenting with undiagnosed febrile illness between June 2009 to October 2010, were evaluated. Testing was done using a commercial ELISA kit for specific IgM antibodies against Orientia tsutsugamushi. Results: Of the 44 patients included in the study, 15 (34%) were found to be positive for IGM antibodies against O. tsutsugamushi. The cases were seen mainly in the months between July to November. The common symptoms noted were fever, myalgias, gastrointestinal complaints, followed by breathlessness, rash and jaundice. The pathognomonic features such as eschar and lymphadenopathy were seen only in two patients. Nearly two third of the patients had leukocytosis (67%) and low serum albumin (60%). The most common complication noticed was hepatitis (80%) followed by acute respiratory distress syndrome (ARDS) (60%), thrombocytopenia (40%) and acute renal failure (33%). Five patients died in the course of illness. Interpretation & conclusions: Our results showed that scrub typhus should be considered in the differential diagnosis of acute febrile illness associated with gastrointestinal symptoms, rash, myalgia , including those with organ dysfunctions such as hepatorenal syndrome, coagulopathy or ARDS. Empirical treatment with doxycycline or macrolides may be given in cases with strong suspicion of scrub typhus.

The Usefullness of the Adenosine Deaminase Activity for the Diagnosis of the Scrub typhus / 감염과화학요법

The mainstay of diagnosing scrub typhus is through serologic testing. However, because of the delay of several days from the onset of the illness to the increase in the antibody titer, diagnosis can be difficult in the early stage of the illness. The aim of this study was to determine the clinical usefulness of adenosine deaminase activity (ADA) in diagnosing scrub typhus. A total of 104 patients were enrolled during the study period. Of these patients, 59 patients were diagnosed with scrub typhus and the mean serum ADA level was 46.7+/-11.6 U/L. High serum ADA levels strongly supported the diagnosis of scrub typhus, especially in patient without eschar. The remaining 44 patients did not have scrub typhus and 95% (42/44) of them had normal serum ADA levels. Therefore, evaluating serum ADA level could help diagnose patients with acute febrile disease such as scrub typhus, especially in its early stage of disease progression.

The Usefullness of the Adenosine Deaminase Activity for the Diagnosis of the Scrub typhus / 감염과화학요법

The mainstay of diagnosing scrub typhus is through serologic testing. However, because of the delay of several days from the onset of the illness to the increase in the antibody titer, diagnosis can be difficult in the early stage of the illness. The aim of this study was to determine the clinical usefulness of adenosine deaminase activity (ADA) in diagnosing scrub typhus. A total of 104 patients were enrolled during the study period. Of these patients, 59 patients were diagnosed with scrub typhus and the mean serum ADA level was 46.7+/-11.6 U/L. High serum ADA levels strongly supported the diagnosis of scrub typhus, especially in patient without eschar. The remaining 44 patients did not have scrub typhus and 95% (42/44) of them had normal serum ADA levels. Therefore, evaluating serum ADA level could help diagnose patients with acute febrile disease such as scrub typhus, especially in its early stage of disease progression.