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Category: Volume 07 Issue 03 March 2019
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Title: A Study of Cardiopulmonary Manifestations in Patients with Rickettsial Fever at a Tertiary Care Centre

Authors: Dr Suman G R, Dr Muralidhar H, Dr Dharanidhar Reddy

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.78

Abstract

Background and Objectives: Rickettsial diseases are considered some of the most important emerging diseases which are increasingly being recognized in India. The clinical spectrums of rickettsial diseases are broad, with most infections being of mild-to-moderate severity. Cardiopulmonary manifestations are quite common as the severity of rickettsial disease increases. This study aims at studying the cardiopulmonary manifestations in patients with rickettsial fever. Prompt antibiotic therapy, even based on suspicion, shortens the course of the disease lowers the risk of complications and in turn reduces morbidity and mortality due to rickettsial diseases.

Materials and Methods: The present study is a cross sectional observational study. A thorough history taking and clinical examination was conducted on patients admitted with acute febrile illness. The necessary investigations for these patients were sent, the reports of which were collected later on. The cases which showed Weil-Felix test positivity with 1:80 and above titres were analyzed.

Results: Weil-Felix positive patients with 1:80 titers or above had fever (100%), chills/rigors (75.6%), myalgia (67.9%),dyspnoea (32.1%) and cough (46.2%).Considering signs, 17.9% had pallor, 48.7% had tachycardia, 17.9% had bradycardia and 51.3% had respiratory signs during examination. 8 patients who had ECG changes had sinus tachycardia (3) and sinus bradycardia (5). Of the 78 patients 19 patients had pleural effusion and 21 patients had ARDS.

Intepretation and Conclusion: Clinical manifestations like fever, myalgia and cough were quite common in rickettsial fever patients. More than half the patients presented with respiratory signs like tachypnoea, creptations, rhonchi and reduced breath sounds. 21 patients demonstrated features of ARDS on chest radiography. This study emphasizes the fact that a diagnosis of rickettsial fever should be suspected, when a patient presents with fever and respiratory signs/symptoms along with cardiovascular manifestations, as early detection of the disease could reduce morbidity & mortality.

Keywords: Rickettsial fever, typhus group, spotted group, scrub group.

References

  1. Mahajan SK, Rolain JM, Sankhyan N, Kaushal RK, Raoult D. Pediatric Scrub Typhus in Indian Himalayas. Indian Journal of Pediatrics 2008;75(9):947-9.
  2. Kumar K, Jain S, Kumar A. Outbreak Indian tick typhus amongst residents of Deol village, District, Kangra, Himachal Pradesh (INDIA). Int J Med Public Health 2011;1:67-71.
  3. Tilak R, Kunwar R, Wankhade UB, Tilak VW. Emergence of Schoengastiella ligula as the vector of scrub typhus outbreak in Darjeeling: Has Leptotrombidium deliense been replaced? Indian J Public Health 2011;55:92-9.
  4. Dass R, Deka NM, Duwarah SG, Barman H, Hoque R, Mili D, Barthakur D (2011) Characteristics of pediatric scrub typhus during an outbreak in the North Eastern region of India: peculiarities in clinical presentation, laboratory findings and complications. Indian J Pediatr 78: 1365-1370.
  5. Chanta C, Chanta S (2005) Clinical study of 20 children with scrub typhus at Chiang Rai Regional Hospital. J Med Assoc Thai 88: 1867-1872.
  6. Viswanathan S, Muthu V, Iqbal N, Remalayam B, George T. Scrub Typhus Meningitis in South India- A Retrospective Study. PLoS ONE 2013;8(6):1-8.
  7. Subbalaxmi MVS, Madisetty MK, Prasad AK, Teja VD, Swaroopa K, Chandra N. Outbreak of Scrub Typhus in Andhra Pradesh - Experience at a Tertiary Care Hospital. Journal of the association of physicians of India 2014;62;490-6.
  8. Wu K-M, Wu Z-W, Peng G-Q, et al. Scrub typhus: radiologic pulmonary findings, clinical manifestations and serious complications in scrub typhus: experiences from a teaching hospital in Eastern Taiwan. Intl J Gerontol 2009;3:223-32.
  9. Charoensak A, Chawalparit O, Suttinont C, et al. Scrub Typhus: chest radiographic and clinical findings in 130 Thai Patients. J Med Assoc Thai 2006;89:600-07.
  10. Kasper, Dennis L, Fauci et al. Harrison's Principles of Internal Medicine. 19th edition. New York: McGraw Hill Education, 2015.
  11. Tsay RW, Chang FY. Serious complications in scrub typhus. J Microbiol Immunol Infect 1998;31:240–4.
  12. La Scola B, Raoult D. Laboratory Diagnosis of Rickettsioses: Current Approaches to Diagnosis of Old and New Rickettsial Diseases. J Clin Microbiol 1997;35:2715–27.
  13. Amano K, Suzuki N, Fujita M, et al. Serological reactivity of sera from scrub typhus patients against Weil-Felix test antigens Microbiol Immunol 1993;37:927-33.
  14. Amano K, Suzuki N, Hatakeyama H, et al. The reactivity between rickettsiae and Weil-Felix test antigens against sera of rickettsial disease patients. Acta Virol 1992; 36:67-72.
  15. Saah AJ Orientia tsutsugamushi (Scrub Typhus) In Mandell GL, Bennet JE, Doalin R, Edr. Principles and Practice of Infectious Diseases. Philadelphia: Churchill Livingstone; 2000:2056-7.
  16. Chandy S, Thomas K, Mathai E, Antonisamy B, Holloway K, al e. Patterns of antibiotic use in the community and challenges of antibiotic surveillance in a lower-middleincome country setting: a repeated cross-sectional study in Vellore, South India. J Antimicrob Chemother. 2013; 68: 229 - 236.
  17. Kim D, Kang D, Kim J, Chung J, Kim H, et al. Acute renal failure due to acute tubular necrosis caused by direct invasion of Orientia tsutsugamushi. Journal of clinical microbiology. 2008; 46: 1548–1550.
  18. Nachega JB, Bottieau E, Zech F et al. Travel-acquired scrub typhus: emphasis on the differential diagnosis, treatment, and prevention strategies. J Travel Med 2007;14:352–5.
  19. Isaac R, Varghese GM, Mathai E, et al. Scrub Typhus: Prevalence and Diagnostic Issues in Rural Southern India. Clin Infect Dis 2004;39:1395-6.
  20. H Boorugu, M Dinaker, ND Roy, et al. Reporting a case of Scrub Typhus from Andhra Pradesh. J Assoc Physicians India 2010;58:520.
  21. Vivekanandan M, Mani A, Priya YS, et al. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India 2010;58:24-28.
  22. Sharma P, Kakkar R, Shilpa NK, et al. Geographical distribution, effect of season and life cycle of scrub typhus. JK Science 2010;12:63-4.

Corresponding Author

Dr Muralidhar.H

Post Graduate, Department of General Medicine, S.S. Institute of Medical Sciences & Research Centre, Davangere, Karnataka, India