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
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.