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Chest Infections |

Pulmonary Manifestations in Patients With Scrub Typhus Presenting to a Tertiary Care Hospital of Northwest Himalayan Region of India

Surender Kashyap*, MD; Neha Gautam, MBBS; Anil Kanga, MD; Digvijay Singh, MD; Rajesh Kashyap, MD; Santwana Verma, MD
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Kalpana Chawla Govt. Medical College, Karnal, India


Chest. 2012;142(4_MeetingAbstracts):218A. doi:10.1378/chest.1366870
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Abstract

SESSION TYPE: Respiratory Infections Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Scrub typhus is caused by O.tsutsugamushi and transmitted by the bite of larval form of trombiculid mite.It is endemic in Indian subcontinent. Bronchitis, interstitial pneumonitis and ARDS have been reported in scrub typhus.The study aimed to find out the pattern of lung involvement in scrub typhus as such a data is lacking in this population .

METHODS: This was a prospective study conducted over a period of one year in patients admitted with suspected scrub typhus,having fever more than >37.5 deg.C and one or more of the following : Eschar,maculopapular rash,headache,altered sensorium,cough,dyspnoea,abdominal pain, vomiting,deranged liver or renal functions. IgM ELISA kits by InBios International Inc. were used for estimation of IgM antibodies and the sample with sprectophotometric readings of more than cut off was considered 'Reactive'.Diagnosis was made if serological evidence was positive and all such cases, were evaluated for detailed pulmonary involvement including clinical examination, chest radiography, spirometry and HRCT.

RESULTS: Of the 564 patients enrolled in the study, 221 were positive serologically. Female to male ratio was 3.16:1 with age ranging from 4 to 82 years(mean age; 38 years).Maximum cases were reported in the month of August and September. Respiratory findings were noticed only in 69(31.2%) patients. Cough (17.6%), dyspnoea(9.5%) and chest pain(2.3%) were the dominant symptoms.4 patients(1.8%) had cyanosis. Chest involvement was observed more frequently in adults(52.8%)whereas only 8.33% of children had respiratory symptoms. 10% cases were smokers. Chest radiograph was abnormal in 22% cases with in-homogenous opacities in 9.5%of cases, 6.3% had pleural effusion whereas 5% had combination of findings. 32.2% had restrictive ventilatory defect on spirometry.19 patients underwent HRCT and out of these 47.37% had mediastinal lymphadenopathy,42.11% pleural effusion,21% ground glass opacity and 10.5% consolidation.Despite treatment, 15 patients died during the period of study out of which 5 (7.24%) patients had pulmonary involvement including ARDS.

CONCLUSIONS: Scrub typhus is seasonal fever in this part of the world, noticeably more common in adults and females.Pulmonary manifestations were common and occurred in at least one third of cases. Lung involvement contributed significantly to the morbidity and mortality among these patients.

CLINICAL IMPLICATIONS: Awareness,early diagnosis and treatment of scrub typhus is important to reduce the impact of this treatable disease in the region.

DISCLOSURE: The following authors have nothing to disclose: Surender Kashyap, Neha Gautam, Anil Kanga, Digvijay Singh, Rajesh Kashyap, Santwana Verma

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Kalpana Chawla Govt. Medical College, Karnal, India

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