Journal of Clinical and Diagnostic Research. 2020 Jan, Vol-14(1): OC01-OC05 1 1 DOI: 10.7860/JCDR/2020/43000.13408 Original Article Internal Medicine Section Presenting Features and Clinical Profile of Scrub Typhus Fever Cases in Adult Patients Admitted in a Tertiary Care Hospital in Puducherry, India INTRODUCTION Scrub typhus is a bacterial infection caused by Orientia tsutsugamushi. The infection of scrub typhus is caused by the bite of infected chiggers and the clinical manifestation of scrub typhus is characterised by the presence of fever, headache and body pain and rarely can cause rashes. Scrub typhus is mite borne rickettsiosis and is an endaemic infection in Asia specific region and is said to affect about 1 billion people [1]. Although this zoonotic infectious disease is more prevalent in mite infested areas, human beings get in contact with these mites as a result of recreational, occupational or agricultural exposure. During the pre-antibiotic era, scrub typhus was considered a lethal disease and after the advent of several antibiotics, especially doxycycline, the infection is largely controlled. Scrub typhus has been present in Southeast Asia since World War II, however, there has been a resurgence of the infection in India in the last few decades [2]. Although, scrub typhus is prevalent in Indian sub-continent there are very few evidences of its presence in other parts of the country especially in North and East India. There is a very low level of awareness regarding the scrub typhus infection among doctors and therefore the index of suspicion among the clinicians, especially private medical practitioners in rural areas is far lower for scrub typhus infections [3]. There are however many cases reported among the paediatric age group while very few cases are documented in the adult populations. In addition, studies have reported an overall mortality between 7 and 30% for scrub typhus which is fairly higher compared to other infections and zoonotic diseases [4]. Apart from the increased mortality, the scrub typhus infection is also associated with the high risk of complications namely multiorgan dysfunction. There are studies which have documented impairment of the nervous system and renal system but there are few cases which have documented multiorgan dysfunction as a consequence of acquired scrub typhus infection [5]. There is paucity of information regarding the clinical presentation and the pathophysiological manifestation of scrub typhus infection, especially in tropical regions in Southern India. Therefore, this study was carried out in order to substantiate the clinical manifestation of this infection so as to sensitise the primary clinicians regarding the scrub typhus infections. The significance of evaluating scrub typhus in tropical countries like India stems from the fact that the disease is widely distributed in the tsutsugamushi triangle which comprises of various countries in the Asia Pacific region including Japan, China, India, Pakistan, Afghanistan and southern parts of Russia [6]. This study was carried out to determine the clinical profile and manifestation of scrub typhus infection among rural adults in Puducherry, India. MATERIALS AND METHODS This Retrospective study was conducted in the Department of General Medicine in a tertiary care hospital from January 2015 to December 2015. The case records of all the adults who were admitted with scrub typhus infection during the study period were included in the study, after due approval from the institutional ethical board. All the procedure have been followed according to the Deceleration of Helsinki. A TUMBANATHAM 1 , K JAYASINGH 2 , S LOKESH 3 , SELVARAJ STEPHEN 4 Keywords: Eschar, Multiorgan damage, Zoonotic disease ABSTRACT Introduction: The infection of scrub typhus is caused by the bite of infected chiggers and the clinical manifestation of scrub typhus is characterised by the presence of fever, headache and body pain and rarely can causes rashes. There is paucity of information regarding the clinical presentation and the pathophysiological manifestation of scrub typhus infection, especially in tropical regions in Southern India. Aim: To determine the clinical profile and manifestation of scrub typhus infection among adults in Puducherry, India. Materials and Methods: This retrospective study was conducted on data of 79 IgM Immunochromatography (ICT) positive for scrub typhus patients, who were admitted and treated in 2015 in the study institution. Particulars regarding the clinical presentation, laboratory parameters and course in the hospital were documented from the medical records. Chi- square test was carried out to look for statistical significance between clinical and demographic parameters. Results: Fever was the predominant symptom (49.4%) followed by headache (38%) and cough (19%). Eschar was present in 16.4% of the participants, and it was predominantly located in hypochondrium, anterior abdominal wall and sacral region (15.4%). About 17.7% of the participants had abnormal respiratory signs, of which bilateral crackles with ronchi was the most common sign (64.4%). While most common complication was gastrointestinal (18.1%); multi-organ involvement was present in 11.4% of the participants. Participants >40 years of age increasingly presented with symptoms of Central Nervous System compared to younger age group (p<0.05). Conclusion: The features of febrile illness with low total count and thrombocytopenia with high index of suspicion for scrub typhus may prevent mortality due to multiorgan failure by early institution of treatment.