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Clinical profile and determinants of scrub typhus presenting with sepsis based on Sepsis-3 criteria

 Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India

Correspondence Address:
Prasanta Kumar Bhattacharya,
Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-9062.313963

Background & objectives: Scrub typhus has a wide spectrum of clinical presentations from acute febrile illness to sepsis with multi-organ failure with poor prognosis. The aim was to study the clinical presentation of scrub typhus and application of SOFA and qSOFA scores of sepsis-3 criteria to determine sepsis and consequent in-hospital outcomes. Methods: A prospective study was carried out in adults (≥18 years), with scrub typhus diagnosed by IgM ELISA. Sepsis-3 criteria were used to identify patients with sepsis and plan subsequent management. Statistical analysis was done using software SPSS 16.0 and p value of less than 0.05 was taken as significant. Results: Of the 78 scrub typhus patients, 38 (48.71%) presented with sepsis. Mean age in the sepsis group was significantly lower than the non-sepsis group (35.41±11.14 versus 43.56±14.31 years, p<0.05). Mortality was 71.05% in the sepsis group compared to nil in the non-sepsis group. On regression analysis, the presence of eschar (OR=5.2, 95% CI=1.15-23.544, P= 0.032), Acute Respiratory Distress Syndrome (ARDS) (OR=5.33, 95% CI= 1.13-25.16, P = 0.034) and a GCS <10 (OR=9.29, 95% CI=1.04-82.96, P=0.046) were significant predictors of mortality in patients of scrub typhus with sepsis. Interpretation & conclusion: Scrub typhus is more common in young age, with significantly younger patients developing sepsis. Presence of eschar, ARDS and GCS<10 were risk factors for mortality in scrub typhus patients with sepsis.

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