Does the presence of an eschar correlate with severity of scrub typhus infection?

Iqbal Ahmed Atif Shaikh, Paul Prabhakar Abhilash Kundavaram, Shubhanker Mitra, Jonathan Arul Jeevan Jayakaran, Paul Trinity, George M. Varghese


Background & Materials and Methods: In scrub typhus (ST) the correlation of disease severity to the presence or absence of eschar is not known. We describe the differences between patients with an eschar and those without. Results: In the 193 patients, 105 (56%) had an eschar. Patients with an eschar had a higher incidence of renal failure (18.1% vs. 5.7%; P = 0.01), respiratory system involvement (30.5% vs. 13.6%; P = 0.01) and cardiovascular system (CVS) involvement (21.9% vs. 10.2%; P = 0.03). Involvement of the central nervous system, hematological system and gastro-intestinal tract were not statistically significant between the two groups. ST patients with an eschar had significantly higher requirement for noninvasive ventilation (9.1% vs. 1.9%; P = 0.04). Requirement of invasive ventilation and inotropic supports were the same in both groups. Conclusion: The presence of an eschar in patients with ST is associated with a higher incidence of renal dysfunction, CVS and respiratory system involvement and a greater requirement of noninvasive ventilatory support.


Eschar, Scrub typhus, Severity

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Kim DM, Kim SW, Choi SH, Yun NR. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis 2010;10:108.

Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India 2010;58:24-8.

Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, et al. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci 2003;990:359-64.

Mahajan SK. Scrub typhus. J Assoc Physicians India 2005;53:954-8.

Varghese GM, Trowbridge P, Janardhanan J, Thomas K, Peter JV, Mathews P, et al. Clinical profile and improving mortality trend of scrub typhus in South India. Int J Infect Dis 2014;23:39-43.

Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S. Scrub typhus in children at a tertiary hospital in southern India: Clinical profile and complications. J Infect Public Health 2012;5:82-8.

Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, Abraham OC, et al. Scrub typhus: An unrecognized threat in South India - Clinical profile and predictors of mortality. Trop Doct 2010;40:129-33.

Inamdar S, Thunga G, Acharya R, Vijayanarayana K, Shridharan N, Bhrugu P. Study of clinical characteristics and treatment pattern of scrub typhus in tertiary care hospital. J Pharm Sci Res 2013;5: 107-10.

Sirisanthana V, Puthanakit T, Sirisanthana T. Epidemiologic, clinical and laboratory features of scrub typhus in thirty Thai children. Pediatr Infect Dis J 2003;22:341-5.

Narvencar KP, Rodrigues S, Nevrekar RP, Dias L, Dias A, Vaz M, et al. Scrub typhus in patients reporting with acute febrile illness at a tertiary health care institution in Goa. Indian J Med Res 2012;136:1020-4.

Kumar V, Kumar V, Yadav AK, Iyengar S, Bhalla A, Sharma N, et al. Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India. PLoS Negl Trop Dis 2014;8:e2605.

Wang CC, Liu SF, Liu JW, Chung YH, Su MC, Lin MC. Acute respiratory distress syndrome in scrub typhus. Am J Trop Med Hyg 2007;76:1148-52.

Tsay RW, Chang FY. Acute respiratory distress syndrome in scrub typhus. QJM 2002;95:126-8.

Pai H, Sohn S, Seong Y, Kee S, Chang WH, Choe KW. Central nervous system involvement in patients with scrub typhus. Clin Infect Dis 1997;24:436-40.

Varghese GM, Mathew A, Kumar S, Abraham OC, Trowbridge P, Mathai E. Differential diagnosis of scrub typhus meningitis from bacterial meningitis using clinical and laboratory features. Neurol India 2013;61:17-20.

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