Tsutsugamushi Disease (Scrub Typhus) XXXX in North Eastern India: A Prospective Study.

@entity1 @entity129 @entity2003 @entity5422 @entity16 @entity3403 @entity693 @entity1906 @entity10 @entity413
BACKGROUND: Scrub typhus is rampant in northern, eastern, and southern India. Central nervous system involvement in the form of @entity693 or @entity5422 is common in scrub typhus. As specific laboratory methods remain inadequate or inaccessible in developing countries, prompt diagnosis is often difficult. AIM: The aim of this study was to characterize @entity16 in scrub typhus from northeastern region of India. SUBJECTS AND METHODS: We did a prospective study of scrub @entity5422 at North Eastern Indira Gandhi Regional Institute of Medical Sciences among @entity1 admitted to hospital between October 2009 and November 2011. The diagnosis was made based on the clinical pictures, presence of an eschar, and a positive Weil-Felix test (WFT) with a titer of >1:160 and if required a positive scrub IgM enzyme-linked immunosorbent assay. Lumbar puncture was performed in @entity1 with @entity10 , @entity2003 , altered sensorium or @entity129 , and magnetic resonance imaging (MRI) brain performed if needed. RESULTS: Twenty-three @entity1 of @entity693 that were serologically confirmed were included in the study. There were 13 males and 10 females. Fever >= 1 week was the most common manifestation (39.1%). Interestingly, none had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF @entity413 /blood @entity413 , CSF ADA were 17 cells/ L, 90%, 86 mg/dL, 0.6605 and 3.6 U/mL, respectively. All @entity1 were treated with @entity3403 . There was no mortality in our study. CONCLUSIONS: Absence of Eschar does not rule out scrub typhus. Clinical features and CSF findings can mimic @entity1906 so misdiagnosis may lead to unwarranted prolonged empirical antituberculous therapy in cases of @entity5422 . Delay in treatment can be potentially fatal. WFT still serves as a useful and affordable diagnostic tool for this disease in resource-poor countries.
