Title: Thrombocytopenia and Fever during Dengue Epidemic Can Be Scrub Typhus: A Case Report
Authors: Dr Sanjay Fotedar, Dr Anshul Gupta, Dr Varun Yadav, Dr Maninder Hariya
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.159
Abstract
In India scrub typhus despite being endemic is grossly underreported, reason being clinical presentation overlapping with other tropical fevers, specific diagnostic facilities lacking in most areas, and low degree of clinical suspicion. Diagnosis is also further masked if it occurs during the epidemic of other tropical fevers like dengue and malaria. Clinically it manifests as febrile illness with constitutional symptoms like fever, rash, myalgia and headache to fatal complications like ARDS, myocarditis, meningoencephalitis, acute renal failure and gastrointestinal bleeding. High degree of clinical suspicion and early diagnosis is important because of an excellent response to treatment and thereby reducing associated life threatening complications. Authors report a case report of scrub typhus presenting as fever with thrombocytopenia, cojunctival chemosis and bilateral bronco-pneumonia during the time when dengue fever is an epidemic.
References
1. Singh S, Chaudhary D, Varghese GM, Bhalla A, Karthi N, Kalantri S, et al. Tropical fevers: management guidelines. Indian J Crit Care Med 2014;18:62-9.
2. Krishna PV, Ahmed S, Venkata K, Reddy N. A case report of scrub typhus. J Dr NTR Univ Hlth Sci 2015;4:47-9.
3. Subbalaxmi MVS, Madisetty MK, Prasad AK, Swaroopa K, Chandra N, Upadhyaya AC, et al. Outbreak of scrub typhus in Andhra Pradesh – Experience at a tertiary care hospital. J Assoc Phys India 2014;62: 490-96.
4. 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.
5. Park K. Nutrition and health. Parks text-book of preventive and social medicine. 23th ed. Jabalpur: Bhanot, 2015;10 (23):608-68.
6. Kasper et al. Rickettsial Diseases. Harri-sons Principles Of Internal Medicine.19th ed. New York: Mc Graw Hill, 2015; 211(1):11153-68.
7. Watt G. Scrub typhus In Oxford Textbook of Medicine. WarrelDA, Cox TM, Firth JD et al (Edi) 4th Edi. Oxford. Oxford University Press2003;1:629-31.
8. Devine J. A review of scrub typhus man-agement in 2000-2001 and implications for soldiers. JRural and Remote Environm-ental Health2003;2:14-20.
9. Chinprasatsak S, Wilairatana P, Looare-esuwan S, et al. Evaluation of a newly developed dipstick test for the rapiddia-gnosis of scrub typhus in febrile patients. Southeast Asian Trop Med Pub Health 2001;32:132-6.
Kovacova E, Kazar J. Rickttsial. Diseases and their serological diagnosis. Clin Lab 2000;46:239-45.