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The article discusses how Guillain Barre Syndrome is associated with Scrub Typhus infection, a a zoonotic disease, caused by Rickettsia, Orientia tsutsugamushi (OT). Topics include Treatment given including intravenous immunoglobulin (IVIG) or Plasma exchange (PE); and temporal association in the present study supports the notion that GBS might have been triggered by humoral immune response against ST.

Rickettsial illnesses, comprising mainly spotted fever group, typhus group and scrub typhus, are vector-borne re-emerging or newly emerging febrile illnesses where humans are an accidental dead-end host. They are a major cause of non-malarial febrile illnesses among returned travellers. They commonly present as an acute febrile illness and carry a characteristic entry wound (eschar) or a discrete erythematous maculo-popular rash based on the organism and the region. The illness severity is mainly dependent on the virulence of the rickettsial organism and delay in the diagnosis is known to cause severe illness with multi-organ involvement carrying high mortality. Almost all rickettsial infections respond to anti-rickettsial antibiotics such as doxycycline within 48--72 hours. Awareness of rickettsial illnesses and their various clinical presentations helps in early diagnosis and institution of appropriate treatment and hence prevent morbidity and mortality. [ABSTRACT FROM AUTHOR]

Scrub typhus most commonly presents as febrile illness, myalgia, headache, lymphadenopathy and rash. There can be diverse clinical presentations ranging from subclinical presentation to sepsis leading to multiorgan failure. The patient can also present with features of acute abdominal pain which is usually managed conservatively. Scrub typhus cases are commonly reported from rural areas of Indonesia, China, Southeast Asia, Japan and India. Most common lesion is an eschar which starts as a vesicular lesion at the mite bite site. It further forms an ulcer with black necrotic centre. Secondary bacterial infection can also be present at the eschar site forming an abscess at a later stage. The case reported here is one of the rarest presentations where the patient presented with eschar and abscess formation over the previous scar site. Incision and drainage were done for the scar site abscess. ELISA for IgM antibodies to Orientia tsutsugamushi in view of multiple eschars which turned out to be positive. She improved with medical management. [ABSTRACT FROM AUTHOR]

Scrub typhus, a neglected infectious disease caused by the obligate intracellular bacterium Orientia tsutsugamushi , is a major cause of fever across the Asia Pacific region with more than a billion people at risk. Treatment with antibiotics such as doxycycline or chloramphenicol is effective for the majority of patients. In the 1990s, reports from northern Thailand raised a troubling observation; some scrub typhus patients responded poorly to doxycycline, which investigators attributed to doxycycline resistance. Despite the controversial nature of these reports, independent verification was neglected, with subsequent studies speculating on the role of doxycycline resistance in contributing to failure of treatment or prophylaxis. In this review, we have outlined the evidence for drug-resistant Orientia tsutsugamushi , assessed the evidence for doxycycline resistance, and highlight more recent findings unsupportive of doxycycline resistance. We conclude that doxycycline resistance is a misconception, with treatment outcome likely to be determined by other bacterial, host, and pharmacological factors. [ABSTRACT FROM AUTHOR]

Introduction: Children with scrub typhus may present with one or more organ failures. Identifying the predictors of severe disease and need for pediatric intensive care unit (PICU) admission would help clinicians during outbreak seasons. Materials and methods: This observational study included 160 children admitted to the emergency department (ED) with scrub typhus confirmed by polymerase chain reaction (PCR) between January 2013 and December 2015. Demographic, clinical, and laboratory data were collected and predictors for PICU admission were identified. Results: There was a seasonal trend with peak presentation in post-monsoon months between August and October. Mean (SD) age at presentation was 6.8 (3.2) years. Fever was present in all with a median (IQR) duration of 9 (6-11) days. Respiratory distress (42%), altered sensorium (24%), hepatomegaly (93%), splenomegaly (57%), and lymphadenopathy (54%) were other features. Rash and eschar were noted in 24% each. Thrombocytopenia (83%), hypoalbuminemia (63%), and hyponatremia (62%) were common laboratory abnormalities. Meningoencephalitic presentation was noted in 29%; acute kidney injury (AKI) (16%), acute respiratory distress syndrome (ARDS) (11%), and myocarditis (3%) were other organ dysfunctions. Sixty-six (41%) children required PICU admission. Intensive care needs include invasive ventilation (n = 27, 17%), vasoactive drugs therapy for hemodynamic support (n = 43, 27%), osmotherapy to treat raised intracranial pressure (n = 27, 17%), and renal replacement therapy (n = 3, 2%). Mortality was 8.8%. On multivariable analysis, lymphadenopathy, respiratory distress, shock, elevated lactate, and meningoencephalitis predicted the requirement of PICU admission. Conclusion: Scrub typhus presents with organ dysfunction during post-monsoon months. We identified predictors of intensive care in children with scrub typhus admitted to ED. Clinical significance: Our results would help clinicians identify severe cases and prioritize resources. [ABSTRACT FROM AUTHOR]

Scrub typhus, a mite-borne zoonotic disease, is endemic in several parts of India. It may cause multisystemic disease involving lungs, heart, spleen, liver, hematological system, and nervous system. Neurological involvement may include meningoencephalitis, cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, muscle dysfunction, neuroleptic malignant syndrome, parkinsonian syndrome, and Guillain–Barre syndrome. Here, we report a rare patient of scrub typhus, who developed meningoencephalitis followed by long-segment myelitis and axonal polyneuropathy, with hepatic, renal, hematological, and pulmonary involvement, following acute febrile illness with associated neurocysticercosis. He gained consciousness with a resolution of almost all of his complaints, with the exception of muscular power, which showed partial improvement following treatment with doxycycline, azithromycin, and steroids. What needs to be explored is whether the existence of neurological scrub typhus with neurocysticercosis is the coincidental price paid for living in the tropics or there is something more to it as in case of Japanese encephalitis and neurocysticercosis co-infection. [ABSTRACT FROM AUTHOR]

Scrub typhus has reemerged with a different geographical distribution and varied clinical presentation like acute encephalitis syndrome (AES), which is a less known entity in scrub typhus. In this case series, we studied the clinical profile and outcome of eight patients who presented with AES and a positive scrub serology without any other identifiable cause of encephalopathy. All these patients had fever, altered sensorium, and nuchal rigidity, while seizures were present in six (75%) patients and papilledema in two (25%) patients. Complications like shock, pulmonary edema, and gastrointestinal (GI) bleed were observed in three (37%) patients. All patients except for one responded well to the treatment and recovered completely. Scrub typhus should be suspected early in patients presenting with AES. [ABSTRACT FROM AUTHOR]

Aim of the Study: Scrub typhus has been globally recognized as an emerging infectious disease contributing significantly to pyrexia of unknown origin (PUO) and a potential cause of multiorgan dysfunction syndrome (MODS). We studied the incidence of scrub typhus as a cause of pediatric intensive care unit (PICU) admission and MODS in our hospital and its clinical and laboratory characteristics to measure the incidence of MODS caused by scrub typhus. Materials and Methods: This study was done in a pediatric teaching hospital in Kolkata, India. Records of patients admitted with PUO from March 2012 to December 2015 were reviewed. Rathi-Goodman-Aghai scoring system was used to identify potential ST patients and confirmed by serological testing. Clinical characteristics, laboratory findings, and treatment response were noted of those needing PICU admissions. Results: Ninety-seven cases of scrub typhus have been identified during that period. PICU admission was needed in 30 of them (31%) which contributed 8.43% of total PICU admissions. Among these 30 patients, 16 (53%) developed MODS which contributed 18.29% of total MODS admitted in PICU. Septic shock was the most common manifestation in as many as 18 (60%) patients followed by encephalopathy in 13 (43%). Patients were treated with either doxycycline alone or in combination with azithromycin. Mean time to complete defervescence was 32 h after first dose of doxycycline. The outcome was excellent without a single mortality. Conclusion: Scrub typhus is an important cause of MODS in this part of the world, especially in fevers associated with features as identified and not responding to conventional antibiotics. [ABSTRACT FROM AUTHOR]

Background: Undifferentiated febrile illness (UFI) includes typhoid and typhus fevers and generally designates fever without any localizing signs. UFI is a great therapeutic challenge in countries like Nepal because of the lack of available point-of-care, rapid diagnostic tests. Often patients are empirically treated as presumed enteric fever. Due to the development of high-level resistance to traditionally used fluoroquinolones against enteric fever, azithromycin is now commonly used to treat enteric fever/UFI. The re-emergence of susceptibility of Salmonella typhi to co-trimoxazole makes it a promising oral treatment for UFIs in general. We present a protocol of a randomized controlled trial of azithromycin versus co-trimoxazole for the treatment of UFI.Methods/design: This is a parallel-group, double-blind, 1:1, randomized controlled trial of co-trimoxazole versus azithromycin for the treatment of UFI in Nepal. Participants will be patients aged 2 to 65 years, presenting with fever without clear focus for at least 4 days, complying with other study criteria and willing to provide written informed consent. Patients will be randomized either to azithromycin 20 mg/kg/day (maximum 1000 mg/day) in a single daily dose and an identical placebo or co-trimoxazole 60 mg/kg/day (maximum 3000 mg/day) in two divided doses for 7 days. Patients will be followed up with twice-daily telephone calls for 7 days or for at least 48 h after they become afebrile, whichever is later; by home visits on days 2 and 4 of treatment; and by hospital visits on days 7, 14, 28 and 63. The endpoints will be fever clearance time, treatment failure, time to treatment failure, and adverse events. The estimated sample size is 330. The primary analysis population will be all the randomized population and subanalysis will be repeated on patients with blood culture-confirmed enteric fever and culture-negative patients.Discussion: Both azithromycin and co-trimoxazole are available in Nepal and are extensively used in the treatment of UFI. Therefore, it is important to know the better orally administered antimicrobial to treat enteric fever and other UFIs especially against the background of fluoroquinolone-resistant enteric fever.Trial Registration: ClinicalTrials.gov, ID: NCT02773407 . Registered on 5 May 2016. [ABSTRACT FROM AUTHOR]

To determine prevalence of severe fever with thrombocytopenia syndrome in South Korea, we examined serum samples from patients with fever and insect bite history in scrub typhus-endemic areas. During the 2013 scrub typhus season, prevalence of this syndrome among patients suspected of having scrub typhus was high (23.0%), suggesting possible co-infection. [ABSTRACT FROM AUTHOR]

The article discusess the diagnosis of hemophagocytic lymphohistiocytosis in a young child with fever and unexplained acute kidney injury. It mentions involvement of a multisystem involvement including renal parenchymal infiltration and inflammation in the same; and use of pulse steroids followed by oral prednisolone for treating the same.

The article describes the case of a 14-year-old female presented with scrub typhus febrile respiratory illness with seizures and changes of posterior reversible encephalopathy syndrome (PRES) which were reversed in four weeks duration. Topics include clinical characteristics of PRES, infections that have been attributed to PRES commonly, and plausible explanation for PRES seen in the patient.

We studied rickettsioses in southern Sri Lanka. Of 883 febrile patients with paired serum samples, 156 (17.7%) had acute rickettsioses; rickettsioses were unsuspected at presentation. Additionally, 342 (38.7%) had exposure to spotted fever and/or typhus group rickettsioses and 121 (13.7%) scrub typhus. Increased awareness of rickettsioses and better tests are needed. [ABSTRACT FROM AUTHOR]

Objectives: To know the etiologic profile in patients with febrile syndrome reported as negative for Bartonella infection or with a negative result in thick smears for malaria in two pilot areas (Northern Coast and Eastern Jungle in Peru). Materials and methods: A longitudinal and descriptive study was performed between May 2000 and July 2001 in four health facilities: Chiclayito and Salitral in Piura, Yurimaguas Hospital, and San Juan Health Center in Loreto. Febrile patients between 5 and 65 years old were included with negative smears for Bartonella or negative thick smears for malaria. The following tests were performed in the samples obtained: indirect immunofluorescence for typhus (only in Piura), ELISA IgM for leptospirosis and ELISA IgM-IgG for dengue fever, yellow fever, Mayaro, Oropuche and Venezuelan equine encephalitis (VEE). Results: Isolation of dengue fever virus was achieved in 27 (6,3%) patients, VEE virus was found in five patients, and group C virus was found in one patient. Dengue fever 2 and 3 viruses were identified in Chiclayito. VEE and group C virus were isolated in San Juan patients. Anti-dengue fever IgM was found in 43 (9,6%) patients, and yellow fever IgM was found in 21 (4,7%) patients, most of them from Yurimaguas. Also, VEE IgM was found in seven patients, Mayaro virus IgM was found in one and Oropuche virus IgM was found in four. Leptospirosis was the second most frequent cause of febrile syndrome (3,8%); while typhus was confirmed using indirect immunofluorescence in five Chiclayito patients. Conclusions: Studying the etiology of febrile syndrome allowed us to detect circulation of EEV virus, the presence of dengue fever 3 virus in Peru and also the prevalence of arboviral infections as a cause of febrile syndrome in the Peruvian Northern Coast and Eastern Jungle in the absence of epidemic activity. [ABSTRACT FROM AUTHOR]

Concurrent occurance of scrub typhus with vivax malaria has seldom been reported in the literature. If the coinfection is missed fatal complications may occur as both malaria even by Plasmodium vivax and scrub typhus are also associated with fatal complications. [ABSTRACT FROM AUTHOR]

Fever with rash is a common cause for dermatological referral. The causes can range from viral to protozoal, bacterial or spirochaetal. A case of rickettsial fever is reported. [ABSTRACT FROM AUTHOR]

A review of the article "Scrub Typhus: Clinical Spectrum and Outcome," by Venkategowda PM, Rao SM, and Mutkule DP, which appeared in the periodical "Indian Journal of Critical Care Medicine" on April 2015 is presented.