Clinical Manifestation and Complications of Scrub Typhus Cases: A Hospital-based Observational Study from Rural Part of West Bengal

Introduction: Scrub typhus is very common re-emerging Rickettsia infection in India and many other South East Asian countries. The unplanned urbanization, deforestation and easy transportation leads to changes of place of occurrence of scrub typhus from hilly and forest terrains to plan land with different clinical manifestation. Aim: This study was conducted to identify the regional characteristic of clinical sign, symptom and treatment outcome of scrub typhus patients admitted in a tertiary level hospital of Murshidabad district of West Bengal. Methods: An observational cross sectional study was conducted among 82 hospitalized scrub typhus patients during September, 2019 to March, 2020. Patients were selected by purposive sampling procedure. Data were analyzed in descriptive statistic. Results: All study participants presented with acute febrile illness with other symptoms like headache, cough, dyspnea, nausea, generalized weakness, abdominal pain and myalgia. On examination, patients had hepatosplenomegaly (21%), lymphadenopathy (7%), pedal edema (14%), Icterus (12%) and eschar (4%). On investigation, elevated ALT (37%), elevated AST (36%), Low platelet count (25%), low Hb% (52%), elevated WBC count (37%) levels were the most common findings. Interestingly few patients diagnosed with co-morbid infections eg: enteric fever (12%), Urinary tract infection (12%), respiratory tract infection (27%), dengue fever (5%) and malaria (2%). Low mortality rate (4%) was observed due to tertiary level health care services and increased awareness among local medical fraternities on scrub typhus apart from lower virulence or indigenous resistance as host or environment factor. Conclusion: Scrub typhus is an important zoonotic disease of variable presentation with low fatality if diagnosed and treated early. It is necessary to include scrub typhus serology test as routine blood test for all acute febrile illness patients for this area.