Evidence and Manifestations of Scrub Typhus: A Clinical Case Series from Kerala

Abstract

Background: Scrub typhus, caused by Orientia tsutsugamushi, may be difficult to recognise because its clinical manifestations overlap with those of other acute febrile illnesses. Aim: This study describes the clinical features, laboratory findings and treatment outcomes of patients with scrub typhus at a tertiary care hospital in Kerala. Case Presentation: This retrospective case series included 11 patients admitted between August and December 2020. Clinical examinations, complete blood counts, liver function tests, eschar findings and scrub typhus IgM results were reviewed. Complications and responses to azithromycin treatment were recorded. Results: Nine patients were aged 20–60 years, one was younger than 20 years and one was older than 60 years; nine were female. Fever, headache, vomiting and thrombocytopenia were reported in all patients. Hyponatraemia occurred in three patients, abdominal distension in two, and myocarditis and bilateral crepitation in one patient. Eschars and positive IgM results were documented in all 11 patients. Aspartate aminotransferase values ranged from 65 to 311 U/L, while alanine aminotransferase values ranged from 33 to 250 U/L. All patients received intravenous azithromycin followed by oral treatment after clinical improvement. Most hospital stays lasted 3–7 days, and all patients recovered. Conclusion: The findings illustrate the clinical and laboratory features observed in this small hospital-based series and highlight the importance of considering scrub typhus when evaluating compatible acute febrile presentations.