A STUDY ON CLINICAL AND LABORATORY PROFILE OF PATIENTS WITH ESCHAR-POSITIVE SCRUB TYPHUS; ADMITTED TO TERTIARY CARE CENTER IN NORTHERN SRI LANKA

Abstract

Intro: Scrub typhus, caused by Orientia tsutsugbmushi, is a serious public health problem in the Asia-Pacific region and it is also endemic in the countries of south and southeast Asia. As most of the clinical features are nonspecific, it causes major diagnostic as well as management challenge [1]. This study was aimed to describe the clinical, biochemical and hematological profiles of eschar positive scrub typhus. Methods: This cross-sectional study was conducted during1st of May 2020- 31st October 2020 in medical units of Teaching Hospital Jaffna, Sri Lanka. Data were collected using designed data collection form and the relevant laboratory and clinical data retrieved from the patients’ records and were analyzed using SPSS26. Findings: Total of 85 participants who had fever and eschar as defined by case definition were recruited for this study. Mean duration of fever was 5.92+2.06. Majority of them (56.47%) had fever more than 5 days. Eschar was mainly found in axilla (35.3%) followed by groin (16.5%), torso (10.6%), arms (9.4%), head (7.1%), sub-mammary (7.1%), thigh (5.9%), umbilicus (3.5%), genitalia 2.4% and legs 2.4%with decreasing order. Apart from fever, body aches, headache and sore throat were among the commonest symptoms. Amongst the clinical signs, the regional lymphadenopathy was the commonest (42%) sign, followed by hepatomegaly (12.9%) and splenomegaly (11.8%). The commonest respiratory sign was bilateral crepitation observed in 12.9% of them. Haematological features of patients included thrombocytopenia (54.1%), eosinophilia (55.3%), elevated ESR (81.2%) and CRP (94.4%), neutrophilia (32.9%) and lymphocytosis (12.9%). Majority of the patients showed elevated liver enzymes. Conclusion: In conclusion, the diagnosis of Scrub typhus is quite difficult in our setting due to lack of availability of the diagnostic test and non-specific clinical presentation. However, the high degree of suspicion, extensive clinical examination and the basic haematological and biochemical tests would support the diagnosis.