CLINICAL CHARACTERISTICS, MANAGEMENT PRACTICES AND IN-HOSPITAL OUTCOMES OF SCRUB TYPHUS PATIENTS IN A TERTIARY CARE CENTER IN THE NORTH EASTERN STATE, TRIPURA

Background- With the changing epidemiology, scrub typhus is now among the commonest causes of AFI in India and a high suspicion should be maintained, and an early diagnosis and promt management is warranted to prevent complications. Objective - Clinical characteristics, management practices and in-hospital outcomes of scrub typhus patients. Methods- a Cross-sectional retrospective study was conducted among 110 scrub typhus patients attending Agartala Government Medical College and GB Pant Hospital, a tertiary care centre of Tripura in last one year period. Their clinical profile, laboratory studies and management has been recorded and data has been evaluated with SPSS 21.0 for windows with p- value <0.05. Results- the commonest presenting symptoms of scrub typhus are high-grade fever with chills , headache and it most commonly effects farmers. Most commonly effected age group was 40-50 years of age. Most of the patients were from West Tripura followed by Khowai Tripura and least patients were from North Tripura. Predominately it occured in September, October and November i.e. in post monsoon period. The pathognomonic eschar was present in 43% patients and rarest presentation was paraparesis (0.9%). Lymphadenopathy (9%), neck rigidity (6%), hepatomegaly (10%), splenomegaly (4%), acute respiratory distress syndrome was seen in 14% patients. Hepatic involvement was the most common complication seen in our study (42%). Anemia was present in 25% and thrombocytopenia was present in 22% patients. Subside of fever to doxycycline injection seen in 73% on day1 and 84% on day2. 19% Patient required icu admission. 9% developed ARDS and 6% required ET tube intubation and mechanical ventilation. 6% developed hypotension requiring inotropic support. 4% developed severe thrombocytopenia(<10,000) required platelet transfusion. 11% developed acute kidney injury requiring haemodialysis. Survival rate were 93% and mortality 7%. In conclusion, scrub typhus became the leading infectious cause of acute febrile illness in North eastern state, Tripura. A high suspicion should be maintained, and an early diagnosis and promt management is warranted to prevent mortality and morbidity of patients.