Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India.

<h4>Background</h4>Infection-related acute kidney injury (AKI) is an important preventable cause of morbidity and mortality in the tropical region. The prevalence and outcome of kidney involvement, especially AKI, in scrub typhus is not known. We investigated all patients with undiagnose...

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Autores principales:	Vivek Kumar, Vinod Kumar, Ashok K Yadav, Sreenivasa Iyengar, Ashish Bhalla, Navneet Sharma, Ritesh Aggarwal, Sanjay Jain, Vivekanand Jha
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/7ae2e3cb3dd44b3b9de4a77876e10bb2
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spelling	oai:doaj.org-article:7ae2e3cb3dd44b3b9de4a77876e10bb22021-11-18T09:16:27ZScrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India.1935-27271935-273510.1371/journal.pntd.0002605https://doaj.org/article/7ae2e3cb3dd44b3b9de4a77876e10bb22014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24498445/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>Infection-related acute kidney injury (AKI) is an important preventable cause of morbidity and mortality in the tropical region. The prevalence and outcome of kidney involvement, especially AKI, in scrub typhus is not known. We investigated all patients with undiagnosed fever and multisystem involvement for scrub typhus and present the pattern of renal involvement seen.<h4>Methods</h4>From September 2011 to November 2012, blood samples of all the patients with unexplained acute febrile illness and/or varying organ involvement were evaluated for evidence of scrub typhus. A confirmed case of scrub typhus was defined as one with detectable Orientia tsutsugamushi deoxyribonucleic acid (DNA) in patient's blood sample by nested polymerase chain reaction (PCR) targeting the gene encoding 56-kDa antigen and without any alternative etiological diagnosis. Renal involvement was defined by demonstration of abnormal urinalysis and/or reduced glomerular filtration rate. AKI was defined as per Kidney Disease: Improving Global Outcomes (KDIGO) definition.<h4>Results</h4>Out of 201 patients tested during this period, 49 were positive by nested PCR for scrub typhus. Mean age of study population was 34.1±14.4 (range 11-65) years. Majority were males and a seasonal trend was evident with most cases following the rainy season. Overall, renal abnormalities were seen in 82% patients, 53% of patients had AKI (stage 1, 2 and 3 in 10%, 8% and 35%, respectively). The urinalysis was abnormal in 61%, with dipstick positive albuminuria (55%) and microscopic hematuria (16%) being most common. Acute respiratory distress syndrome (ARDS) and shock were seen in 57% and 16% of patients, respectively. Hyperbilirubinemia was associated with AKI (p = 0.013). A total of 8 patients (including three with dialysis dependent AKI) expired whereas rest all made uneventful recovery. Jaundice, oliguria, ARDS and AKI were associated with mortality. However, after multivariate analysis, only oliguric AKI remained a significant predictor of mortality (p = 0.002).<h4>Conclusions</h4>Scrub typhus was diagnosed in 24% of patients presenting with unexplained febrile illness according to a strict case definition not previously used in this region. Renal abnormalities were seen in almost 82% of all patients with evidence of AKI in 53%. Our finding is contrary to current perception that scrub typhus rarely causes renal dysfunction. We suggest that all patients with unexplained febrile illness be investigated for scrub typhus and AKI looked for in scrub typhus patients.Vivek KumarVinod KumarAshok K YadavAshok K YadavSreenivasa IyengarAshish BhallaNavneet SharmaRitesh AggarwalSanjay JainVivekanand JhaPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 8, Iss 1, p e2605 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Vivek Kumar Vinod Kumar Ashok K Yadav Ashok K Yadav Sreenivasa Iyengar Ashish Bhalla Navneet Sharma Ritesh Aggarwal Sanjay Jain Vivekanand Jha Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India.
description	<h4>Background</h4>Infection-related acute kidney injury (AKI) is an important preventable cause of morbidity and mortality in the tropical region. The prevalence and outcome of kidney involvement, especially AKI, in scrub typhus is not known. We investigated all patients with undiagnosed fever and multisystem involvement for scrub typhus and present the pattern of renal involvement seen.<h4>Methods</h4>From September 2011 to November 2012, blood samples of all the patients with unexplained acute febrile illness and/or varying organ involvement were evaluated for evidence of scrub typhus. A confirmed case of scrub typhus was defined as one with detectable Orientia tsutsugamushi deoxyribonucleic acid (DNA) in patient's blood sample by nested polymerase chain reaction (PCR) targeting the gene encoding 56-kDa antigen and without any alternative etiological diagnosis. Renal involvement was defined by demonstration of abnormal urinalysis and/or reduced glomerular filtration rate. AKI was defined as per Kidney Disease: Improving Global Outcomes (KDIGO) definition.<h4>Results</h4>Out of 201 patients tested during this period, 49 were positive by nested PCR for scrub typhus. Mean age of study population was 34.1±14.4 (range 11-65) years. Majority were males and a seasonal trend was evident with most cases following the rainy season. Overall, renal abnormalities were seen in 82% patients, 53% of patients had AKI (stage 1, 2 and 3 in 10%, 8% and 35%, respectively). The urinalysis was abnormal in 61%, with dipstick positive albuminuria (55%) and microscopic hematuria (16%) being most common. Acute respiratory distress syndrome (ARDS) and shock were seen in 57% and 16% of patients, respectively. Hyperbilirubinemia was associated with AKI (p = 0.013). A total of 8 patients (including three with dialysis dependent AKI) expired whereas rest all made uneventful recovery. Jaundice, oliguria, ARDS and AKI were associated with mortality. However, after multivariate analysis, only oliguric AKI remained a significant predictor of mortality (p = 0.002).<h4>Conclusions</h4>Scrub typhus was diagnosed in 24% of patients presenting with unexplained febrile illness according to a strict case definition not previously used in this region. Renal abnormalities were seen in almost 82% of all patients with evidence of AKI in 53%. Our finding is contrary to current perception that scrub typhus rarely causes renal dysfunction. We suggest that all patients with unexplained febrile illness be investigated for scrub typhus and AKI looked for in scrub typhus patients.
format	article
author	Vivek Kumar Vinod Kumar Ashok K Yadav Ashok K Yadav Sreenivasa Iyengar Ashish Bhalla Navneet Sharma Ritesh Aggarwal Sanjay Jain Vivekanand Jha
author_facet	Vivek Kumar Vinod Kumar Ashok K Yadav Ashok K Yadav Sreenivasa Iyengar Ashish Bhalla Navneet Sharma Ritesh Aggarwal Sanjay Jain Vivekanand Jha
author_sort	Vivek Kumar
title	Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India.
title_short	Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India.
title_full	Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India.
title_fullStr	Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India.
title_full_unstemmed	Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India.
title_sort	scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in india.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/7ae2e3cb3dd44b3b9de4a77876e10bb2
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Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India.

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