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Khatri P, Upadhyaya A, Kandel N, Upadhyaya S, Panth H. HLA-B27 Negative Reactive Monoarthritis of the Hip Joint Triggered by Scrub Typhus: A Case Report. JNMA J Nepal Med Assoc 2023; 61:475-478. [PMID: 37203900 PMCID: PMC10896433 DOI: 10.31729/jnma.8153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
Scrub typhus is common in rural Nepal's southern plains, but its diagnosis remains difficult due to a lack of clinical suspicion and poor diagnostic resources. The absence of common manifestations of the condition including eschar might further complicate this problem and may result in treatment delays. We report a case of scrub typhus with the primary presentation of reactive monoarthritis of the left hip joint in a 19-year-old male who presented with difficulty in walking, and pain over the left hip joint. Ultrasonography of the left hip and thigh showed features of synovitis and iliopsoas bursitis. After a meticulous workup, a diagnosis of human leukocyte antigen B27 negative reactive monoarthritis of the left hip joint triggered by scrub typhus infection was made and the patient was treated with doxycycline. Delays in treatment and the rate of complications can be prevented with high clinical suspicion and awareness of the atypical presentation of the condition. Keywords HLA-B27; case reports; reactive arthritis; scrub typhus.
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Affiliation(s)
- Prabin Khatri
- Department of Clinical Immunology and Rheumatology, Medanta Institute of Education & Research, Gurugram, Haryana, India
| | | | - Nirajan Kandel
- Sangla Primary Health Center, Tarkeshwor, Kathmandu, Nepal
| | | | - Himal Panth
- Arogya Multispecialty Healthcare and Diagnostic Center, Bhairahawa, Rupandehi, Nepal
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2
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Stefański M. GDP effects of pandemics: a historical perspective. EMPIRICAL ECONOMICS 2022; 63:2949-2995. [PMID: 35411126 PMCID: PMC8986453 DOI: 10.1007/s00181-022-02227-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
The paper estimates dynamic effects of pandemics on GDP per capita with local projections, controlling for the effects of wars and weather conditions, using a novel dataset that covers 33 countries and stretches back to the thirteenth century. On average, pandemics are found to have prolonged and highly statistically significant effects on GDP per capita-a pandemic killing 1% of the population tends to increase GDP per capita by approx. 0.3% after about 20 years. The study of a more detailed dataset available for the UK reveals that this results mainly from an increase in per capita land and a disproportionate impact of pandemics on low-productivity workers, while monetary expansion, institutional change and innovation could also play some role. At the same time, the effects of pandemics are found to vary with scale and across time and countries, with positive effects present following the Black Death and the Spanish flu pandemics, especially in Northern Europe. This suggests that only the largest and most unexpected pandemics have a positive impact on income.
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Salaveria K, Smith S, Liu YH, Bagshaw R, Ott M, Stewart A, Law M, Carter A, Hanson J. The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia. Am J Trop Med Hyg 2022; 106:257-267. [PMID: 34662860 PMCID: PMC8733535 DOI: 10.4269/ajtmh.21-0615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/31/2021] [Indexed: 01/03/2023] Open
Abstract
Many patients with leptospirosis, melioidosis, and rickettsial infection require intensive care unit (ICU) admission in tropical Australia every year. The multi-organ dysfunction associated with these infections results in significantly elevated severity of illness (SOI) scores. However, the accuracy of these SOI scores in predicting death from these tropical infections is incompletely defined. This retrospective study was performed at Cairns Hospital, a tertiary-referral hospital in tropical Australia. All patients admitted to ICU with laboratory-confirmed leptospirosis, melioidosis, and rickettsial disease between January 1, 1999 and June 30, 2020, were eligible for the study. The ability of Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Simplified Acute Physiology Scores (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores to predict death before ICU discharge was evaluated. Overall, 18 (12.1%) of the 149 included patients died: 15/74 (20.3%) with melioidosis, 2/54 (3.7%) with leptospirosis and 1/21 (4.8%) with rickettsial disease. However, the APACHE II, APACHE III, SAPS II, and SOFA scores significantly overestimated the case-fatality rate of all the infections; the disparity between the predicted and observed mortality was most marked in the cases of leptospirosis and rickettsial disease. Commonly used SOI scores significantly overestimate the case-fatality rate of melioidosis, leptospirosis, and rickettsial infections in Australian ICU patients. This may be at least partly explained by the unique pathophysiology of these infections, particularly leptospirosis and rickettsial disease. However, SOI scores may still be useful in facilitating the comparison of disease severity in clinical trials that examine patients with these pathogens.
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Affiliation(s)
- Kris Salaveria
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Yu-Hsuan Liu
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | - Richard Bagshaw
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Markus Ott
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | | | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Angus Carter
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia;,James Cook University, Cairns Campus, Cairns, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia;,Kirby Institute, University of New South Wales, Sydney, Australia;,Address correspondence to Josh Hanson, Kirby Institute, Level 6, Wallace Wurth Building, High Street, UNSW, Kensington NSW 2052, Australia. E-mail:
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4
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Gautam J, Yadav RS, Shrestha S, Singh BM, Maharjan R. Scrub Typhus: Report of Three Cases From Rural Nepal and a Brief Literature Review. Cureus 2021; 13:e18376. [PMID: 34725620 PMCID: PMC8555355 DOI: 10.7759/cureus.18376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/29/2022] Open
Abstract
Scrub typhus is endemic among farmers in the rural southern part of Nepal. It is grossly underdiagnosed due to a lack of clinical suspicion and inadequate testing facilities. The most common clinical features of the disease include fever, rashes, vomiting, myalgia, and eschar. The disease may present with ocular changes such as conjunctival injection, gastrointestinal features such as hepatitis and splenomegaly, acute kidney injury (AKI), or neurological findings in the form of meningoencephalitis. Herein, we present a report of three cases of scrub typhus from a rural part of South-west Nepal who failed to receive appropriate treatment initially. One of the patients recovered well with the treatment, the other developed AKI but recovered over the next few weeks. One of the patients died due to sepsis/multiorgan failure secondary to scrub typhus. While managing such cases in places with limited diagnostic facilities, the incorporation of early appropriate empirical therapy for scrub typhus after a careful clinical assessment prevents complications and saves lives.
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Affiliation(s)
- Jeevan Gautam
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Randhir S Yadav
- Department of Pediatrics, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Shumneva Shrestha
- Department of Pediatrics, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Bishnu Mohan Singh
- Division of Clinical and Translational Research, Larkin Community Hospital, Miami, USA.,Internal Medicine, Hetauda City Hospital, Hetauda, NPL
| | - Renusha Maharjan
- Department of Surgical Nursing, Institute of Medcine, Kathmandu, NPL
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Dhimal M, Dumre SP, Sharma GN, Khanal P, Ranabhat K, Shah LP, Lal BK, Jha R, Upadhyaya BP, Acharya B, Shrestha SK, Davidson SA, Charoensinphon P, Karki KB. An outbreak investigation of scrub typhus in Nepal: confirmation of local transmission. BMC Infect Dis 2021; 21:193. [PMID: 33602136 PMCID: PMC7893900 DOI: 10.1186/s12879-021-05866-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
Background Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness in the areas of tsutsugamushi triangle caused by Orientia tsutsugamushi. It is frequently diagnosed in South Asian countries, although clear epidemiological information is not available from Nepal. After the 2015 earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported. The objective of this study was to investigate epidemiology of scrub typhus and its causative agents in humans, animals, and chigger mites to understand the ongoing transmission ecology. Methods Scrub typhus cases with confirmed diagnosis throughout the country were included in the analysis. Studies were concentrated in the Chitwan district, the site of a major outbreak in 2016. Additional nation-wide data from 2015 to 2017 available from the government database included to analyse the disease distribution by geographical mapping. Results From 2015 to 2017, 1239 scrub typhus cases were confirmed with the largest outbreak occurring in 2016 with 831 (67.1%) cases. The case fatality rate was 5.7% in 2015 which declined to 1.1% in 2017. A nationwide outbreak of scrub typhus was declared as the cases were detected in 52 out of the 75 districts of Nepal. Seasonal trend was observed with a peak during August and September. In addition to the human cases, the presence of O. tsutsugamushi was also confirmed in animals (rodents) and chigger mites (Leptotrombidium imphalum) from the outbreak areas of southern Nepal. Conclusion The detection of O. tsutsugamushi in humans, animals, and chigger mites from outbreak locations and wide-spread reports of scrub typhus throughout the country consecutively for 3 years confirms the ongoing transmission of O. tsutsugamushi with a firmly established ecology in Nepal. The country’s health system needs to be strengthened for systematic surveillance, early outbreak detection, and immediate actions including treatment and preventive measures. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05866-6.
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Affiliation(s)
- Meghnath Dhimal
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal.
| | - Shyam Prakash Dumre
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal.,Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Guna Nidhi Sharma
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.,Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Pratik Khanal
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal.,Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Kamal Ranabhat
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.,Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Lalan Prasad Shah
- Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Bibek Kumar Lal
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Runa Jha
- National Public Health Laboratory, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Bishnu Prasad Upadhyaya
- National Public Health Laboratory, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Bhim Acharya
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | | | - Silas A Davidson
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | | | - Khem B Karki
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal.,Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Bagshaw RJ, Stewart AGA, Smith S, Carter AW, Hanson J. The Characteristics and Clinical Course of Patients with Scrub Typhus and Queensland Tick Typhus Infection Requiring Intensive Care Unit Admission: A 23-year Case Series from Queensland, Tropical Australia. Am J Trop Med Hyg 2020; 103:2472-2477. [PMID: 32959771 DOI: 10.4269/ajtmh.20-0780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Scrub typhus and Queensland tick typhus (QTT)-rickettsial infections endemic to tropical Australia-can cause life-threatening disease. This retrospective study examined the clinical course of all patients with laboratory-confirmed scrub typhus or QTT admitted to the intensive care unit (ICU) of a tertiary referral hospital in tropical Australia between 1997 and 2019. Of the 22 patients, 13 had scrub typhus and nine had QTT. The patients' median (interquartile range [IQR]) age was 50 (38-67) years; 14/22 (64%) had no comorbidity. Patients presented a median (IQR) of seven (5-10) days after symptom onset. Median (IQR) Acute Physiology and Chronic Health Evaluation II scores were 13 (9-17) for scrub typhus and 13 (10-15) for QTT cases (P = 0.61). Following hospital admission, the median (IQR) time to ICU admission was five (2-19) hours. The median (IQR, range) length of ICU stay was 4.4 (2.9-15.9, 0.8-33.8) days. Multi-organ support was required in 11/22 (50%), 5/22 (22%) required only vasopressor support, 2/22 (9%) required only invasive ventilation, and 4/22 (18%) were admitted for monitoring. Patients were ventilated using protective lung strategies, and fluid management was conservative. Standard vasopressors were used, indications for renal replacement therapy were conventional, and blood product usage was restrictive; 9/22 (41%) received corticosteroids. One patient with QTT died, and two (8%) additional patients with QTT developed purpura fulminans requiring digital amputation. Death or permanent disability occurred in 3/9 (33%) QTT and 0/13 scrub typhus cases (P = 0.055). Queensland tick typhus and scrub typhus can cause multi-organ failure requiring ICU care in otherwise well individuals. Queensland tick typhus appears to have a more severe clinical phenotype than previously believed.
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Affiliation(s)
| | | | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Angus W Carter
- Department of Intensive Care Medicine, Cairns Hospital, Cairns, Australia
| | - Josh Hanson
- The Kirby Institute, University of New South Wales, Sydney, Australia.,Department of Medicine, Cairns Hospital, Cairns, Australia
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Nallasamy K, Gupta S, Bansal A, Biswal M, Jayashree M, Zaman K, Williams V, Kumar A. Clinical Profile and Predictors of Intensive Care Unit Admission in Pediatric Scrub Typhus: A Retrospective Observational Study from North India. Indian J Crit Care Med 2020; 24:445-450. [PMID: 32863638 PMCID: PMC7435082 DOI: 10.5005/jp-journals-10071-23445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction Children with scrub typhus may present with one or more organ failures. Identifying the predictors of severe disease and need for pediatric intensive care unit (PICU) admission would help clinicians during outbreak seasons. Materials and methods This observational study included 160 children admitted to the emergency department (ED) with scrub typhus confirmed by polymerase chain reaction (PCR) between January 2013 and December 2015. Demographic, clinical, and laboratory data were collected and predictors for PICU admission were identified. Results There was a seasonal trend with peak presentation in post-monsoon months between August and October. Mean (SD) age at presentation was 6.8 (3.2) years. Fever was present in all with a median (IQR) duration of 9 (6–11) days. Respiratory distress (42%), altered sensorium (24%), hepatomegaly (93%), splenomegaly (57%), and lymphadenopathy (54%) were other features. Rash and eschar were noted in 24% each. Thrombocytopenia (83%), hypoalbuminemia (63%), and hyponatremia (62%) were common laboratory abnormalities. Meningoencephalitic presentation was noted in 29%; acute kidney injury (AKI) (16%), acute respiratory distress syndrome (ARDS) (11%), and myocarditis (3%) were other organ dysfunctions. Sixty-six (41%) children required PICU admission. Intensive care needs include invasive ventilation (n = 27, 17%), vasoactive drugs therapy for hemodynamic support (n = 43, 27%), osmotherapy to treat raised intracranial pressure (n = 27, 17%), and renal replacement therapy (n = 3, 2%). Mortality was 8.8%. On multivariable analysis, lymphadenopathy, respiratory distress, shock, elevated lactate, and meningoencephalitis predicted the requirement of PICU admission. Conclusion Scrub typhus presents with organ dysfunction during post-monsoon months. We identified predictors of intensive care in children with scrub typhus admitted to ED. Clinical significance Our results would help clinicians identify severe cases and prioritize resources. How to cite this article Nallasamy K, Gupta S, Bansal A, Biswal M, Jayashree M, Zaman K, et al. Clinical Profile and Predictors of Intensive Care Unit Admission in Pediatric Scrub Typhus: A Retrospective Observational Study from North India. Indian J Crit Care Med 2020;24(6):445–450.
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Affiliation(s)
- Karthi Nallasamy
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalu Gupta
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Bansal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muralidharan Jayashree
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamran Zaman
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijai Williams
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhay Kumar
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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