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- Title
Scrub Typhus and Other Rickettsial Infections.
- Authors
Gunasekaran, Karthik; Bal, Deepti; Varghese, George M.
- Abstract
Scrub typhus and other rickettsial infections contribute to 25 - 50% of acute undifferentiated febrile illnesses in endemic regions. Delayed recognition and therapy increase the morbidity and mortality. The constellation of fever with eschar or rash and multisystem involvement should facilitate the diagnosis and initiation of appropriate therapy. The pathological hallmark of rickettsial infections is endothelial infection and inflammation causing vasculitis. Endothelial inflammation results in microvascular dysfunction and increased vascular permeability. Immune and endothelial activation may worsen microvascular dysfunction, predisposing to multi-organ failure. Serology is the mainstay of diagnosis, although false negatives occur early in the disease. Point-of-care rapid diagnostic tests and molecular techniques, such as quantitative polymerase chain reaction (qPCR), can hasten diagnostic processes. Intravenous doxycycline with a loading dose is the most widely used antibiotic in critically ill patients, with azithromycin as a suitable alternative. Early appropriate treatment and organ support can decrease the duration of illness and be life-saving.
- Subjects
ANTIBIOTICS; RICKETTSIAL disease diagnosis; DELAYED diagnosis; RICKETTSIAL diseases; FEVER; INTRAVENOUS therapy; ENDOTHELIUM; POINT-of-care testing; CRITICALLY ill; INFLAMMATION; DOXYCYCLINE; PATIENTS; EXANTHEMA; SEROLOGY; DISEASE duration; POLYMERASE chain reaction
- Publication
Indian Journal of Critical Care Medicine, 2021, Vol 25, Issue S2, pS138
- ISSN
0972-5229
- Publication type
Article
- DOI
10.5005/jp-journals-10071-23841