Prospective study to assess the treatment modalities and fever defervescence in patients with scrub typhus from a tertiary care centre in South India

Prospective study to assess the treatment modalities and fever defervescence in patients with scrub typhus from a tertiary care centre in South India

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Background and objectives: Fever defervescence in scrub typhus, a zoonotic bacterial infection is used as a surrogate marker of disease resolution.Failure of fever defervescence prompts clinicians to suspect alternate diagnoses and treatment.In this observational study, various treatment regimens were correlated with clinical outcomes.

Methods: All adult patients with a diagnosed scrub typhus were included; various antibiotic regimens used and clinical outcomes were studied.Data was analyzed using SPSS software for windows 16, with a 2-sided P-value of 0.05 or less was considered statistically significant.

Results: In 177 hospitalized patients with scrub typhus, combination 4 Piece Modular Sectional therapy (doxycycline and azithromycin) was used in 74 subjects with doxycycline and azithromycin used in 46 and 57 subjects, respectively.Incidence of delayed defervescence was seen in 31.6%, Combination therapy being preferred in sicker patients (SOFA score 8.

82).Presence of respiratory dysfunction was associated with a delay in fever defervescence [risk ratio 2.50(1.

18-5.3)].Patients receiving doxycycline did better in terms of oxygen requirement and the presence of hypotension.

The overall case fatality rate was 5.6%.The severity of illness rather than the choice of antibiotics predicted the outcome in scrub typhus.

Interpretation & conclusion: Combination therapy with doxycycline and azithromycin is the most common regimen used.Incidence of 4 Channel LOC delayed defervescence (31.6%) is increasing despite therapy and the involvement of respiratory dysfunction is an independent predictor of delayed fever defervescence.