Coagulation Abnormalities in Severe Scrub Typhus and Their Association with Complications

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dc.contributor.authorSingla, Den_US
dc.contributor.authorSingh, Ben_US
dc.contributor.authorAhire, Ken_US
dc.contributor.authorMahajan, Sanjay Ken_US
dc.date.accessioned2023-06-17T08:23:14Z
dc.date.available2023-06-17T08:23:14Z
dc.date.issued2023-05
dc.description.abstractAim: To describe coagulation abnormalities and their association with complications in patients with severe scrub typhus. Materials and methods: A cohort study was conducted among all patients of severe scrub typhus [immunoglobulin M (IgM) positive] who reported to this facility from 1st August 2019 to 31st July 2020 and met our inclusion criteria. We estimated the incidence of severe thrombocytopenia (<50,000/µL) and overt disseminated intravascular coagulation (DIC) (DIC score of ?5). We determined the association [risk (RR) ratios] of these abnormalities with complications of scrub typhus, namely—septic shock, multiple organ dysfunction syndrome (MODS), and septic shock with MODS. Results: In total, 71 patients were studied with a mean age of 50 ± 15.5 years, of which 45 (63.4%) were females. On presentation, fever 70 (98.5%), myalgias 22 (31.0%), loose stools 13(18.3%), cough, vomiting, headache 11 (15.5%), altered sensorium 10(14.1%), and pain abdomen 9 (12.7%) were main symptoms. On examination, hypotension 31 (43.7%), eschar 25 (35.2%), icterus 17 (23.9%), and rash 16 (22.5%) were noted. The d-dimer (>0.5 µg/mL) levels were increased in all (100%) patients. Thrombocytopenia (91.5%) was the commonest hematological abnormality and 31 (43.6%) of them had severe thrombocytopenia, 25 (35.2%) patients had low fibrinogen levels (<200 mg/dL) and prothrombin time (PT >16.7 seconds) was prolonged in 20 (28.1%). A total of 42 (59.1%) patients developed MODS, 33 (46.4%) developed septic shock, 24 (33.8 %) had MODS with septic shock, 17 (23.9%) developed overt DIC, and eight (11.2%) died. Severe thrombocytopenia (p = ?0.028) and overt DIC (p = 0.045) were significantly associated with septic shock development. Conclusion: In the patients admitted with severe scrub typhus; thrombocytopenia was the commonest hematological abnormality. The development of septic shock was significantly associated with severe thrombocytopenia and overt DIC.en_US
dc.identifier.affiliationsResident, Department of Medicineen_US
dc.identifier.affiliationsAssociate Professor, Department of Community Medicineen_US
dc.identifier.affiliationsProfessor, Department of Medicine, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, Indiaen_US
dc.identifier.citationSingla D, Singh B, Ahire K, Mahajan Sanjay K. Coagulation Abnormalities in Severe Scrub Typhus and Their Association with Complications. Journal of the Association of Physicians of India. 2023 May; 71(5): 29-32en_US
dc.identifier.issn0004 – 5772
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/216404
dc.languageenen_US
dc.publisherAssociation of Physicians of Indiaen_US
dc.relation.issuenumber5en_US
dc.relation.volume71en_US
dc.source.urihttps://doi.org/10.5005/japi-11001-0237en_US
dc.titleCoagulation Abnormalities in Severe Scrub Typhus and Their Association with Complicationsen_US
dc.typeJournal Articleen_US
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