PREVALANCE OF PULMONARY & RADIOLOGICAL MANISFESTATIONS IN SCRUB TYPHUS PATIENTS IN INDEX MEDICAL COLLEGE, INDORE

1Dr. Shiv Kumar Pandey (Junior Resident 3rd Year), 2Dr. Vishal Malviya (Junior Resident 3rd Year), 3Dr. Kumar Girendra (Professor & HOD) & 4Dr. Abhijeet Khandelwal (Associate Professor) 1,2,3&4Dept. of Respiratory Medicine, Index Medical College Hospital & Research Centre, Indore, M.P. Article Info: Received 20 August 2021; Accepted 29 September 2021 DOI: https://doi.org/10.32553/ijmbs.v5i10.2235 Corresponding author: Dr. Vishal Malviya Conflict of interest: No conflict of interest. Abstract Background & Method: 20 patients with scrub typhus who visited Index Medical College Hospital & Research Centre, Indore. Diagnosis of scrub typhus was made from blood samples based on serology (scrub typhus IgM / IgG antibody). We observed the following symptoms – eschar, cough, SOB, fever, chest pain, nausea /vomiting, abdominal pain, seizures, & the various laboratory investigations were done (TLC, ESR, S.CREATINE, LFT, SERUM ELECTROLYTES ETC.). CXR (PA / AP) were analysed on the basis of the presence, location and zonal predilection for consolidations, reticulo nodular shadows, hilar shadows and lower lobe haziness. Conclusion: Pulmonary manifestation of Scrub typhus is uncommon. But can be fatal, particulary in the form of ARDS. Antibiotic therapy may prove beneficial in initial phase. In acute febrile illness (SCRUB TYPHUS), pulmonary symptoms and radiological menifestations should be rule out in early stages to prevent the mortality.


Introduction
Scrub typhus, also known as tsutsugamushi disease, is an acute febrile illness caused by infection with Orientia tsutsugamushi and characterized by focal or disseminated vasculitis and perivasculitis, which may involve the lungs, heart, liver, spleen, and central nervous system (1)(2)(3). Scrub typhus is a public health problem in Asia, where about 1 million new cases are identified annually and 1 billion people may be at risk for this disease (4). In addition, reports of infection are becoming increasingly common in travelers returning from Asia to their home countries (5,6). The symptoms are usually mild and the clinical course self-limited, with spontaneous recovery after a few days; however, some cases are more severe and protracted, and the disease may be fatal. The diagnosis of scrub typhus is based on the patient's history of exposure, the clinical features, and the results of serologic testing (7,8). The radiologic findings of scrub typhus are varied and nonspecific (9). Nevertheless, an awareness of the related findings at imaging, especially at computed tomography (CT), may facilitate accurate diagnosis.
Scrub Typhus is also known as Tsutsugamushi disease. It is as bacterial infection transmitted by Larval Trombiculid Mites. Causative agent -Orientia Tsutsugamushi, is an intracellular bacterium leads to eschar formation at inoculation site.
Aim-to estimate prevalence of pulmonary manifestations and radiological findings in scrub typhus patients, visited Index Medical College, Indore

Objectives
• To determine the frequency of pattern of pulmonary symptoms in scrub typhus patients. • To determine frequency of pattern of Cxray findings in patients with scrub typhus.

Material & Method
Observational study was done of 20 patients with scrub typhus who visited Index Medical College Hospital & Research Centre, Indore from 1st August 2019 to 30th July 2021.
Diagnosis of scrub typhus was made from blood samples based on serology (scrub typhus IgM / IgG antibody).
We observed the following symptoms -eschar, cough, SOB, fever, chest pain, nausea /vomiting, abdominal pain, seizures, & the various laboratory investigations were done (TLC, ESR, S.CREATINE, LFT, SERUM ELECTROLYTES ETC.). CXR (PA / AP) were analysed on the basis of the presence, location and zonal predilection for consolidations, reticulo nodular shadows, hilar shadows and lower lobe haziness.

Inclusion criterias-Age > 16 years & no previous history of pulmonary disease.
Exclusion criterias -Patients having chronic pulmonary disease (pneumonia, bronchiectasis); with cardiovascular illness; immune compromised patients. demonstrating the relationship between IP and severity of the disease among patients with scrub typhus.

Results
The characteristic pathophysiologic findings in scrub typhus are well known. Multiplication of the organisms in the endothelial cells lining the small blood vessels causes an endothelial proliferation and perivascular inflammatory cell infiltration, and it results in rash, hemorrhage, and microthrombi. The result is a widespread infectious vasculitis or perivasculitis (11). Such microangiopathies may involve the heart, lungs, brain, kidneys, gastrointestinal tract, liver, spleen and lymph nodes (1,4,6,(8)(9)(10). The clinical parameters representing the severity of the disease are known to be hypotension, thrombocytopenia, leukocytosis, hypoxia, acute renal failure, hypoalbuminemia and hepatic dysfunction (3,(5)(6)(7). Although IP frequently occurs in the patients with scrub typhus, its exact pathophysiologic mechanism is not well known. The marked dilatation and congestion of septal capillaries, extravasation of red blood cells into the alveoli, and septal widening by the lymphocytes, histiocytes and a few polymorphonuclear leukocytes were found in the lung of mice infected with the rickettsia (12). When considering this pathologic study and the fact that the main pathogenesis of scrub typhus is widespread microangiopathy, we suggested that this microangiopathic lesion could be associated with the causes of IP (13). Therefore, we assumed that IP (Interstitial Pneumonia) would be associated with other clinical parameters that represent the severity of the disease.

Conclusion
Pulmonary manifestation of Scrub typhus is uncommon. But can be fatal, particulary in the form of ARDS. Antibiotic therapy may prove beneficial in initial phase. In acute febrile illness (SCRUB TYPHUS), pulmonary symptoms and radiological menifestations should be rule out in early stages to prevent the mortality.