Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India

Introduction Scrub typhus is a resurging zoonotic infection prevalent in South Asia with many recent outbreaks in India. It can mimic other tropical infections and the disease spectrum ranges from subclinical illness to life-threatening disease with multiorgan dysfunction. This study was conducted to study the pattern of hepatic and renal injury. Methods A retrospective study was done on 176 patients diagnosed by detecting IgM antibodies using an enzyme-linked immunosorbent assay (ELISA) over a period of three years at a tertiary center in Chandigarh, India. They were treated with doxycycline (azithromycin if pregnant) and supportive therapies. The patterns of hepatic and renal functions, along with the need of renal replacement therapy, were recorded and evaluated. The values were expressed as mean ± SD, and p values were calculated to establish statistical significance. Results Most of the cases were from the state of Haryana (37.5%), followed by Punjab (33.5%), Himachal Pradesh (13.6%), Uttar Pradesh (10.2%) and Chandigarh (5%). 30% of the study population was engaged in agriculture. The mean age was 32.3 ± 13.5 years with range of 13-65 years. A peak in the incidence was observed during monsoon months. Approximately 13% of the patients died. Urea, creatinine, bilirubin and aspartate transaminase were found to be higher in mortality group with statistical significance (p < 0.05). Alanine transaminase was higher and albumin was lower in the mortality group but without statistical significance. 27.8% had acute kidney injury, 90.9% had liver dysfunction and one patient had acute liver failure. All the pregnant patients had fetal loss. Conclusion Renal and liver dysfunctions are common in scrub typhus, and their occurrence adversely affects the outcome.

Keywords: acute kidney injury; acute liver failure; aki; chandigarh; hepatic and renal; hepatitis; india; liver dysfunction; scrub typhus.