Fever with non-responding bronchospasm- a rare presentation of scrub typhus in India

Lung involvement is a commonly seen in scrub typhus. It ranges from simple pneumonitis to ARDS. Prompt and timely management of such cases has favourable outcome. Isolated non responding bronchospasm in absence of typical clinical features of scrub typhus can pose a diagnostic challenge. We report a case of man from Eastern India with short duration fever, persistent headache, and isolated bronchospasm responding to oral doxycycline. There was partial response to oral azithromycin. We also highlight the importance of re-examining a patient in non-responding case as it has led to identification of eschar.

Content

Author and article information

Journal

Title: Annals of Tropical Medicine & Public Health

Publisher: Africa Health Research Organization

Publication date (Electronic): 13 June 2022

Volume: 1

Issue: 1

Affiliations

[1 ] Calcutta School of Tropical Medicine, Kolkata, India

Author notes

[* ]Email: propkb5@ 123456gmail.com .

Author information

Pranab Kumar Bhattacharya https://orcid.org/0000-0001-5430-3814

Article

DOI: 10.36295/ATMPH/2022/3258

SO-VID: 54872b58-51aa-4925-8fce-11f5df6cd4eb

License:

This work has been published open access under Creative Commons Attribution License CC BY 4.0 , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com .

History

Date received : 5 June 2022

Date accepted : 11 June 2022

Funding

Nil

Data availability: All data generated or analysed during this study are included in this published article (and its supplementary information files).

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: Brochospasm,Scrub typhus,partial response,Azithromycin,Eshar

References

Khandelwal Hariom, Rai Vinay, Jangpangi Dev Singh. Scrub typhus: Experience in management of cases with pulmonary involvement in critical care unit. Indian Journal of Critical Care Medicine. Vol. 20(3):200–201. 2016. Jaypee Brothers Medical Publishing. [Cross Ref]
Varghese GeorgeM, Raj Deepa, Francis MarkR, Sarkar Rajiv, Trowbridge Paul, Muliyil Jayaprakash. Epidemiology & risk factors of scrub typhus in south India. Indian Journal of Medical Research. Vol. 144(1)2016. Medknow. [Cross Ref]
Paris Daniel H., Walker David H., Day Nicholas P., Shelite Thomas R.. Unresolved Problems Related to Scrub Typhus: A Seriously Neglected Life-Threatening Disease. The American Journal of Tropical Medicine and Hygiene. Vol. 89(2):301–307. 2013. American Society of Tropical Medicine and Hygiene. [Cross Ref]
Isaac R., Varghese G. M., Mathai E., Manjula J., Joseph I.. Scrub Typhus: Prevalence and Diagnostic Issues in Rural Southern India. Clinical Infectious Diseases. Vol. 39(9):1395–1396. 2004. Oxford University Press (OUP). [Cross Ref]
Peesapati Nrushen, Lakkapragada Rohit, Sunitha S, Sivaram PV. Clinical manifestations and complications of scrub typhus: A hospital-based study from North Andhra. Astrocyte. Vol. 2(3)2015. Medknow. [Cross Ref]
Abhilash KPP, Mannam PR, Rajendran K, John RA, Ramasami P. Chest radiographic manifestations of scrub typhus. Journal of Postgraduate Medicine. Vol. 62(4)2016. Medknow. [Cross Ref]
Sahoo Jyoti Narayan, Harde Yogesh. Acute respiratory failure in scrub typhus patients. Indian Journal of Critical Care Medicine. Vol. 20(8):480–484. 2016. Jaypee Brothers Medical Publishing. [Cross Ref]
Bhargava Anurag, Kaushik Reshma, Kaushik RajeevMohan, Sharma Anita, Ahmad Sohaib, Dhar Minakshi, Mittal Garima, Khanduri Sushant, Pant Priyannk, Kakkar Rajesh. Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality. Indian Journal of Medical Research. Vol. 144(6)2016. Medknow. [Cross Ref]
Bhattacharyya Prithwis, Rapsang AmyG. Scrub typhus. Indian Journal of Anaesthesia. Vol. 57(2)2013. Medknow. [Cross Ref]
Mandell Lionel A., Wunderink Richard G., Anzueto Antonio, Bartlett John G., Campbell G. Douglas, Dean Nathan C., Dowell Scott F., File Thomas M., Musher Daniel M., Niederman Michael S., Torres Antonio, Whitney Cynthia G.. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinical Infectious Diseases. Vol. 44(Supplement_2)2007. Oxford University Press (OUP). [Cross Ref]

Comments

Comment on this article

[1] Khandelwal Hariom, Rai Vinay, Jangpangi Dev Singh. Scrub typhus: Experience in management of cases with pulmonary involvement in critical care unit. Indian Journal of Critical Care Medicine. Vol. 20(3):200–201. 2016. Jaypee Brothers Medical Publishing. [Cross Ref]

[2] Varghese GeorgeM, Raj Deepa, Francis MarkR, Sarkar Rajiv, Trowbridge Paul, Muliyil Jayaprakash. Epidemiology & risk factors of scrub typhus in south India. Indian Journal of Medical Research. Vol. 144(1)2016. Medknow. [Cross Ref]

[3] Paris Daniel H., Walker David H., Day Nicholas P., Shelite Thomas R.. Unresolved Problems Related to Scrub Typhus: A Seriously Neglected Life-Threatening Disease. The American Journal of Tropical Medicine and Hygiene. Vol. 89(2):301–307. 2013. American Society of Tropical Medicine and Hygiene. [Cross Ref]

[4] Isaac R., Varghese G. M., Mathai E., Manjula J., Joseph I.. Scrub Typhus: Prevalence and Diagnostic Issues in Rural Southern India. Clinical Infectious Diseases. Vol. 39(9):1395–1396. 2004. Oxford University Press (OUP). [Cross Ref]

[5] Peesapati Nrushen, Lakkapragada Rohit, Sunitha S, Sivaram PV. Clinical manifestations and complications of scrub typhus: A hospital-based study from North Andhra. Astrocyte. Vol. 2(3)2015. Medknow. [Cross Ref]

[6] Abhilash KPP, Mannam PR, Rajendran K, John RA, Ramasami P. Chest radiographic manifestations of scrub typhus. Journal of Postgraduate Medicine. Vol. 62(4)2016. Medknow. [Cross Ref]

[7] Sahoo Jyoti Narayan, Harde Yogesh. Acute respiratory failure in scrub typhus patients. Indian Journal of Critical Care Medicine. Vol. 20(8):480–484. 2016. Jaypee Brothers Medical Publishing. [Cross Ref]

[8] Bhargava Anurag, Kaushik Reshma, Kaushik RajeevMohan, Sharma Anita, Ahmad Sohaib, Dhar Minakshi, Mittal Garima, Khanduri Sushant, Pant Priyannk, Kakkar Rajesh. Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality. Indian Journal of Medical Research. Vol. 144(6)2016. Medknow. [Cross Ref]

[9] Bhattacharyya Prithwis, Rapsang AmyG. Scrub typhus. Indian Journal of Anaesthesia. Vol. 57(2)2013. Medknow. [Cross Ref]

[10] Mandell Lionel A., Wunderink Richard G., Anzueto Antonio, Bartlett John G., Campbell G. Douglas, Dean Nathan C., Dowell Scott F., File Thomas M., Musher Daniel M., Niederman Michael S., Torres Antonio, Whitney Cynthia G.. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinical Infectious Diseases. Vol. 44(Supplement_2)2007. Oxford University Press (OUP). [Cross Ref]