Journal des maladies infectieuses et de la médecine

Aims and Objective: To study the occurrence of scrub typhus in patients with cirrhosis at a tertiary care centre at Delhi. Material and Methods: This was a retrospective study of 4 patients who were admitted to institute of liver and biliary sciences from September 2017 to October 2018 with chief complaints indicating systemic involvement and were subsequently diagnosed as scrub typhus while they were in the hospital.In all cases diagnosis was based on detection of antibody against Orientia tsutsugamushi using IgM ELISA. Results: Eschar, the pathognomic feature of scrub typhus was present in only one case. Abdomen, nape of neck, groin and axilla were the observed sites of eschar. Lymphadenopathy was present in all patients. Thrombocytopenia was observed in two patients at the time of admission. Alanine transaminase, aspartate transaminase and alkaline phosphatase was elevated in all the cases. Bilirubin was also found to be raised in three cases. Laboratory evidence of hepatic dysfunction was present in all cases. In all cases diagnosis of scrub typhus was made by IgM ELISA. All patients were put on Doxycycline along with treatment of other comorbid conditions. All the patients were cured and no mortality occurred. Conclusion: A patient presenting with fever of long duration with elevated liver enzymes, a diagnosis of scrub typhus should be considered. An early diagnosis & timely antibiotic therapy prevents further complications and significantly reduces mortality. An empirical therapy with doxycycline without laboratory tests, if there is high index of suspicion is a matter of further study and debate.

In patients with immunosuppression, Strongyloideshyperinfection syndrome may occur producing pulmonary symptoms. We report a case of a young male patient who presented with symptoms of intestinal obstruction followed by hemoptysis and breathlessness. He had no evidence of immunosuppression. Sputum and stool examination showed Strongyloides larvae and the patient had complete recovery with treatment.