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. 2018 Feb 4;7(1):16-23.
doi: 10.5492/wjccm.v7.i1.16.

Spectrum of cardiac manifestations and its relationship to outcomes in patients admitted with scrub typhus infection

Gunasekaran Karthik  1 , Thomas Isaiah Sudarsan  2 , John Victor Peter  2 , Thambu Sudarsanam  1 , George M Varghese  3 , Paul Kundavaram  1 , Sowmya Sathyendra  1 , Ramya Iyyadurai  1 , Kishore Pichamuthu  2
Affiliations

Spectrum of cardiac manifestations and its relationship to outcomes in patients admitted with scrub typhus infection

Gunasekaran Karthik et al. World J Crit Care Med. .

Abstract

Aim: To study the spectrum of cardiac manifestations in scrub typhus infection and assess its relationship to outcomes.

Methods: Demographic data, electrocardiographic (ECG) changes, left ventricular (LV) systolic and diastolic function, myocardial injury (defined as troponin T > 14 pg/mL), and pericardial effusion were documented. Myocarditis was diagnosed when myocardial injury was associated with global LV systolic dysfunction. The relationship between myocarditis and outcomes was assessed using logistic regression analysis and expressed as odds ratio (OR) with 95%CI.

Results: The cohort (n = 81; 35 males) aged 49.4 ± 16.1 years (mean, SD) presented 8.1 ± 3.1 d after symptom onset. The APACHE-II score was 15.7 ± 7.0. Forty-eight (59%) patients were ventilated, and 46 (56%) required vasoactive agents. Mortality was 9.9%. ECG changes were non-specific; sinus tachycardia was the most common finding. Myocardial injury was evident in 61.7% of patients and LV systolic dysfunction in 30.9%. A diagnosis of myocarditis was made in 12.3%. In addition, seven patients with regional wall motion abnormalities had LV systolic dysfunction and elevated cardiac enzymes. Mild diastolic dysfunction was observed in 18 (22%) patients. Mild to moderate pericardial effusion was seen in 51%. On multivariate logistic regression analysis, patients with myocarditis tended to be older (OR = 1.04, 95%CI: 0.99-1.09), had shorter symptom duration (OR = 0.69, 95%CI: 0.49-0.98), and tended to stay longer in hospital (OR = 1.17, 95%CI: 0.98-1.40). Myocarditis was not associated with increased mortality.

Conclusion: In scrub typhus infection, cardiac manifestations are frequent and associated with increased morbidity but not mortality.

Keywords: Myocarditis; Outcome; Scrub typhus.

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Conflict of interest statement

Conflict-of-interest statement: There are no financial implications or conflict of interest to declare for any of the authors.

References

    1. Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, Abraham OC, Abraham AM, Thomas K. Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Trop Doct. 2010;40:129–133. - PubMed
    1. Varghese GM, Trowbridge P, Janardhanan J, Thomas K, Peter JV, Mathews P, Abraham OC, Kavitha ML. Clinical profile and improving mortality trend of scrub typhus in South India. Int J Infect Dis. 2014;23:39–43. - PubMed
    1. Griffith M, Peter JV, Karthik G, Ramakrishna K, Prakash JA, Kalki RC, Varghese GM, Chrispal A, Pichamuthu K, Iyyadurai R, et al. Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission. Indian J Crit Care Med. 2014;18:497–502. - PMC - PubMed
    1. Sittiwangkul R, Pongprot Y, Silviliarat S, Oberdorfer P, Jittamala P, Sirisanthana V. Acute fulminant myocarditis in scrub typhus. Ann Trop Paediatr. 2008;28:149–154. - PubMed
    1. Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S. Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. J Infect Public Health. 2012;5:82–88. - PubMed

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