Tryaksh International Journal of Emergency Medicine and Case Reports


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Volume-1 Issue-1, 2020


SCRUB TYPHUS PRESENTING AS BILATERAL SUBCONJUCTIVAL HAEMORRHAGE Article Type: Case Report

Dr Anubhav Chauhan

Senior Resident, Deptt. of Ophthalmology, Dr Yashwant Singh Parmar Govt. Medical College, Nahan, District Sirmour, Himachal Pradesh, India. Email: chauhan.anubhav2@gmail.com

Suggested Citation :

Citation: Dr Anubhav Chauhan, Scrub Typhus Presenting as Bilateral Subconjuctival Haemorrhage, Tryaksh International Journal of Emergency Medicine and Case Reports (TIJEMC), Volume 1 Issue 1: TIJEMC-19010101.

Abstract

Scrub typhus is a caused by Orientia tsutsugamushi. It affects people of all ages. It is an acute febrile illness, associated with rash and often an eschar. A wide spectrum of clinical manifestations are associated with this disease and it affects nearly every organ system of the body. Subconjuctival haemorrhage is one of the rare manifestations of this disease and was seen in our case. Methods: A 16-year-old boy underwent a complete systemic examination plus laboratory investigation for his febrile illness which came out to be scrub typhus.
Keywords: Scrub typhus,ocular,manifestation

Full Text

Case
A 16-year-old boy was admitted in our institution with a history of fever with bilateral red eyes for the past five days. His general physical examination revealed high
Blood investigations revealed mildly deranged renal function and liver function tests with marked thrombocytopenia and proteinuria.Tests for scrub typhus was positive while tests for malarial parasite and dengue were negative.Supportive therapy in the form of intravenous fluids along with antibiotics led to complete improvement in the health of the child.The rare feature of our case was that thrombocytopenia in the patient manifested as bilateral subconjuctival haemorrhages while no eschar, organomegaly and lymphadenopathy was seen.
Discussion
Scrub typhus is a disease caused by the pathogen Orientia tsutsugamushi.The infected larval stages of mites (chiggers) inoculate humans (accidental hosts) while feeding and transmit the disease. It can present as a simple febrile illness or can present with multiple organ dysfunction in severe cases. Mortality rates from scrub typhus is estimated to lie between 0%- 30% in untreated cases.[1] It usually presents as an acute febrile illness.

Abstract
Scrub typhus is a caused by Orientia tsutsugamushi. It affects people of all ages. It is an acute febrile illness, associated with rash and often an eschar. A wide spectrum of clinical manifestations are associated with this disease and it affects nearly every organ system of the body. Subconjuctival haemorrhage is one of the rare manifestations of this disease and was seen in our case.
Methods: A 16-year-old boy underwent a complete systemic examination plus laboratory investigation for his febrile illness which came out to be scrub typhus.
Keywords: Scrub typhus,ocular,manifestation
Tryaksh International Journal of Emergency Medicine and Case Reports (TIJEMC) 2019| Volume 1| Issue1 1
grade fever while his systemic examination involving chest, cardiovascular system,abdomen,skin and central nervous system was within normal limits.Ocular examination revealed bilateral subconjuctival haemorrhages(figure 1a and figure 1b) while rest of his ocular profile was normal.
with high fever, malaise, headache, cough and generalised lymphadenopathy. The most characteristic clinical feature of scrub typhus is the presence of an eschar at the site of the bite of the mite. If present, it is almost diagnostic. The prevalence of an eschar is highly variable, from 7 to 80%. Ocular manifestations in the form of papilloedema, soft exudates, engorgement of the retinal veins, uveitis, subconjunctival haemorrhages, optic neuritis and branch retinal vein occlusion has been reported.[2]
Laboratory studies usually reveal leukopenia, thrombocytopenia, deranged hepatic and renal function, proteinuria and reticulonodular infiltrate. Laboratory confirmation of scrub typhus is generally by serological methods.The recommended treatment regimen for scrub typhus is doxycycline. Alternative regimens include tetracycline, chloramphenicol, azithromycin, ciprofloxacin, rifampicin, and roxithromycin.[3]
References
1. Rajapakse S, Rodrigo C , Fernando D. Scrub typhus: pathophysiology, clinical manifestations and prognosis. Asian Pacific Journal of Tropical Medicine 2012;5(4):261-264.
2. Rajapakse S, Weeratunga P, Sivayoganathan S, Fernando SD. Clinical manifestations of scrub typhus. Trans R Soc Trop Med Hyg 2017; 00: 1–12.
3. Rapsang AG, Bhattacharyya P. Scrub typhus. Indian J Anaesth 2013; 57(2): 127–134.
Scrub Typhus Presenting as Bilateral Subconjuctival Haemorrhage
Tryaksh International Journal of Emergency Medicine and Case Reports (TIJEMC) 2019| Volume 1| Issue1 2
Dr. Anubhav Chauhan, Senior Resident, Deptt. of Ophthalmology, Dr Yashwant Singh Parmar Govt. Medical College, Nahan, District Sirmour, Himachal Pradesh, India. Email:chauhan.anubhav2@gmail.com telephone:+919816991482.


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