Predictors of mortality in scrub typhus fever: A cross-sectional study from central India

Scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi , has re-emerged as a major public health challenge in India, especially in rural and resource-constrained areas. Due to its nonspecific presentation and limited diagnostic access, early diagnosis is often missed, leading to potentially fatal complications like acute respiratory distress syndrome (ARDS), renal failure, liver dysfunction, and encephalopathy. This cross-sectional study aimed to identify clinical and laboratory predictors of mortality in scrub typhus patients and emphasize the vital role of primary care physicians in early diagnosis and management.

A total of 200 patients with serologically confirmed scrub typhus were enrolled over a one-year period. Detailed demographic, clinical, laboratory, and outcome data were collected and analyzed to determine associations with in-hospital mortality.

Out of 200 patients, 168 (84%) recovered while 32 (16%) died. Mortality was higher in older patients, females, and rural residents. Symptoms like breathlessness, jaundice, abnormal behavior, and myalgia were strongly associated with poor outcomes. Laboratory findings including thrombocytopenia, elevated liver enzymes, creatinine, and high CRP were significant mortality predictors. Major complications included ARDS, renal failure, and liver failure. Farming occupation and rural residence also correlated with increased risk of death ( p < 0.01).

Scrub typhus remains a significant cause of mortality, especially in rural and resource-limited areas. Patients presenting with severe symptoms and abnormal laboratory markers are at higher risk of poor outcomes. Early recognition of these high-risk features by healthcare providers is critical. Prompt and targeted management can significantly improve survival rates.