Vol. 3, Issue 6 (2017)
Eschar in various stages: A vital clue in febrile illness
Author(s): Ajay Kumar Khandal
Abstract: Scrub typhus is a common aetiology for acute febrile illness in Indian circumstances, despite its commonness it is often considered late in the differential diagnosis, as its clinical features overlap with common tropical fever: typhoid fever, dengue and malaria. Moreover, lack of diagnostic facility by ELISA and IFA (immunoflorescene assay) in practice settings hinders its timely diagnosis. The pathologic basis of disease in scrub typhus is a vasculitis (infective) as the causative organism invades the endothelium. Understandably, it causes various organ impairment viz pneumonia, acute respiratory distress syndrome (ARDS), pericarditis, encephalitis, acute kidney injury, thrombocytopenia and hepatic injury, resulting in significant morbidity and mortality, when not suspected and treated early. Presence of eschar is a pathognomonic clinical feature, but its prevalence varies widely, however, when thoroughly sought for, it can provide a vital clue to this neglected entity, more-so, in resource limited setups where this single clinical finding in the setting of acute undiffe, rentiated fever can be life saving. We report a case of acute febrile illness, with dyspnea and interstitial infiltrates on chest Xray, who was treated as enteric fever since eight days, whereby the discovery of the eschar lead to timely diagnosis and intervention, halting the progression of the disease to severe pneumonia and ARDS.