{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T20:05:12Z","timestamp":1787169912626,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Background and objectives:<\/jats:italic>\n                      Fever defervescence in scrub typhus, a zoonotic bacterial infection is used as a surrogate marker of disease resolution. Failure of fever defervescence prompts clinicians to suspect alternate diagnoses and treatment. In this observational study, various treatment regimens were correlated with clinical outcomes.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Methods:<\/jats:italic>\n                      All adult patients with a diagnosed scrub typhus were included; various antibiotic regimens used and clinical outcomes were studied. Data was analyzed using SPSS software for windows 16, with a 2-sided P-value of 0.05 or less was considered statistically significant.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Results:<\/jats:italic>\n                      In 177 hospitalized patients with scrub typhus, combination therapy (doxycycline and azithromycin) was used in 74 subjects with doxycycline and azithromycin used in 46 and 57 subjects, respectively. Incidence of delayed defervescence was seen in 31.6%, Combination therapy being preferred in sicker patients (SOFA score 8.82). Presence of respiratory dysfunction was associated with a delay in fever defervescence [risk ratio 2.50(1.18-5.3)]. Patients receiving doxycycline did better in terms of oxygen requirement and the presence of hypotension. The overall case fatality rate was 5.6%. The severity of illness rather than the choice of antibiotics predicted the outcome in scrub typhus.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Interpretation &amp; conclusion:<\/jats:italic>\n                      Combination therapy with doxycycline and azithromycin is the most common regimen used. Incidence of delayed defervescence (31.6%) is increasing despite therapy and the involvement of respiratory dysfunction is an independent predictor of delayed fever defervescence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/0972-9062.321748","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T05:57:43Z","timestamp":1637215063000},"page":"33-38","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Prospective study to assess the treatment modalities and fever defervescence in patients with scrub typhus from a tertiary care centre in South India"],"prefix":"10.4103","volume":"58","author":[{"given":"Rohit","family":"Barnabas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KPP","family":"Abhilash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George M","family":"Varghese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Shubanker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Ramya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JAJ","family":"Prakash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-5-20240830","doi-asserted-by":"crossref","first-page":"147","DOI":"10.4103\/0974-777X.192966","article-title":"Acute undifferentiated febrile illness in patients presenting to a Tertiary Care Hospital in South India: clinical spectrum and outcome","volume":"8","author":"Abhilash","year":"2016","journal-title":"J Global Infect Dis"},{"key":"R2-5-20240830","doi-asserted-by":"crossref","first-page":"S203","DOI":"10.1086\/596576","article-title":"Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi","volume":"48","author":"Kelly","year":"2009","journal-title":"Clin Infect Dis"},{"key":"R3-5-20240830","doi-asserted-by":"crossref","first-page":"177","DOI":"10.4103\/0022-3859.118033","article-title":"Eschar in scrub typhus:A valuable clue to the diagnosis","volume":"59","author":"Abhilash","year":"2013","journal-title":"J Postgrad Med"},{"key":"R4-5-20240830","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ijid.2014.02.009","article-title":"Clinical profile and improving mortality trend of scrub typhus in South India","volume":"23","author":"Varghese","year":"2014","journal-title":"Int J Infect Dis"},{"key":"R5-5-20240830","doi-asserted-by":"crossref","first-page":"e981","DOI":"10.1016\/j.ijid.2013.05.017","article-title":"Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome","volume":"17","author":"Varghese","year":"2013","journal-title":"Int J Infect Dis"},{"key":"R6-5-20240830","doi-asserted-by":"crossref","first-page":"e0003971","DOI":"10.1371\/journal.pntd.0003971","article-title":"A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi)","volume":"9","author":"Taylor","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"R7-5-20240830","doi-asserted-by":"crossref","first-page":"441","DOI":"10.4269\/ajtmh.2008.79.441","article-title":"Clinical Characteristics of Acute Q Fever, Scrub Typhus, and Murine Typhus with Delayed Defervescence Despite Doxycycline Treatment","volume":"79","author":"Lai","year":"2008","journal-title":"Am. 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