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Govindarajan R, Sankar SG, Kumar MS, Rajamannar V, Krishnamoorthi R, Anand AAP, Kumar A, Samuel PP. Molecular detection of Orientia tsutsugamushi in ectoparasites & their small mammal hosts captured from scrub typhus endemic areas in Madurai district, India. Indian J Med Res 2024; 159:180-192. [PMID: 38494626 PMCID: PMC11050748 DOI: 10.4103/ijmr.ijmr_3530_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND OBJECTIVES Scrub typhus, caused by Orientia tsutsugamushi present in small mammals harbouring the ectoparasites. A study was undertaken to detect the pathogen present in small mammals and its ectoparasites in the scrub typhus-reported areas. METHODS The small mammals (rodents/shrews) and its ectoparasites were screened for O. tsutsugamushi using nested PCR amplification of the groEL gene. Small mammals were collected by trapping and screened for ectoparasites (mites, ticks and fleas) by combing method. RESULTS All the chigger mites collected were tested negative for O. tsutsugamushi . Interestingly, adult non-trombiculid mites ( Oribatida sp., Dermanyssus gallinae ), fleas ( Xenopsylla astia, X. cheopis, Ctenophalides felis and Ctenophalides sp.) and ticks ( Rhipicephalus sanguineus , R. haemaphysaloides ) screened were found to be positive for O. tsutsugamushi , which the authors believe is the first report on these species globally. Bandicota bengalensis with O. tsutsugamushi infection is reported for the first time in India. The O. tsutsugamushi groEL sequences from the positive samples were similar to the reference strains, Karp and Ikeda and phylogenetically clustered in clade IV with less evolutionary divergence. The blood samples of Rattus rattus , Suncus murinus and B. bengalensis collected from this area were tested positive for O. tsutsugamushi ; interestingly, the sequence similarity was much pronounced with their ectoparasites indicating the transmission of the pathogen to host or vice versa . INTERPRETATION CONCLUSIONS The outcome of the present investigations widened our scope on the pathogens present in ectoparasites and rodents/shrews from this area. This will help to formulate the required vector control methods to combat zoonotic diseases.
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Affiliation(s)
- R. Govindarajan
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - S. Gowri Sankar
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - M. Senthil Kumar
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - V. Rajamannar
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | | | | | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Puducherry, India
| | - P. Philip Samuel
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
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Sun H, Lei L, Li J, Niu H, Yang J, Chen M. Clinical treatment of patients with scrub typhus-induced liver injury and intracranial infection. J Int Med Res 2023; 51:3000605231214503. [PMID: 38008898 PMCID: PMC10683569 DOI: 10.1177/03000605231214503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/27/2023] [Indexed: 11/28/2023] Open
Abstract
Scrub typhus is an infectious disease caused by Orientia tsutsugamushi, a bacterium within the family Rickettsiaceae. The clinical symptoms are usually acute and are characterized by fever, eschar formation or ulceration, local or generalized lymphadenopathy, and rash. Because of the extensive damage to small blood vessels throughout the body, scrub typhus can involve multiple systems and organs, causing damage to the respiratory, digestive, and nervous systems and inducing kidney and liver dysfunction. Death can occur in severe cases. We herein report two cases of scrub typhus with liver damage and intracranial infection. Among patients with scrub typhus, the risk of death is significantly higher in those who develop liver injury and intracranial infection. However, there are few reports on the treatment of patients with liver injury and intracranial infection caused by scrub typhus, and relevant treatment experience is thus lacking. Our clinical case report helps to fill the knowledge gap in this area.
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Affiliation(s)
- HongKui Sun
- Critical Care Department, Zhongshan City People’s Hospital, China
| | - Li Lei
- Department of Respiratory Medicine, Zhongshan City People’s Hospital, China
| | - JianWei Li
- Critical Care Department, Zhongshan City People’s Hospital, China
| | - Haiming Niu
- Critical Care Department, Zhongshan City People’s Hospital, China
| | - Jiezhang Yang
- Critical Care Department, Zhongshan City People’s Hospital, China
| | - MiaoLian Chen
- Critical Care Department, Zhongshan City People’s Hospital, China
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John KJ, George TK, Joy M, John B, Abraham O, Prasad J. Costs & outcomes of hospitalized scrub typhus infection in a tertiary hospital in south India. Indian J Med Res 2023; 157:559-567. [PMID: 37530311 PMCID: PMC10466492 DOI: 10.4103/ijmr.ijmr_3917_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 07/08/2023] Open
Abstract
Background & objectives Scrub typhus is a rickettsial infection seen along the Asian-Pacific rim and imposes a considerable burden on affected people in low- and middle-income countries. The present study was aimed to determine the direct cost of hospitalization of scrub typhus and its trend over six years. Methods This was a retrospective, observational, hospital based study of individuals admitted to the hospital, diagnosed with scrub typhus over six years, from January 2013 to December 2018. The potential out of pocket expenditure was evaluated. Results A total of 198 patients were included in the study. The median cost of admission (adjusted to INR 2020) for the six years (2013 to 2018) was found to be ₹ 37,026 (US $ 490) [interquartile range (IQR) 22,996-64,992]. The median cost for patients admitted to the intensive care unit (ICU) was ₹ 128,046 (US $ 1695) (IQR 71,575-201,171), while the cost for patients admitted to the ward-alone was ₹ 33,232 (US $ 440) (IQR 19,609-45,373). The multivariable analysis showed that ARDS and SOFA score were the independent predictors of ICU admission. Interpretation & conclusions Hospitalisation for scrub typhus is associated with a substantial healthcare expense. The predictors of increased cost were the presence of acute respiratory distress syndrome (ARDS), shock, increasing sequential organ failure assessment (SOFA) score and duration of hospital stay.
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Affiliation(s)
- Kevin John John
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tarun K. George
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Melvin Joy
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bimi John
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - O.C. Abraham
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jasmine Prasad
- Department of Community Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Nallan K, Rajan G, Sivathanu L, Devaraju P, Thiruppathi B, Kumar A, Rajaiah P. Molecular Detection of Multiple Genotypes of Orientia tsutsugamushi Causing Scrub Typhus in Febrile Patients from Theni District, South India. Trop Med Infect Dis 2023; 8:tropicalmed8030174. [PMID: 36977175 PMCID: PMC10058992 DOI: 10.3390/tropicalmed8030174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Scrub typhus (St) is a re-emerging mite-transmitted public health problem in Southeast Asia with escalating case incidences in the endemic areas. Though, more than 40 genotypes of the causative agent Orientia tsutsugamushi (Ot) have been documented, the information on the circulating genotypes in India is scanty. A hospital-based retrospective screening was undertaken to map the circulating molecular subtypes of the etiological agent in serologically confirmed scrub typhus (St) human cases, by targeting the GroEL gene of O. tsutsugamushi using the nested polymerase chain reaction method. Nine out of 34 samples (26%) yielded positive results and DNA sequencing analysis of six positive samples out of nine revealed that the sequences were related to three major genotypes, such as Karp (HSB1, FAR1), Kato (Wuj/2014, UT76), and Kawasaki (Kuroki, Boryong, Gilliam, and Hwasung). Additionally, the St-positive samples exhibited 100% and 99.45%; 97.53% and 97.81%; 96.99% nucleotide identity with the closely related Karp, Kato, and Kawasaki-related sequences, respectively. Overall, 94% of the nucleotides were conserved, and the variable site was 20/365 (5.5%). The prevalence of multiple genotypes among human cases further stresses the need to conduct in-depth studies to map the genotypes and their clinical relevance, and the contributing risk factors for the emergence of St cases in this area.
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Affiliation(s)
| | - Gopinathan Rajan
- Department of Microbiology, Government Medical College and Hospital, Theni 625 512, India
| | - Lallitha Sivathanu
- Department of Microbiology, Government Medical College and Hospital, Theni 625 512, India
| | | | | | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Puducherry 605 006, India
| | - Paramasivan Rajaiah
- ICMR-Vector Control Research Centre, Field Unit, Madurai 625 002, India
- Correspondence: ; Tel.: +91-9442026705 or +91-4522525131
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Li X, Wei X, Yin W, Soares Magalhaes RJ, Xu Y, Wen L, Peng H, Qian Q, Sun H, Zhang W. Using ecological niche modeling to predict the potential distribution of scrub typhus in Fujian Province, China. Parasit Vectors 2023; 16:44. [PMID: 36721181 PMCID: PMC9887782 DOI: 10.1186/s13071-023-05668-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/13/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the increasing number of cases of scrub typhus and its expanding geographical distribution in China, its potential distribution in Fujian Province, which is endemic for the disease, has yet to be investigated. METHODS A negative binomial regression model for panel data mainly comprising meteorological, socioeconomic and land cover variables was used to determine the risk factors for the occurrence of scrub typhus. Maximum entropy modeling was used to identify the key predictive variables of scrub typhus and their ranges, map the suitability of different environments for the disease, and estimate the proportion of the population at different levels of infection risk. RESULTS The final multivariate negative binomial regression model for panel data showed that the annual mean normalized difference vegetation index had the strongest correlation with the number of scrub typhus cases. With each 0.1% rise in shrubland and 1% rise in barren land there was a 75.0% and 37.0% increase in monthly scrub typhus cases, respectively. In contrast, each unit rise in mean wind speed in the previous 2 months and each 1% increase in water bodies corresponded to a decrease of 40.0% and 4.0% in monthly scrub typhus cases, respectively. The predictions of the maximum entropy model were robust, and the average area under the curve value was as high as 0.864. The best predictive variables for scrub typhus occurrence were population density, annual mean normalized difference vegetation index, and land cover types. The projected potentially most suitable areas for scrub typhus were widely distributed across the eastern coastal area of Fujian Province, with highly suitable and moderately suitable areas accounting for 16.14% and 9.42%, respectively. Of the total human population of the province, 81.63% reside in highly suitable areas for scrub typhus. CONCLUSIONS These findings could help deepen our understanding of the risk factors of scrub typhus, and provide information for public health authorities in Fujian Province to develop more effective surveillance and control strategies in identified high risk areas in Fujian Province.
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Affiliation(s)
- Xuan Li
- grid.186775.a0000 0000 9490 772XDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China ,grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xianyu Wei
- grid.186775.a0000 0000 9490 772XDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China ,grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Wenwu Yin
- grid.198530.60000 0000 8803 2373Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ricardo J. Soares Magalhaes
- grid.1003.20000 0000 9320 7537Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Brisbane, Australia ,grid.1003.20000 0000 9320 7537Child Health Research Center, The University of Queensland, Brisbane, Australia
| | - Yuanyong Xu
- grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Liang Wen
- grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hong Peng
- grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Quan Qian
- grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hailong Sun
- grid.186775.a0000 0000 9490 772XDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China ,grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Wenyi Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China ,grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
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Badekar S, Mane A, Sane S, Kamble S. Risk factors for acute scrub typhus infection among housewives - A subgroup analysis of pooled community-based serosurvey in Gorakhpur, India. Indian J Med Res 2023; 158:28-31. [PMID: 37602583 PMCID: PMC10550063 DOI: 10.4103/ijmr.ijmr_4815_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Indexed: 07/08/2023] Open
Affiliation(s)
- Suvarna Badekar
- Division of Epidemiology, ICMR-National AIDS Research Institute, Pune 411 026, Maharashtra, India
| | - Arati Mane
- Division of Microbiology, ICMR-National AIDS Research Institute, Pune 411 026, Maharashtra, India
| | - Suvarna Sane
- Division of Epidemiology, ICMR-National AIDS Research Institute, Pune 411 026, Maharashtra, India
| | - Suchit Kamble
- Division of Epidemiology, ICMR-National AIDS Research Institute, Pune 411 026, Maharashtra, India
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Qian L, Wang Y, Wei X, Liu P, Magalhaes RJS, Qian Q, Peng H, Wen L, Xu Y, Sun H, Yin W, Zhang W. Epidemiological characteristics and spatiotemporal patterns of scrub typhus in Fujian province during 2012–2020. PLoS Negl Trop Dis 2022; 16:e0010278. [PMID: 36174105 PMCID: PMC9553047 DOI: 10.1371/journal.pntd.0010278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/11/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Scrub typhus has become a serious public health concern in the Asia-Pacific region including China. There were new natural foci continuously recognized and dramatically increased reported cases in mainland China. However, the epidemiological characteristics and spatiotemporal patterns of scrub typhus in Fujian province have yet to be investigated. Objective This study proposes to explore demographic characteristics and spatiotemporal dynamics of scrub typhus cases in Fujian province, and to detect high-risk regions between January 2012 and December 2020 at county/district scale and thereby help in devising public health strategies to improve scrub typhus prevention and control measures. Method Monthly cases of scrub typhus reported at the county level in Fujian province during 2012–2020 were collected from the National Notifiable Disease Surveillance System. Time-series analyses, spatial autocorrelation analyses and space-time scan statistics were applied to identify and visualize the spatiotemporal patterns of scrub typhus cases in Fujian province. The demographic differences of scrub typhus cases from high-risk and low-risk counties in Fujian province were also compared. Results A total of 11,859 scrub typhus cases reported in 87 counties from Fujian province were analyzed and the incidence showed an increasing trend from 2012 (2.31 per 100,000) to 2020 (3.20 per 100,000) with a peak in 2018 (4.59 per 100,000). There existed two seasonal peaks in June-July and September-October every year in Fujian province. A significant positive spatial autocorrelation of scrub typhus incidence in Fujian province was observed with Moran’s I values ranging from 0.258 to 0.471 (P<0.001). Several distinct spatiotemporal clusters mainly concentrated in north and southern parts of Fujian province. Compared to low-risk regions, a greater proportion of cases were female, farmer, and older residents in high-risk counties. Conclusions These results demonstrate a clear spatiotemporal heterogeneity of scrub typhus cases in Fujian province, and provide the evidence in directing future researches on risk factors and effectively assist local health authorities in the refinement of public health interventions against scrub typhus transmission in the high risk regions. Scrub typhus is a vector-borne zoonotic disease caused by Orientia tsutsugamushi and is popular in the Asia-Pacific area. Nowadays scrub typhus has been recognized as a considerable burden on public health in Fujian province. We explored the epidemiological characteristics, spatiotemporal patterns and diffusion characteristics of scrub typhus, and detected high-risk regions at the county level in Fujian province between January 2012 and December 2020. Our results indicated that the majority of cases were reported in June-July and September-October and that that middle aged and elderly people were more prone to infection every year in Fujian province. The spatial autocorrelation analysis revealed clustering in geographic distribution of cases and several distinct spatiotemporal clusters were identified in north and southern parts of Fujian province. Compared with cases from low-risk areas, a higher proportion of cases were female, farmer, and older residents in high-risk counties.
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Affiliation(s)
- Li Qian
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yong Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xianyu Wei
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Ping Liu
- Department of General Practice, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China
| | - Ricardo J. Soares Magalhaes
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Brisbane, Australia
- Child Health Research Center, The University of Queensland, Brisbane, Australia
| | - Quan Qian
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hong Peng
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Liang Wen
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yuanyong Xu
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hailong Sun
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Wenwu Yin
- Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (WY); (WZ)
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- * E-mail: (WY); (WZ)
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The Incidence of Orientia Tsutsugamushi Infection in Rural South India. Epidemiol Infect 2022; 150:e132. [PMID: 35765168 PMCID: PMC9306010 DOI: 10.1017/s0950268822001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Scrub typhus is a common bacterial infection in Asia caused by Orientia tsutsugamushi. This serological cohort study estimated the incidence of infection in a rural population in South India. Participants were enrolled through systematic sampling in 46 villages at baseline, and revisited the following year. Blood samples were tested for IgG antibodies using ELISA, followed by indirect immunofluorescence assays (IFA) in those positive for ELISA at both rounds. A case was defined as sero-conversion (ELISA), or at least a 4-fold titre increase (IFA), between the two time points. In addition to crude incidence rate estimates, we used piecewise linear rates across calendar months, with rates proportional to the monthly incidence of local hospital cases to address seasonality and unequal follow-up times. Of 402 participants, 61.7% were female. The mean age was 46.7 years, (range 13–88). 21 participants showed evidence for serological infection. The estimated incidence was 4.4 per 100 person-years (95% CI 2.8–6.7). The piecewise linear rates approach resulted in a similar estimate of 4.6 per 100 person years (95% CI 2.9–6.9). Considering previous estimates of symptomatic scrub typhus incidence in the same study population, only about 2–5% of infections may result in clinically relevant disease.
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Kumar M, Valiaveetil KA, Chandran J, Mohan VR, Chandrasekar K, Ghosh U, Punnen A, Rose W. Scrub Typhus: A Spatial and Temporal Analysis from South India. J Trop Pediatr 2022; 68:6651465. [PMID: 35903921 DOI: 10.1093/tropej/fmac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Scrub typhus is a zoonotic rickettsial disease caused by the bacterium Orientia tsutsugamushi. The non-specificity of presentation, low index of suspicion and the poor availability of diagnostic tests often lead to delayed diagnosis and significant morbidity and mortality. Temperature, humidity, rainfall and Normalized Difference Vegetation Index (NDVI) on the spatio-temporal clustering of scrub typhus cases in children in three contiguous administrative districts in South India over 5 years were studied. A total of 419 children were diagnosed with scrub typhus during the study period. A surge of children with scrub typhus was noted when the NVDI ranged between 0.6 and 0.8 µm. Temperature, humidity and rainfall had a major role in the incidence of scrub typhus.
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Affiliation(s)
- Madhan Kumar
- Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Jolly Chandran
- Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Venkata Raghava Mohan
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - K Chandrasekar
- Crop Parameter Retrieval Division, Agricultural Sciences Applications Group, National Remote Sensing Centre, Hyderabad, India
| | - Urmi Ghosh
- Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu Punnen
- Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Winsley Rose
- Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India
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Scrub Typhus: An Emerging Etiology among Undiagnosed Febrile Cases in Western Part of Uttar Pradesh, India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Scrub typhus is a re-emerging zoonotic rickettsial disease and is prevalent in many parts of India. Scrub typhus in Uttar Pradesh is virtually unknown but has shown emergence in recent reports. In this context, a prospective study was planned to analyze the prevalence and clinic-epidemiological parameters of scrub typhus in febrile patients present in JNMC hospital. Patients of >15 years with undiagnosed acute febrile illness of more than 5 days with or without acute respiratory failure and acute renal failure (ARF) were included in the study. Clinical profile was recorded through predesigned proforma. Blood samples were collected and serological tests were performed. PCR was performed on whole blood samples of positive patients. Total 414 patients, who were negative for other common febrile etiologies, i.e.: malaria, dengue, enteric fever were included in the study. Out of 414 patients, 112 (27%) were found positive for scrub typhus by ELISA and micro-immunofluorescence (MIF). PCR was negative in all cases. Slight male predominance (52.6%) was observed. Significant number of positive cases 90(80.3%) were between 18-46 years of age (P value <0.05). Majority of cases appeared during winter season Respiratory involvement was significant in positive cases (P value <0.05). Among the gastro-intestinal symptoms, diarrhea and vomiting were also significant (P value <0.005). All the patients responded to the treatment. No complications and mortality was observed. Scrub typhus should be considered in undiagnosed febrile patients coming from rural and agricultural background with respiratory and gastrointestinal symptoms. Serology is reliable in the diagnosis of scrub typhus as molecular testing is costly, labor intensive and not helpful.
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Ranjit S, Kissoon N. Challenges and Solutions in translating sepsis guidelines into practice in resource-limited settings. Transl Pediatr 2021; 10:2646-2665. [PMID: 34765491 PMCID: PMC8578780 DOI: 10.21037/tp-20-310] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/05/2021] [Indexed: 11/24/2022] Open
Abstract
Sepsis and septic shock are major contributors to the global burden of disease, with a large proportion of patients and deaths with sepsis estimated to occur in low- and middle-income countries (LMICs). There are numerous barriers to reducing the large global burden of sepsis including challenges in quantifying attributable morbidity and mortality, poverty, inadequate awareness, health inequity, under-resourced public health, and low-resilient acute health care delivery systems. Context-specific approaches to this significant problem are necessary on account of important differences in populations at-risk, the nature of infecting pathogens, and the healthcare capacity to manage sepsis in LMIC. We review these challenges and propose an outline of some solutions to tackle them which include strengthening the healthcare systems, accurate and early identification of sepsis the need for inclusive research and context-specific treatment guidelines, and advocacy. Specifically, strengthening pediatric intensive care units (PICU) services can effectively treat the life-threatening complications of common diseases, such as diarrhoea, respiratory infections, severe malaria, and dengue, thereby improving the quality of pediatric care overall without the need for expensive interventions. A thoughtful approach to developing paediatric intensive care services in LMICs begins with basic fundamentals: training healthcare providers in knowledge and skills, selecting effective equipment that is resource-appropriate, and having an enabling leadership to provide location-appropriate care. These basics, if built in sustainable manner, have the potential to permit an efficient pediatric critical care service to be established that can significantly improve sepsis and other critical care outcomes.
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Affiliation(s)
- Suchitra Ranjit
- Senior Consultant and Head, Pediatric ICU, Apollo Children's Hospital, Chennai, India
| | - Niranjan Kissoon
- Children's and Women's Global Health, UBC & BC Children's Hospital Professor in Critical Care - Global Child Health, Department of Pediatrics and Emergency Medicine, UBC, Child and Family Research Institute, Vice President Global Sepsis Alliance, Vancouver, Canada
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Tran HTD, Hattendorf J, Do HM, Hoang TT, Hoang HTH, Lam HN, Huynh MK, Vu LTH, Zinsstag J, Paris DH, Schelling E. Ecological and behavioural risk factors of scrub typhus in central Vietnam: a case-control study. Infect Dis Poverty 2021; 10:110. [PMID: 34412700 PMCID: PMC8374119 DOI: 10.1186/s40249-021-00893-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 12/04/2022] Open
Abstract
Background The risk factors for scrub typhus in Vietnam remain unknown. Scrub typhus caused by Orientia tsutsugamushi often presents as an undifferentiated febrile illness and remains under appreciated due to the limited availability of diagnostic tests. This tropical rickettsial illness is increasingly recognized as an important cause of non-malaria acute undifferentiated fever in Asia. This study aimed to investigate behavioural and ecological related risk factors of scrub typhus to prevent this potentially life-threatening disease in Vietnam. Methods We conducted a clinical hospital-based active surveillance study, and a retrospective residence-enrolment date-age-matched case–control study in Khanh Hoa province, Vietnam, from August 2018 to March 2020. Clinical examinations, polymerase chain reaction and enzyme-linked immunosorbent assay IgM tests were applied to define cases and controls. All enrolled participants filled out a questionnaire including demographic socio-economic status, personal behaviors/protective equipment, habitat connections, land use, and possible exposure to the vector. Multivariable conditional logistic regression was used to define the scrub typhus associated risk factors. Results We identified 44 confirmed cases and matched them with 152 controls. Among cases and controls, the largest age group was the 41–50 years old and males accounted for 61.4% and 42.8%, respectively. There were similarities in demographic characteristics between the two groups, with the exception of occupation. Several factors were significantly associated with acquisition of scrub typhus, including sitting/laying directly on household floor [adjusted OR (aOR) = 4.9, 95% CI: 1.6–15.1, P = 0.006], household with poor sanitation/conditions (aOR = 7.9, 95% CI: 1.9–32.9, P = 0.005), workplace environment with risk (aOR = 3.0, 95% CI: 1.2–7.6, P = 0.020), always observing mice around home (aOR = 3.7, 95% CI: 1.4–9.9, P = 0.008), and use of personal protective equipment in the field (aOR = 0.4, 95% CI: 0.1–1.1, P = 0.076). Conclusions Ecological and household hygiene-related factors were more associated with scrub typhus infection, than individual-level exposure activities in the hyper-endemic area. These findings support local education and allow people to protect themselves from scrub typhus, especially in areas with limitations in diagnostic capacity. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00893-6.
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Affiliation(s)
- Hanh Thi Duc Tran
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,Department of Epidemiology, Hanoi University of Public Health, Hanoi, Vietnam. .,University of Basel, Basel, Switzerland.
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hung Manh Do
- Department for Infectious Disease Control and Prevention, Nha Trang Pasteur Institute, Nha Trang, Khanh Hoa, Vietnam
| | - Thanh Tien Hoang
- Department for Infectious Disease Control and Prevention, Nha Trang Pasteur Institute, Nha Trang, Khanh Hoa, Vietnam
| | - Hang Thi Hai Hoang
- Department for Infectious Disease Control and Prevention, Nha Trang Pasteur Institute, Nha Trang, Khanh Hoa, Vietnam
| | - Hoa Ngoc Lam
- Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | - Mai Kim Huynh
- Department of Microbiology and Immunology, Nha Trang Pasteur Institute, Nha Trang, Khanh Hoa, Vietnam
| | - Lan Thi Hoang Vu
- Department of Epidemiology, Hanoi University of Public Health, Hanoi, Vietnam
| | - Jakob Zinsstag
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Daniel Henry Paris
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Sadanandane C, Elango A, Panneer D, Mary KA, Kumar NP, P Paily K, Mishra BB, Sankari T, Jambulingam P. Seasonal abundance of Leptotrombidium deliense, the vector of scrub typhus, in areas reporting acute encephalitis syndrome in Gorakhpur district, Uttar Pradesh, India. EXPERIMENTAL & APPLIED ACAROLOGY 2021; 84:795-808. [PMID: 34328572 DOI: 10.1007/s10493-021-00650-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
The rickettsial pathogen Orientia tsutsugamushi, causing scrub typhus, has been implicated as a major cause of acute encephalitis syndrome (AES) in many places in India including Gorakhpur district of Uttar Pradesh. Seasonal abundance of the principal vector mite of the pathogen, Leptotrombidium deliense, its animal hosts, and prevalence of infection on them are important attributes in the assessment of outbreaks of the disease. Hence, these aspects were investigated, seasonally, in rural villages of Gorakhpur district, where peak incidence of AES cases were reported. A total of 903 animals (rodents/shrews) was collected using 6484 Sherman traps in eight study villages (14% overall trap rate). A sum of 5526 trombiculid mites comprising 12 species was collected from 676 live rodents/shrews screened. Suncus murinus, the Asian house shrew was the predominant species (67%). Among trombiculids, the principal vector mite, L. deliense, was predominant (64.7%) and its infestation index (i.e., average number of chiggers per host animal) was 5.3. The L. deliense infestation index was higher during July to November with a peak in October. Out of 401 animal sera samples screened, 68% were positive for antibodies against O. tsutsugamushi. Of 465 blood samples tested by nested PCR, seven were positive for the 56 kDa gene of O. tsutsugamushi. In conventional PCR, 41 out of 265 samples were positive for the 60 kDa groEL gene of O. tsutsugamushi. Among the 5526 mite samples, tested as 352 pools through nested PCR, four pools were positive for 56 kDa gene. Phylogenetic analysis of 56 and 60 kDa genes confirmed circulation of Karp and TA678 (rodents) and TA678 (mite) serotypes of O. tsutsugamushi in Gorakhpur. Peak incidence of AES in Gorakhpur district occurs during the rainy season (July-October), coinciding with the peak abundance of L. deliense. These results indicate involvement of L. deliense as the vector mite transmitting the scrub typhus pathogen O. tsutsugamushi to humans in the rural areas of Gorakhpur district, India.
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Affiliation(s)
- Candasamy Sadanandane
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Ayyanar Elango
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India.
| | - Devaraju Panneer
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | | | - Narendran Pradeep Kumar
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Kummankottil P Paily
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Bhuwan Bhaskar Mishra
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
| | - Thirumal Sankari
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Puducherry, 605006, India
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14
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Verma SK, Gupta KK, Arya RK, Kumar V, Reddy DH, Chaudhary SC, Sonkar SK, Kumar S, Verma N, Sharma D. Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India. J Family Med Prim Care 2021; 10:1459-1465. [PMID: 34041194 PMCID: PMC8140274 DOI: 10.4103/jfmpc.jfmpc_1162_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/08/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022] Open
Abstract
Background Scrub typhus is a neglected rickettsial disease in India. Every year, we are facing outbreaks of Scrub typhus after Monsoon season. Patients present with a wide clinical spectrum ranging from pyrexia of unknown origin to multiple organ dysfunction. Some of these clinical features overlap with presentation of other tropical infections prevalent in Indian subcontinent, which leads to diagnostic dilemma and delay in diagnosis. Hence, we planned this study to know the demographic, clinical and biochemical profile of scrub typhus patients. Methods This was an observational study conducted in department of Medicine, King George's Medical University Lucknow, India a leading tertiary care hospital of Northern India. All scrub typhus patients were evaluated by detailed history, examination and laboratory tests. Results We enrolled 52 patients in our study. The mean age of the patients was 35.17 ± 16.90 years with majority (82.7%) of patients from rural background. All the patients had fever with an average duration of 9.6 ± 2 days. Most of the patients developed hepatitis (69.2%) followed by acute encephalitis syndrome (47%), acute kidney injury (23.1%) and acute respiratory failure (19.2%). Eschar was found in 11 patients (21.2%). Conclusion Scrub typhus is often misdiagnosed or diagnosed late due to its wide clinical spectrum overlapping with clinical presentation of other commonly prevalent tropical diseases. One should always consider the differential diagnosis of scrub typhus while evaluating a young febrile patient of rural background, with features of single or multiple organ dysfunction and laboratory findings of leucocytosis, thrombocytopenia and elevation of transaminases.
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Affiliation(s)
- Sudhir K Verma
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kamlesh K Gupta
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh K Arya
- Department of Medicine, Government Medical College, Orai, Jalaun, Uttar Pradesh, India
| | - Vivek Kumar
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D Himanshu Reddy
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shyam C Chaudhary
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satyendra K Sonkar
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satish Kumar
- Department of Endocrinology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neeraj Verma
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deepak Sharma
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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15
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Dhimal M, Dumre SP, Sharma GN, Khanal P, Ranabhat K, Shah LP, Lal BK, Jha R, Upadhyaya BP, Acharya B, Shrestha SK, Davidson SA, Charoensinphon P, Karki KB. An outbreak investigation of scrub typhus in Nepal: confirmation of local transmission. BMC Infect Dis 2021; 21:193. [PMID: 33602136 PMCID: PMC7893900 DOI: 10.1186/s12879-021-05866-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
Background Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness in the areas of tsutsugamushi triangle caused by Orientia tsutsugamushi. It is frequently diagnosed in South Asian countries, although clear epidemiological information is not available from Nepal. After the 2015 earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported. The objective of this study was to investigate epidemiology of scrub typhus and its causative agents in humans, animals, and chigger mites to understand the ongoing transmission ecology. Methods Scrub typhus cases with confirmed diagnosis throughout the country were included in the analysis. Studies were concentrated in the Chitwan district, the site of a major outbreak in 2016. Additional nation-wide data from 2015 to 2017 available from the government database included to analyse the disease distribution by geographical mapping. Results From 2015 to 2017, 1239 scrub typhus cases were confirmed with the largest outbreak occurring in 2016 with 831 (67.1%) cases. The case fatality rate was 5.7% in 2015 which declined to 1.1% in 2017. A nationwide outbreak of scrub typhus was declared as the cases were detected in 52 out of the 75 districts of Nepal. Seasonal trend was observed with a peak during August and September. In addition to the human cases, the presence of O. tsutsugamushi was also confirmed in animals (rodents) and chigger mites (Leptotrombidium imphalum) from the outbreak areas of southern Nepal. Conclusion The detection of O. tsutsugamushi in humans, animals, and chigger mites from outbreak locations and wide-spread reports of scrub typhus throughout the country consecutively for 3 years confirms the ongoing transmission of O. tsutsugamushi with a firmly established ecology in Nepal. The country’s health system needs to be strengthened for systematic surveillance, early outbreak detection, and immediate actions including treatment and preventive measures. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05866-6.
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Affiliation(s)
- Meghnath Dhimal
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal.
| | - Shyam Prakash Dumre
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal.,Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Guna Nidhi Sharma
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.,Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Pratik Khanal
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal.,Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Kamal Ranabhat
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.,Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Lalan Prasad Shah
- Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Bibek Kumar Lal
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Runa Jha
- National Public Health Laboratory, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Bishnu Prasad Upadhyaya
- National Public Health Laboratory, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Bhim Acharya
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | | | - Silas A Davidson
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | | | - Khem B Karki
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal.,Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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16
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Clinical Profile and Predictors of Outcome for Pediatric Scrub Typhus at a Tertiary Care Hospital. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2020. [DOI: 10.5812/pedinfect.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Scrub typhus is an important cause of acute undifferentiated fever. It is currently one of the most covert re-emerging infections and the most common rickettsial infection caused by Orientia tsutsugamushi. Untreated cases can have mortality rates as high as 30-35%. Objectives: This study was done to study demographical data, clinical profile, and predictors of outcome for scrub typhus in children who were admitted to our institution, a tertiary care hospital in south India. Methods: In this retrospective study, children diagnosed with scrub typhus based on IgM enzyme-linked immunosorbent assay (ELISA), between January 2012 and June 2019 were included. Detailed history, clinical examination findings, laboratory profile, complications, and outcome were analyzed. Results: A total of 120 patients were identified, of whom 84 (42 males- and 42 females) cases satisfied the inclusion criteria and were analyzed. About 80 (95%) cases had a complete recovery, whereas 4 patients (5%) died of multiple complications. Hypotension, hypoxia, altered sensorium, hypoalbuminemia, elevated liver enzymes, azotemia, and deranged coagulation on admission were considered as poor predictors of outcome for scrub typhus. Conclusions: Pediatric scrub typhus is a common infection and should be suspected in cases with fever for more than 5 days and non-specific signs and symptoms. Early detection and timely management lead to a higher recovery rate. Hypotension, hypoxia, azotemia, altered sensorium, and bleeding manifestations on admission were associated with unfavorable outcomes.
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17
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Kala D, Gupta S, Nagraik R, Verma V, Thakur A, Kaushal A. Diagnosis of scrub typhus: recent advancements and challenges. 3 Biotech 2020; 10:396. [PMID: 32834918 PMCID: PMC7431554 DOI: 10.1007/s13205-020-02389-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Scrub typhus is a mite-borne, acute febrile illness caused by the bacterium Orientia tsutsugamushi. It is a re-emerging infectious disease of the tsutsugamushi triangle. Scrub typhus is transmitted through bites of contaminated chiggers (larval stage). Diagnosis of scrub typhus is challenging as its symptoms mimic with other acute febrile illnesses. Several methods are effectual for diagnosis of scrub typhus that includes enzyme-linked immunosorbent assay (ELISA), immunofluorescence assay (IFA), immunochromatographic test (ICT), Weil-Felix, polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP). Weil-Felix test was initially used for the diagnosis of scrub typhus in underdeveloped countries but not preferred due to a lack of both specificity and sensitivity. Other immuno-based methods like IFA and ELISA are most outrank for detection of scrub typhus due to their higher sensitivity and specificity, but not vigorous to lay bare the infection at early stages and need the convalescent sampling for verification of positive samples. On another deed, PCR based methods becoming acceptable over era due to its dexterity of early-stage diagnosis with higher specificity and sensitivity but lack its applicability in circumstances of scrub typhus due to the variegated genetic makeup of Orientia tsutsugamushi among its serotypes. The present review focused on various detection methods along with their advantages and disadvantages used in the diagnosis of scrub typhus. A comparison between available methods of diagnosis with challenges in the detection of scrub typhus is also summarized.
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Affiliation(s)
- Deepak Kala
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
| | | | | | | | - Atul Thakur
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
| | - Ankur Kaushal
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
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18
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Gaba S, Garg S, Gupta M, Gupta R. Haemorrhagic encephalitis in the garb of scrub typhus. BMJ Case Rep 2020; 13:13/8/e235790. [PMID: 32859623 DOI: 10.1136/bcr-2020-235790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 19-year-old girl presented with fever, headache, vomiting and drowsiness. She had grade 1 papilloedema and neck rigidity but no focal deficits or seizures. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, slightly elevated protein and normal glucose. MRI of the brain showed a hyperintense lesion in left ganglio-capsular region on the fluid attenuation inversion recovery sequence with perilesional oedema and mild midline shift. Haemorrhage was seen in the region on susceptibility weighted imaging . The patient was thoroughly investigated for known causes of meningoencephalitis, but the diagnosis of scrub typhus was delayed till the 10th day of illness. She was treated with doxycycline for 2 weeks and had marked improvement, both clinically and radiologically. Literature review has revealed that although meningoencephalitis in scrub typhus is not uncommon, such atypical lesions on brain MRI are a rarity. Serial imaging was performed to document the disease progression and resolution on treatment.
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Affiliation(s)
- Saurabh Gaba
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Swati Garg
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Rekha Gupta
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
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19
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Thakur CK, Chaudhry R, Gupta N, Vinayaraj EV, Singh V, Das BK, Jadon RS, Wig N, Lodha R, Kabra SK, Dey AB, Chhabra M. Scrub typhus in patients with acute febrile illness: a 5-year study from India. QJM 2020; 113:404-410. [PMID: 31790119 DOI: 10.1093/qjmed/hcz308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/17/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Scrub typhus was once thought to be a disease of rural origin and was confined to specific pockets in South Asia. Early diagnosis and treatment is extremely important as it is associated with high mortality if left untreated. AIM To delineate the clinical and molecular epidemiology of scrub typhus in patients presenting with acute febrile illness from various parts of India. METHODS During the study period of 5 years (October 2013 to October 2018), a total of 1742 patients with acute febrile illness <15 days were enrolled after taking informed consent. Patients were diagnosed using IgM Enzyme-linked immunosorbent assay (ELISA) based on the pre-determined region specific cut offs. Patients with positive IgM ELISA were also subjected to IgM Immunofluorescence assay and nested polymerase chain reaction (PCR) assay. The demographic and relevant clinical details of the patients were documented and analyzed. RESULTS A total of 210 (12.1%) patients were diagnosed with scrub typhus. Of these, nested PCR was positive in only 85 patients. Sequencing and phylogenetic analysis showed that the predominant circulating genotypes were Gilliam and Karp. On multivariate analysis, acute respiratory distress syndrome, myocarditis, encephalitis/encephalopathy, jaundice and splenomegaly were significantly more common in those patients who were diagnosed with scrub typhus. A total of 14 patients diagnosed with scrub typhus succumbed to the illness. CONCLUSION Patients with fever, headache, pulmonary manifestations, CNS manifestations, myocarditis, transaminitis or thrombocytopenia presenting in the monsoon and post-monsoon season should be evaluated for scrub typhus irrespective of the geographical location in India.
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Affiliation(s)
| | | | - N Gupta
- Department of Microbiology
- Department of Medicine
| | | | | | | | | | | | | | | | - A B Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - M Chhabra
- Department of Microbiology, Dr. Ram Manohar Lohia Hospital, Post Graduate Institute of Medical Education and Research, Baba Kharak Singh Marg, Connaught Place, New Delhi 110001, India
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20
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Devamani CS, Schmidt WP, Ariyoshi K, Anitha A, Kalaimani S, Prakash JAJ. Risk Factors for Scrub Typhus, Murine Typhus, and Spotted Fever Seropositivity in Urban Areas, Rural Plains, and Peri-Forest Hill Villages in South India: A Cross-Sectional Study. Am J Trop Med Hyg 2020; 103:238-248. [PMID: 32458785 PMCID: PMC7356468 DOI: 10.4269/ajtmh.19-0642] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Scrub typhus and spotted fever group rickettsioses are thought to be common causes of febrile illness in India, whereas they rarely test for murine typhus. This cross-sectional study explored the risk factors associated with scrub typhus, tick-borne spotted fever, and murine typhus seropositivity in three different geographical settings, urban, rural, and hill villages in Tamil Nadu, South India. We enrolled 1,353 participants living in 48 clusters. The study included a questionnaire survey and blood sampling. Blood was tested for Orientia tsutsugamushi (scrub typhus), Rickettsia typhi (murine typhus), and spotted fever group Rickettsia IgG using ELISA. The seroprevalence of scrub typhus, spotted fever, and murine typhus were 20.4%, 10.4%, and 5.4%, respectively. Scrub typhus had the highest prevalence in rural areas (28.1%), and spotted fever was most common in peri-forested areas (14.9%). Murine typhus was more common in rural (8.7%) than urban areas (5.4%) and absent in peri-forested hill areas. Agricultural workers had a higher relative risk for scrub typhus, especially in urban areas. For murine typhus, proximity to a waterbody and owning a dog were found to be major risk factors. The main risk factors for spotted fever were agricultural work and living in proximity to a forest. Urban, rural plains, and hill settings display distinct epidemiological pattern of Orientia and rickettsial infections. Although scrub typhus and spotted fever were associated with known risk factors in this study, the findings suggest a different ecology of murine typhus transmission compared with other studies conducted in Asia.
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Affiliation(s)
| | - Wolf-Peter Schmidt
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Arumugam Anitha
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Saravanan Kalaimani
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - John A J Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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21
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Gaba S, Gaba N, Gupta M, Sharma S. Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India. Cureus 2020; 12:e7925. [PMID: 32494535 PMCID: PMC7265748 DOI: 10.7759/cureus.7925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction Scrub typhus is a resurging zoonotic infection prevalent in South Asia with many recent outbreaks in India. It can mimic other tropical infections and the disease spectrum ranges from subclinical illness to life-threatening disease with multiorgan dysfunction. This study was conducted to study the pattern of hepatic and renal injury. Methods A retrospective study was done on 176 patients diagnosed by detecting IgM antibodies using an enzyme-linked immunosorbent assay (ELISA) over a period of three years at a tertiary center in Chandigarh, India. They were treated with doxycycline (azithromycin if pregnant) and supportive therapies. The patterns of hepatic and renal functions, along with the need of renal replacement therapy, were recorded and evaluated. The values were expressed as mean ± SD, and p values were calculated to establish statistical significance. Results Most of the cases were from the state of Haryana (37.5%), followed by Punjab (33.5%), Himachal Pradesh (13.6%), Uttar Pradesh (10.2%) and Chandigarh (5%). 30% of the study population was engaged in agriculture. The mean age was 32.3 ± 13.5 years with range of 13-65 years. A peak in the incidence was observed during monsoon months. Approximately 13% of the patients died. Urea, creatinine, bilirubin and aspartate transaminase were found to be higher in mortality group with statistical significance (p < 0.05). Alanine transaminase was higher and albumin was lower in the mortality group but without statistical significance. 27.8% had acute kidney injury, 90.9% had liver dysfunction and one patient had acute liver failure. All the pregnant patients had fetal loss. Conclusion Renal and liver dysfunctions are common in scrub typhus, and their occurrence adversely affects the outcome.
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Affiliation(s)
- Saurabh Gaba
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Nayana Gaba
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Monica Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Sanjana Sharma
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
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Mapping Environmental Suitability of Scrub Typhus in Nepal Using MaxEnt and Random Forest Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234845. [PMID: 31810239 PMCID: PMC6926588 DOI: 10.3390/ijerph16234845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 11/17/2022]
Abstract
Being a globally emerging mite-borne zoonotic disease, scrub typhus is a serious public health concern in Nepal. Mapping environmental suitability and quantifying the human population under risk of the disease is important for prevention and control efforts. In this study, we model and map the environmental suitability of scrub typhus using the ecological niche approach, machine learning modeling techniques, and report locations of scrub typhus along with several climatic, topographic, Normalized Difference Vegetation Index (NDVI), and proximity explanatory variables and estimated population under the risk of disease at a national level. Both MaxEnt and RF technique results reveal robust predictive power with test The area under curve (AUC) and true skill statistics (TSS) of above 0.8 and 0.6, respectively. Spatial prediction reveals that environmentally suitable areas of scrub typhus are widely distributed across the country particularly in the low-land Tarai and less elevated river valleys. We found that areas close to agricultural land with gentle slopes have higher suitability of scrub typhus occurrence. Despite several speculations on the association between scrub typhus and proximity to earthquake epicenters, we did not find a significant role of proximity to earthquake epicenters in the distribution of scrub typhus in Nepal. About 43% of the population living in highly suitable areas for scrub typhus are at higher risk of infection, followed by 29% living in suitable areas of moderate-risk, and about 22% living in moderately suitable areas of lower risk. These findings could be useful in selecting priority areas for surveillance and control strategies effectively.
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Rose W, Kang G, Verghese VP, Candassamy S, Samuel P, Prakash JJA, Muliyil J. Risk factors for acquisition of scrub typhus in children admitted to a tertiary centre and its surrounding districts in South India: a case control study. BMC Infect Dis 2019; 19:665. [PMID: 31349809 PMCID: PMC6660696 DOI: 10.1186/s12879-019-4299-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 07/18/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Scrub typhus is a mite borne zoonosis common in the tropics with no good preventive strategy. Children are also affected leading to considerable morbidity and mortality. We conducted a case control study and a vector survey to determine the risk factors for acquisition of scrub typhus. METHODS A case control study with a 1:2 case control ratio was conducted over a 2 year period at a tertiary care centre and its surrounding districts in South India. Cases were children < 15 years with confirmed scrub typhus. Controls were age and locality matched community controls without fever. Demographic, environmental and behavioural risk factors were obtained in cases and controls by an interview and an environmental survey. A vector survey was also undertaken in the immediate vicinity of the cases. RESULTS Case Control study: 101 cases and 167 controls were analysed. On multivariate analysis, significant association was observed with environmental factors such as the presence of a water body within 100 m of the house (OR 3.56(1.36,9.75); p 0.011), cooking outside the house (OR 5.61 (1.51,23.01); p 0.011), owning pets (OR 3.33(1.16,9.09); p 0.031), and the presence of bushes within 5 m of the house (OR 2.78 (1.11,7.69); p 0.033). Of the behavioural factors, the child going to school by a vehicle (OR 3.12 (2.29,8.37); p 0.006) was associated with an increased risk. Drying clothes on a clothesline showed a trend towards protection from acquiring scrub typhus (OR 0.31 (0.08, 1.08); p 0.077). Vector survey:26 rodents were trapped in as many houses. Trombiculid mites were isolated in 24 houses with 9(34.6%) being able to transmit scrub typhus. 254 trombiculid mites belonging to four species and two genera were collected. Leptotrombidium deliense, (33.5%). Schoengastiella ligula, (11.0%) of the total mite specimens collected. S. ligula always co-existed with L. deliense. The estimated Chigger index for Leptotrombidium deliense and Schoengastiella ligula was 3.27and 1.08 per animal respectively. CONCLUSIONS Our study highlights risk factors for scrub typhus, some of which may be modifiable. A clean peri-domestic environment free of vegetation, drying clothes on a clothesline and cooking indoors may decrease the risk of scrub typhus.
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Affiliation(s)
- Winsley Rose
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu India
| | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu India
- Present Address: Translational Health Science and Technology Institute, Faridabad, Haryana India
| | | | | | - Prasanna Samuel
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu India
| | | | - Jayaprakash Muliyil
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu India
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Thangaraj JWV, Vasanthapuram R, Machado L, Arunkumar G, Sodha SV, Zaman K, Bhatnagar T, Hameed SKS, Kumar A, Abdulmajeed J, Velayudhan A, Deoshatwar A, Desai AS, Kumar KH, Gupta N, Laserson K, Murhekar M. Risk Factors for Acquiring Scrub Typhus among Children in Deoria and Gorakhpur Districts, Uttar Pradesh, India, 2017. Emerg Infect Dis 2019; 24:2364-2367. [PMID: 30457537 PMCID: PMC6256400 DOI: 10.3201/eid2412.180695] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Scrub typhus is associated with outbreaks of acute encephalitis syndrome in Uttar Pradesh, India. A case-control study indicated that children residing, playing, or visiting fields; living with firewood stored indoors; handling cattle fodder; and practicing open defecation were at increased risk for scrub typhus. Communication messages should focus on changing these behaviors.
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Devamani CS, Prakash JAJ, Alexander N, Suzuki M, Schmidt WP. Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study. PLoS Negl Trop Dis 2019; 13:e0007160. [PMID: 30802243 PMCID: PMC6405239 DOI: 10.1371/journal.pntd.0007160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/07/2019] [Accepted: 01/15/2019] [Indexed: 01/30/2023] Open
Abstract
Background The burden of scrub typhus in endemic areas is poorly understood. This study aimed at estimating the proportion of hospitalisations and outpatient visits for undifferentiated fever in the community that may be attributable to scrub typhus. Methodology and principal findings The study was a retrospective cohort with a nested case-control study conducted in the South Indian state of Tamil Nadu. We conducted house-to-house screening in 48 villages (42965 people, 11964 households) to identify hospitalised or outpatient cases due to undifferentiated fever during the preceding scrub typhus season. We used scrub typhus IgG to determine past infection. We calculated adjusted odds ratios for the association between IgG positivity and case status. Odds ratios were used to estimate population attributable fractions (PAF) indicating the proportion of hospitalised and outpatient fever cases attributable to scrub typhus. We identified 58 cases of hospitalisation and 236 outpatient treatments. 562 people were enrolled as control group to estimate the background IgG sero-prevalence. IgG prevalence was 20.3% in controls, 26.3% in outpatient cases and 43.1% in hospitalised cases. The PAFs suggested that 29.5% of hospitalisations and 6.1% of outpatient cases may have been due to scrub typhus. In villages with a high IgG prevalence (defined as ≥15% among controls), the corresponding PAFs were 43.4% for hospitalisations and 5.6% for outpatients. The estimated annual incidence of scrub typhus was 0.8/1000 people (0.3/1000 in low, and 1.3/1000 in high prevalence villages). Evidence for recall error suggested that the true incidences may be about twice as high as these figures. Conclusions The study suggests scrub typhus as an important cause for febrile hospitalisations in the community. The results confirm the adequacy of empirical treatment for scrub typhus in hospitalised cases with undifferentiated fever. Since scrub typhus may be rare among stable outpatients, the use of empirical treatment remains doubtful in these. Scrub typhus is an important cause of fever in many Asian countries, including China, India, Vietnam and Japan. It is caused by the intra-cellular bacteria Orientia tsutsugamushi and is transmitted to humans by mite larvae (chiggers) which attach to the skin of the host. Scrub typhus is potentially life-threatening but treatable with relatively cheap antibiotics such as doxycycline. The incidence of scrub typhus in the community is not known as most studies were done at hospitals and health posts lacking a clearly defined source-population for patients seeking health care for fever. In this study, the proportion of fever cases due to scrub typhus and the incidence of the infection were estimated by retrospective case identification in a population of 42000 people living in 48 villages in the South Indian state of Tamil Nadu. We found that about 30% to 40% of hospitalisations for undifferentiated fever may be due to scrub typhus. In contrast, scrub typhus accounted for only about 5% of outpatient fever cases. Our findings confirm the need for large population-based cohort studies to better understand the epidemiology of scrub typhus in endemic settings.
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Affiliation(s)
| | - John A. J. Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Wolf-Peter Schmidt
- Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Dinesh Kumar N, Arun Babu T, Vijayadevagaran V, Ananthakrishnan S, Kittu D. Clinical Profile of Scrub Typhus Meningoencephalitis among South Indian Children. J Trop Pediatr 2018; 64:472-478. [PMID: 29272545 DOI: 10.1093/tropej/fmx096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Re-emerging scrub typhus is gaining recognition as an important cause of paediatric meningoencephalitis in tropics. We studied the clinical profile of scrub typhus meningoencephalitis (STME) in children <12 years. Of 270 serology-confirmed cases of scrub typhus, 14 (5%) had features consistent with STME and 9 (64%) of these children were between 5 and 12 years of age; 12 (85%) children presented to the hospital during the second week of illness. Fever, headache and altered sensorium were observed in all children, while meningeal signs, papilledema and seizures were observed in 8 (57%), 7 (50%) and 6 (43%) children, respectively. The mean CSF protein level, glucose level, cell count and percentage of lymphocytes were 75 mg/dl, 46 mg/dl, 41 cells and 86%, respectively. STME should be considered in febrile children from endemic area with neurological features, such as headache or altered sensorium. Lumbar puncture is mandatory to confirm STME and rule out close differential diagnosis, such as pyogenic and tubercular meningitis.
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Affiliation(s)
- Narayanasamy Dinesh Kumar
- Department of Pediatrics, Indira Gandhi Medical College and Research Institute, 255, Vazhudavoor Road, Kathirkamam, Puducherry 605009, India
| | - Thirunavukkarasu Arun Babu
- Department of Pediatrics, Indira Gandhi Medical College and Research Institute, 255, Vazhudavoor Road, Kathirkamam, Puducherry 605009, India
| | - Vijayasankar Vijayadevagaran
- Department of Pediatrics, Indira Gandhi Medical College and Research Institute, 255, Vazhudavoor Road, Kathirkamam, Puducherry 605009, India
| | - Shanthi Ananthakrishnan
- Department of Pediatrics, Indira Gandhi Medical College and Research Institute, 255, Vazhudavoor Road, Kathirkamam, Puducherry 605009, India
| | - Devi Kittu
- Department of Community Medicine, Indira Gandhi Medical College and Research Institute, 255, Vazhudavoor Road, Kathirkamam, Puducherry 605009, India
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Ranjan J, Prakash JAJ. Scrub typhus re-emergence in India: Contributing factors and way forward. Med Hypotheses 2018; 115:61-64. [DOI: 10.1016/j.mehy.2018.03.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/30/2018] [Indexed: 11/29/2022]
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Rawat V, Singh RK, Kumar A, Saxena SR, Varshney U, Kumar M. Epidemiological, clinical and laboratory profile of scrub typhus cases detected by serology and RT-PCR in Kumaon, Uttarakhand: a hospital-based study. Trop Doct 2017; 48:103-106. [PMID: 29173047 DOI: 10.1177/0049475517743891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We analysed the epidemiology, clinical and laboratory data of the 168 scrub typhus cases confirmed by a combination of any one of the following: real time polymerase chain reaction (RT-PCR) and/or immunofluorescence assay (IFA) (IgM and/or IgG). The peak season for scrub typhus was from July to October. By multivariate binary logistic regression analysis, the risk of scrub typhus was about four times in those working in occupation related to forest work. Major clinical manifestations were fever (100%), myalgia (65%), cough (51%) and vomiting (46%); major complications were meningitis/meningoencephatilitis (12.5%) and multi-organ failure (MOF) and pneumonia (5.3% each). Laboratory investigations revealed raised aminotranferase levels and thrombocytopenia in most confirmed cases. We conclude that scrub typhus is an important cause of febrile illness in the Kumaon hills of Uttarakhand where this disease had not previously been considered to exist.
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Affiliation(s)
- Vinita Rawat
- 1 Associate Professor, Department of Microbiology, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Rajesh Kumar Singh
- 2 Associate Professor, Department of Community Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Ashok Kumar
- 3 Associate Professor, Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Sandip R Saxena
- 4 Professor, Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Umesh Varshney
- 5 Professor, Department of Microbiology, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Mukesh Kumar
- 6 Assistant Professor, Department of Microbiology, Government Medical College, Haldwani, Nainital, Uttarakhand, India
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Ittyachen AM, Abraham SP, Krishnamoorthy S, Vijayan A, Kokkat J. Immune thrombocytopenia with multi-organ dysfunction syndrome as a rare presentation of scrub typhus: a case report. BMC Res Notes 2017; 10:496. [PMID: 28985768 PMCID: PMC5639588 DOI: 10.1186/s13104-017-2826-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 09/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background Scrub typhus is an acute infectious illness caused by Orientia tsutsugamushi. It is endemic to a part of the world known as the “tsutsugamushi triangle”. Humans are accidental hosts in this zoonotic disease. About a third of patients admitted with scrub typhus have evidence of multi-organ dysfunction. Multi-organ dysfunction secondary to scrub typhus carries a high mortality rate. Case presentation We report a 65-year old lady who was admitted in a Tertiary Care Center in the state of Kerala in India, with 7 day history of fever, myalgia and reduced urine output. Head to foot examination revealed the presence of an eschar on her chest. One week prior to the onset of her illness she had gone trekking through a hilly forest area. She was clinically suspected to have scrub typhus, which was later confirmed with laboratory tests. She developed multi-organ dysfunction syndrome secondary to this illness. Though there was an improvement in the multi-organ dysfunction, thrombocytopenia alone failed to improve. Bone marrow study was done which was suggestive of immune thrombocytopenia. Patient was given a course of steroids with which the thrombocytopenia improved. Conclusion Failure of platelet count to normalize even after there has been a general improvement of other markers of multi-organ dysfunction in scrub typhus should prompt the clinician to consider other potential causes of thrombocytopenia. An unusual finding as this calls for further research to understand the molecular mechanisms behind such an event. Further, considering the close similarity in clinical presentation of several tropical illnesses, meticulous history taking and a detailed physical examination needs to be emphasized.
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Affiliation(s)
- Abraham M Ittyachen
- M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India. .,Department of Medicine, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India.
| | - Saramma P Abraham
- M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India.,Department of Anaesthesiology, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India
| | - Smitha Krishnamoorthy
- M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India.,Department of Medicine, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India
| | - Anuroopa Vijayan
- M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India.,Department of Medicine, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India
| | - Jayamohan Kokkat
- M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India.,Department of Medicine, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India
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