Scrub Typhus an  Emerging disease, comes to Tricity

Recently, it has been seen that there have sudden increase in number of cases of fever in both children and adults due to Scrub typhus or tsutsugamushi disease reporting to PGI. The disease is caused due to bacteria known as Orientia tsutsugamushi that lives primarily in mites (the primary reservoir) belonging to the species Leptotrombidium  akamushi (chiggers mite)

 The name tsutsugamushi is derived from two Japanese words: tsutsuga, meaning something small and dangerous, and mushi, meaning creature). The infection is called scrub typhus because it generally occurs after exposure to areas with secondary (scrub) vegetation. It has recently been found, however, that the disease can also be prevalent in such areas as sandy beaches, mountain deserts, and equatorial rain forests.

Scrub typhus has been reported from various regions of India especially the hilly regions of the Himalayas, Shimla, Assam, West Bengal but the interesting finding is that many of theses cases reporting in PGI  are from urban  locales (e.g. Chandigarh  Himachal, punjab  and Haryana . We have received 40  blood samples from adults as well as children which are confirmed to be scrub typhus during the month of August only . Earlier disease was not present in urban population and was thought to exist only in hilly areas in forest.  Fever is present in all patients with mainly vomiting, respiratory distress, altered sensorium . Eschar which is quite pathognomic of scrub typhus was present in 3 patients. Other clinical features included jaundice with hepatosplenomegaly All the patients are responding very well to doxycycline and azithromycin.  Last year during the months of august and September , 80 cases of scrub typus were reported.

 Humans are infected accidentally, usually during rainy season.  The site bitten by mite forms an eschar. Necrotic eschar at the inoculating site of the mite is pathognomic of scrub typhus. The eschar resembles skin burn of a cigarette butt.

Clinical picture of scrub typhus is typically associated with fever, eschar, rash, myalgia, and lymphadenopathy. Although eschars have high diagnostic value, the lesions are painless and without any itching sensation in most cases, causing the infection to be undetected by most patients. Scrub typhus can mimic acute abdomen which sometimes can lead to even surgery.

 Severe scrub typhus usually presents as multiple organ damage including carditis, acute respiratory distress syndrome hepatitis renal failure encephalitis, disseminated intravascular coagulopathy (DIC) and septic shock

Thus, Scrub Typhus is diagnosed with difficulty because of its nonspecific, varied clinical presentation, long list of differential diagnosis and non availability of recommended serological tests at the primary health care level. Diagnosis of scrub typhus in this region, thus demands, a high degree of clinical suspicion and familiarity with the various clinical manifestations, availability and use of rapid immunological test in suspected case to allow early diagnosis and timely initiation of appropriate therapy and thereby reducing patient morbidity and mortality.

The treatment should be initiated early to reduce morbidity and mortality. Even empirical treatment in case of suspected cases is thus recommended. The conventional treatment includes broad spectrum antibiotics like doxycycline (adults) & chloramphenicol (in paediatric population). Rifampicin & azithromycin have been used successfully in areas where scrub typhus is resistant to the conventional therapy.