Be aware ( Beware) of Scrub Typhus

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Scrub typhus is an acute, zoonotic, febrile illness of humans. Scrub typhus is an emerging disease, which is grossly under-diagnosed in developing countries due to its non-specific clinical presentation, limited awareness, and low index of suspicion among clinicians and lack of diagnostic facilities. Nagpur medical fraternity is recently noticing outbreaks of this disease. Many patients are reaching Orange City Hospital & Research Institute from all corners of Central India with undiagnosed fever with multiple complications.

Highlighting this disease; Dr.Devayani Buche, Physician stated that Scrub typhus usually affects previously healthy active persons and if undiagnosed or diagnosed late, may prove to be life-threatening.

Diagnosis of scrub typhus is based on a high index of suspicion and careful clinical, laboratory and epidemiological evaluation.

Dr.Rajesh Atal, Critical Care Physician added that Scrub typhus is an acute febrile illness caused by orientia tsutsugamushi transmitted to humans by the bite of the larva of mites. It causes disseminated vasculitic and perivascular inflammatory lesions resulting in significant vascular leakage and end-organ injury. After an incubation period of 6-21 days, onset is characterized by fever, headache, myalgia, cough, and gastrointestinal symptoms.

Dr.Milind Pande, Pathologist stated that laboratory studies usually reveal leukopenia, thrombocytopenia, deranged hepatic and renal function, proteinuria and reticulonodular infiltrate. Weil-Felix, Enzyme-linked immunosorbent assay, Rapid lateral flow-assay, Western blot, Immunochromatographic test, indirect fluorescent assay, indirect immunoperoxidase, PCR amplification of orientia genes and isolation/inoculation are some other high end ways and means to confirm the disease.

Dr. Nikhil Balankhe, Physician mentioned that Scrub Typhus also known as tsutsugamushi disease means dangerous bug in Japanese language.   O. Tsutsugamushi is transmitted to humans by the bite of the larva of trombiculid mites (chiggers) which are almost microscopic, often brilliantly colored. Infected chiggers are found particularly in areas of heavy scrub vegetation during the wet season, therefore this disease has also been called river/flood fever when mites lay eggs. Rodents are carriers. The word “scrub” was applied because of the type of vegetation that maintains the chigger−mammal relationship.

Dr.Kuldeep Sukhadeve, Paediatrician clarified that in children, scrub typhus may be mild or severe. Most patients present with fever and regional/generalized lymphadenopathy. A single painless eschar, maculopapular rash, hepatomegaly, splenomegaly and gastrointestinal symptoms may be present.

Dr.Ganesh Bure who leads the team of Intensivists at Critical Care Complex of Orange City Hospital & Research Institute for round the clock service emphasized that in the ICU, aggressive management like appropriate ventilator strategy in ARDS patients, dialysis of renal failure patients, and correction of haematological abnormalities etc. Of such patients is imperative to prevent high mortality associated with the complications. Preventing sepsis and multi organ failure can be possible in ICU settings with specific treatment protocols and supportive management.

Dr.Upendra Kumar, Physician cited that preventive measures especially in the absence of an effective vaccine can be primordial, primary and secondary. Primordial prevention entails prevention of emergence of risk factors. Best measure would be to avoid going to places like farms, areas abundant of bushes, rodents and domestic animals. Primary prevention includes health promotion and specific protection.

Dr.Ashish Shukla, Chest Physician added that advocacy, awareness and education activities, Habitat modification , Rat population control, wearing protective clothes, using insect repellents and Chemoprophylaxis are some ways of Primary prevention. Once the disease has occurred in an individual, then comes the role of secondary prevention which includes early diagnosis and treatment.

On the issue of Scrub Typhus and Pregnancy, Dr.Bindu Menon, Obstetrician stated that currently tetracycline and chloramphenicol are recommended for treatment for non-pregnant patients. According to Food and Drug Association tetracycline is classified as a class D drug and should not be used during pregnancy. Chloramphenicol is classified as a class C drug. Hence Single dose of azithromycin is used in pregnant women.

Dr.Ashwini Tayade, Infectious Disease Specialist concluded that early diagnosis of acute scrub typhus can greatly reduce the chance of life threatening complications and guide optimal therapy.