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Himachal Pradesh
Published Date: 2016-07-20 00:02:21
Subject: PRO/SOAS> Scrub typhus - India (03): (Himachal Pradesh)
Archive Number: 20160720.4355230
SCRUB TYPHUS - INDIA (03): (HIMACHAL PRADESH)
*********************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Tue 19 Jul 2016
Source The Times of India (TOI), Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/c...w/53274147.cms
With monsoons, scrub typhus is back in Himachal Pradesh which has already gripped 19 people being found positive with disease and around 200 suspected cases have been tested in Indira Gandhi and Medical College and Hospital (IGMCH) in Shimla alone. So far, no related deaths have been reported in the state.
This high intensity fever is caused due to the mites in the shrubs causing the bacterial (bacteria _orientia tsutsugamushi_) infection. Risk of this disease is very high during and after monsoons due to grass cutting.
IGMCH senior medical superintendent Dr Ramesh Chand said that with monsoons, cases of scrub typhus are increasing in the state day by day. "We have got more positive cases from district Mandi, Bilaspur and Shimla," he added. He said that with increasing awareness, now suspected patients are reaching hospital in the initial stage. "In suspicion, people should immediately reach nearby hospitals as its treatment becomes difficult if diagnosed in a later stage which can cause death also," he added.
In 2015, scrub typhus took lives of around 20 people and around 15 cases from rural Himachal were reaching the IGMCH every day. The patients, who died, belonged to Chhota Shimla, Chirgaon, Theog, Chaupal, Rohru in Shimla, Kasauli in Solan, Sarkaghat in Mandi, Nirmand in Kullu, Jhandatta in Bilaspur and Shilai in Sirmaur. Maximum of the deaths had been reported from the state capital Shimla. In 2014, more than 1000 people were reported positive with the disease in IGMCH.
--
Communicated by:
ProMED-SoAs
[Scrub typhus is an acute, febrile, infectious illness caused by _Orientia (formerly _Rickettsia_) tsutsugamushi_. It is also known as tsutsugamushi disease. Scrub typhus was originally described from Japan in 1899. Humans are accidental hosts in this zoonotic disease.
Scrub typhus is transmitted to humans and rodents by some species of trombiculid mites ("chiggers" and others). The adult mites have a 4-stage lifecycle: egg, larva, nymph, and adult. The larva is the only stage (chigger) that can transmit the disease to humans and other vertebrates, since the other life stages (nymph and adult) do not feed on vertebrate animals. Both the nymph and the adult are free-living in the soilhttp://www.searo.who.int/entity/emer...rub_Typhus.pdf.
As per the media report above, 19 cases were found positive for scrub typhus in Himachal Pradesh. The report does not mention the laboratory tests used to confirm the diagnosis. The early diagnosis of acute scrub typhus can reduce the chance of life-threatening complications and guide optimal therapy with the antibiotic doxycycline. There is a need to create awareness regarding prevention and control of scrub typhus among the community.
In India, scrub typhus has been reported from several states, including Himachal Pradesh, Kerala, Karnataka, Rajasthan, Jammu and Kashmir, and Tamil Nadu (see 'ProMED-SOAS postings listed below andhttp://www.ncdc.gov.in/writereaddata...8604739980.pdf. - Mod.GS
See Also
Scrub typhus - India (02): (Rajasthan) fatal 20160625.4307473
Scrub typhus - India (01): (Kerala) 20160318.4103540
2015
----
Scrub typhus - India (09): (Tamil Nadu) rise in cases 20151229.3897521
Scrub typhus - India (08): (Maharashtra) fatal 20150927.3670099
Scrub typhus - India (07): (Himachal Pradesh) 20150916.3649350
Scrub typhus - India (06): (Kerala) 20150914.3644003
Scrub typhus - India (05): (Rajasthan) susp., fatal 20150903.3621583
Scrub typhus - India (04): (Karnataka) Bengaluru, susp. 20150816.3581146
Scrub typhus - India (03): (Himachal Pradesh) 20150705.3485554
Scrub typhus - India (02): (Tamil Nadu) 20150405.3277392
Scrub typhus - India (01): (Tamil Nadu) 20150202.3137412
2014
----
Scrub typhus - India (06): (Jaipur) 20141019.2878831
Scrub typhus - India (05): (Rajasthan) 20141002.2822611
Scrub typhus - India (04): (Himachal Pradesh) 20140925.2800886
Scrub typhus - India (03): (Rajasthan) fatal 20140922.2795344
Scrub typhus - India (02): (Rajasthan) 20140827.2718241
Scrub typhus - India: (Himachal Pradesh) 20140722.2625353
.................................................g s/ao/pkb
Rajasthan
Scrub typhus cases in summer surprise doctors
Syed Intishab Ali | Jun 24, 2016, 07.55 AM IST
Jaipur: Scrub typhus cases reported even in summers have surprised the doctors of Sawai Man Singh (SMS) hospital. even persons brought to the SMS hospital were diagnosed with scrub typhus in June. Five such cases were reported in May and 13 were brought to the hospital in April. So far this year, five patients have already succumbed to the disease in the hospital. In 2015, four patients had died.
...
http://timesofindia.indiatimes.com/c...w/52893966.cms
Kerala
KERALA
ALAPPUZHA, March 18, 2016
Updated: March 18, 2016 05:49 IST
Scrub typhus reported in Cherthala
SPECIAL CORRESPONDENT
Among infectious diseases under close surveillance in State since January 2012
Scrub typhus, an infectious disease spread by mites, has been found in Cherthala for the first time. The incidence of the disease was reported in other districts last year, according to Health Department officials.
Viswakala, assistant professor, Community Medicine, Alappuzha TD Medical College, says more than 900 cases were reported in Kerala last year, of which 16 persons died.
...
http://www.thehindu.com/news/nationa...cle8368415.ece
Pediatric scrub typhus in Southern Kerala: An emerging public health problem doi:10.1016/j.cegh.2016.03.003
Abstract
Background
Scrub typhus is a potentially fatal rickettsial infection endemic in Asia. But there are only very few reports of pediatric scrub typhus from Southern Kerala, which is situated in South India.
Objective
To study the clinicoepidemiological profile of pediatric patients with scrub typhus in Southern Kerala.
Methods
Clinical profile of 108 consecutive, 1- to 12-year-old children diagnosed with scrub typhus admitted in a tertiary care teaching hospital in South India from August 2011 to May 2015 was studied.
Results
The median age of affected children was 6.83 years with a male to female ratio 1.42:1. Definite clustering of cases was noted from Nedumangaud Taluk, a hilly area in Trivandrum district (24%). A seasonal pattern was observed with a peak during the months of August?January (84.26%). Most common symptoms apart from fever were cough, abdominal pain, and vomiting. Most common signs were splenomegaly in 68.52% of cases and lymph node enlargement in 59.26% of cases. Eschar was present in 44.44% of cases, with the commonest site being inguinal region. Complications were seen in 9.25% of cases. Myocarditis was the most common complication and one case had associated coronary artery dilatation also. Case fatality rate was only 0.93%. Doxycycline and azithromycin were the antibiotics used. Fever subsided within 24 h of starting treatment in 73.15% of cases and within 48 h in 84.26% of cases.
Conclusion
Scrub typhus is a common cause of fever in South India. Awareness among medical professional should be a high priority as late detection is the cause of failure of treatment, complications, and even mortality.
Keywords
? 2016 INDIACLEN. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.
http://www.sciencedirect.com/science...13398416300124
Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications
Rwituja Thomas, Preeti Puranik, Bhuvanesh Kalal, Carl Britto, Savitha Kamalesh, Sylvan Rego, Anita Shet
St Johns? Medical College Hospital, Bangalore, India
Abstract
Introduction: Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management.
Methodology: Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data.
Results: Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive Weil-Felix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Overall mortality among hospitalised children was 1.9%.
Conclusions: This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.
Keywords
rickettsial infections; children; India
http://www.jidc.org/index.php/journa.../view/27367015
Bihar
Monday , July 4 , 2016 |
Encephalitis scare in city
Shuchismita Chakraborty
...
Jaiswal, who was also a part of the team, said: "Scrub typhus infection has been detected in nearly 30 per cent samples of the total number of suspected AES cases across the state. The infection wasn't found in previous AES cases. The discovery might help in treating AES as there are drugs to treat the infection. ANMCH needs a polymerase chain reaction machine that can diagnose AES within 24 hours."
http://www.telegraphindia.com/116070...p#.V49bn7iANBc
Scrub Typhus in a Tertiary Care Hospital in North India+Author Affiliations
Scrub typhus, a zoonotic disease caused by the bacterium Orientia tsutsugamushi, has become endemic in many parts of India. We studied the clinical profile of this infection in 228 patients that reported to this tertiary care center from July 2013 to December 2014. The median age of patients was 35 years (interquartile range = 24.5?48.5 years), and 111 were males and 117 females. A high-grade fever occurred in 85%, breathlessness in 42%, jaundice in 32%, abdominal pain in 28%, renal failure in 11%, diarrhea in 10%, rashes in 9%, and seizures in 7%. Common laboratory abnormalities at presentation were a deranged hepatic function in 61%, anemia in 54%, leukopenia in 15%, and thrombocytopenia in 90% of our patients. Acute kidney injury (32%), acute respiratory distress syndrome (ARDS) (25%), and DIC (16%) were the commonest complications. A hepatorenal syndrome was seen in 38% and multiple organ dysfunction syndrome (MODS) in 20% patients. The overall case fatality rate was 13.6%. In univariate analysis, ARDS requiring mechanical ventilation, acute kidney injury requiring hemodialysis, hypotension requiring inotropic support, central nervous system dysfunction at presentation, and MODS were inversely associated with survival. Survival was significantly higher in patients that presented with a duration of fever < 10 days compared with those that presented ≥ 12 days (P < 0.05) after onset. In conclusion, scrub typhus has become a leading infectious disease in north India and an important cause of infectious fever. An increasing awareness of this disease coupled with prompt management will go a long way in reducing both morbidity and mortality from this disease.
Mithu Medhi1*, Aparna Sonowal2
, Lahari Saikia3
, Sanjeeb Kakati4
, Md Ezaz Hussain5
1*Assistant Professor, 2Demonstrator, 3Professor and Head, 5MSc (Statistics)- Data Manager, Department of Microbiology,
4Professor, Department of Medicine, Assam Medical College & Hospital, Dibrugarh, Assam, INDIA.
ABSTRACT
Introduction: Scrub typhus is an acute febrile infectious illness
caused by Orientia tsutsugamushi, transmitted to humans by
the bite of the larva of trombiculid mites. The study was
undertaken to know the seroprevalence of Scrub typhus
among clinically suspected cases and its association with
different parameters like age, gender, geographical location,
season etc.
Methods: This prospective cross-sectional hospital based
study was carried out on consecutive non repetitive clinically
suspected cases satisfying the case definition as per DHRICMR
guideline attending Assam Medical College & Hospital
during the study period of March 2014 to February 2016.
Serum samples were tested for Scrub typhus IgM antibodies
by ELISA method.
Results: A total of 802 no of cases were included in the study.
Of them 124 (15.46 %) were positive for Scrub typhus. Cases
were presented with fever, headache, myalgia, nausea and
vomiting, joint pain, seizure, altered mental status,
unconsciousness, retro-orbital pain, lymphadenopathy,
maculo-papular rash etc. Eschar was seen in two patients.
Hepatosplenomegaly was observed in 13.71% patients. The
study showed no significant association of the disease with the
age and sex of the patient (p>0.05). Most of the cases were
found in June- February. 90.32 % cases were reported from
rural area and the association was statistically significant.
(p<0.001)
Conclusion: It is recommended to include Scrub typhus in the
differential diagnosis of acute febrile illness in this region which
will help in proper diagnosis, timely and adequate treatment
and avoidance of the complications and mortality.
...
Clinical, Laboratory Profile and Outcome of Scrub Typhus in
Children
Dr Murali Krishnan P1
, Dr Sree Chandhu Padarthi2
1
(Department Of Paediatrics Meenakshi Medical college and Research Institute/ Meenakshi University, India)
2
(Department Of PaediatricsMeenakshi Medical college and Research Institute/ Meenakshi University, India)
Abstract : Objective : To study the clinical, laboratory profile and outcome of scrub typhus in children.
Methodology: Children admitted with unexplained fever and diagnosed as scrub typhus between Nov 2013 and
Mar 2015 were included in this study. Detailed history, clinical examination findings, laboratory profile,
complications and outcome were analysed. Results: Total of 100 children were included and all of them
presented with unexplained fever and any one or more of the following features like headache, abdominal pain,
vomiting, eschar, rash, hepatospleenomegaly and shock. IgM ELISA was done to confirm the diagnosis.
Neutrophilia, thrombocytopenia, elevated liver enzymes, raised CRP and anaemia were observed in this study.
Complications like shock, pneumonitis, seizure, gastro intestinal bleeding and renal failure were observed. All
the children responded promptly to therapy with either doxycycline or azithromycin and recovered completely
without any residual impairment. Conclusion: Scrub typhus is not uncommon in children. High index of
suspicion based on clinical features with or without eschar and prompt therapy with specific antibiotic will
result in complete recovery from scrub typhus and favourable outcome.
...
No mortality was
reported in our study.
...
http://www.iosrjournals.org/iosr-jdm...0152103032.pdf
Health Sciences
OPEN ACCESS PEER REVIEWED E-JOURNAL
KERALA UNIVERSITY OF HEALTH SCIENCES
HOME | LOGIN2012; Vol.1,No.1 APRIL - JUNE
ISSN 2319 ? 4154
ABOUT JOURNALKUHS SUBMIT ARTICLEBROWSE JOURNALSCONTENTSCONTACT
CASE REPORT
SAJAN CHRISTOPHER MD, Department of Medicine K. SREEKANTHAN, MD, Department of Infectious Diseases, Government Medical College, Thiruvananthapuram ? 695011, Kerala, India
Scrub Typhus presenting as Atypical Pneumonia
Abstract
Scrub typhus is being increasingly reported in India. It is highly endemic in suburban regions of Thiruvananthapuram. It should be considered in the differential diagnosis of patients with acute febrile illness, including those with altered sensorium, pneumonitis, atypical pneumonia, acute respiratory distress syndrome (ARDS), thrombocytopenia, and abnormalities in liver function tests,. We report a case of scrub typhus presenting as atypical pneumonia highlighting the wide variation in clinical presentations. A thorough knowledge of the clinical features of scrub typhus including its complications and its varied presentations is important for providing early appropriate life saving empiric treatment for patients.
...
ORIGINAL CONTRIBUTION: CLINICS IN INFECTIOUS DISEASES
Year : 2015 | Volume : 2 | Issue : 3 | Page : 116-120
Clinical manifestations and complications of scrub typhus: A hospital-based study from North Andhra
Nrushen Peesapati, Rohit Lakkapragada, S Sunitha, PV Sivaram
Department of General Medicine, Tirumala Hospital, Vizianagaram, Andhra Pradesh, India
Date of Web Publication 2-May-2016
Correspondence Address:
Nrushen Peesapati
MIG 170, Vuda Phase 4, Vizianagaram - 535 003, Andhra Pradesh
India
Login to access the Email id
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2349-0977.181508
Abstract
Aims and Objectives: To describe the diversity of clinical manifestations, laboratory findings, and outcome of scrub typhus in hospitalized patients of Tirumala Hospital, Vizianagaram, during 2014?2015. Materials and Methods: All cases of acute febrile illness diagnosed as scrub typhus were analyzed. Diagnosis was made by ELISA-based IgM serology. Observations and Results: A total of sixty patients were included in the study. All of them presented with fever; the other major symptoms were headache, cough, dyspnea, and myalgias. On examination, patients had hepatosplenomegaly, lymphadenopathy, and eschar. On investigation, elevated serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase with normal and elevated bilirubin levels were the most common findings. Other laboratory findings were thrombocytopenia and deranged renal function tests.Other complications were multiorgan dysfunction syndrome, acute respiratory distress syndrome, hypotension, and meningoencephalitis. Majority responded to doxycycline. Conclusion: Scrub typhus though prevalent is under-reported in our country. It should be considered as an important differential diagnosis in a febrile patient with thrombocytopenia, deranged liver or renal functions, Early diagnosis and appropriate treatment is rewarding and prevents morbidity and mortality.
http://www.astrocyte.in/article.asp?...last=Peesapati
Incidence of Scrub Typhus in a Tertiary Care Hospital in Uttarakhand.
Dr Sulekha Nautiyal, Dr Shalabh Jauhari, Dr. Noopur Goel, Dr. B.S. Mahawal
Shri Guru Ram Rai Institute of Medical & Health Sciences
Manuscript History: Abstract
Received: 15 November 2015 Final Accepted: 26 December 2015 Published Online: January 2016 Key words: Eschar, ICT for Scrub Typhus, IgM ELISA for Scrub Typhus. *Corresponding Author
Dr Sulekha Nautiyal.
Context: Scrub typhus is an important cause of acute undifferentiated febrile illness. Due to non specific clinical presentation cases are often missed, although endemic in our country. IgM Ab detection by ELISA and Rapid Immunochromatographic test (ICT) are commonly employed for its diagnosis. Aim: To study the incidence of Scrub typhus in population attending our hospital in Uttarakhand. Settings and Design: This prospective study was carried out from September 2013 to November 2013 in cases of PUO with high suspicion of scrub typhus. Material and Methods: A total of 294 samples were subjected to a spectrum of tests(ICT for antibodies against Orientia tsutsugamushi, IgM, IgG Ab & NS1Ag for Dengue, IgM to Salmonella Typhi) based on clinical suspicion of febrile illness. Positive samples for Orientia tsutsugamushi were retested by ELISA for IgM antibodies against O. tsutsugamushi. Results: Out of 294 cases of PUO, 61 /294 (20.7%) were found to be positive for IgM Ab to Orientia tsutsugamushi, 27 /294 (9.18%) IgM, IgG Ab & NS1Ag for Dengue, and one out of 294(0.003%) for IgM Ab to Salmonella Typhi. One case was found to be reactive for both IgM Ab for Orientia tsutsugamushi and Dengue. Data was analyzed in correlation with clinical features. Conclusions: This study implies emergence of scrub typhus in our region. It is thus suggested that high index of suspicion for scrub typhus should be maintained for cases presenting with acute febrile illness to avoid false negative reporting owing to absence of eschar formation which is pathognomic feature of disease and rarely seen in Indian sub-continent.
Copy Right, IJAR, 2016,. All rights reserved.
https://www.google.com/url?sa=t&rct=...27521224,d.dmo
Himachal Pradesh
Published Date: 2016-07-20 00:02:21
Subject: PRO/SOAS> Scrub typhus - India (03): (Himachal Pradesh)
Archive Number: 20160720.4355230
SCRUB TYPHUS - INDIA (03): (HIMACHAL PRADESH)
*********************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Tue 19 Jul 2016
Source The Times of India (TOI), Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/c...w/53274147.cms
With monsoons, scrub typhus is back in Himachal Pradesh which has already gripped 19 people being found positive with disease and around 200 suspected cases have been tested in Indira Gandhi and Medical College and Hospital (IGMCH) in Shimla alone. So far, no related deaths have been reported in the state.
This high intensity fever is caused due to the mites in the shrubs causing the bacterial (bacteria _orientia tsutsugamushi_) infection. Risk of this disease is very high during and after monsoons due to grass cutting.
IGMCH senior medical superintendent Dr Ramesh Chand said that with monsoons, cases of scrub typhus are increasing in the state day by day. "We have got more positive cases from district Mandi, Bilaspur and Shimla," he added. He said that with increasing awareness, now suspected patients are reaching hospital in the initial stage. "In suspicion, people should immediately reach nearby hospitals as its treatment becomes difficult if diagnosed in a later stage which can cause death also," he added.
In 2015, scrub typhus took lives of around 20 people and around 15 cases from rural Himachal were reaching the IGMCH every day. The patients, who died, belonged to Chhota Shimla, Chirgaon, Theog, Chaupal, Rohru in Shimla, Kasauli in Solan, Sarkaghat in Mandi, Nirmand in Kullu, Jhandatta in Bilaspur and Shilai in Sirmaur. Maximum of the deaths had been reported from the state capital Shimla. In 2014, more than 1000 people were reported positive with the disease in IGMCH.
--
Communicated by:
ProMED-SoAs
[Scrub typhus is an acute, febrile, infectious illness caused by _Orientia (formerly _Rickettsia_) tsutsugamushi_. It is also known as tsutsugamushi disease. Scrub typhus was originally described from Japan in 1899. Humans are accidental hosts in this zoonotic disease.
Scrub typhus is transmitted to humans and rodents by some species of trombiculid mites ("chiggers" and others). The adult mites have a 4-stage lifecycle: egg, larva, nymph, and adult. The larva is the only stage (chigger) that can transmit the disease to humans and other vertebrates, since the other life stages (nymph and adult) do not feed on vertebrate animals. Both the nymph and the adult are free-living in the soilhttp://www.searo.who.int/entity/emer...rub_Typhus.pdf.
As per the media report above, 19 cases were found positive for scrub typhus in Himachal Pradesh. The report does not mention the laboratory tests used to confirm the diagnosis. The early diagnosis of acute scrub typhus can reduce the chance of life-threatening complications and guide optimal therapy with the antibiotic doxycycline. There is a need to create awareness regarding prevention and control of scrub typhus among the community.
In India, scrub typhus has been reported from several states, including Himachal Pradesh, Kerala, Karnataka, Rajasthan, Jammu and Kashmir, and Tamil Nadu (see 'ProMED-SOAS postings listed below andhttp://www.ncdc.gov.in/writereaddata...8604739980.pdf. - Mod.GS
See Also
Scrub typhus - India (02): (Rajasthan) fatal 20160625.4307473
Scrub typhus - India (01): (Kerala) 20160318.4103540
2015
----
Scrub typhus - India (09): (Tamil Nadu) rise in cases 20151229.3897521
Scrub typhus - India (08): (Maharashtra) fatal 20150927.3670099
Scrub typhus - India (07): (Himachal Pradesh) 20150916.3649350
Scrub typhus - India (06): (Kerala) 20150914.3644003
Scrub typhus - India (05): (Rajasthan) susp., fatal 20150903.3621583
Scrub typhus - India (04): (Karnataka) Bengaluru, susp. 20150816.3581146
Scrub typhus - India (03): (Himachal Pradesh) 20150705.3485554
Scrub typhus - India (02): (Tamil Nadu) 20150405.3277392
Scrub typhus - India (01): (Tamil Nadu) 20150202.3137412
2014
----
Scrub typhus - India (06): (Jaipur) 20141019.2878831
Scrub typhus - India (05): (Rajasthan) 20141002.2822611
Scrub typhus - India (04): (Himachal Pradesh) 20140925.2800886
Scrub typhus - India (03): (Rajasthan) fatal 20140922.2795344
Scrub typhus - India (02): (Rajasthan) 20140827.2718241
Scrub typhus - India: (Himachal Pradesh) 20140722.2625353
.................................................g s/ao/pkb
Rajasthan
Scrub typhus cases in summer surprise doctors
Syed Intishab Ali | Jun 24, 2016, 07.55 AM IST
Jaipur: Scrub typhus cases reported even in summers have surprised the doctors of Sawai Man Singh (SMS) hospital. even persons brought to the SMS hospital were diagnosed with scrub typhus in June. Five such cases were reported in May and 13 were brought to the hospital in April. So far this year, five patients have already succumbed to the disease in the hospital. In 2015, four patients had died.
...
http://timesofindia.indiatimes.com/c...w/52893966.cms
Kerala
KERALA
ALAPPUZHA, March 18, 2016
Updated: March 18, 2016 05:49 IST
Scrub typhus reported in Cherthala
SPECIAL CORRESPONDENT
Among infectious diseases under close surveillance in State since January 2012
Scrub typhus, an infectious disease spread by mites, has been found in Cherthala for the first time. The incidence of the disease was reported in other districts last year, according to Health Department officials.
Viswakala, assistant professor, Community Medicine, Alappuzha TD Medical College, says more than 900 cases were reported in Kerala last year, of which 16 persons died.
...
http://www.thehindu.com/news/nationa...cle8368415.ece
Pediatric scrub typhus in Southern Kerala: An emerging public health problem doi:10.1016/j.cegh.2016.03.003
Abstract
Background
Scrub typhus is a potentially fatal rickettsial infection endemic in Asia. But there are only very few reports of pediatric scrub typhus from Southern Kerala, which is situated in South India.
Objective
To study the clinicoepidemiological profile of pediatric patients with scrub typhus in Southern Kerala.
Methods
Clinical profile of 108 consecutive, 1- to 12-year-old children diagnosed with scrub typhus admitted in a tertiary care teaching hospital in South India from August 2011 to May 2015 was studied.
Results
The median age of affected children was 6.83 years with a male to female ratio 1.42:1. Definite clustering of cases was noted from Nedumangaud Taluk, a hilly area in Trivandrum district (24%). A seasonal pattern was observed with a peak during the months of August?January (84.26%). Most common symptoms apart from fever were cough, abdominal pain, and vomiting. Most common signs were splenomegaly in 68.52% of cases and lymph node enlargement in 59.26% of cases. Eschar was present in 44.44% of cases, with the commonest site being inguinal region. Complications were seen in 9.25% of cases. Myocarditis was the most common complication and one case had associated coronary artery dilatation also. Case fatality rate was only 0.93%. Doxycycline and azithromycin were the antibiotics used. Fever subsided within 24 h of starting treatment in 73.15% of cases and within 48 h in 84.26% of cases.
Conclusion
Scrub typhus is a common cause of fever in South India. Awareness among medical professional should be a high priority as late detection is the cause of failure of treatment, complications, and even mortality.
Keywords
- Children;
- Eschar;
- Rickettsial;
- Orientia tsutsugamushi;
- Scrub typhus
? 2016 INDIACLEN. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.
http://www.sciencedirect.com/science...13398416300124
Five-year analysis of rickettsial fevers in children in South India: Clinical manifestations and complications
Rwituja Thomas, Preeti Puranik, Bhuvanesh Kalal, Carl Britto, Savitha Kamalesh, Sylvan Rego, Anita Shet
St Johns? Medical College Hospital, Bangalore, India
doi:10.3855/jidc.6822
Abstract
Introduction: Rickettsial infections are re-emerging in the Indian subcontinent, especially among children. Understanding geographical and clinical epidemiology will facilitate early diagnosis and management.
Methodology: Children aged <18yrs hospitalized with clinically-diagnosed rickettsial fever were reviewed retrospectively. Frequency distributions and odds ratios were calculated from tabulated data.
Results: Among 262 children hospitalized between January 2008-December 2012, median age was five years, and 61% were male children. Hospitalized cases increased steadily every year, with the highest burden (74%) occurring between September and January each year. Mean duration of fever was 11.5 days. Rash was present in 54.2% (142/262) of children, with 37.0% involving palms and soles. Prevalence of malnutrition was high (45% of children were underweight and 28% had stunting). Retinal vasculitis was seen in 13.7% (36/262), and the risk appeared higher in females. Severe complications were seen in 29% (purpura fulminans, 7.6%; meningitis and meningoencephalitis, 28%; septic shock, 1.9%; acute respiratory distress syndrome, 1.1%). Complications were more likely to occur in anemic children. Positive Weil-Felix test results (titers ≥1:160) were seen in 70% of cases. Elevated OX-K titers suggestive of scrub typhus were seen in 80% (147/184). Patients were treated with chloramphenicol (32%) or doxycycline (68%). Overall mortality among hospitalised children was 1.9%.
Conclusions: This five-year analysis from southern India shows a high burden and increasing trend of rickettsial infections among children. The occurrence of retinal vasculitis and a high rate of severe complications draw attention to the need for early diagnosis and management of these infections.
Keywords
rickettsial infections; children; India
| Full Text: |
Bihar
Monday , July 4 , 2016 |
Encephalitis scare in city
Shuchismita Chakraborty
...
Jaiswal, who was also a part of the team, said: "Scrub typhus infection has been detected in nearly 30 per cent samples of the total number of suspected AES cases across the state. The infection wasn't found in previous AES cases. The discovery might help in treating AES as there are drugs to treat the infection. ANMCH needs a polymerase chain reaction machine that can diagnose AES within 24 hours."
http://www.telegraphindia.com/116070...p#.V49bn7iANBc
Scrub Typhus in a Tertiary Care Hospital in North India+Author Affiliations
- 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- 2Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- Authors' addresses: Navneet Sharma, Sanjay Jain, and Ashish Bhalla, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mails: navneetsharma@hotmail.com, sanjayvanita@yahoo.com, and bhalla_ashish@gmail.com. Manisha Biswal, Abhay Kumar, and Kamran Zaman, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mails: manisha.biswal@gmail.com, ankaushik2@gmail.com, and kamran3zaman@gmail.com.
- ↵* Address correspondence to Navneet Sharma, Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Room No. 15, 4th Floor, F-Block, Chandigarh 160012, India. E-mail:navneetsharma@hotmail.com
Scrub typhus, a zoonotic disease caused by the bacterium Orientia tsutsugamushi, has become endemic in many parts of India. We studied the clinical profile of this infection in 228 patients that reported to this tertiary care center from July 2013 to December 2014. The median age of patients was 35 years (interquartile range = 24.5?48.5 years), and 111 were males and 117 females. A high-grade fever occurred in 85%, breathlessness in 42%, jaundice in 32%, abdominal pain in 28%, renal failure in 11%, diarrhea in 10%, rashes in 9%, and seizures in 7%. Common laboratory abnormalities at presentation were a deranged hepatic function in 61%, anemia in 54%, leukopenia in 15%, and thrombocytopenia in 90% of our patients. Acute kidney injury (32%), acute respiratory distress syndrome (ARDS) (25%), and DIC (16%) were the commonest complications. A hepatorenal syndrome was seen in 38% and multiple organ dysfunction syndrome (MODS) in 20% patients. The overall case fatality rate was 13.6%. In univariate analysis, ARDS requiring mechanical ventilation, acute kidney injury requiring hemodialysis, hypotension requiring inotropic support, central nervous system dysfunction at presentation, and MODS were inversely associated with survival. Survival was significantly higher in patients that presented with a duration of fever < 10 days compared with those that presented ≥ 12 days (P < 0.05) after onset. In conclusion, scrub typhus has become a leading infectious disease in north India and an important cause of infectious fever. An increasing awareness of this disease coupled with prompt management will go a long way in reducing both morbidity and mortality from this disease.
- Received February 5, 2016.
- Accepted April 30, 2016.
- ? The American Society of Tropical Medicine and Hygiene
- http://www.ajtmh.org/content/early/2...-0086.abstract
Mithu Medhi1*, Aparna Sonowal2
, Lahari Saikia3
, Sanjeeb Kakati4
, Md Ezaz Hussain5
1*Assistant Professor, 2Demonstrator, 3Professor and Head, 5MSc (Statistics)- Data Manager, Department of Microbiology,
4Professor, Department of Medicine, Assam Medical College & Hospital, Dibrugarh, Assam, INDIA.
ABSTRACT
Introduction: Scrub typhus is an acute febrile infectious illness
caused by Orientia tsutsugamushi, transmitted to humans by
the bite of the larva of trombiculid mites. The study was
undertaken to know the seroprevalence of Scrub typhus
among clinically suspected cases and its association with
different parameters like age, gender, geographical location,
season etc.
Methods: This prospective cross-sectional hospital based
study was carried out on consecutive non repetitive clinically
suspected cases satisfying the case definition as per DHRICMR
guideline attending Assam Medical College & Hospital
during the study period of March 2014 to February 2016.
Serum samples were tested for Scrub typhus IgM antibodies
by ELISA method.
Results: A total of 802 no of cases were included in the study.
Of them 124 (15.46 %) were positive for Scrub typhus. Cases
were presented with fever, headache, myalgia, nausea and
vomiting, joint pain, seizure, altered mental status,
unconsciousness, retro-orbital pain, lymphadenopathy,
maculo-papular rash etc. Eschar was seen in two patients.
Hepatosplenomegaly was observed in 13.71% patients. The
study showed no significant association of the disease with the
age and sex of the patient (p>0.05). Most of the cases were
found in June- February. 90.32 % cases were reported from
rural area and the association was statistically significant.
(p<0.001)
Conclusion: It is recommended to include Scrub typhus in the
differential diagnosis of acute febrile illness in this region which
will help in proper diagnosis, timely and adequate treatment
and avoidance of the complications and mortality.
...
Clinical, Laboratory Profile and Outcome of Scrub Typhus in
Children
Dr Murali Krishnan P1
, Dr Sree Chandhu Padarthi2
1
(Department Of Paediatrics Meenakshi Medical college and Research Institute/ Meenakshi University, India)
2
(Department Of PaediatricsMeenakshi Medical college and Research Institute/ Meenakshi University, India)
Abstract : Objective : To study the clinical, laboratory profile and outcome of scrub typhus in children.
Methodology: Children admitted with unexplained fever and diagnosed as scrub typhus between Nov 2013 and
Mar 2015 were included in this study. Detailed history, clinical examination findings, laboratory profile,
complications and outcome were analysed. Results: Total of 100 children were included and all of them
presented with unexplained fever and any one or more of the following features like headache, abdominal pain,
vomiting, eschar, rash, hepatospleenomegaly and shock. IgM ELISA was done to confirm the diagnosis.
Neutrophilia, thrombocytopenia, elevated liver enzymes, raised CRP and anaemia were observed in this study.
Complications like shock, pneumonitis, seizure, gastro intestinal bleeding and renal failure were observed. All
the children responded promptly to therapy with either doxycycline or azithromycin and recovered completely
without any residual impairment. Conclusion: Scrub typhus is not uncommon in children. High index of
suspicion based on clinical features with or without eschar and prompt therapy with specific antibiotic will
result in complete recovery from scrub typhus and favourable outcome.
...
No mortality was
reported in our study.
...
http://www.iosrjournals.org/iosr-jdm...0152103032.pdf
Health Sciences
OPEN ACCESS PEER REVIEWED E-JOURNAL
KERALA UNIVERSITY OF HEALTH SCIENCES
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CASE REPORT
SAJAN CHRISTOPHER MD, Department of Medicine K. SREEKANTHAN, MD, Department of Infectious Diseases, Government Medical College, Thiruvananthapuram ? 695011, Kerala, India
Scrub Typhus presenting as Atypical Pneumonia
Abstract
Scrub typhus is being increasingly reported in India. It is highly endemic in suburban regions of Thiruvananthapuram. It should be considered in the differential diagnosis of patients with acute febrile illness, including those with altered sensorium, pneumonitis, atypical pneumonia, acute respiratory distress syndrome (ARDS), thrombocytopenia, and abnormalities in liver function tests,. We report a case of scrub typhus presenting as atypical pneumonia highlighting the wide variation in clinical presentations. A thorough knowledge of the clinical features of scrub typhus including its complications and its varied presentations is important for providing early appropriate life saving empiric treatment for patients.
...
ORIGINAL CONTRIBUTION: CLINICS IN INFECTIOUS DISEASES
Year : 2015 | Volume : 2 | Issue : 3 | Page : 116-120
Clinical manifestations and complications of scrub typhus: A hospital-based study from North Andhra
Nrushen Peesapati, Rohit Lakkapragada, S Sunitha, PV Sivaram
Department of General Medicine, Tirumala Hospital, Vizianagaram, Andhra Pradesh, India
Date of Web Publication 2-May-2016
Correspondence Address:
Nrushen Peesapati
MIG 170, Vuda Phase 4, Vizianagaram - 535 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2349-0977.181508
Abstract
Aims and Objectives: To describe the diversity of clinical manifestations, laboratory findings, and outcome of scrub typhus in hospitalized patients of Tirumala Hospital, Vizianagaram, during 2014?2015. Materials and Methods: All cases of acute febrile illness diagnosed as scrub typhus were analyzed. Diagnosis was made by ELISA-based IgM serology. Observations and Results: A total of sixty patients were included in the study. All of them presented with fever; the other major symptoms were headache, cough, dyspnea, and myalgias. On examination, patients had hepatosplenomegaly, lymphadenopathy, and eschar. On investigation, elevated serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase with normal and elevated bilirubin levels were the most common findings. Other laboratory findings were thrombocytopenia and deranged renal function tests.Other complications were multiorgan dysfunction syndrome, acute respiratory distress syndrome, hypotension, and meningoencephalitis. Majority responded to doxycycline. Conclusion: Scrub typhus though prevalent is under-reported in our country. It should be considered as an important differential diagnosis in a febrile patient with thrombocytopenia, deranged liver or renal functions, Early diagnosis and appropriate treatment is rewarding and prevents morbidity and mortality.
http://www.astrocyte.in/article.asp?...last=Peesapati
Incidence of Scrub Typhus in a Tertiary Care Hospital in Uttarakhand.
Dr Sulekha Nautiyal, Dr Shalabh Jauhari, Dr. Noopur Goel, Dr. B.S. Mahawal
Shri Guru Ram Rai Institute of Medical & Health Sciences
Manuscript History: Abstract
Received: 15 November 2015 Final Accepted: 26 December 2015 Published Online: January 2016 Key words: Eschar, ICT for Scrub Typhus, IgM ELISA for Scrub Typhus. *Corresponding Author
Dr Sulekha Nautiyal.
Context: Scrub typhus is an important cause of acute undifferentiated febrile illness. Due to non specific clinical presentation cases are often missed, although endemic in our country. IgM Ab detection by ELISA and Rapid Immunochromatographic test (ICT) are commonly employed for its diagnosis. Aim: To study the incidence of Scrub typhus in population attending our hospital in Uttarakhand. Settings and Design: This prospective study was carried out from September 2013 to November 2013 in cases of PUO with high suspicion of scrub typhus. Material and Methods: A total of 294 samples were subjected to a spectrum of tests(ICT for antibodies against Orientia tsutsugamushi, IgM, IgG Ab & NS1Ag for Dengue, IgM to Salmonella Typhi) based on clinical suspicion of febrile illness. Positive samples for Orientia tsutsugamushi were retested by ELISA for IgM antibodies against O. tsutsugamushi. Results: Out of 294 cases of PUO, 61 /294 (20.7%) were found to be positive for IgM Ab to Orientia tsutsugamushi, 27 /294 (9.18%) IgM, IgG Ab & NS1Ag for Dengue, and one out of 294(0.003%) for IgM Ab to Salmonella Typhi. One case was found to be reactive for both IgM Ab for Orientia tsutsugamushi and Dengue. Data was analyzed in correlation with clinical features. Conclusions: This study implies emergence of scrub typhus in our region. It is thus suggested that high index of suspicion for scrub typhus should be maintained for cases presenting with acute febrile illness to avoid false negative reporting owing to absence of eschar formation which is pathognomic feature of disease and rarely seen in Indian sub-continent.
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