Ronan Kelly
Retired 2020
Link to 2013 thread; http://www.flutrackers.com/forum/showthread.php?t=211938
Published Date: 2014-05-15 17:45:00
Subject: PRO/AH/EDR> Scrub typhus - India: (MH)
Archive Number: 20140515.2475762
SCRUB TYPHUS - INDIA: (MAHARASHTRA)
***********************************
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: Wed 14 May 2014
Source: Pune Mirror [edited]
http://www.punemirror.in/pune/other...-a-new-lease-of-life/articleshow/35113698.cms
For a week, a 64-year-old [man] suffered from high fever, body ache, headache, and nausea, despite taking medicines. He later developed jaundice, gastrointestinal bleeding, septicemia and acute respiratory distress syndrome (ARDS).
It was when he was admitted at Kharadi-based Columbia Asia Hospital [Pune, Maharashtra State] last month [April 2014], that [his] disease was diagnosed -- scrub typhus (ST) -- a rare illness that leads to multi-organ dysfunction, having a mortality rate of 90 percent. Doctors say the disease is curable using antibiotics, but it can get out of hand if diagnosis is delayed.
ST is a mite-borne infectious disease caused by _Orientia tsutsugamushi_. Infectious diseases experts say that due to low literature [?], number of reported cases in the city cannot be enumerated.
Dr Sanjay Pujari, director, Institute of Infectious Diseases (IID), said, "ST is rare, and I have not seen a case with so many complications. This type of infection is normally wrongly diagnosed as leptospirosis, malaria, jaundice and typhoid. Developing ARDS in this infection is even rarer. If patients slip into multiorgan failure, they have very low survival chances."
[The patient] was treated by Dr Mahesh Lakhe, an infectious diseases specialist at Columbia Asia hospital. "He suffered from high fever and loss of appetite. He took treatment from a local doctor, but in vain. Later, he developed gastrointestinal bleeding, ARDS, meningitis and also septicemia. With so many complications he was admitted to the ICU and was diagnosed after a blood and biopsy test, as he had lesions all over his body. The samples were sent to Christian Medical College, Vellore [Tamil Nadu State], which confirmed the infection," Lakhe said. Saying that scrub typhus is frequently wrongly diagnosed, Lakhe added, "This infection looks like typhoid and jaundice, but if treated appropriately and on time, a patient can be saved."
Elaborating on how [the patient] was treated, Dr Sunil Rao, general manager of Columbia hospital, said, "The patient was treated with antibiotics and hemodialysis, without any surgical intervention. We saved [the patient]'s life, even though ST infections have less than a 10 per cent survival rate."
After successfully treating [the patient], the hospital, in association with Indian Medical Association, is now geared up to conduct workshops in rural areas to educate people about early diagnosis of this infection.
Dr Rajesh Gadia, head of Infectious Diseases at King Edward Memorial (KEM) Hospital, said, "ST can be treated with strong antibiotics, but since it is reported rarely, maybe one case in 6 months, not many physicians are aware of the clinical presentations. If this infection is not treated within 3 days, it could lead to death."
[Byline: By Nozia Sayyed]
--
Communicated by:
=
<promed@promedmail.org>
[ProMED-mail previously reported on scrub typhus in the Indian state of Maharashtra: see ProMED-mail posts Scrub typhus - India (12): (MH) fatal 20121109.1402125 and Scrub typhus - India (03): (MH) 20120203.1031108.
Scrub typhus is caused by _Orientia tsutsugamushi_, a rickettsia-like microorganism that is transmitted by chiggers, the larval stage of trombiculid mites, which feed on the skin cells of animals, including humans and rodents. After feeding on their hosts, chiggers drop to the ground and become nymphs, which then mature into adults that feed only on plant materials. The cutaneous reaction to chiggers leaves a characteristic black eschar that is useful for making the diagnosis. Humans become infected when they accidentally encroach in an area where the infected chigger-rodent cycle is occurring, most often areas of low-lying scrub brush or transitional vegetation. Rodents may serve as reservoirs, although transovarial transmission in mites is the dominant mechanism for maintenance of _O. tsutsugamushi_ in nature (http://www.cdc.gov/ncidod/EID/vol9no12/03-0212.htm).
Illness in humans develops after an incubation period of 6 to 21 days and usually begins with an eschar at the site of a chigger bite. Fever, headache, lymphadenopathy, and myalgias are common, and a maculopapular rash may also be present. Pneumonitis, meningoencephalitis, jaundice, renal failure, and myocarditis can develop during the prolonged clinical course of untreated illness. Because death rates for untreated scrub typhus patients are 1-30 per cent, treatment with doxycycline should begin immediately upon suspicion of scrub typhus without awaiting laboratory confirmation (http://wwwnc.cdc.gov/eid/content/12/2/pdfs/v12-n2.pdf).
The Weil-Felix test is an agglutination test based on the detection of antibodies to various _Proteus_ species, which contain antigens that cross-react with rickettsial antigens. The Weil-Felix test continues to be used for the diagnosis of scrub typhus in resource-poor regions, but it has poor sensitivity and specificity (http://www.japi.org/august2006/O-619.pdf). The gold standard for the diagnosis of scrub typhus is the indirect fluorescent antibody (IFA) assay, but the fluorescence microscopes that are required for performance of this assay are often not available in resource-poor settings where scrub typhus is endemic.
Kharadi is the northeastern section of the city of Pune, the 7th largest city in India and the 2nd largest in the Indian state of Maharashtra. For a map of India showing the location of Kharadi, Pune, see https://www.google.com/maps/place/K...2!3m1!1s0x3bc2c3c3288ba495:0x38e833613a63004a. Columbia Asia is a Kuala Lumpur, Malaysia-based chain of hospitals in Asia, with 24 medical facilities across India, Malaysia, Vietnam and Indonesia (http://en.wikipedia.org/wiki/Columbia_Asia). The company offers full-service hospitals built in neighborhoods, rather than the central city. Columbia Asia Kharadi-Pune is a 100-bedded multispecialty facility, close to the IT parks in Kharadi (http://www.india.columbiaasia.com/hospitals/pune). - Mod.ML]
[Photos of the eschar, rash and mite: http://4.bp.blogspot.com/_liYunANNUeg/S6__eaONgfI/AAAAAAAAAOQ/SbDuYjL-dHM/s1600/scrub2+.JPG. - Mod.JW
2012
----
Scrub typhus - India (12): (MH) fatal 20121109.1402125
Scrub typhus - India (03): (MH) 20120203.1031108
.................................................ml/je/dk
http://promedmail.org/direct.php?id=20140515.2475762
Published Date: 2014-05-15 17:45:00
Subject: PRO/AH/EDR> Scrub typhus - India: (MH)
Archive Number: 20140515.2475762
SCRUB TYPHUS - INDIA: (MAHARASHTRA)
***********************************
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: Wed 14 May 2014
Source: Pune Mirror [edited]
http://www.punemirror.in/pune/other...-a-new-lease-of-life/articleshow/35113698.cms
For a week, a 64-year-old [man] suffered from high fever, body ache, headache, and nausea, despite taking medicines. He later developed jaundice, gastrointestinal bleeding, septicemia and acute respiratory distress syndrome (ARDS).
It was when he was admitted at Kharadi-based Columbia Asia Hospital [Pune, Maharashtra State] last month [April 2014], that [his] disease was diagnosed -- scrub typhus (ST) -- a rare illness that leads to multi-organ dysfunction, having a mortality rate of 90 percent. Doctors say the disease is curable using antibiotics, but it can get out of hand if diagnosis is delayed.
ST is a mite-borne infectious disease caused by _Orientia tsutsugamushi_. Infectious diseases experts say that due to low literature [?], number of reported cases in the city cannot be enumerated.
Dr Sanjay Pujari, director, Institute of Infectious Diseases (IID), said, "ST is rare, and I have not seen a case with so many complications. This type of infection is normally wrongly diagnosed as leptospirosis, malaria, jaundice and typhoid. Developing ARDS in this infection is even rarer. If patients slip into multiorgan failure, they have very low survival chances."
[The patient] was treated by Dr Mahesh Lakhe, an infectious diseases specialist at Columbia Asia hospital. "He suffered from high fever and loss of appetite. He took treatment from a local doctor, but in vain. Later, he developed gastrointestinal bleeding, ARDS, meningitis and also septicemia. With so many complications he was admitted to the ICU and was diagnosed after a blood and biopsy test, as he had lesions all over his body. The samples were sent to Christian Medical College, Vellore [Tamil Nadu State], which confirmed the infection," Lakhe said. Saying that scrub typhus is frequently wrongly diagnosed, Lakhe added, "This infection looks like typhoid and jaundice, but if treated appropriately and on time, a patient can be saved."
Elaborating on how [the patient] was treated, Dr Sunil Rao, general manager of Columbia hospital, said, "The patient was treated with antibiotics and hemodialysis, without any surgical intervention. We saved [the patient]'s life, even though ST infections have less than a 10 per cent survival rate."
After successfully treating [the patient], the hospital, in association with Indian Medical Association, is now geared up to conduct workshops in rural areas to educate people about early diagnosis of this infection.
Dr Rajesh Gadia, head of Infectious Diseases at King Edward Memorial (KEM) Hospital, said, "ST can be treated with strong antibiotics, but since it is reported rarely, maybe one case in 6 months, not many physicians are aware of the clinical presentations. If this infection is not treated within 3 days, it could lead to death."
[Byline: By Nozia Sayyed]
--
Communicated by:
=
<promed@promedmail.org>
[ProMED-mail previously reported on scrub typhus in the Indian state of Maharashtra: see ProMED-mail posts Scrub typhus - India (12): (MH) fatal 20121109.1402125 and Scrub typhus - India (03): (MH) 20120203.1031108.
Scrub typhus is caused by _Orientia tsutsugamushi_, a rickettsia-like microorganism that is transmitted by chiggers, the larval stage of trombiculid mites, which feed on the skin cells of animals, including humans and rodents. After feeding on their hosts, chiggers drop to the ground and become nymphs, which then mature into adults that feed only on plant materials. The cutaneous reaction to chiggers leaves a characteristic black eschar that is useful for making the diagnosis. Humans become infected when they accidentally encroach in an area where the infected chigger-rodent cycle is occurring, most often areas of low-lying scrub brush or transitional vegetation. Rodents may serve as reservoirs, although transovarial transmission in mites is the dominant mechanism for maintenance of _O. tsutsugamushi_ in nature (http://www.cdc.gov/ncidod/EID/vol9no12/03-0212.htm).
Illness in humans develops after an incubation period of 6 to 21 days and usually begins with an eschar at the site of a chigger bite. Fever, headache, lymphadenopathy, and myalgias are common, and a maculopapular rash may also be present. Pneumonitis, meningoencephalitis, jaundice, renal failure, and myocarditis can develop during the prolonged clinical course of untreated illness. Because death rates for untreated scrub typhus patients are 1-30 per cent, treatment with doxycycline should begin immediately upon suspicion of scrub typhus without awaiting laboratory confirmation (http://wwwnc.cdc.gov/eid/content/12/2/pdfs/v12-n2.pdf).
The Weil-Felix test is an agglutination test based on the detection of antibodies to various _Proteus_ species, which contain antigens that cross-react with rickettsial antigens. The Weil-Felix test continues to be used for the diagnosis of scrub typhus in resource-poor regions, but it has poor sensitivity and specificity (http://www.japi.org/august2006/O-619.pdf). The gold standard for the diagnosis of scrub typhus is the indirect fluorescent antibody (IFA) assay, but the fluorescence microscopes that are required for performance of this assay are often not available in resource-poor settings where scrub typhus is endemic.
Kharadi is the northeastern section of the city of Pune, the 7th largest city in India and the 2nd largest in the Indian state of Maharashtra. For a map of India showing the location of Kharadi, Pune, see https://www.google.com/maps/place/K...2!3m1!1s0x3bc2c3c3288ba495:0x38e833613a63004a. Columbia Asia is a Kuala Lumpur, Malaysia-based chain of hospitals in Asia, with 24 medical facilities across India, Malaysia, Vietnam and Indonesia (http://en.wikipedia.org/wiki/Columbia_Asia). The company offers full-service hospitals built in neighborhoods, rather than the central city. Columbia Asia Kharadi-Pune is a 100-bedded multispecialty facility, close to the IT parks in Kharadi (http://www.india.columbiaasia.com/hospitals/pune). - Mod.ML]
[Photos of the eschar, rash and mite: http://4.bp.blogspot.com/_liYunANNUeg/S6__eaONgfI/AAAAAAAAAOQ/SbDuYjL-dHM/s1600/scrub2+.JPG. - Mod.JW
2012
----
Scrub typhus - India (12): (MH) fatal 20121109.1402125
Scrub typhus - India (03): (MH) 20120203.1031108
.................................................ml/je/dk
http://promedmail.org/direct.php?id=20140515.2475762
