Clinico-epidemiological Analysis of Scrub Typhus in Hospitalised Patients Presenting with Acute Undifferentiated Febrile Illness: A Hospital-Based Study from Eastern India

Behera, Bijayini; Biswal, Manisha; Das, Rashmi Ranjan; Dey, Anupam; Jena, J.; Dhal, Sagarika; Mohanty, Srujana; Mishra, Baijayantimala; Praharaj, Ashok Kumar

doi:10.4103/ijmm.ijmm_19_147

Cited by 19 publications

(26 citation statements)

References 11 publications

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“…Scrub typhus is reported as the leading cause of treatable non-malarial febrile illness by prospective studies of acute febrile illness from Asia [1,16]. The mean estimate of scrub typhus (25.3%) among the studies reporting AUFI in this review is similar to the burden of scrub typhus among the patients presenting to hospitals with fever that is seen in large studies from India [2,9]. Though the number of cases reported varied across the years, this review showed that there was an increasing trend of scrub typhus over time in India, suggesting a worsening situation since 2010.…”

Section: Plos Neglected Tropical Diseasessupporting

confidence: 57%

“…Scrub typhus, caused by the bacteria Orientia tsutsugamushi and transmitted by Leptotrombidium mites, is responsible for a potentially fatal tropical infection which is a grossly under-recognized public health problem in India [1,2]. About a million cases of scrub typhus are reported annually and the disease is associated with high mortality [3].…”

Section: Introductionmentioning

confidence: 99%

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The burden of scrub typhus in India: A systematic review

et al. 2021

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Background Scrub typhus, a vector-borne zoonotic infection caused by the bacteria Orientia tsutsugamushi, is one of the most common and clinically important rickettsial infections worldwide. An estimated one million cases occur annually with a high case fatality rate. Although scrub typhus is a major public health threat in India, the burden and distribution remains unclear. We aimed to estimate the burden of scrub typhus in India. Methodology We performed a systematic review of published literature on scrub typhus from India to extract information on epidemiology, morbidity, and mortality. Important databases were searched using keywords and appropriate combinations. We identified observational, interventional, and population-based studies and extracted the data to evaluate the number of cases diagnosed using serology or PCR and the number of deaths due to scrub typhus. We conducted a systematic narrative synthesis to summarize included studies. Principal findings In the last decade, there were 18,781 confirmed scrub typhus cases reported in 138 hospital-based studies and two community-based studies. IgM ELISA was used in 122 studies to confirm the cases in majority (89%). The proportion of scrub typhus among acute undifferentiated febrile illness (AUFI) studies was 25.3%, and community seroprevalence was 34.2%. Ninety studies had data published on multiple organ involvement out of which 17.4% of cases had multiple organ dysfunction syndromes, 20.4% patients required ICU admission, and 19.1% needed ventilation. The overall case-fatality rate was 6.3%, and the mortality among those with multi-organ dysfunction syndrome was as high as 38.9%. Conclusion/significance Scrub typhus, a common acute febrile illness in India causing severe morbidity, accounts for a large number of deaths. The burden of the disease has been underappreciated. Early diagnosis and prompt treatment can significantly reduce complications and mortality. Establishing good surveillance and instituting appropriate control measures are urgently needed.

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Section: Plos Neglected Tropical Diseasessupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

The burden of scrub typhus in India: A systematic review

et al. 2021

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“…Six studies (42.9%) were retrospective observational studies [ 26 , 30 , 33 , 34 , 36 , 38 ], six were cross-sectional studies [ 27 – 29 , 31 , 37 , 39 ], and two [ 32 , 35 ] were cohort studies. Most studies (10/14, 71.4%) were conducted in India [ 26 – 28 , 30 – 33 , 37 – 39 ], and four studies [ 29 , 34 – 36 ] were conducted in Thailand. Nine studies [ 26 – 28 , 31 – 33 , 35 , 38 , 39 ] enrolled febrile patients (7920 cases), four [ 29 , 34 , 36 , 37 ] enrolled malaria-positive patients (639 cases), and one study [ 30 ] enrolled scrub-typhus-positive patients (240 cases).…”

Section: Resultsmentioning

confidence: 99%

“…Most studies (10/14, 71.4%) were conducted in India [ 26 – 28 , 30 – 33 , 37 – 39 ], and four studies [ 29 , 34 – 36 ] were conducted in Thailand. Nine studies [ 26 – 28 , 31 – 33 , 35 , 38 , 39 ] enrolled febrile patients (7920 cases), four [ 29 , 34 , 36 , 37 ] enrolled malaria-positive patients (639 cases), and one study [ 30 ] enrolled scrub-typhus-positive patients (240 cases). In the febrile patient studies, 56 co-infections in 7920 patients were reported, and in the studies that enrolled malaria-positive patients [ 29 , 34 , 36 , 37 ], 265 of 639 cases were reported co-infected.…”

Section: Resultsmentioning

confidence: 99%

“…The quality of the included studies was assessed using the Joanna Briggs Institute checklist for analytical cross-sectional studies. Four studies [ 29 , 31 , 35 , 38 ] were considered high-quality studies, while 10 studies [ 26 – 28 , 30 , 32 – 34 , 36 , 37 , 39 ] were categorized as moderate-quality studies (Additional file 2 : Table S2).…”

Section: Resultsmentioning

confidence: 99%

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Prevalence of malaria and scrub typhus co-infection in febrile patients: a systematic review and meta-analysis

et al. 2021

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Background Little information is available about malaria and scrub typhus co-infection. This study aimed to investigate the pooled prevalence of malaria and scrub typhus co-infection in febrile patients. Further, it aimed to estimate the prevalence of scrub typhus infection among patients with malaria and the odds of co-infection. This will aid the diagnosis and management of co-infected patients in endemic areas. Methods We searched for relevant studies in three databases: PubMed, Scopus, and Web of Science. We assessed the quality of the included studies using the Joanna Briggs Institute checklist for analytical cross-sectional studies. We estimated (1) the pooled prevalence of malaria and scrub typhus co-infection, (2) the pooled prevalence of scrub typhus infection in malaria-positive patients, and (3) the pooled odds of co-infection using the DerSimonian–Laird method for random-effects models. The study results and summary estimates were visualized on a forest plot as point estimates (effect size, prevalence) and 95% confidence intervals (CI). We assessed the heterogeneity of the studies by Cochrane Q or I2 statistics. We performed subgroup analyses of countries and scrub typhus diagnostic tests to explore the sources of heterogeneity of the included studies. We assessed publication bias if more than 10 studies were used to estimate the outcome. All data analyses were conducted using Stata version 14 (StataCorp, College Station, TX, USA). Results Of the 542 studies retrieved from three databases, we included 14 meeting the inclusion criteria in the systematic review and meta-analysis. The pooled prevalence of malaria and scrub typhus co-infection (56 cases) among febrile patients (7920 cases) was 1% (95% CI: 0–1%, I2: 78.28%), while the pooled prevalence of scrub typhus infection (321 cases) in patients with malaria (1418 cases) was 21% (95% CI: 12–30%, I2: 98.15%). Subgroup analysis showed that the pooled prevalence of scrub typhus infection among patients with malaria in India was 8% (95% CI: 4–13%, I2: 85.87%, nine studies with 59/794 cases), while the pooled prevalence of scrub typhus infection among patients with malaria in Thailand was 35% (95% CI: 7–64%, I2: 98.9%, four studies with 262/624 cases). The co-infections did not occur by chance (P = 0.013, odds: 0.43, 95% CI: 0.22–0.84%, I2: 60.9%). In the sensitivity analysis, the pooled prevalence of malaria and scrub typhus co-infection among febrile patients was 0% (95% CI: 0–1%, I2: 59.91%). Conclusions The present study showed the pooled prevalence and a significant association between malaria and scrub typhus. The results show the status of co-infection. Further research into co-infection in endemic areas is needed, in particular, to determine whether co-infection can accelerate disease progression or protect against severe disease. Graphical abstract

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