Epidemiology &amp; risk factors of scrub typhus in south India

Varghese, George M.; Raj, Deepa; Francis, Mark R.; Sarkar, Rajiv; Trowbridge, Paul; Muliyil, Jayaprakash

doi:10.4103/0971-5916.193292

Cited by 43 publications

(56 citation statements)

References 14 publications

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“…Earlier scrub typhus was considered to occur mostly in rural areas; however, now India as a whole has been shown to be endemic for it with outbreaks reported even from the metropolitans [5][6][7][8]. A retrospective study on 709 patients admitted at a tertiary care hospital in South India has identified farming, not wearing shirt at home, living in houses adjacent to bushes and shrubs as risk factors for acquiring the infection [12]. Many of our patients did not have the risk factors conventionally associated with acquiring the infection.…”

Section: Discussionmentioning

confidence: 99%

Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India

Gaba

Gupta

et al. 2020

Cureus

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Introduction Scrub typhus is a resurging zoonotic infection prevalent in South Asia with many recent outbreaks in India. It can mimic other tropical infections and the disease spectrum ranges from subclinical illness to life-threatening disease with multiorgan dysfunction. This study was conducted to study the pattern of hepatic and renal injury. Methods A retrospective study was done on 176 patients diagnosed by detecting IgM antibodies using an enzyme-linked immunosorbent assay (ELISA) over a period of three years at a tertiary center in Chandigarh, India. They were treated with doxycycline (azithromycin if pregnant) and supportive therapies. The patterns of hepatic and renal functions, along with the need of renal replacement therapy, were recorded and evaluated. The values were expressed as mean ± SD, and p values were calculated to establish statistical significance. Results Most of the cases were from the state of Haryana (37.5%), followed by Punjab (33.5%), Himachal Pradesh (13.6%), Uttar Pradesh (10.2%) and Chandigarh (5%). 30% of the study population was engaged in agriculture. The mean age was 32.3 ± 13.5 years with range of 13-65 years. A peak in the incidence was observed during monsoon months. Approximately 13% of the patients died. Urea, creatinine, bilirubin and aspartate transaminase were found to be higher in mortality group with statistical significance (p < 0.05). Alanine transaminase was higher and albumin was lower in the mortality group but without statistical significance. 27.8% had acute kidney injury, 90.9% had liver dysfunction and one patient had acute liver failure. All the pregnant patients had fetal loss. Conclusion Renal and liver dysfunctions are common in scrub typhus, and their occurrence adversely affects the outcome.

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Section: Discussionmentioning

confidence: 99%

Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India

Gaba

Gupta

et al. 2020

Cureus

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“…Scrub typhus occurs sporadically between seasons. 12 The seasonality of spotted fever and murine typhus has not been studied. The study was conducted in all three geographic settings (urban communities, rural plain villages, and peri-forest hill villages).…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Scrub Typhus, Murine Typhus, and Spotted Fever Seropositivity in Urban Areas, Rural Plains, and Peri-Forest Hill Villages in South India: A Cross-Sectional Study

Devamani

Schmidt

Ariyoshi

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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. Scrub typhus and spotted fever group rickettsioses are thought to be common causes of febrile illness in India, whereas they rarely test for murine typhus. This cross-sectional study explored the risk factors associated with scrub typhus, tick-borne spotted fever, and murine typhus seropositivity in three different geographical settings, urban, rural, and hill villages in Tamil Nadu, South India. We enrolled 1,353 participants living in 48 clusters. The study included a questionnaire survey and blood sampling. Blood was tested for Orientia tsutsugamushi (scrub typhus), Rickettsia typhi (murine typhus), and spotted fever group Rickettsia IgG using ELISA. The seroprevalence of scrub typhus, spotted fever, and murine typhus were 20.4%, 10.4%, and 5.4%, respectively. Scrub typhus had the highest prevalence in rural areas (28.1%), and spotted fever was most common in peri-forested areas (14.9%). Murine typhus was more common in rural (8.7%) than urban areas (5.4%) and absent in peri-forested hill areas. Agricultural workers had a higher relative risk for scrub typhus, especially in urban areas. For murine typhus, proximity to a waterbody and owning a dog were found to be major risk factors. The main risk factors for spotted fever were agricultural work and living in proximity to a forest. Urban, rural plains, and hill settings display distinct epidemiological pattern of Orientia and rickettsial infections. Although scrub typhus and spotted fever were associated with known risk factors in this study, the findings suggest a different ecology of murine typhus transmission compared with other studies conducted in Asia.

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“…The highest number of cases were reported in October, December and January in the period immediately after the Southeast and Northwest monsoon in Tamil Nadu. 4 Majority of cases of scrub typhus in our institution are also seen during the cooler months and rainy season between months of August and December. Similar finding has been reported in earlier studies.…”

Section: Discussionmentioning

confidence: 99%

A study of clinical and laboratory profile of scrub typhus in children in a tertiary hospital in South India

Kumar

Srinivasan

2017

Int J Contemp Pediatr

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Background: Scrub typhus is an acute febrile illness caused by infection with Orientia tsutsugamushi. The present study was conducted to study the clinical features, laboratory profile, complications and response to therapy among children suffering from scrub typhus in a tertiary health care institution of Tamil Nadu, India.Methods: The study was conducted at Saveetha Medical College Hospital, Tamil Nadu, India. Duration of the study was from August to December, 2015 in the Department of Pediatrics. Children with clinically suspected Scrub typhus were subjected to detailed clinical examination and investigation. Diagnosis of scrub typhus was confirmed by IgM ELISA. Results: 34 patients were diagnosed as suffering from scrub typhus. Common symptoms noted were fever, headache, cough and cold, chills, rigor, myalgia and vomiting. The common complications noted were thrombocytopenia in 16 children (47%) and features of meningoencephalitis and hepatitis were present in 2 children (5.8%). Eschar was identified in 24 (70.5%) patients. Mixed infection was seen in 4 (11.7%) children who had concurrent culture positive Urinary Tract Infection. Conclusions: Scrub typhus is an acute febrile illness which requires high index of suspicion for early diagnosis, monitoring of the clinical and laboratory parameters and prompt treatment which may help in complete cure without further complications and morbidity.

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Epidemiology & risk factors of scrub typhus in south India

Cited by 43 publications

References 14 publications

Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India

Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India

Risk Factors for Scrub Typhus, Murine Typhus, and Spotted Fever Seropositivity in Urban Areas, Rural Plains, and Peri-Forest Hill Villages in South India: A Cross-Sectional Study

A study of clinical and laboratory profile of scrub typhus in children in a tertiary hospital in South India

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