Abstract
Scrub typhus is a mite-borne acute febrile illness caused by Orientia. tsutsugamushi, a zoonotic bacterial infection common in the region known as the tsutsugamushi triangle. This study aims to determine the seroprevalence, seasonal variation, and risk factors of scrub typhus among the acute febrile illness patients attending different hospitals of central Nepal. Blood samples were collected from hospitalized patients of acute febrile illness suspected of scrub typhus infection attending different hospitals of central Nepal from April 2017 to March 2018. The IgM antibody to Orientia tsutsugamushi was detected by using the Scrub Typhus Detect™ Kit. Among the total cases (1585), 358 (22.58%) were positive for IgM Antibodies. Multivariate analysis identified several risks factors to be significantly associated with the scrub typhus infection, including gender (female) (odds ratio [OR] = 1.976, p ≤ 0.001, confidence interval [CI] = 1.417–2.756), rural residential location (odds ratio [OR] = 0.431, p = 0.001, confidence interval [CI] = 0.260–0.715), house near grassland (odds ratio [OR] = 3.288, p ≤ 0.001, confidence interval [CI] = 1.935–5.587), and working in the field (odds ratio [OR] = 9.764, p = 0.004, confidence interval [CI] = 2.059–46.315). The study findings indicate scrub typhus infection to be a significant health problem in Nepal. The proper diagnosis of infection cases, timely institution of therapy, public awareness, and vector control are important measures to be taken for the prevention and management of scrub typhus.
Highlights
Scrub typhus is a mite-borne acute febrile infectious illness caused by Orientia tsutsugamushi; a zoonotic bacterial infection common in the region known as the tsutsugamushi triangle which extends from northern Japan and far-eastern Russia in the north, to northern Australia in the south, and to Pakistan in the west [1]
A cross sectional descriptive study was conducted among hospitalized acute febrile illness patients with suspected scrub typhus cases in central Nepal for one year starting from April 2017 to March 2018
The IgM antibody to Orientia tsutsugamushi was detected by using Scrub Typhus DetectTM Kit, In Bios International, USA, and the optical density was measured by HumaReader HS, ELISA reader, with optical density (OD) >0.50 being considered positive
Summary
Scrub typhus is a mite-borne acute febrile infectious illness caused by Orientia tsutsugamushi; a zoonotic bacterial infection common in the region known as the tsutsugamushi triangle which extends from northern Japan and far-eastern Russia in the north, to northern Australia in the south, and to Pakistan in the west [1]. The causative organism, Orientia tsutsugamushi, is transmitted to humans by the larval stage (chiggers) bite of the trombiculid mites, possibly Leptotrombidium delience [3] Since these mites are widely distributed in different types of vegetation e.g., forests, rice paddies and plantations, farmers and people who engage in outdoor activities are at a higher risk of contracting scrub typhus [4]. Recent studies on scrub typhus have reported the existence of various clinical manifestations with abnormal laboratory findings [5]. This disease is most common in resource limited settings such as rural areas and is difficult to differentiate clinically from other infections such as malaria, dengue, enteric fever and leptospirosis [6]. The aims of this study were to determine the seroprevalence, seasonal variation, risk factors, clinical characteristic and laboratory profile of scrub typhus among the acute febrile illness patients attending different hospitals of central Nepal
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