Scrub Typhus Re-Emergence of The Neglected, Silent Killer in Himachal Pradesh (India)

Abstract

Scrub typhus is one of the common causes of fever in the foothills of the Himalayan region of India, affecting almost all age groups of patients. Scrub typhus is a zoonotic mite-borne bacterial disease that is transmitted to the population by the bite of larvae of the infected trombiculid mites that bite humans. Currently, scrub typhus appears to be re-emerging and spreading in the non-endemic areas with alarming antibiotic resistance patterns. It is a threat to more than a billion people and causes significant mortality worldwide. Clinical features can present in a variety of ways in patients suffering with scrub typhus. It causes multiple organ dysfunction syndrome and mortality can range 60-70% without effective therapy. Scrub Typhus presenting with bicytopenia, pancytopenia, hepatomegaly, and splenomegaly. This present study aims to know the varied clinical presentation in scrub typhus patients with Pancytopenia and Bicytopenia and the incidence of hepatomegaly and splenomegaly in the paediatric age group. Prospective observational study conducted in the Department of Paediatrics in Dr. RPGMC Tanda Himachal Pradesh (India). The study included all patients except those falling in the exclusion criteria and only after informed written consent. A total of 37 children admitted with scrub typhus bicytopenia and pancytopenia were enrolled for one year, that is from March 2013 to March 2014. Bicytopenia was observed in 30 patients (81.08%) and pancytopenia in 7 (18.91%) cases in typhus patients. Hepatomegaly was observed in 28 patients (73.68%) and splenomegaly in 16 patients (42.10%). Anaemia was seen in 35 (94.59%) patients. Males 13 were less affected than females 24 with a male-to-female ratio of .54 to 1. The most common age group affected was 11-15 years with female prudence with a male: female ratio of 0.54:1. Pallor was the most common sign in 35 (94.59%) followed by hepatomegaly 28(73.68%) and splenomegaly in 16(42.10%) patients. It is very important to start empirical therapy in a patient with fever and multiorgan dysfunction syndrome for scrub typhus to reduce mortality. There is an urgent need to establish next-generation metagenomic sequencing centers in the region at the tertiary-level institutes for the detection of new antigenic variations.