Cases Of Typhus Research Articles

Scrub typhus masquerading as acute acalculous cholecystitis in a child - a case report.

We describe a case of scrub typhus in a 12-year old boy who presented with symptoms mimicking acute acalculous cholecystitis. He tested positive for anti-scrub typhus IgM antibodies. Treatment with oral azithromycin led to significant improvement and resolution of symptoms. Thus it is important to consider scrub typhus as a differential diagnosis for an acute abdomen in endemic areas. Timely diagnosis may avoid unnecessary suffering.

Rare neurological and neuropsychiatric manifestations of scrub typhus: a case series of 10 cases

IntroductionScrub typhus is a potentially life-threatening but curable disease that can produce multi-organ failure. Neurological manifestations in scrub typhus have gained attention recently, where the entire neural axis except the myoneural junction can be involved. Although the pathogenesis of neurological involvement has not been established, immune-mediated mechanisms are suspected. This article reports the clinicopathological features of scrub typhus cases presenting several rare neurological and neuropsychiatric manifestations. MethodsThree hundred fifty-four serologically confirmed scrub typhus cases were admitted to the Department of General Medicine of Burdwan Medical College and Hospital (West Bengal, India) between May 2018 and May 2022. There were 50 patients who had predominantly neurological manifestations. Of these 50 cases, ten patients presented with extremely rare neurological manifestations. ResultsWe report 10 cases of scrub typhus (four men and six women) who presented with complex neurological pictures (posterior reversible encephalopathy syndrome, Opalski syndrome, parkinsonism, cerebellitis, isolated opsoclonus, acute transverse myelitis, myositis, polyradiculoneuropathy with cranial neuropathy, acute transient behavioral changes, and fibromyalgia). Immune-mediated mechanisms might have mediated the pathogenesis of most cases following scrub typhus infection. ConclusionFrom a clinicopathological point of view, each case was unique in its presentation and treatment response. In any acute onset neurological disorders associated with febrile illness in the tropics or subtropics, scrub typhus infection should be included in the differential diagnosis, despite the absence of eschar and unremarkable neuroimaging findings. This otherwise curable disease may result in multi-organ dysfunction syndrome and death if the diagnosis is delayed.

Usefulness of next-generation sequencing for laboratory diagnosis of rickettsiosis.

Rickettsiosis includes a diversity of culture-negative non-specific systemic infections. Laboratory diagnosis of rickettsiosis is often not easy. In this 12-month study, six patients with a variety of rickettsia infections of the spotted fever group, typhus group and scrub typhus were diagnosed directly or indirectly by metagenomic next-generation sequencing (mNGS). The patient with Japanese spotted fever was rapidly made when mNGS analysis of the patient's blood revealed Rickettsia japonica sequences. For the two patients with Rickettsia felis chest infections, the bacterium was detected in the bronchoalveolar lavage of one case and lung biopsy of the other. Both patients had underlying malignancies, carcinoma of the breast and carcinoma of the lung respectively, and were on chemotherapy with immunosuppressive effect. For the remaining three patients who presented over a period of 13 weeks, all had fever, headache and the typical eschar. They also had increased serum transaminases and responded promptly to doxycycline. However, the Weil-Felix test results of all three patients were negative. Since we considered the three cases typical of rickettsiosis, we submitted their serum samples for mNGS analysis. Results showed that Orientia tsutsugamushi sequences were present in the serum of one case. In view of the positive mNGS results, we repeated the Weil-Felix test for the residual sera of all three patients and it revealed that those of the other two cases showed OX-19 titers of 1:640 and 1:160 respectively, inferring that these two patients probably had rickettsiosis of the typhus group. As for the patient positive for O. tsutsugamushi sequences, we also detected IgM for O. tsutsugamushi in the serum, which double confirmed that it was a case of scrub typhus. mNGS is an important molecular tool and can complement serology for laboratory diagnosis of rickettsiosis.

A clinicoepidemiological study of serologically diagnosed acute febrile illness in a teaching hospital, Kolkata

ABSTRACT Introduction: Similar presenting manifestations in early phase and lack of awareness of aetiology of acute febrile illness (AFI) are major challenges in management of AFI. Material and Methods: This was a retrospective observational cross-sectional study conducted in the Department of Microbiology, NRS Medical College, from 1 July 2022 to 30 June 2023 in serologically diagnosed febrile patients attending the outpatient department or admitted. Clinical and epidemiological data and laboratory parameters were recorded in a pretested structured questionnaire study tool, and collected data were analysed on MS-Excel sheets with various charts and tables. Results: A total of 1711 serologically diagnosed febrile patients showed preponderance of dengue (38.3%), followed by leptospirosis (25%), scrub typhus (23.9%), malaria (12.6%), and enteric fever (1.92%). A majority of cases were male, less than 40 years of age, and from the rural population (73.2%), except in malaria (urban = 79.6%). The mean duration of fever was 9 days. Febrile cases were recorded maximum during the monsoon and postmonsoon periods (66.5%). The common manifestations are fever, headache (46.2%), pain abdomen (7.8%), nausea, and vomiting (9.4%). Thrombocytopenia with bleeding manifestation was higher in dengue (18%) cases. Mortality in dengue cases was recorded with multiorgan dysfunction syndrome (MODS). Scrub typhus cases showed seizure (8.3%) and altered sensorium (5%) due to fatal meningoencephalitis. Fatality in leptospirosis was mostly due to acute kidney injury (29.5%) and Weil’s disease (4.4%). Conclusion: Misdiagnosis or incorrect diagnosis and delay in initiation of appropriate treatment results in increased morbidity and mortality in AFI. Determination of epidemiological features and clinical manifestations of AFI along with timely correct diagnosis will benefit clinicians in proper treatment initiation, thereby reducing morbidity and mortality.

Two complicated cases of severe scrub typhus, eschar- a non-negligible sign: Case reports and literature review.

Scrub typhus is a mite-borne, acute febrile disease caused by Orientia tsutsugamushi. The endemic areas of scrub typhus are expanding, both globally and in China. Patients who are not treated promptly, are likely to die of multiple organ dysfunction syndrome. Case I A 61-year-old female patient complained of sudden chest tightness and shortness of breath accompanied by fever for 6 days. Case II A 54-year-old male patient complained of fever and cough for 4 days and renal insufficiency for 2 days. Scrub typhus, multiple organ dysfunction syndrome. After the definite diagnosis, both patients were treated with doxycycline and various organ supports. The patient in case I was ultimately not salvageable. The patient in case II was successfully cured by the prompt administration of doxycycline along with continuous renal replacement therapy. With early diagnosis and treatment, patients can completely recover. Eschar, a characteristic sign of scrub typhus, is often overlooked, leading to delayed diagnosis and regrettable outcomes.

Frequency and distribution of eschar in patients with scrub typhus in India: systematic review of literature and meta-analysis.

Scrub typhus is a mite-borne tropical febrile illness with high mortality if untreated. The presence of eschar is pathognomonic, but a wide range of frequencies of eschar positivity has been reported in Indian patients. Therefore, this systematic review and meta-analysis aimed to ascertain the frequency (overall and geographic region-wise) and anatomical distribution of eschar in scrub typhus in India. We searched articles in two databases using: [(scrub OR typhus OR Orientia) AND (eschar) AND (India)]. The articles were independently screened and critically appraised by two authors. The frequency and distribution of eschar in patients with scrub typhus were pooled using a random-effect model. After the title-abstract and full-text screening, 107 articles (34002 cases of scrub typhus) were finally included. The overall pooled proportion of eschar positivity was 28.5% (95% CI: 24.1 to 32.9%). The pooled eschar positivity varied from ≤12% in Haryana, Rajasthan, Madhya Pradesh, Punjab, and Meghalaya to ≥46% in Tamil Nadu and Tripura. The pooled proportion of eschar positivity in the 'trunk' (39.3%), 'groin' (23.8%), and 'axilla' (16.5%) was higher than in the 'limbs' (9.9%) and 'head' (11.3%). Eschar is reported in less than a third of the patients with scrub typhus in India. Most eschars were in the groin, axilla, and the trunk. There is a need to create awareness amongst physicians of the need for thorough physical examination.

Validation of the Scrub Typhus Encephalitis Assessment Tool for the Management of Acute Encephalitis Syndrome

Abstract Introduction: Acute encephalitis syndrome (AES) is one of the important causes of mortality among children in India. Active management of the cases, followed by addressing the cause of AES, is the key strategy for preventing mortality. Lack of laboratory facility and difficulty of sampling blood and cerebrospinal fluid (CSF) for assessing causes is one of the important barriers to early initiation of treatment. The main objective of the study is to validate the Scrub Typhus Encephalitis Assessment Tool (SEAT) for the management of AES. Methods: The study is a continuation of a study conducted in a tertiary care hospital in Eastern Uttar Pradesh. A machine learning (LightGBM) model was built to predict the probability of scrub typhus diagnosis among patients with acute encephalitis. Three models were built: one with sociodemographic characters, the second with Model 1 variables and blood parameters, and the third with Model 2 variables and CSF parameters. Results: The sensitivity of diagnosing the scrub typhus case was 71%, 77.5%, and 83% in Model 1, Model 2, and Model 3, respectively, and specificity was 61.5%, 75.5%, and 76.3%, respectively, in the models. In Model 1 fever duration, in Models 2 and 3, neutrophil/lymphocyte ratio was the most important predictor for differentiating the scrub and nonscrub cases. Conclusion: With the available sensitivity and specificity of the tool, the SEAT can be a valuable tool for the prediction of scrub typhus as a cause of AES cases in remote areas.

Prevalence, Clinico-Laboratory Features and Outcomes of Paediatric Scrub Typhus Cases in a Tertiary Care Centre in Eastern India: A prospective observational study.

Scrub typhus is the most common rickettsial disease in India, caused by Orientia tsutsugamushi and transmitted by chigger mites. Previously prevalent in South India, a resurgence of scrub typhus cases has recently affected Eastern India. This study aimed to estimate the prevalence and describe the clinico-laboratory profile of scrub typhus in paediatric patients (1-12 years old) living in Eastern India. This prospective observational study was conducted from January to December 2019 at the Dr B C Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India. All acute undifferentiated cases of febrile illness, in patients aged between 1-12 years, were tested using scrub typhus serology by ELISA. Demographic details, clinical features, laboratory findings, complications and treatment outcomes of these scrub typhus patients were extracted and analysed. Out of 1,473 patients with acute febrile illness, 67 (4.5%) children were diagnosed with scrub typhus. The mean age of the selected patients was 5.22 ± 3.05 years, and the majority (64.2%) had been running a fever since the preceding 7-14 days. Gastrointestinal symptoms such as vomiting (43.3%) and abdominal pain (32.8%) were most frequently observed. Major clinical signs of scrub typhus were hepatomegaly (41.8%) and splenomegaly (31.3%). Complications were observed in 74.6% of patients, with thrombocytopenia (40.3%) and meningoencephalitis (29.9%) occurring more frequently. The case fatality rate of the study sample was 1.5%. Classical eschar was absent in three-fourth of the studied patients. Hence, this study advocates laboratory scrub typhus tests for all suspected cases in the endemic region (Eastern India). Prompt treatment with doxycycline and/or azithromycin could prevent complications such as thrombocytopenia/meningoencephalitis and reduce mortality.

Seroprevalence and Clinical Profile of Leptospirosis and Scrub Typhus in Clinically Suspected Patients at a Tertiary Care Center: A Retrospective Study from Theni, Tamil Nadu

Abstract Background: Leptospirosis and Scrub typhus are zoonotic illnesses that are found worldwide. Scrub typhus is a rickettsial infection caused by Orientia tsutsugamushi and spread through the biting of a mite’s chigger. Leptospirosis is an anthropozoonotic illness that can be found anywhere but is most common in tropical and subtropical areas. In this study, we report the seroprevalence of Scrub typhus and Leptospirosis with relation to demographic factors in clinically suspected patients attending a tertiary care hospital in Theni, Tamil Nadu. Methods: This is a retrospective study in which 9574 serum samples from clinically suspected cases were collected from January 2018 to December 2023 and tested for immunoglobulin M (IgM) antibodies for Scrub typhus using the enzyme-linked immunosorbent assay (ELISA) and rapid test. A blood sample was taken from each patient, and an IgM ELISA was performed to make the diagnosis. The ELISA cut-off was determined. Results: In this study, 9574 probable cases, 4306 were examined for Leptospira IgM ELISA and 5268 for Scrub typhus IgM ELISA. Out of 4306 suspected Leptospira cases, 167 (3.8%) were positive and 485 (9.2%) were positive in 5268 suspected Scrub typhus cases. The bulk of Leptospirosis and Scrub typhus cases were in the 21–40 years’ age range, followed by the 0–20 years’ age range. Males were found to have higher seroprevalence (57.1%) than females (42.9%). Conclusions: Scrub typhus and leptospirosis are developing infections, and prompt treatment can save many lives. It is strongly advised to take a programmatic approach to the prevention, control, and management of these developing diseases.

Incidence of Scrub Typhus according to Changes in Geographic and Demographic Characteristic in the Chungcheong Region of Korea.

To ascertain the incidence trends of scrub typhus in the Chungcheong region, we analyzed the epidemiological survey information of 14,379 cases of scrub typhus reported to the integrated disease health management system of the Korea Centers for Disease Control and Prevention between 2012 and 2022, along with demographic data from the Korean Statistics Information Service. Geographical analyses were performed to confirm the correlation between high-risk areas and the proportion of elderly people. The average age, proportion of elderly people, and changes in the agricultural population were statistically associated with incidence. The incidence of scrub typhus, and the agricultural population, in the Chungcheong region has decreased compared with that in 2012-2013. However, recent trends indicate a resurgence linked to increased outdoor activity, with higher risks observed in older age groups. Additionally, advancing age correlates with a heightened probability of reinfection and additional infections with other febrile diseases. The incidence of scrub typhus in the Chungcheong region (2012-2022) is changing according to age and route of infection, highlighting the need for revised prevention and promotion policies.

A case of scrub typhus with meningitis as the onset: Case report and literature review.

Scrub typhus is a naturally occurring acute febrile disease caused by Orientia tsutsugamushi. Although it can cause multiple organ dysfunction, central nervous system infections are uncommon. A 17-year-old male presented with a 5-day history of fever and headaches. The MRI of the head revealed thickness and enhancement of the left temporal lobe and tentorium cerebelli, indicating potential inflammation. The patient was diagnosed with a central nervous system infection. Ceftriaxone and acyclovir were administered intravenously to treat the infection, reduce fever, restore acid-base balance, and manage electrolyte disorders. Despite receiving ceftriaxone and acyclovir as infection therapy, there was no improvement. Additional multipathogen metagenomic testing indicated the presence of O tsutsugamushi infection, and an eschar was identified in the left axilla. The diagnosis was changed to scrub typhus with meningitis and the therapy was modified to intravenous doxycycline. Following a 2-day therapy, the body temperature normalized, and the fever subsided. The patient was diagnosed with scrub typhus accompanied by meningitis, and doxycycline treatment was effective. Rarely reported cases of scrub typhus with meningitis and the lack of identifiable symptoms increase the chance of misdiagnosis or oversight. Patients with central nervous system infections presenting with fever and headache unresponsive to conventional antibacterial and antiviral treatment should be considered for scrub typhus with meningitis. Prompt multipathogen metagenomic testing is recommended to confirm the diagnosis and modify the treatment accordingly.

Utility of next-generation sequencing for the etiological diagnosis of Orientia tsutsugamushi infection

BackgroundScrub typhus, an acute febrile disease caused by Orientia tsutsugamushi, is transmitted to humans through infected chigger mites. We present a case of scrub typhus in a previously healthy man from Shandong Province diagnosed using next-generation sequencing (NGS) and PCR and review recent literature on NGS for scrub typhus diagnosis. MethodsNGS was utilized for testing whole blood collected on admission. Confirmatory testing was done by detecting IgM and IgG antibodies to Orientia in acute and convalescent sera by ELISA. Orientia 47-kDa protein gene TaqMan and standard PCR of the 56-kDa protein gene and Sanger sequencing were performed on eschar scab DNA. ResultsThe NGS diagnosis was confirmed by 47-kDa protein gene TaqMan and sequencing of a fragment of the O. tsutsugamushi 56-kDa protein gene from the eschar scab. Analysis of this sequence and the NGS data indicated O. tsutsugamushi strain Cheeloo2020 is a novel genotype. Mapping of the NGS data against the O. tsutsugamushi Gilliam strain genome sequence identified 304 reads with high similarity. ConclusionsNGS is not only useful for multiplex diagnosis of scrub typhus, but also provides insight into the genetic diversity of O. tsutsugamushi. The common failure to submit sequences to databases makes it difficult to determine the minimal quantity and quality of NGS data being used for the positive identification of Orientia DNA in clinical specimens.

First laboratory-confirmed case of scrub typhus in Shijiazhuang City, Hebei Province

ObjectiveDefining whether a suspected case was due to scrub typhus through laboratory testing, to understand the prevalence of scrub typhus in Shijiazhuang City, Hebei Province.MethodsAn epidemiological investigation was conducted on the suspected case, utilizing Weil-Felix test and indirect immunofluorescence assay (IFA) to detect specific antibodies against O. tsutsugamushi in serum specimens. Additionally, PCR amplification of the 56-kDa and groEL genes was performed, followed by constructing a phylogenetic tree to identify the genotype.ResultsThe acute phase titer of the Weil-Felix test for the case was 1:160, which increased to 1:320 in the recovery phase. IFA assay revealed IgG titers against O. tsutsugamushi of 1:64 in the acute phase and 1:256 in the recovery phase. Sequence alignment of the PCR amplified fragment showed the highest similarity with the O. tsutsugamushi genotype. Kawasaki sequence, ranging from 99.71 to 100.00%. The strain exhibited the closest genetic relationship with the known O. tsutsugamushi Kawasaki genotype.ConclusionThis study confirms the presence of O. tsutsugamushi in Shijiazhuang City, Hebei Province, with the identified strain belonging to the Kawasaki genotype, marking the first diagnosis of this strain in the region.

Microbiome and mitogenomics of the chigger mite Pentidionis agamae: potential role as an Orientia vector and associations with divergent clades of Wolbachia and Borrelia.

Trombiculid mites are globally distributed, highly diverse arachnids that largely lack molecular resources such as whole mitogenomes for the elucidation of taxonomic relationships. Trombiculid larvae (chiggers) parasitise vertebrates and can transmit bacteria (Orientia spp.) responsible for scrub typhus, a zoonotic febrile illness. Orientia tsutsugamushi causes most cases of scrub typhus and is endemic to the Asia-Pacific Region, where it is transmitted by Leptotrombidium spp. chiggers. However, in Dubai, Candidatus Orientia chuto was isolated from a case of scrub typhus and is also known to circulate among rodents in Saudi Arabia and Kenya, although its vectors remain poorly defined. In addition to Orientia, chiggers are often infected with other potential pathogens or arthropod-specific endosymbionts, but their significance for trombiculid biology and public health is unclear. Ten chigger species were collected from rodents in southwestern Saudi Arabia. Chiggers were pooled according to species and screened for Orientia DNA by PCR. Two species (Microtrombicula muhaylensis and Pentidionis agamae) produced positive results for the htrA gene, although Ca. Orientia chuto DNA was confirmed by Sanger sequencing only in P. agamae. Metagenomic sequencing of three pools of P. agamae provided evidence for two other bacterial associates: a spirochaete and a Wolbachia symbiont. Phylogenetic analysis of 16S rRNA and multi-locus sequence typing genes placed the spirochaete in a clade of micromammal-associated Borrelia spp. that are widely-distributed globally with no known vector. For the Wolbachia symbiont, a genome assembly was obtained that allowed phylogenetic localisation in a novel, divergent clade. Cytochrome c oxidase I (COI) barcodes for Saudi Arabian chiggers enabled comparisons with global chigger diversity, revealing several cases of discordance with classical taxonomy. Complete mitogenome assemblies were obtained for the three P. agamae pools and almost 50 SNPs were identified, despite a common geographic origin. P. agamae was identified as a potential vector of Ca. Orientia chuto on the Arabian Peninsula. The detection of an unusual Borrelia sp. and a divergent Wolbachia symbiont in P. agamae indicated links with chigger microbiomes in other parts of the world, while COI barcoding and mitogenomic analyses greatly extended our understanding of inter- and intraspecific relationships in trombiculid mites.

Epidemiology of Murine Typhus in Taiwan from 2013 to 2020.

Murine typhus is a flea-borne disease caused by Rickettsia typhi infection. The disease is a notifiable infectious disease in Taiwan. Specimens from suspected cases are required to be sent to the Taiwan Centers for Disease Control and Prevention for laboratory diagnosis. In this study, 204 cases of murine typhus were identified by bacterial isolation, real-time polymerase chain reaction, or indirect immunofluorescence assay between 2013 and 2020. The average incidence rate was 0.11/100,000 person-years (95% CI: 0.08-0.13). Murine typhus occurred throughout the year, but it was most prevalent in summer (May to August). The majority of patients were males (75%), residents of Kaohsiung city (31%), and worked in agriculture, forestry, fishing, and animal husbandry (27%). Fever was the most common symptom, present in 95.6% of patients, followed by headache (41%), myalgia (33%), and liver dysfunction (33%). Only 13% of patients had a rash. Up to 80% of cases were among hospitalized patients, and 43% of patients developed severe manifestations. Serological assays also indicated coinfection events. Seven patients showed a 4-fold increase in antibody titers against Orientia tsutsugamushi (N = 2), Coxiella burnetii (n = 2), and Leptospira (N = 3). In conclusion, murine typhus is an endemic and important zoonotic rickettsial disease in Taiwan that cannot be ignored. Further epidemiological surveillance and clinical characteristics should be continuously investigated to prevent and control murine typhus.

IJCM_309A: Epidemiological Trends, Clinical Features, and Outcomes in Scrub typhus patients admitted to a tertiary care hospital in Odisha

Background: Scrub typhus is an emerging public health threat in South-Asian countries; with the growing number of cases in India, an understanding of local patterns of disease and factors that place individuals at risk is pivotal to future preventive measures. Objective: To analyze the epidemiological features- annual number of cases, age distribution, sex distribution, and seasonal distribution over the four years. To find out the clinical profile, laboratory features and outcomes of cases of scrub typhus, and to identify the predictors of disease severity. Methodology: A comprehensive retrospective review of scrub typhus cases reported over a 4-year period (2019-2023) was done, with a monthly trend of patients admitted. Data was collected from the case records of patients for demographic characteristics, clinical features, treatment, and outcomes, length of stay (LOS), complications, and mortality. Data was presented in frequencies and proportions, odds ratio (OR) was calculated and a p-value of Results: A total of 886 cases were reported over the four-years. There was a declining epidemiological trend in 2020-21 and then an increasing one. Scrub typhus cases exhibited seasonality, with a peak incidence during winter season. Males were more commonly affected (58.01%), and the age group most susceptible was 19-64 years (52.22%), followed by one-month to 18years (32.22%). Clinical presentations typically included fever (96%), eschar formation (8%) and rash (8%). Complications like pneumonia (13.88%) and AKI (11.73%), were observed in a significant proportion of cases. Mortality was reported in 4.40% of cases. Altered sensorium, deranged LFT, hypotension requiring ionotropic support, requirement of ventilatory support predicted poor outcome. Conclusion: Scrub typhus was seen to cause a multi-system infection among the studied population, causing significant morbidity and mortality. The conditions found associated with poor outcome and mortality can be used as risk factor predictors and help patient management.

Study of Clinical and Demographic Profile of Scrub Typhus Patients Admitted to a Tertiary Care Hospital in Central India

Objectives: To study epidemiological characteristics, clinical features, laboratory findings, and clinical outcomes in cases of scrub typhus. Additionally, the study aims to identify the predictors of disease severity.Methods: This cross-sectional study was conducted in the Department of General Medicine at Dr PDM Medical College in Amaravati, India. The study duration was 6 months, from July 2023 to December 2023. All clinically confirmed patients with scrub typhus were evaluated through history, clinical examination, and appropriate laboratory investigations. The clinical and laboratory profiles, hospital course, and outcomes were analyzed. Organ dysfunction upon admission was assessed using the sequential organ failure assessment (SOFA) score.Results: A total of 200 cases were included in the study. The majority of the cases were in the age range of 31-40 years, and most of them were males. The highest number of scrub typhus cases occurred in September. The most common presenting symptoms were fever (81%), followed by nausea (37.5%), generalized weakness (34%), abdominal pain, eschar (21.5%), breathlessness, and cough (21% each), headache (19%), vomiting (15%), and altered sensorium (4.5%). The majority of patients (72.5%) did not experience any complications, while 55 patients (27.5%) developed multi-organ dysfunction syndrome (MODS) as a complication. The mortality rate was 1%.Conclusion: Scrub typhus is a significant cause of acute febrile illness in the Vidarbha region of Maharashtra. It can present with various clinical manifestations, with or without an eschar. Early diagnosis and appropriate treatment of these cases can lead to minimal complications.

Scrub typhus among patients with acute febrile illness in a tertiary health care centre

Scrub typhus, caused by Orientia tsutsugamushi and transmitted by bite of larval trombiculid mite of the Leptotrombidium genus and is a vector borne zoonotic disease. It has been predominantly reported from Southeast Asia, the Asian Pacific Rim, and Australia. The incidence of this disease is increased in India. These patients show an acute undifferentiated febrile illness and laboratory confirmation is essential. Delay in diagnosis may be fatal. : To assess the Scrub typhus burden among acute febrile illness patients. This Cross-sectional study, conducted in Dept. of Microbiology, Basaveshwara Medical College & Hospital, Chitradurga, Karnataka, India. Study duration was from August 2020 to January 2021. In this study, a total of 100 febrile illness patients were involved. Among them, 66 were males and 34 females. Under aseptic conditions, venous blood samples were collected from all subjects. Serum was separated by centrifugation, aliquoted, and stored at −20°C for further testing. The serum sample was tested for scrub typhus IgM ELISA using the INBIOS kit. Samples were also checked for dengue fever, typhoid fever, leptospirosis, and malaria. The serum samples that tested positive for any other infectious disease mentioned above (with or without detectable rickettsial antibodies) were excluded from the study. Data was represented in numbers and percentages. : In this study, out of 100 samples 30 were seropositive. Of the 30 seropositive scrub typhus cases, women were 11 (37%) and men were 19 (63%), suggesting that seropositivity was more in men than women. Among the seropositive cases, maximum number of the cases were in 16-30 years (33%) of age, followed by 31–45 years (23%). In this study, more number of positive cases 17 (56.6%) were found during the post-monsoon season i.e., October and November 2020. Fever, the most common symptom (100%). Headache, reported in (70 %) of cases, myalgia (40%), abdominal pain (37%), cough (23%), vomiting (20%), lymphadenopathy (17%), rashes (13%), hepato-spleenomegaly (10%), eschar (3%). The study results may conclude that Scrub typhus seropositivity rate was higher in males than females and also to be included in differential diagnosis of fever of unknown origin.

Epidemiological and clinical characteristics of scrub typhus in Guizhou Province, China: An outbreak study of scrub typhus.

The reported cases of scrub typhus (ST) have continued to escalate, with outbreaks occurring regionally in China. These pose an increasing public health threat at a time when public health has been overwhelmed. During the period from July to August 2022, in Rongjiang County, Guizhou Province, China, 13 out of 21 fever patients were diagnosed with scrub typhus, based on epidemiological investigation and blood test analysis. The major clinical symptoms of these patients showed fever, chills, headache, eschar, fatigue and pneumonia, which were accompanied by a rise in C-reactive protein, neutrophils, alanine transaminase (ALT) and aspartate aminotransferase (AST). Furthermore, nearly half of them exhibited abnormal electrocardiogram activity. Through semi-nested PCR, Sanger sequencing and phylogenetic tree construction, the Karp strain of Orientia tsutsugamushi (O. tsutsugamushi) was confirmed as the pathogen causing ST in Rongjiang County, which shared the same evolutionary branch with O. tsutsugamushi isolated from wild mouse liver or spleen, indicating that the wild mouse plays an important role in transmitting the disease. In contrast to the sporadic cases in the past, our study is the first to disclose an epidemic and the corresponding clinical characteristics of ST in Guizhou province, which is of great significance for the prevention and treatment of regional illnesses.

Scrub typhus in pregnancy - A threat to maternal and fetal outcome.

Scrub typhus is an acute febrile illness transmitted by the bite of trombiculid mite in the larval stage. Scrub typhus is rare in pregnancy and there is paucity of data on the clinical outcome of scrub typhus during pregnancy. We present five cases of scrub typhus complicating pregnancy who were admitted in the obstetric ward at AIIMS Rishikesh, India during the antenatal period for management. The first patient presented at term pregnancy in semiconscious state while the rest were preterm between 31 and 34 weeks period of gestation. The age at presentation was 21-31 years. All five had febrile illness of >5 days' duration along with cough. Fever investigations like blood culture, peripheral smear for malarial parasite, dengue serology, widal test, and urine culture were negative. Serology for scrub typhus was positive in all. Once diagnosis was confirmed for scrub typhus, patients were given the drug of choice azithromycin 500 mg twice daily for five days. Scrub typhus complicating pregnancy led to maternal mortality in one patient. It resulted in one preterm delivery, one intrauterine fetal death, and rest three were delivered at term with good perinatal outcome. Scrub typhus is common in endemic areas like Uttarakhand, India. It has a poor fetal outcome. If diagnosed early and treatment started, maternal and fetal prognosis can be favorable. As large case series are unavailable in literature, it is difficult to predict the course of disease which at times may be fulminant.