Cases Of Typhus Research Articles

Efficacy of Oral Doxycycline versus Intravenous Doxycycline for the Treatment of Uncomplicated Scrub Typhus in Children: A Prospective Interventional Study

Introduction: Orientia tsutsugamushi causes acute febrile illness known as scrub typhus, which is spread by the bite of the trombiculid mite. Doxycycline is the first-line treatment for clinically diagnosed cases of scrub typhus. If not diagnosed and treated early, it can lead to complications such as acute renal failure, meningoencephalitis, gastrointestinal bleeding, and multiple organ failure. However, there have been no trials comparing the effectiveness of oral and Intravenous (i.v.) doxycycline for scrub typhus treatment. Aim: To assess the efficacy of intravenous versus oral doxycycline in managing uncomplicated scrub typhus. Materials and Methods: This prospective interventional research was conducted in the Paediatrics Department at Maharajah’s Institute of Medical Sciences, Vizianagaram, India, from June 2021 to July 2022. Out of a total of 178 children diagnosed with scrub typhus during the study period, 102 children who received either oral or intravenous doxycycline as monotherapy were included. The primary outcome measures studied were the incidence of delayed defervescence and the time of defervescence. The t-test or Mann-Whitney test was applied for continuous data, and the Chi-square test or Fischer’s-exact test was used to compare dichotomous variables. Results: The mean age of children treated with oral doxycycline was 9.5±2.7 years and with i.v. doxycycline was 8.2±2.4 years. Among the 178 children diagnosed with scrub typhus, 102 (57.3%) children treated with doxycycline alone were included in the study. Out of these, 78 (76.4%) cases received oral doxycycline, while 28 (27.4%) cases received intravenous doxycycline. There was no statistically significant difference in the response rate between the two groups. The p-value for time to defervescence was 0.672, and the p-value for the incidence of delayed defervescence was 0.9845. Conclusion: Both oral and intravenous forms of doxycycline demonstrated similar efficacy in the treatment of scrub typhus. Nearly all children in both groups became afebrile within 72 hours after starting treatment.

1336. Six-Year Clinical Experience of Pediatric Murine Typhus in Houston, TX

Abstract Background Murine typhus is a flea-borne rickettsial disease endemic to gulf states. It shares clinical features of Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C). We sought to explore the six-year experience with murine typhus among children living in Houston, TX. Methods We conducted a retrospective chart review to identify clinical and laboratory features of children with murine typhus from January 2015 to July 2021. Cases were identified by positive Rickettsia typhi serology with single IgG >=1:256, single IgM >=1:128, or increase in IgG from 1:64 to 1:28 in convalescent sera. Results 162 cases of pediatric murine typhus were identified. Most cases (85, 52.5%) occurred in the summer. There was a bimodal distribution of age, with peaks at 4 and 17 years (Figure 1). Most children (96, 59.3%) required hospitalization; 11 were admitted to intensive care, and 3 required intubation. All children had fever; the mean duration of fever at presentation was 8.9 days (+/-2.9). Only 67 (41.4%) had a combination of fever, headache, and rash (Table 1). 64 (39.5%) had documented flea or opossum exposure. The most common laboratory abnormalities were elevated serum liver transaminases, hypoalbuminemia, thrombocytopenia, and hyponatremia (Table 1). Cardiac abnormalities were not uncommon: 20/59 (33.9%) had an abnormal electrocardiogram, 5/50 (10.0%) had troponin >0.04 ng/mL, and 4/50 (8.0%) had b-type natriuretic protein >100 pg/mL (Table 1). Most children (149, 92.0%) were diagnosed based on positive initial serological testing. Nine (5.6%) received intravenous immunoglobulin for a diagnosis of KD before typhus was diagnosed. The median duration of hospitalization was 3 days (IQR 2,5), and most children were treated with doxycycline (146, 90.1%). Figure 1.Histogram of age at time of murine typhus diagnosis.Table 1.Clinical and Laboratory Features of Children Diagnosed with Murine Typhus. Conclusion Murine typhus is a common cause of prolonged unexplained fever in children living in endemic areas and shares clinical features of KD and MIS-C. Cardiac abnormalities are not uncommon, and severity of illness can range from outpatient to intensive care. Lack of flea or opossum exposure or lack of headache or rash does not rule out infection. Therefore, a high index of suspicion is warranted, and initial serology testing may accelerate diagnosis in children with prolonged fever. Disclosures All Authors: No reported disclosures.

1369. Ten Year Trends of Typhus Fever in North Texas: Epidemiologic Characteristics and Clinical Manifestations

Abstract Background Murine Typhus remains endemic in southern California and in southern Texas where it is transmitted by fleas, with opossums serving as the amplifying host. In Texas, the disease is increasingly recognized in municipalities outside its historic rural range and is spreading in a northward distribution. Since its expansion, we have observed increased cases in the Dallas-Fort Worth (DFW) area and aim to describe murine typhus in North Texas from 2011-2021. Methods Leveraging the electronic health record, we retrospectively identified 482 individuals tested for murine typhus by Rickettsia typhi (R. typhi) serology in 2 Dallas hospitals. We subsequently collected epidemiologic characteristics, clinical features, and outcomes of 58 patients with positive R. typhi serologies ( >1:64). Results Of the 58 patients with positive R. typhi serology, 39 (67%) were male, 45 (78%) were White, and 23 (40%) were Hispanic. Seventy-nine percent had symptom onset between May and November, and 36/58 (62%) were diagnosed in 2020 and 2021. Twenty-six (45%) had exposure to dogs, 18 (31%) to cats, and 13 (22%) to opossums. Twelve (21%) patients were immunocompromised. Fifty-two (90%) had fever, 35 (60%) headache, 26 (45%) nausea and vomiting, 26 (45%) rash, 25 (43%) myalgia, 20 (34%) cough, and 17 (29%) abdominal pain. In 2020 and 2021, 35/36 (97%) patients were additionally tested for COVID-19, and 29/35 (83%) patients had more than one negative SARS-CoV-2 test prior to R. typhi serologies being sent. Twenty-one out of fifty (42%) had an abnormal chest x-ray (CXR) and 28/30 (93%) had an abnormal chest computed tomography (CT). Nine (16%) had hypoxia, 9 (16%) required an intensive care unit, and 3 (5%) required mechanical ventilation. No patients died within 30 days of diagnosis. Conclusion Our study highlights the expansion of murine typhus in North Texas (Figure 1) and demonstrates the heightened need for clinicians to be aware of this disease in the appropriate epidemiologic and clinical settings. We also describe increasing rates of respiratory findings, demonstrated through over half of patients having at least one respiratory symptom, and 93% having an abnormal chest CT (findings traditionally associated with severe disease). Figure 1:Heatmap Distribution of Murine Typhus Cases in the Dallas-Fort Worth Metroplex (2011-2021) Disclosures Christoph U. Lehmann, MD, FAAP, FACMI, FIAHSI, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria Helen L. King, MD, Gilead Sciences: Grant/Research Support.

Clinical profile and outcomes of Scrub typhus in pregnant women presenting to a tertiary care hospital of North India

Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging endemic zoonosis in the Asia Pacific region. It is a febrile condition ranging in severity from mild to severe, with fatality rates as high as 30%. The present study aims towards analysing the clinical profile and pregnancy outcomes in 27 cases of scrub typhus admitted to a tertiary care centre in North India. The medical records of 27 pregnant women who had scrub typhus were analysed. The IgM ELISA was used to look for IgM antibodies to Orientia tsutsugamushi in the patient’s serum sample. An optical density of more than or equal to 0.468 was considered as positive. Majority of the pregnant females delivered healthy and live babies. However, poor foetal outcomes were observed in four (14.8%) cases with intrauterine deaths occurring in two (7.4%) cases and still birth in one (3.7%) case, while one (3.7%) patient had spontaneous abortion. Maternal mortality was reported in one patient (3.7%) due to a delay in diagnosis. In endemic settings, a strong index of suspicion for scrub typhus is necessary in pregnant females presenting with fever. The key to reducing morbidity in both the mother and foetus is early diagnosis and treatment. Impact Statement What is already known on this subject? Scrub typhus is a febrile condition ranging in severity from mild to severe, with 30% mortality in untreated patients. What do the results of this study add? Majority of the pregnant females delivered healthy and live babies. However, poor foetal outcomes were observed in four (14.8%) cases with intrauterine deaths occurring in two (7.4%) cases and still birth in one (3.7%) case, while one (3.7%) patient had spontaneous abortion. Maternal mortality was reported in one patient (3.7%) due to a delay in diagnosis. What are the implications of these findings for clinical practice and/or further research? In endemic settings, a strong index of suspicion for scrub typhus is necessary for pregnant females presenting with fever. The key to reducing morbidity in both the mother and foetus is early diagnosis and treatment.

How meteorological factors impacting on scrub typhus incidences in the main epidemic areas of 10 provinces, China, 2006-2018.

Scrub typhus, caused by Orientia tsutsugamushi, is a serious public health problem in the Asia-Pacific region, threatening the health of more than one billion people. China is one of the countries with the most serious disease burden of scrub typhus. Previous epidemiological evidence indicated that meteorological factors may affect the incidence of scrub typhus, but there was limited evidence for the correlation between local natural environment factors dominated by meteorological factors and scrub typhus. This study aimed to evaluate the correlation between monthly scrub typhus incidence and meteorological factors in areas with high scrub typhus prevalence using a distributed lag non-linear model (DLNM). The monthly data on scrub typhus cases in ten provinces from 2006 to 2018 and meteorological parameters were obtained from the Public Health Science Data Center and the National Meteorological Data Sharing Center. The results of the single-variable and multiple-variable models showed a non-linear relationship between incidence and meteorological factors of mean temperature (Tmean), rainfall (RF), sunshine hours (SH), and relative humidity (RH). Taking the median of meteorological factors as the reference value, the relative risks (RRs) of monthly Tmean at 0°C, RH at 46%, and RF at 800 mm were most significant, with RRs of 2.28 (95% CI: 0.95-5.43), 1.71 (95% CI: 1.39-2.09), and 3.33 (95% CI: 1.89-5.86). In conclusion, relatively high temperature, high humidity, and favorable rainfall were associated with an increased risk of scrub typhus.

Recent Threat of Scrub Typhus in India: A Narrative Review

Scrub typhus is an endemic illness transmitted by vectors and induced by bacteria. It is the most common and severe rickettsial disease. There are many more cases every year with a significant case fatality rate. Despite being a serious public health threat in India, it is uncertain how widespread and burdensome scrub typhus is. The scarcity of statistical information and pertinent health records on scrub typhus in the outbreak region demonstrates that there is still a significant knowledge gap about this neglected illness. Clinical manifestations of this illness include kidney failure, disability, and severe kidney failure. Undifferentiated symptoms, late diagnosis, and treatment failure are all responsible for deaths. Knowing about this disease is important from a public health point of view due to difficulties in specific diagnosis and a shortage of laboratory services in so many places. India is known to have scrub typhus cases, and doctors should be aware of this potentially dangerous but easily curable illness. The disease is highly difficult to identify clinically from other acute afebrile infections due to common symptoms and a paucity of the lesion in the Indian population. The mainstay of diagnosis is antibody-based serological testing. Within the first week of symptoms, scrub typhus can be diagnosed using molecular and serological tests. Our objective is to identify how severe scrub typhus is in India and to investigate the current epidemiology, etiology, complications, management, and treatment of the disease in both long-established endemic regions and new infection foci.

Epidemiological characteristics and spatiotemporal patterns of scrub typhus in Fujian province during 2012-2020.

BackgroundScrub typhus has become a serious public health concern in the Asia-Pacific region including China. There were new natural foci continuously recognized and dramatically increased reported cases in mainland China. However, the epidemiological characteristics and spatiotemporal patterns of scrub typhus in Fujian province have yet to be investigated.ObjectiveThis study proposes to explore demographic characteristics and spatiotemporal dynamics of scrub typhus cases in Fujian province, and to detect high-risk regions between January 2012 and December 2020 at county/district scale and thereby help in devising public health strategies to improve scrub typhus prevention and control measures.MethodMonthly cases of scrub typhus reported at the county level in Fujian province during 2012–2020 were collected from the National Notifiable Disease Surveillance System. Time-series analyses, spatial autocorrelation analyses and space-time scan statistics were applied to identify and visualize the spatiotemporal patterns of scrub typhus cases in Fujian province. The demographic differences of scrub typhus cases from high-risk and low-risk counties in Fujian province were also compared.ResultsA total of 11,859 scrub typhus cases reported in 87 counties from Fujian province were analyzed and the incidence showed an increasing trend from 2012 (2.31 per 100,000) to 2020 (3.20 per 100,000) with a peak in 2018 (4.59 per 100,000). There existed two seasonal peaks in June-July and September-October every year in Fujian province. A significant positive spatial autocorrelation of scrub typhus incidence in Fujian province was observed with Moran’s I values ranging from 0.258 to 0.471 (P<0.001). Several distinct spatiotemporal clusters mainly concentrated in north and southern parts of Fujian province. Compared to low-risk regions, a greater proportion of cases were female, farmer, and older residents in high-risk counties.ConclusionsThese results demonstrate a clear spatiotemporal heterogeneity of scrub typhus cases in Fujian province, and provide the evidence in directing future researches on risk factors and effectively assist local health authorities in the refinement of public health interventions against scrub typhus transmission in the high risk regions.

The Temporal Lagged Relationship Between Meteorological Factors and Scrub Typhus With the Distributed Lag Non-linear Model in Rural Southwest China.

Background:Meteorological factors can affect the emergence of scrub typhus for a period lasting days to weeks after their occurrence. Furthermore, the relationship between meteorological factors and scrub typhus is complicated because of lagged and non-linear patterns. Investigating the lagged correlation patterns between meteorological variables and scrub typhus may promote an understanding of this association and be beneficial for preventing disease outbreaks.MethodsWe extracted data on scrub typhus cases in rural areas of Panzhihua in Southwest China every week from 2008 to 2017 from the China Information System for Disease Control and Prevention. The distributed lag non-linear model (DLNM) was used to study the temporal lagged correlation between weekly meteorological factors and weekly scrub typhus.ResultsThere were obvious lagged associations between some weather factors (rainfall, relative humidity, and air temperature) and scrub typhus with the same overall effect trend, an inverse-U shape; moreover, different meteorological factors had different significant delayed contributions compared with reference values in many cases. In addition, at the same lag time, the relative risk increased with the increase of exposure level for all weather variables when presenting a positive association.ConclusionsThe results found that different meteorological factors have different patterns and magnitudes for the lagged correlation between weather factors and scrub typhus. The lag shape and association for meteorological information is applicable for developing an early warning system for scrub typhus.

160 Halved incidence of scrub typhus after travel restriction to confine a surge of COVID-19 in Taiwan in 2021

Scrub typhus is a rickettsial disease that is usually transmitted by mite exposure. Infected patients may present with a fever, fatigue, headache, and muscle pain. A blackish skin lesion, called eschar, is pathognomic. The mortality rate in untreated cases is high. The first case of scrub typhus in Taiwan was reported in 1908 during the Japanese colonization. In this article, using the National Infectious Disease Statistics System (NIDSS) from the Taiwan CDC, we analyzed the dynamic incidence of scrub typhus from 2016 to 2021, both seasonally and geographically.

Prevalence of Thrombocytopenia in Acute Kidney Injury Cases Associated Scrub Typhus

Scrub typhus is a vector borne zoonotic disease producing varieties of clinical complications like acute encephalitis syndrome (AES), Acute respiratory distress syndrome (ARDS), multi organs dysfunction(MODS) and deaths also. Acute kidney injury (AKI) is one of the common clinical manifestations while progressing for MODS, where AKI has been found to be associated with thrombocytopenia .In this review a small effort has been made to throw light upon prevalence of thrombocytopenia in scrub typhus cases.

A Study of the Profile of Scrub Typhus in a Tertiary Care Hospital in Jharkhand: An Underestimated Problem.

Background and objectiveScrub typhus (ST) is a rickettsial infection caused by Orientia tsutsugamushi, which is transmitted by the bite of the larval stage (chiggers) of trombiculid mites. Although it presents as an acute undifferentiated febrile illness (AUFI), its course can be complicated with acute respiratory distress syndrome, acute kidney injury (AKI), myocarditis, meningoencephalitis, hepatitis, multi-organ dysfunction syndrome (MODS), and ultimately death. This study aimed to evaluate the epidemiological features, clinical profile, laboratory features, and clinical outcomes of cases of scrub typhus and identify the predictors of disease severity.Methods and materialsThis study is a retrospective observational study that included confirmed cases of scrub typhus admitted in the medical wards and critical care unit (CCU) of Tata Main Hospital (TMH) from January 1, 2019, to December 31, 2021. The case records of patients were analyzed for demographic characteristics, clinical features, treatment, and outcomes, which included length of stay (LOS), complications, and mortality. The required odds ratio (OR) was calculated, univariate and binary regression analyses were done, and a p-value of <0.05 was considered statistically significant.ResultsOf the 42 confirmed cases, 38.1% were males and 61.9% were females. The average age of male patients was 12.6 ± 11.2 years, while that of females was 22 ± 19.3 years. Of the patients, 64.3% were in the age group of 1-20 years. The clinical manifestations in descending order were fever (71.2%), skin rash (19.1%), cough (16.7%), vomiting (28.6%), altered sensorium (23.8%), abdominal pain (23.8%), loose stools (14.3%), seizures (14.3%), anasarca (9.7%), breathlessness (9.7%), and melena (7.1%). Eschar was noted in 38.1% of patients. Swelling of the body (6.7%) and lymphadenopathy (10%) were seen exclusively in children. The common laboratory abnormalities observed were leukocytosis in 34.3% of cases; thrombocytopenia in 68.8% of cases, of which 25% of patients had platelets < 50,000/mm3; and transaminitis in 87.5% of cases. The ratio of AST/ALT of more than one was seen in 89.3% of patients, while it was less than one in 10.7% of patients. The average C-reactive protein (CRP) level was 10.9 ± 6.3 mg/dL. The complications noted were acute respiratory distress syndrome (ARDS) (16.7%), meningoencephalitis (21.4%), septic shock (14.3%), capillary leak syndrome (26.2%), thrombocytopenia (68.8%), transaminitis (87.5%), myocarditis (4.8%), disseminated intravascular coagulation (2.4%), and hypocalcemia (11.9%). The average length of stay (LOS) was 8.1 ± 4.2 days. Twenty-four (57.2%) patients required transfer to the critical care unit (CCU) for managing various complications. There was no mortality in this series, giving rise to the case fatality ratio (CFR) of 0.ConclusionScrub typhus is a reemerging cause of acute febrile illness. The highest number of cases were found during the post-monsoon period and in those with rural backgrounds. It presents with varying clinical manifestations with or without eschar. Hence, a high degree of suspicion along with a thorough clinical examination is needed to diagnose this condition. The disease responds dramatically to doxycycline. One must be aware of its complications and atypical presentations, as a timely diagnosis can reduce the morbidity and mortality associated with this disease.

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.

Clinical and Demographic Characteristics of the Autumn-winter Type of Scrub Typhus Cases in a Peripheral Medical College of West Bengal, India

Clinical and Demographic Characteristics of the Autumn-winter Type of Scrub Typhus Cases in a Peripheral Medical College of West Bengal, India

Cross sectional studies on the ectoparasites among rodents in scrub typhus cases in Karnal and Kaithal Districts of Haryana, India

Orientia tsutsugamushi is a mite-borne bacterium belonging to the family Rickettsiaceae and is responsible for a disease called scrub typhus in humans, which is transmitted by the vector mite Leptotrombidium deliense (common ectoparasite on rodents) in most of Asian countries including India. The study conducted in selected villages of Karnal and Kaithal districts of Haryana state, India revealed four species of rodents - Rattus rattus, norveigicus, Bandicota indica and Suncus murinus. Dust mite Dermatophagoides farina; chigger mite L. deliense and fleas Xenopsylla astia and X. cheopis were prevalent on the rodents.

Neurological Manifestations of Scrub Typhus.

The occurrence of cases of scrub typhus is on the rise in South Asian and Southeast Asian countries. The present review discusses neurological complications following scrub typhus to appraise clinicians practicing in endemic regions about considering this treatable disease in the differential diagnosis of acute febrile illnesses, especially when accompanied with clinical neurological features. While the association of aseptic meningitis, encephalitis, and meningoencephalitis with scrub typhus is well known, more recently described neurological syndromes associated with scrub typhus include acute disseminated encephalomyelitis, various cranial nerve palsies, cerebellitis, cerebrovascular diseases including cerebral venous sinus thrombosis, transverse myelitis, longitudinally extensive transverse myelitis, Guillain-Barré syndrome, opsoclonus-myoclonus syndrome, parkinsonism, and many more. Early diagnosis is key to successful treatment. While diagnostic confirmation is generally made by the detection of IgM antibody by either ELISA or indirect fluorescent antibody tests, conventional PCR using 56kDa gene (cPCR) and loop-mediated isothermal amplification assay (LAMP assay), as well as a newly introduced metagenomic next-generation sequencing (mNGS), are currently available for detection of Orientia tsutsugamushi infection in clinically suspected cases. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The cutaneous hallmark of the disease is the "eschar." Scrub typhus results in multisystem involvement. Neurological compromise is present in about 20% of scrub typhus patients and affects both the central nervous system and the peripheral nervous system. The postulated underlying mechanisms include direct invasion of the organism, a vasculitis-like process, or an immune-mediated injury. Diagnosis of scrub typhus is confirmed by detection of O. tsutsugamushiIgM antibody in serum. Awareness among clinicians regarding the varied presentations of this disease is very important in order to reduce morbidity and mortality. Co-infection with dengue and/or chickungunya viruses may occur in endemic regions. The history of an acute febrile illness preceding the neurological illness is crucial. A very careful search for the eschar is essential; however, the absence of the skin lesion cannot exclude the diagnosis of scrub typhus. Neurological manifestations mostly respond to doxycycline therapy.

Scrub Typhus: A Spatial and Temporal Analysis from South India.

Scrub typhus is a zoonotic rickettsial disease caused by the bacterium Orientia tsutsugamushi. The non-specificity of presentation, low index of suspicion and the poor availability of diagnostic tests often lead to delayed diagnosis and significant morbidity and mortality. Temperature, humidity, rainfall and Normalized Difference Vegetation Index (NDVI) on the spatio-temporal clustering of scrub typhus cases in children in three contiguous administrative districts in South India over 5 years were studied. A total of 419 children were diagnosed with scrub typhus during the study period. A surge of children with scrub typhus was noted when the NVDI ranged between 0.6 and 0.8 µm. Temperature, humidity and rainfall had a major role in the incidence of scrub typhus.

Scrub typhus outbreak in rural area of Purba Medinipur district, West Bengal, India in 2021

Background: Scrub typhus is a reemerging zoonotic disease with no definite preventive measures. Mild to severe clinical manifestation of scrub typhus are occurring in tropical countries. We conducted investigation to confirm the outbreak and vector survey to ascertain transmission of scrub typhus.Methods: A cross sectional study was conducted in Sahid Matangini block of Purba Medinipur district, West Bengal, India between November’ 2020 and January’ 2021. All suspected scrub typhus cases were included for investigation. Environmental and vector survey was also conducted in affected villages.Results: Among total 71 cases, 51 cases were tested for scrub typhus and positivity rate was 13.72% (7/51). Positivity rate was higher in women 9.80% (5/51) than men. Cases found in adult women in the age group of 19-45 years were 35.21% (25/71) and in the children below the age of 15 years were 23.94% (17/71). All the patients developed fever followed by headache, myalgia, cough, rash &amp; eschar. Outbreak started in November’ 2020 and maximum cases were found in December’ 2020. Dumping of household waste inside house was 93%, agriculture fields close to residential houses were 80% and pet animals in household were 69% of total case patients. Trap positivity was 37.5% (3/8) and after examination in laboratory ectoparasites such as adult mites were identified.Conclusions: This was an outbreak of scrub typhus. Mites were found in peri-domestic areas. Household waste is to be dumped away from the residential houses. A clean and vegetation free household environment with proper washing of feet and hand may decrease the risk of scrub typhus.

Simple clinical and laboratory predictors to improve empirical treatment strategies in areas of high scrub typhus and dengue endemicity, central Vietnam.

BackgroundDengue fever is highly endemic in Vietnam, but scrub typhus—although recognized as an endemic disease—remains underappreciated. These diseases together are likely to account for more than half of the acute undifferentiated fever burden in Vietnam. Scrub typhus (ST) is a bacterial disease requiring antimicrobial treatment, while dengue fever (DF) is of viral etiology and does not. The access to adequate diagnostics and the current understanding of empirical treatment strategies for both illnesses remain limited. In this study we aimed to contribute to the clinical decision process in the management of these two important etiologies of febrile illness in Vietnam.MethodsUsing retrospective data from 221 PCR-confirmed scrub typhus cases and 387 NS1 protein positive dengue fever patients admitted to five hospitals in Khanh Hoa province (central Vietnam), we defined predictive characteristics for both diseases that support simple clinical decision making with potential to inform decision algorithms in future. We developed models to discriminate scrub typhus from dengue fever using multivariable logistic regression (M-LR) and classification and regression trees (CART). Regression trees were developed for the entire data set initially and pruned, based on cross-validation. Regression models were developed in a training data set involving 60% of the total sample and validated in the complementary subsample. Probability cut points for the distinction between scrub typhus and dengue fever were chosen to maximise the sum of sensitivity and specificity.ResultsUsing M-LR, following seven predictors were identified, that reliably differentiate ST from DF; eschar, regional lymphadenopathy, an occupation in nature, increased days of fever on admission, increased neutrophil count, decreased ratio of neutrophils/lymphocytes, and age over 40. Sensitivity and specificity of predictions based on these seven factors reached 93.7% and 99.5%, respectively. When excluding the “eschar” variable, the values dropped to 76.3% and 92.3%, respectively.The CART model generated one further variable; increased days of fever on admission, when eschar was included, the sensitivity and specificity was 95% and 96.9%, respectively. The model without eschar involved the following six variables; regional lymphadenopathy, increased days of fever on admission, increased neutrophil count, increased lymphocyte count, platelet count ≥ 47 G/L and age over 28 years as predictors of ST and provided a sensitivity of 77.4% and a specificity of 90.7%.ConclusionsThe generated algorithms contribute to differentiating scrub typhus from dengue fever using basic clinical and laboratory parameters, supporting clinical decision making in areas where dengue and scrub typhus are co-endemic in Vietnam.

Severe scrub typhus infection in infancy with multiple organ dysfunction

Background: Scrub typhus is relatively less common among infants but found to have a mentionable association with multiple organ dysfunction and turbulent course. The aim of this study was to delineate the clinicolaboratory profile of infantile scrub typhus, complication, course of illness, and responsiveness to therapy. Subjects and Methods: This retrospective observational study was undertaken in two tertiary care pediatric teaching centers in eastern India among infants with diagnosis of scrub typhus. Clinical features, especially pattern of organ dysfunction, laboratory findings with emphasis on hyperferritinemia, and treatment schedules with responsiveness to therapy, were analyzed retrospectively. Results: A total of 272 cases of scrub typhus had been admitted during the study period. Among them, 17 kids (6.25%) were infants. All of them presented with lethargy and poor feeding as a common complaint along with seizures and respiratory distress. Seven out of 17 (41%) were identified early. Fifteen (88%) were critically ill and required pediatric intensive care unit admission, out of which 13 (76.4%) patients were put on ventilator support. Thirteen (76.4%) of them developed hyperferritinemia with multi-organ dysfunction syndrome (MODS) and required additional immunotherapy. Sixteen of them recovered completely without any sequelae. Severe complications such as acute respiratory distress syndrome and MODS were significantly high (P = 0.001 and 0.004, respectively) and hospital stay was longer (P-0.04) in infants in comparison to older children. Conclusion: We conclude that infantile scrub typhus, though not very common, should be considered an important differential in infants presenting with an acute febrile illness with hyperferritinemia and MODS. Infants with scrub typhus can have a more stormy disease course compared to their older counterparts.

Emergence of Scrub Typhus in Urban Areas: a Report from South India

Aims: To study the epidemiology and clinical presentation of Scrub typhus in Southern India.&#x0D; Study design: Observational study&#x0D; Place and Duration of Study: Apollo Hospital, Chennai, India, between January 2010 and December 2011.&#x0D; Methodology: This is an observational study of 182 patients from a tertiary care center between January 2010 and December 2011. Cases of scrub typhus were defined by a positive IgM scrub typhus ELISA, compatible clinical features and negative workup for other pathogens. Epidemiological data and clinical data were collected from the records for the study purpose.&#x0D; Results: Fever (100%), headache (69.7%) and cough (47.8%) were the predominant presenting symptoms. The majority (85.7%) of cases were during the period from July to December in both the years, corresponding to the monsoon in South India. 62% of cases were from urban areas and 47.3 % of cases required admission to the critical care unit. An eschar was present in 46.7% of cases and 97.3% of the cases improved with therapy. All patients received either doxycycline or azithromycin or a combination of both as therapy. Defervescence was seen within 72 hours in 98.5% of patients. &#x0D; Conclusion: Scrub typhus is a re-emerging disease in South India. It should be considered in the differential diagnosis of acute undifferentiated febrile illness even in urban areas in all age groups, especially during the monsoon season. Careful search for an eschar is important. Treatment with doxycycline or azithromycin is effective. The mortality rate is expected to be high if untreated, so we suggest that these antibiotics be part of initial empiric therapy whenever the disease is in the differential diagnosis in all severely ill patients awaiting diagnostic results.