scholarly journals An outbreak investigation of scrub typhus in Nepal: confirmation of local transmission

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Meghnath Dhimal ◽  
Shyam Prakash Dumre ◽  
Guna Nidhi Sharma ◽  
Pratik Khanal ◽  
Kamal Ranabhat ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Case Fatality ◽  
Febrile Illness ◽  
Outbreak Detection ◽  
Transmission Ecology ◽  
Major Outbreak ◽  
Causative Agents ◽  
Outbreak Areas ◽  
The Government ◽  
Epidemiological Information

Abstract Background Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness in the areas of tsutsugamushi triangle caused by Orientia tsutsugamushi. It is frequently diagnosed in South Asian countries, although clear epidemiological information is not available from Nepal. After the 2015 earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported. The objective of this study was to investigate epidemiology of scrub typhus and its causative agents in humans, animals, and chigger mites to understand the ongoing transmission ecology. Methods Scrub typhus cases with confirmed diagnosis throughout the country were included in the analysis. Studies were concentrated in the Chitwan district, the site of a major outbreak in 2016. Additional nation-wide data from 2015 to 2017 available from the government database included to analyse the disease distribution by geographical mapping. Results From 2015 to 2017, 1239 scrub typhus cases were confirmed with the largest outbreak occurring in 2016 with 831 (67.1%) cases. The case fatality rate was 5.7% in 2015 which declined to 1.1% in 2017. A nationwide outbreak of scrub typhus was declared as the cases were detected in 52 out of the 75 districts of Nepal. Seasonal trend was observed with a peak during August and September. In addition to the human cases, the presence of O. tsutsugamushi was also confirmed in animals (rodents) and chigger mites (Leptotrombidium imphalum) from the outbreak areas of southern Nepal. Conclusion The detection of O. tsutsugamushi in humans, animals, and chigger mites from outbreak locations and wide-spread reports of scrub typhus throughout the country consecutively for 3 years confirms the ongoing transmission of O. tsutsugamushi with a firmly established ecology in Nepal. The country’s health system needs to be strengthened for systematic surveillance, early outbreak detection, and immediate actions including treatment and preventive measures.

scholarly journals Confirmation of local transmission of Orientia tsutsugamushi during scrub typhus outbreaks in Nepal

2019 ◽  
Author(s):  
Meghnath Dhimal ◽  
Shyam Prakhas Dumre ◽  
Guna Niddhi Sharma ◽  
Pratik Khanal ◽  
Kamal Ranabhat ◽  
...  
Keyword(s):  
Preventive Measures ◽  
Scrub Typhus ◽  
Case Fatality ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
2015 Gorkha Earthquake ◽  
Causative Agents ◽  
The Government ◽  
Local Transmission ◽  
Immediate Response

ABSTRACTBackgroundScrub typhus is a severely ignored tropical disease and a leading cause of undifferentiated febrile illness worldwide caused by infection of an obligate intracellular bacteria Orientia tsutsugamushi. It has been rapidly expanding in South Asian countries, although clear epidemiological information is not available from Nepal. After the 2015 earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported. The objective of this study was to investigate scrub typhus and its causative agents in human, rodent and chigger mites to better understand the ongoing transmission ecology.MethodsScrub typhus cases with confirmed diagnosis throughout the country were included in the analysis. Studies were concentrated in the Chitwan district, the site of a major outbreak in 2016. Additional country-wide data from 2015 to 2017 was made available from the government database to analyse the disease distribution using geographical mapping.ResultsDuring 2015-2017, 1,239 scrub typhus cases were confirmed with the largest outbreak occurring in 2016 with 831 (67.1%) cases. The remainder 267 cases were reported in 2017. The case fatality rate was 5.7% in 2015 and declined to 1.1% in 2017. Nationwide outbreak of scrub typhus was identified as the cases were found from 52 of the 75 districts of Nepal. A seasonal trend was observed with a peak during August and September (p = 0.01). In addition to the human cases, the presence of O. tsutsugamushi was also confirmed in rodents and chigger mites from the outbreak areas of southern Nepal.ConclusionThe detection of O. tsutsugamushi in human, rodent, and chigger mites from outbreak locations and wide-spread reports of scrub typhus throughout the country over two years confirms the ongoing transmission of O. tsutsugamushi with a firmly established ecology in Nepal. The country’s health system needs to be strengthened for systematic surveillance, early outbreaks detection, and immediate response actions including treatment and preventive measures.Author SummaryScrub typhus is a disease caused by a bacteria called Orientia tsutsugamushi and transmitted to people through bites of infected chiggers (larval mites). After the 2015 Gorkha earthquake in Nepal, a sudden upsurge in scrub typhus cases was reported with repeated outbreaks from different parts of the country. This study has documted epidemiology of scrub typhus and its causative agents in human, rodent and chigger mites confimring the local transmission O. tsutsugamushi with a firmly established ecology in Nepal. The local transmission of the diseases from most parts of the country demands strengthening for systematic surveillance, early outbreaks detection, and immediate response actions including treatment and preventive measures.

scholarly journals Scrub typhus: a hospital-based study in the northern districts of West Bengal, India

2019 ◽  
Vol 7 (6) ◽  
pp. 2403
Author(s):  
Sanjay Kumar Mallick ◽  
Santanu Hazra ◽  
Tanmoy Nandi ◽  
Arunabha Sarkar
Keyword(s):  
Case Fatality Rate ◽  
West Bengal ◽  
Scrub Typhus ◽  
Case Fatality ◽  
Febrile Illness ◽  
Asia Pacific ◽  
Enzyme Linked Immunosorbent Assay ◽  
Acute Febrile Illness ◽  
Fatality Rate ◽  
Serological Tests

Background: Scrub typhus caused by Orientia tsutsugamushi, is a mite-borne zoonotic acute febrile illness. Geographically, it is confined to the Asia-Pacific region and important re-emerging infection in India. Clinical diagnosis of scrub typhus from other acute febrile illness is very difficult due to nonspecific symptoms and the relative absence of eschar in the Indian population. Case fatality rate varies from 30-70% depending on the clinical suspicion, delay in diagnosis and treatment. Antibody-based serological tests are the mainstay of diagnosis. IgM enzyme-linked immunosorbent assay (ELISA) against O. tsutsugamushi is helpful for the diagnosis of scrub typhus within the first week of illness.Methods: The aim of the study was to determine the prevalence of the disease in Northern districts of West Bengal, India using IgM ELISA.Results: Out of 577 serum samples tested 10.05% were positive for IgM antibodies. Majority of cases were below 40 years of age with higher prevalence in female patients. The disease showed a seasonal trend with a peak during the monsoon and later months. The case fatality rate among ELISA positive cases was 32.76%.Conclusions: Significant seropositivity against scrub typhus among cases of acute febrile illness with relatively higher mortality indicates that scrub typhus should be included in the differential diagnosis and confirmed by IgM ELISA.

scholarly journals The burden of scrub typhus in India: A systematic review

2021 ◽  
Vol 15 (7) ◽  
pp. e0009619
Author(s):  
Emily Devasagayam ◽  
Divya Dayanand ◽  
Debasree Kundu ◽  
Mohan S. Kamath ◽  
Richard Kirubakaran ◽  
...  
Keyword(s):  
Systematic Review ◽  
Organ Dysfunction ◽  
Case Fatality Rate ◽  
Scrub Typhus ◽  
Case Fatality ◽  
Febrile Illness ◽  
Multiple Organ ◽  
Control Measures ◽  
Fatality Rate ◽  
Rickettsial Infections

Background Scrub typhus, a vector-borne zoonotic infection caused by the bacteria Orientia tsutsugamushi, is one of the most common and clinically important rickettsial infections worldwide. An estimated one million cases occur annually with a high case fatality rate. Although scrub typhus is a major public health threat in India, the burden and distribution remains unclear. We aimed to estimate the burden of scrub typhus in India. Methodology We performed a systematic review of published literature on scrub typhus from India to extract information on epidemiology, morbidity, and mortality. Important databases were searched using keywords and appropriate combinations. We identified observational, interventional, and population-based studies and extracted the data to evaluate the number of cases diagnosed using serology or PCR and the number of deaths due to scrub typhus. We conducted a systematic narrative synthesis to summarize included studies. Principal findings In the last decade, there were 18,781 confirmed scrub typhus cases reported in 138 hospital-based studies and two community-based studies. IgM ELISA was used in 122 studies to confirm the cases in majority (89%). The proportion of scrub typhus among acute undifferentiated febrile illness (AUFI) studies was 25.3%, and community seroprevalence was 34.2%. Ninety studies had data published on multiple organ involvement out of which 17.4% of cases had multiple organ dysfunction syndromes, 20.4% patients required ICU admission, and 19.1% needed ventilation. The overall case-fatality rate was 6.3%, and the mortality among those with multi-organ dysfunction syndrome was as high as 38.9%. Conclusion/significance Scrub typhus, a common acute febrile illness in India causing severe morbidity, accounts for a large number of deaths. The burden of the disease has been underappreciated. Early diagnosis and prompt treatment can significantly reduce complications and mortality. Establishing good surveillance and instituting appropriate control measures are urgently needed.

Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

2016 ◽  
Vol 5 (09) ◽  
pp. 4896
Author(s):  
Sripriya C.S.* ◽  
Shanthi B. ◽  
Arockia Doss S. ◽  
Antonie Raj I. ◽  
Mohana Priya
Keyword(s):  
Scrub Typhus ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
The Past ◽  
Igm Elisa ◽  
The Mean ◽  
Specific Symptoms ◽  
Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45. 

Covid-19 Cases in India: A Visual Exploratory Data Analysis Model (Preprint)

2020 ◽  
Author(s):  
Jayesh S
Keyword(s):  
Data Analysis ◽  
Exploratory Data Analysis ◽  
Case Fatality ◽  
Public Health Emergency ◽  
Virus Spread ◽  
Analysis Model ◽  
Case Fatality Ratio ◽  
First Case ◽  
Exploratory Data ◽  
The Government

UNSTRUCTURED Covid-19 outbreak was first reported in Wuhan, China. The deadly virus spread not just the disease, but fear around the globe. On January 2020, WHO declared COVID-19 as a Public Health Emergency of International Concern (PHEIC). First case of Covid-19 in India was reported on January 30, 2020. By the time, India was prepared in fighting against the virus. India has taken various measures to tackle the situation. In this paper, an exploratory data analysis of Covid-19 cases in India is carried out. Data namely number of cases, testing done, Case Fatality ratio, Number of deaths, change in visits stringency index and measures taken by the government is used for modelling and visual exploratory data analysis.

scholarly journals Differential Laboratory Diagnosis of Acute Fever in Guinea: Preparedness for the Threat of Hemorrhagic Fevers

2021 ◽  
Vol 18 (11) ◽  
pp. 6022
Author(s):  
Vladimir G. Dedkov ◽  
N’Faly Magassouba ◽  
Olga A. Stukolova ◽  
Victoria A. Savina ◽  
Jakob Camara ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Febrile Illness ◽  
Laboratory Diagnosis ◽  
Acute Febrile Illness ◽  
Causative Pathogen ◽  
Hemorrhagic Fevers ◽  
Wide Range ◽  
Causative Agents ◽  
Pathognomonic Sign

Acute febrile illnesses occur frequently in Guinea. Acute fever itself is not a unique, hallmark indication (pathognomonic sign) of any one illness or disease. In the infectious disease context, fever’s underlying cause can be a wide range of viral or bacterial pathogens, including the Ebola virus. In this study, molecular and serological methods were used to analyze samples from patients hospitalized with acute febrile illness in various regions of Guinea. This analysis was undertaken with the goal of accomplishing differential diagnosis (determination of causative pathogen) in such cases. As a result, a number of pathogens, both viral and bacterial, were identified in Guinea as causative agents behind acute febrile illness. In approximately 60% of the studied samples, however, a definitive determination could not be made.

scholarly journals Scrub Typhus and Molecular Characterization of Orientia tsutsugamushi from Central Nepal

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 422
Author(s):  
Rajendra Gautam ◽  
Keshab Parajuli ◽  
Mythili Tadepalli ◽  
Stephen Graves ◽  
John Stenos ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Limited Information ◽  
Orientia Tsutsugamushi ◽  
Health Measures ◽  
Central Nepal ◽  
Vector Borne

Scrub typhus is a vector-borne, acute febrile illness caused by Orientia tsutsugamushi. Scrub typhus continues to be an important but neglected tropical disease in Nepal. Information on this pathogen in Nepal is limited to serological surveys with little information available on molecular methods to detect O. tsutsugamushi. Limited information exists on the genetic diversity of this pathogen. A total of 282 blood samples were obtained from patients with suspected scrub typhus from central Nepal and 84 (30%) were positive for O. tsutsugamushi by 16S rRNA qPCR. Positive samples were further subjected to 56 kDa and 47 kDa molecular typing and molecularly compared to other O. tsutsugamushi strains. Phylogenetic analysis revealed that Nepalese O. tsutsugamushi strains largely cluster together and cluster away from other O. tsutsugamushi strains from Asia and elsewhere. One exception was the sample of Nepal_1, with its partial 56 kDa sequence clustering more closely with non-Nepalese O. tsutsugamushi 56 kDa sequences, potentially indicating that homologous recombination may influence the genetic diversity of strains in this region. Knowledge on the circulating strains in Nepal is important to the development of diagnostic tests and vaccines to support public health measures to control scrub typhus in this country.

Istanbul During the Balkan Wars (1912–1913)

2014 ◽  
Vol 5 (2) ◽  
pp. 141-164
Author(s):  
Baykal Erol
Keyword(s):  
Direct Consequence ◽  
Balkan Wars ◽  
The Press ◽  
Major Outbreak ◽  
The Government ◽  
Flow Of Information ◽  
Potential Disaster

During the Balkan Wars (1912–1913) Istanbul suddenly found itself at the frontline of an unexpectedly disastrous conflict with its Balkan neighbours. One direct consequence of these wars, through troop mobilisation and refugee movement, was a major outbreak of cholera in the Ottoman capital. While entrepreneurs tried to turn this calamity into profit, by selling (useless) medication, the government tried to control the flow of information regarding the disease in order to better combat the epidemic and both parties used the press to achieve their goals. Despite the chaos of the war and the size of the outbreak, the acted efficiently and successfully prevented a potential disaster.

scholarly journals Active Circulation of Madariaga Virus, a Member of the Eastern Equine Encephalitis Virus Complex, in Northeast Brazil

Pathogens ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 983
Author(s):  
Laura H. V. G. Gil ◽  
Tereza Magalhaes ◽  
Beatriz S. A. S. Santos ◽  
Livia V. Oliveira ◽  
Edmilson F. Oliveira-Filho ◽  
...  
Keyword(s):  
Phylogenetic Analyses ◽  
Case Fatality ◽  
Febrile Illness ◽  
Encephalitis Virus ◽  
Northeast Brazil ◽  
Eastern Equine Encephalitis Virus ◽  
Eastern Equine Encephalitis ◽  
Vaccination Programs ◽  
Transmission Cycle ◽  
Equine Encephalitis Virus

Madariaga virus (MADV) is a member of the eastern equine encephalitis virus (EEEV) complex that circulates in Central and South America. It is a zoonotic, mosquito-borne pathogen, belonging to the family Togaviridae. Disturbances in the natural transmission cycle of this virus result in outbreaks in equines and humans, leading to high case fatality in the former and acute febrile illness or neurological disease in the latter. Although a considerable amount of knowledge exists on the eco-epidemiology of North American EEEV strains, little is known about MADV. In Brazil, the most recent isolations of MADV occurred in 2009 in the States of Paraíba and Ceará, northeast Brazil. Because of that, health authorities have recommended vaccination of animals in these regions. However, in 2019 an equine encephalitis outbreak was reported in a municipality in Ceará. Here, we present the isolation of MADV from two horses that died in this outbreak. The full-length genome of these viruses was sequenced, and phylogenetic analyses performed. Pathological findings from postmortem examination are also discussed. We conclude that MADV is actively circulating in northeast Brazil despite vaccination programs, and call attention to this arbovirus that likely represents an emerging pathogen in Latin America.

Prone ventilation in a pregnant patient with scrub typhus-induced acute respiratory distress syndrome

2021 ◽  
Vol 14 (4) ◽  
pp. e242870
Author(s):  
Meenupriya Arasu ◽  
Nagalakshmi Swaminathan ◽  
Anusha Cherian ◽  
Magesh Parthiban
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Pregnant Patient ◽  
Lung Compliance ◽  
Pcr Assay ◽  
Oxygenation Indices

A 23-year-old primigravida at 20 weeks of gestation presented to our hospital with undifferentiated febrile illness and severe acute respiratory distress syndrome. She was intubated in the emergency department and transferred to the intensive care unit. Initial treatment included ventilatory care, vasopressor support and broad-spectrum antibiotics. Based on a positive PCR assay for scrub typhus, she was treated with intravenous doxycycline and azithromycin. Despite reduction in fever, her oxygenation further declined. Following a risk–benefits assessment, we decided to ventilate her in prone position for 8 hours a day for three consecutive days using a checklist-based protocol. Her oxygenation indices and lung compliance markedly improved over this period, and she was extubated a day later. She was eventually discharged home after 1 week.

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