scholarly journals Clinical profile and complications: scrub typhus in children at a tertiary hospital in south India, Nellore

2021 ◽  
Vol 8 (3) ◽  
pp. 545
Author(s):  
E. Kishore ◽  
S. V. S. Sreedhar
Keyword(s):  
Scrub Typhus ◽  
Febrile Illness ◽  
Tertiary Hospital ◽  
Immunoglobulin M ◽  
Clinical Profile ◽  
Asia Pacific ◽  
Enzyme Linked Immunosorbent Assay ◽  
High Grade Fever ◽  
Medical College ◽  
Life Saving

Background: Rickettsial diseases, including scrub typhus, are emerging across the Asia-Pacific region as a significant source of acute undifferentiated febrile disease. The purpose of the research is to study the clinical profile, symptoms, and results of cases of scrub typhus admitted to rural medical colleges.Methods: From November 2019 to August 2020, this prospective descriptive research was performed at Narayana Medical College, Nellore, Andhra Pradesh, India. Children who were scrub typhus-positive by immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) were tested.Results: 164 children (more than 40 percent of fever cases) were scrub typhus-positive during the study time. Many of the children had a fever. 84.15 percent, 49.40 percent, 37.20 percent, 56.10 percent, and 25 percent respectively saw high-grade fever, chills, vomiting, cough, and headache. In 63.41 percent of children, Eschar was shown. The typical findings were lymphadenopathy (68.30 percent) and hepatomegaly (more than 57 percent). In 47.56 percent, 25.60 percent, 39.63 percent, and 37.19 percent, shock, respiratory failure, pleural effusion, and ascites were observed. Popular lab results were anemia (70.12 percent) and thrombocytopenia (74.40 percent). Complications were recorded in shock (47.56 percent), ARDS (10.36 percent), meningoencephalitis (7.32 percent), and MODS (1.22 percent). The complications were treated with doxycycline (51.21 percent), azithromycin (12.80 percent), and both drugs (35.97 percent) were used to treat the complications.Conclusions: When a child presents with acute febrile illness, hepatosplenomegaly, lymphadenopathy, anemia with thrombocytopenia, and features suggestive of capillary leak diagnosis of scrub typhus must be considered. Doxycycline or azithromycin, proper fluid boluses, inotropes, and O2 through Jackson-Rees circuit are life-saving for scrub typhus and its complications.

scholarly journals A study on clinical profile, complications and outcome of scrub typhus in south Indian children

2017 ◽  
Vol 4 (3) ◽  
pp. 848
Author(s):  
J. Balaji ◽  
P. Punitha ◽  
B. Ramesh Babu ◽  
K. S. Kumaravel
Keyword(s):  
Scrub Typhus ◽  
Febrile Illness ◽  
Clinical Profile ◽  
Asia Pacific ◽  
High Grade Fever ◽  
Indian Children ◽  
College Hospital ◽  
Medical College ◽  
South Indian ◽  
Life Saving

Background: Rickettsial diseases including Scrub Typhus are emerging as an important cause of acute undifferentiated febrile illness throughout the Asia-Pacific region. The objectives of the study are to study the clinical profile, complications and outcome of Scrub Typhus cases admitted in rural medical college.Methods: This prospective descriptive study was done at Government Dharmapuri Medical College Hospital, Tamilnadu, between Jul’2015 and Jan’2016. The children who were positive for Scrub Typhus by IgM Elisa were analyzed.Results: During the study period, 151 children (40% of fever cases) were positive for Scrub Typhus. All the children were presented with fever. High-grade fever, chills, vomiting, cough, head ache, were seen in 83%, 41%, 57%, 56% and 32% respectively. 54% of children had lethargy and 10% children brought with convulsions to hospital. Eschar was seen in 68% of children. Lymphadenopathy (70%) and hepatosplenomegaly (more than 56%) were common findings. Shock, respiratory distress, pleural effusion and ascites were seen in 46%, 36%, 40% and 37% respectively. Anemia (74%) and thrombocytopenia (81%) were common lab findings. Shock (46%), ARDS (12%), Meningoencephalitis (10%) and MODS (1.3%) were complications reported. Doxycycline (53%), Azithromycin (11%) and both drugs (36%) were used. Along with fluids, Dopamine (38%), nor-adrenaline (12%), Oxygen through Jackson-Rees Circuit (28%), Non-invasive ventilation (9%) was needed to treat the complications.Conclusions: When a child presents with acute febrile illness, hepatospleenomegaly, lymphadenopathy, anemia with thrombocytopenia and features suggestive of capilary leak diagnosis of Scrub Typhus must be considered. Doxycycline or Azithromycin, proper fluid boluses, Inotropes and O2 through Jackson-Rees Circuit are life saving for scrub typhus and its complications.

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.

Seroprevalence and clinical profile of scrub typhus in patients presenting with undifferentiated acute febrile illness in a tertiary care centre

2021 ◽  
Vol 12 (4) ◽  
pp. 54-60
Author(s):  
Reena Anie Jose ◽  
Hyma Jose ◽  
Anjali Anne Jacob ◽  
Pramod Thomas ◽  
Renu Mathew ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Laboratory Finding ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Febrile Illness ◽  
Clinical Profile ◽  
Bivariate Analysis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Rickettsial Infections ◽  
Igm Elisa

Background: Scrub typhus (ST) is a common Rickettsial infection which has been increasingly reported from the various states of southern part of India. Aims and Objective: With very few reports from Central Kerala, we aimed to study the seroprevalence of scrub typhus and its clinical profile. Materials and Methods: Patients presenting with acute undifferentiated febrile illness and other symptoms and signs of Rickettsial infections during a period of two years were included in this prospective study. Serodiagnosis of ST was based on a positive Scrub typhus IgM Enzyme Linked Immunosorbent Assay (ELISA) and/or agglutination for OXK in Weil Felix test. The cut-off for ELISA was calculated. The clinical and laboratory details of the positive patients were obtained and bivariate analysis was performed. Results: The cut-off for ST IgM ELISA was calculated and found to be 0.38. Of the 636 samples screened, 34 (5.3%) were positive for ST IgM ELISA. Out of the 34 positive samples, only 5 (0.8%) were positive by Weil Felix test. Most of the ST patients presented during the months of May to January. Rashes were observed in 8.8% of the ST patients and none had signs of eschar. The commonest clinical features included fever, myalgia (52.9%), nausea & vomiting (32.4%), headache (29.4%) and hepatosplenomegaly (29.4%). The commonest abnormal laboratory finding and complication observed were elevated serum transaminases (52.9%) and acute respiratory distress syndrome (17.6%) respectively. Conclusion: The seroprevalence of ST in Central Kerala was 5.3% using Weil Felix test and ST IgM ELISA.

scholarly journals A study of clinical and laboratory profile of scrub typhus in children in a tertiary hospital in South India

2017 ◽  
Vol 4 (2) ◽  
pp. 482
Author(s):  
Radha Kumar ◽  
Purusothaman Srinivasan
Keyword(s):  
Tamil Nadu ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Tertiary Hospital ◽  
Response To Therapy ◽  
Acute Febrile Illness ◽  
College Hospital ◽  
Medical College ◽  
Laboratory Profile ◽  
High Index Of Suspicion

Background: Scrub typhus is an acute febrile illness caused by infection with Orientia tsutsugamushi. The present study was conducted to study the clinical features, laboratory profile, complications and response to therapy among children suffering from scrub typhus in a tertiary health care institution of Tamil Nadu, India.Methods: The study was conducted at Saveetha Medical College Hospital, Tamil Nadu, India. Duration of the study was from August to December, 2015 in the Department of Pediatrics. Children with clinically suspected Scrub typhus were subjected to detailed clinical examination and investigation. Diagnosis of scrub typhus was confirmed by IgM ELISA. Results: 34 patients were diagnosed as suffering from scrub typhus. Common symptoms noted were fever, headache, cough and cold, chills, rigor, myalgia and vomiting. The common complications noted were thrombocytopenia in 16 children (47%) and features of meningoencephalitis and hepatitis were present in 2 children (5.8%). Eschar was identified in 24 (70.5%) patients. Mixed infection was seen in 4 (11.7%) children who had concurrent culture positive Urinary Tract Infection.   Conclusions: Scrub typhus is an acute febrile illness which requires high index of suspicion for early diagnosis, monitoring of the clinical and laboratory parameters and prompt treatment which may help in complete cure without further complications and morbidity.  

scholarly journals Profile of Scrub Typhus Meningitis/Meningoencephalitis in Children with and without Scrub Typhus IgM Antibody in CSF

2021 ◽  
Author(s):  
Bijayini Behera ◽  
Amit Kumar Satapathy ◽  
Jai Ranjan ◽  
Shyam Chandrasekar ◽  
Subhakanta Patel ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Scrub Typhus ◽  
Univariate Analysis ◽  
Febrile Illness ◽  
Immunoglobulin M ◽  
Descriptive Statistics ◽  
Neurological Involvement ◽  
Enzyme Linked Immunosorbent Assay ◽  
Eastern India ◽  
Factors Associated

AbstractThe aim of this article was to study the spectrum of scrub typhus meningitis/meningoencephalitis (STM) cases in children. Children ≤14 years of age with acute undifferentiated febrile illness were included. Immunoglobulin M (IgM) enzyme-linked immunosorbent assay was done in blood and cerebrospinal fluid (CSF) of children with suspected STM. Demographic, clinical, and laboratory details were expressed as descriptive statistics. Factors associated with neurological involvement were identified on univariate analysis. A total of 76 children had ST during the study period (meningitis/meningoencephalitis = 8 [10.5%], of which 5 [62.5%] had detectable ST IgM antibodies in CSF). The included children were 4 to 12 years of age with boys > girls. Headache and vomiting were common in those with STM, whereas hyponatremia and thrombocytopenia were common in those without STM. All children with STM recovered with sequelae in one child (right lateral rectus palsy). There was no mortality. STM has an incidence of 10.5% in children with ST from Eastern India. Headache and vomiting were significant predictors of STM, whereas hyponatremia and thrombocytopenia were significant predictor of non-STM.

scholarly journals Diagnostic Accuracy of the InBios Scrub Typhus Detect™ ELISA for the Detection of IgM Antibodies in Chittagong, Bangladesh

2018 ◽  
Vol 3 (3) ◽  
pp. 95 ◽  
Author(s):  
Stuart Blacksell ◽  
Hugh Kingston ◽  
Ampai Tanganuchitcharnchai ◽  
Meghna Phanichkrivalkosil ◽  
Mosharraf Hossain ◽  
...  
Keyword(s):  
General Population ◽  
Diagnostic Accuracy ◽  
Diagnostic Tests ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
High Sensitivity ◽  
Immunofluorescence Assay ◽  
Immunoglobulin M ◽  
Regional Assessment ◽  
Igm Elisa

Here we estimated the accuracy of the InBios Scrub Typhus Detect™ immunoglobulin M (IgM) ELISA to determine the optimal optical density (OD) cut-off values for the diagnosis of scrub typhus. Patients with undifferentiated febrile illness from Chittagong, Bangladesh, provided samples for reference testing using (i) qPCR using the Orientia spp. 47-kDa htra gene, (ii) IFA ≥1:3200 on admission, (iii) immunofluorescence assay (IFA) ≥1:3200 on admission or 4-fold rise to ≥3200, and (iv) combination of PCR and IFA positivity. For sero-epidemiological purposes (ELISA vs. IFA ≥1:3200 on admission or 4-fold rise to ≥3200), the OD cut-off for admission samples was ≥1.25, resulting in a sensitivity (Sn) of 91.5 (95% confidence interval (95% CI: 96.8–82.5) and a specificity (Sp) of 92.4 (95% CI: 95.0–89.0), while for convalescent samples the OD cut-off was ≥1.50 with Sn of 66.0 (95% CI: 78.5–51.7) and Sp of 96.0 (95% CI: 98.3–92.3). Comparisons against comparator reference tests (ELISA vs. all tests including PCR) indicated the most appropriate cut-off OD to be within the range of 0.75–1.25. For admission samples, the best Sn/Sp compromise was at 1.25 OD (Sn 91.5%, Sp 92.4%) and for convalescent samples at 0.75 OD (Sn 69.8%, Sp 89.5%). A relatively high (stringent) diagnostic cut-off value provides increased diagnostic accuracy with high sensitivity and specificity in the majority of cases, while lowering the cut-off runs the risk of false positivity. This study underlines the need for regional assessment of new diagnostic tests according to the level of endemicity of the disease given the high levels of residual or cross-reacting antibodies in the general population.

scholarly journals Ecological and behavioural risk factors of scrub typhus in central Vietnam: a case-control study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hanh Thi Duc Tran ◽  
Jan Hattendorf ◽  
Hung Manh Do ◽  
Thanh Tien Hoang ◽  
Hang Thi Hai Hoang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Scrub Typhus ◽  
Conditional Logistic Regression ◽  
Febrile Illness ◽  
Case Control ◽  
Enzyme Linked Immunosorbent Assay ◽  
Protective Equipment ◽  
Related Factors ◽  
Control Study

Abstract Background The risk factors for scrub typhus in Vietnam remain unknown. Scrub typhus caused by Orientia tsutsugamushi often presents as an undifferentiated febrile illness and remains under appreciated due to the limited availability of diagnostic tests. This tropical rickettsial illness is increasingly recognized as an important cause of non-malaria acute undifferentiated fever in Asia. This study aimed to investigate behavioural and ecological related risk factors of scrub typhus to prevent this potentially life-threatening disease in Vietnam. Methods We conducted a clinical hospital-based active surveillance study, and a retrospective residence-enrolment date-age-matched case–control study in Khanh Hoa province, Vietnam, from August 2018 to March 2020. Clinical examinations, polymerase chain reaction and enzyme-linked immunosorbent assay IgM tests were applied to define cases and controls. All enrolled participants filled out a questionnaire including demographic socio-economic status, personal behaviors/protective equipment, habitat connections, land use, and possible exposure to the vector. Multivariable conditional logistic regression was used to define the scrub typhus associated risk factors. Results We identified 44 confirmed cases and matched them with 152 controls. Among cases and controls, the largest age group was the 41–50 years old and males accounted for 61.4% and 42.8%, respectively. There were similarities in demographic characteristics between the two groups, with the exception of occupation. Several factors were significantly associated with acquisition of scrub typhus, including sitting/laying directly on household floor [adjusted OR (aOR) = 4.9, 95% CI: 1.6–15.1, P = 0.006], household with poor sanitation/conditions (aOR = 7.9, 95% CI: 1.9–32.9, P = 0.005), workplace environment with risk (aOR = 3.0, 95% CI: 1.2–7.6, P = 0.020), always observing mice around home (aOR = 3.7, 95% CI: 1.4–9.9, P = 0.008), and use of personal protective equipment in the field (aOR = 0.4, 95% CI: 0.1–1.1, P = 0.076). Conclusions Ecological and household hygiene-related factors were more associated with scrub typhus infection, than individual-level exposure activities in the hyper-endemic area. These findings support local education and allow people to protect themselves from scrub typhus, especially in areas with limitations in diagnostic capacity. Graphical abstract

scholarly journals Ecological and microbiological diversity of chigger mites, including vectors of scrub typhus, on small mammals across stratified habitats in Thailand

2019 ◽  
Author(s):  
Kittipong Chaisiri ◽  
A. Christina Gill ◽  
Alexandr A. Stekolnikov ◽  
Soawapak Hinjoy ◽  
John W. McGarry ◽  
...  
Keyword(s):  
Species Richness ◽  
Scrub Typhus ◽  
Bacterial Pathogen ◽  
Febrile Illness ◽  
Asia Pacific ◽  
Habitat Types ◽  
Widespread Species ◽  
Human Land Use ◽  
Β Diversity ◽  
Α Diversity

AbstractScrub typhus, caused by a bacterial pathogen (Orientia spp.), is a potentially life-threatening febrile illness widely distributed in the Asia-Pacific region and is emerging elsewhere. The infection is transmitted by the larval stage of trombiculid mites (“chiggers”) that often exhibit low host specificity. Here, we present an analysis of chigger ecology for 38 species sampled from 11 provinces of Thailand and microbiomes for eight widespread species. In total, >16 000 individual chiggers were collected from 1 574 small mammal specimens belonging to 18 species across four horizontally-stratified habitat types. Chigger species richness was positively associated with higher latitudes, dry seasonal conditions, and host maturity; but negatively associated with increased human land use. Human scrub typhus incidence was found to be positively correlated with chigger species richness. The bacterial microbiome of chiggers was highly diverse, with Sphingobium, Mycobacterium, Neisseriaceae and various Bacillales representing the most abundant taxa. Only Leptotrombidium deliense was found to be infected with Orientia. β-diversity, but not α-diversity, was significantly different between chigger species and geographic regions, although not between habitat types. This first field survey of the chigger microbiome provides a framework for future studies on interactions between pathogens and other symbionts in these understudied vectors.

scholarly journals Ecological and microbiological diversity of chigger mites, including vectors of scrub typhus, on small mammals across stratified habitats in Thailand

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Kittipong Chaisiri ◽  
A. Christina Gill ◽  
Alexandr A. Stekolnikov ◽  
Soawapak Hinjoy ◽  
John W. McGarry ◽  
...  
Keyword(s):  
Species Richness ◽  
Scrub Typhus ◽  
Bacterial Pathogen ◽  
Febrile Illness ◽  
Asia Pacific ◽  
Habitat Types ◽  
Widespread Species ◽  
Human Land Use ◽  
Β Diversity ◽  
Α Diversity

Abstract Background Scrub typhus, caused by a bacterial pathogen (Orientia spp.), is a potentially life-threatening febrile illness widely distributed in the Asia-Pacific region and is emerging elsewhere. The infection is transmitted by the larval stage of trombiculid mites (“chiggers”) that often exhibit low host specificity. Here, we present an analysis of chigger ecology for 38 species sampled from 11 provinces of Thailand and microbiomes for eight widespread species. Results In total, > 16,000 individual chiggers were collected from 1574 small mammal specimens belonging to 18 species across four horizontally-stratified habitat types. Chigger species richness was positively associated with higher latitudes, dry seasonal conditions, and host maturity; but negatively associated with increased human land use. Human scrub typhus incidence was found to be positively correlated with chigger species richness. The bacterial microbiome of chiggers was highly diverse, with Sphingobium, Mycobacterium, Neisseriaceae and various Bacillales representing the most abundant taxa. Only Leptotrombidium deliense was found to be infected with Orientia and another potential pathogen, Borrelia spp., was frequently detected in pools of this species. β-diversity, but not α-diversity, was significantly different between chigger species and geographic regions, although not between habitat types. Conclusion Our study identified several key environmental and host-derived correlates of chigger species richness across Thailand, which in turn impacted on human scrub typhus incidence. Moreover, this first extensive field survey of the chigger microbiome revealed species- and province-level variation in microbial β-diversity across the country, providing a framework for future studies on interactions between pathogens and other symbionts in these understudied vectors.

scholarly journals Evaluation of an Immunoglobulin M Capture Enzyme-Linked Immunosorbent Assay for Diagnosis of Orientia tsutsugamushi Infection

2003 ◽  
Vol 10 (3) ◽  
pp. 394-398 ◽  
Author(s):  
Won-Jong Jang ◽  
Myung-Suk Huh ◽  
Kyung-Hee Park ◽  
Myung-Sik Choi ◽  
Ik-Sang Kim
Keyword(s):  
Immunosorbent Assay ◽  
Scrub Typhus ◽  
Microtiter Plate ◽  
Immunoglobulin M ◽  
Enzyme Linked Immunosorbent Assay ◽  
Orientia Tsutsugamushi ◽  
Serum Samples ◽  
Capture Elisa ◽  
Igm Antibodies ◽  
Immunodominant Antigen

ABSTRACT To differentiate scrub typhus from other acute febrile diseases, a rapid and reliable serological diagnosis is important. We developed an immunoglobulin M (IgM) capture enzyme-linked immunosorbent assay (ELISA) for diagnosis of recent Orientia tsutsugamushi infections in humans. The 56-kDa major outer membrane protein of O. tsutsugamushi is well known as the most immunodominant antigen in scrub typhus. The test is based on the use of the biotinylated recombinant 56-kDa protein of O. tsutsugamushi Boryong, Bor56, which was expressed as a fusion protein with a maltose-binding protein in Escherichia coli. In the test, the serum IgM antibodies were captured by anti-human IgM antibodies coated onto a microtiter plate. The captured IgM antibodies were revealed through sequential addition of biotinylated Bor56 antigen and peroxidase-conjugated streptavidin to the plate. The IgM capture ELISA was compared with the immunofluorescence antibody assay (IFA) by testing 176 serum samples from patients with diagnosed cases of rickettsial disease and patients with other acute febrile diseases. Of the 81 IgG IFA-positive samples, 78 tested positive (sensitivity, 96.3%) and all 31 IgM IFA-positive samples tested positive (sensitivity, 100%) by the IgM capture ELISA. The specificity of the IgM capture ELISA was 99%, and 1 of the 95 IFA-negative samples was positive in the assay. These results strongly suggest that IgM capture ELISA using the recombinant Bor56 antigen is a reliable and detailed method for the detection of early O. tsutsugamushi infection.

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