Scrub Typhus – A Threatening Scenario in North Bengal

2021 ◽  
Vol 8 (39) ◽  
pp. 3417-3422
Author(s):  
Asraful Islam ◽  
Rajdeep Saha ◽  
Arup Roy
Keyword(s):  
Urban Area ◽  
Rural Areas ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Severe Illness ◽  
Enzyme Linked Immunosorbent Assay ◽  
Bacterial Disease ◽  
Care Hospital ◽  
Orientia Tsutsugamushi ◽  
Elisa Testing

BACKGROUND Scrub typhus is a mite borne zoonotic bacterial disease caused by Orientia tsutsugamushi. It is transmitted by bite of chiggers of trombiculid mite. Clinical features generally include fever, headache, and myalgia, with or without eschar/rash. People with severe illness may develop organ failure and bleeding which can be fatal if left untreated. This study was done to detect outbreak of cases of scrub typhus in Eastern India. These mites generally live in paddy fields of forested area and people visiting those areas are generally affected. Now a days these mites migrate to urban area resulting in increased incidence of scrub typhus infection in urban area. This study was conducted in collaboration with another institute. The purpose of this study was to find out the incidence of scrub typhus in our area and the relationship between occurrence of scrub typhus and seasonal, age and sex variation. METHODS This study was carried out in our tertiary care hospital with 441 samples for a period of one year (01.01.2019 to 31.12.19). All the blood samples collected from febrile patients were subjected to Weil Felix test. If the titre is > 1 : 160; this was further confirmed by specific IgM testing. Both Weil-Felix tests and IgM scrub typhus positive tests were noted. RESULTS Out of 441 samples, 98 (22.2 %, n = 441) samples were positive for both WeilFelix and scrub typhus IgM by enzyme linked immunosorbent assay (ELISA) testing. Most of the cases were seen in males. Seasonal distribution showed higher cases in the months of September and October. CONCLUSIONS In our study, the highest numbers of scrub typhus cases were found in rural areas, during the harvesting period of July–September specially in monsoon or post monsoon period when there is abundance of mite larva. This infection is also reported high in cases among children in the age group of 1 - 14 years. Patients who tested positive for scrub typhus improved radically with doxycycline. KEYWORDS Orientia Tsutsugamushi, Scrub Typhus, IgM ELISA

scholarly journals Clinical Profile and Predictors of Outcome for Pediatric Scrub Typhus at a Tertiary Care Hospital

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Kiruthika Muthukrishnan ◽  
Shruthi Tarikere ◽  
Rajakumar Padur Sivaraman ◽  
Shuba Sankaranarayanan ◽  
Krithika Prabaharan ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Emerging Infections ◽  
Predictors Of Outcome ◽  
Altered Sensorium ◽  
Elevated Liver Enzymes

Background: Scrub typhus is an important cause of acute undifferentiated fever. It is currently one of the most covert re-emerging infections and the most common rickettsial infection caused by Orientia tsutsugamushi. Untreated cases can have mortality rates as high as 30-35%. Objectives: This study was done to study demographical data, clinical profile, and predictors of outcome for scrub typhus in children who were admitted to our institution, a tertiary care hospital in south India. Methods: In this retrospective study, children diagnosed with scrub typhus based on IgM enzyme-linked immunosorbent assay (ELISA), between January 2012 and June 2019 were included. Detailed history, clinical examination findings, laboratory profile, complications, and outcome were analyzed. Results: A total of 120 patients were identified, of whom 84 (42 males- and 42 females) cases satisfied the inclusion criteria and were analyzed. About 80 (95%) cases had a complete recovery, whereas 4 patients (5%) died of multiple complications. Hypotension, hypoxia, altered sensorium, hypoalbuminemia, elevated liver enzymes, azotemia, and deranged coagulation on admission were considered as poor predictors of outcome for scrub typhus. Conclusions: Pediatric scrub typhus is a common infection and should be suspected in cases with fever for more than 5 days and non-specific signs and symptoms. Early detection and timely management lead to a higher recovery rate. Hypotension, hypoxia, azotemia, altered sensorium, and bleeding manifestations on admission were associated with unfavorable outcomes.

scholarly journals Serological Detection and Epidemiological Factors Associated with Scrub Typhus among Undifferentiated Febrile Illness Patients in a Tertiary Care Hospital

2021 ◽  
Author(s):  
V.M. Somasunder ◽  
K. Akila ◽  
S. Sijimol ◽  
S. Senthamarai ◽  
S. Sivasankari ◽  
...  
Keyword(s):  
Rural Areas ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Laboratory Diagnosis ◽  
P Value ◽  
Care Hospital ◽  
Serum Samples ◽  
Serological Tests ◽  
Igm Elisa

Scrub typhus is an arthropod-borne zoonotic bacterial infection caused by Orientia tsutsugamushi. It presents clinically as a non-specific febrile illness that needs a high index of clinical suspicion for diagnosis. The mortality rate can be as high as 30% if not treated appropriately. Laboratory diagnosis is therefore important for confirming the cause of illness prior to initiating appropriate therapy. Hence we aimed to detect scrub typhus in serum samples of undifferentiated febrile illness patients and to correlate with the socioeconomic status of these individuals. We also aimed to study the seasonal variation associated with the disease. Serum samples from 143 febrile patients who were negative for other febrile illnesses were subjected to scrub typhus IgM ELISA. Scrub typhus IgM antibodies were found in 14 (9.8%) individuals of which 41-60 years being the most affected age group. Scrub typhus positivity was high during the months of October to December (P-value 0.0056) with the individuals from the rural areas being the most affected (P-value 0.027). To conclude, this study emphasises the importance of serological tests to detect scrub typhus and to include it as a differential diagnosis among undifferentiated febrile illnesses.

scholarly journals Increasing trend in pediatric scrub typhus admissions in a tertiary care hospital, South India: Clinical profile and outcomes of cases over four years, 2011-2014.

2017 ◽  
Vol 4 (3) ◽  
pp. 915 ◽  
Author(s):  
Gandhimathi K. ◽  
Pruthu Thekkur ◽  
Marie Gilbert Majella ◽  
Kalaiselvi Selvaraj ◽  
Palanivel Chinnakali ◽  
...  
Keyword(s):  
Rural Areas ◽  
South India ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Specific Treatment ◽  
Clinical Profile ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Tertiary Teaching ◽  
Increasing Trend

Background: In developing countries, clinical profile based empirical treatment is practiced for treating pediatric scrub typhus cases. Knowledge on pattern of symptoms and signs will help in early initiation of specific treatment. This study was aimed to describe clinical profile and trends in admissions of pediatric scrub typhus cases in a tertiary teaching hospital.Methods: A record based cross sectional descriptive study was conducted among all clinically diagnosed scrub typhus pediatric (<13 years of age) cases admitted between 1st January 2011 and 31st December 2014 in a tertiary teaching hospital, South India. Data on symptoms, signs, laboratory findings, treatment and outcome were extracted from clinical case records. Data were entered and analyzed using Epi Data software.Results: Of the total 228 cases, 124 (54.4%) were males, 131 (57.4%) were less than five years of age and 88% were from rural areas. Fever (100%), vomiting (61.2%) and cough (54.8%) were the most common symptoms. Hepatomegaly (88.6%), splenomegaly (64.5%), lymphadenopathy (48.7%), edema (43.4%) and eschar (38.6%) were the common signs observed. Anemia was present in 122 (59.8%) and thrombocytopenia in 75 (33.3%) children.  Only one child (0.4%) died.  There was an increasing trend in proportion of scrub typhus cases to overall admissions from 1% to 2.2% over four-year period (2011-2014). More cases were admitted between the months of September and January.  Conclusions:Scrub typhus contributed to significant pediatric admissions in the tertiary care centre with an increase in cases over years. Treatment with doxycycline or azithromycin showed good response and mortality was very low 

scholarly journals Prevalence of hepatitis C among pregnant females attending antenatal clinic at a tertiary care hospital in Lucknow, Uttar Pradesh, India

2020 ◽  
Vol 7 (2) ◽  
pp. 314
Author(s):  
Noor Jahan ◽  
Nitin Chaudhary ◽  
Asma Nigar ◽  
Siraj Ahmad ◽  
Razia Khatoon ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Rural Areas ◽  
Urban Areas ◽  
Tertiary Care ◽  
Antenatal Clinic ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Hepatitis C Infection ◽  
Cross Sectional ◽  
Pregnant Females

Background: Hepatitis C virus (HCV) is a major causative agent of parenterally acquired hepatitis. Vertical transmission of HCV occurs from mother to infant during pregnancy, delivery, or neonatal period. Hepatitis C infection among pregnant females can adversely affect both mother and fetus, leading to chronic infection in infants who later develop liver cirrhosis and hepatocellular carcinoma. Objective of the study was to evaluate the prevalence of hepatitis C among pregnant females attending antenatal clinic.Methods: A hospital based cross-sectional study was done over a period of six months from January to June 2019. A total of 550 pregnant females were included in the study who attended Antenatal Clinic for routine check-up and whose blood samples were sent to Microbiology Laboratory for screening of anti-HCV antibodies by Enzyme linked Immunosorbent Assay (ELISA) method.Results: Out of 550 pregnant females tested, 3 were found to be reactive to anti-HCV antibodies by ELISA; hence the prevalence was found to be 0.5%. All 3 seropositive females belonged to age group 26-35 years, were indoor patients (IPD) and belonged to lower socio-economic class. Majority of seropositive females belonged to urban areas (66.7%, 2/3) as compared to those from rural areas (33.3%, 1/3).Conclusions: Although, prevalence of hepatitis C was found to be less among pregnant females attending ANC of this institute, still routine screening of all pregnant females for anti-HCV antibodies is highly recommended, for timely detection of disease in mothers and prevention of its transmission to infants.

scholarly journals Demographic variables and clinical profile of scrub typhus patients: experience from a tertiary care center in Udaipur, Rajasthan

2021 ◽  
Vol 8 (12) ◽  
pp. 5814
Author(s):  
Suresh Chaudhary ◽  
Mukul Dixit ◽  
Anjana Verma ◽  
Hemlata Mittal ◽  
Medha Mathur
Keyword(s):  
Rural Areas ◽  
Scrub Typhus ◽  
Care Center ◽  
Tertiary Care ◽  
Demographic Variables ◽  
Clinical Profile ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Effective Strategies ◽  
Patients Experience

Background: Scrub typhus is an acute febrile bacterial zoonoses, caused by Orientia tsutsugamushi and is associated with a range of complications, including sepsis, Acute respiratory distress syndrome (ARDS), pre-renal azotemia and Multiorgan dysfunction syndrome (MODS). The objective of this study was to study the demographic variables and clinical profile of the patients diagnosed with scrub typhus. admitted in a tertiary care hospital in Udaipur, Rajasthan.Methods: It was a longitudinal, observational study, conducted in a tertiary care centre in Udaipur, Rajasthan from January 2020-June 2021. All patients, diagnosed (positive for antibody IgM) with scrub typhus in the hospital during the study period were included in the study. Information about the patients was collected using a pre-tested questionnaire and clinical examination, after taking the informed consent from the study participants.Results: Mean age of the patients was 36.4±19 years. Majority (69.4%) of the patients were from rural area and fever was the most common (83.9%) symptom experienced. Eschar was found in only 1.6% of patients. About 87.1% of the patients had complications, with MODS, being the most common affecting about 34% of the total patients. The patients from rural areas were found to have significantly higher odds (OR=1.61) of having complications as compared to urban area patients (CI=1.09-4.3).  Conclusions: This article draws attention to the fact that scrub typhus is quite on rise and most of the cases are associated with complications. There is a need to develop effective strategies and interventions to stop this rampant rise of the cases in India. 

scholarly journals Comparison of Weil Felix Test and ELISA with the Gold Standard IFA for the Diagnosis of Scrub Typhus in Clinically Suspected Cases of Scrub Typhus at a Tertiary Care Hospital in Tamil Nadu

2021 ◽  
Vol 8 (21) ◽  
pp. 1722-1725
Author(s):  
Anisha Elizabeth Jacob ◽  
Marina Thomas ◽  
v Appalaraju
Keyword(s):  
Gold Standard ◽  
Tamil Nadu ◽  
Scrub Typhus ◽  
Fluorescent Antibody ◽  
Tertiary Care ◽  
Antibody Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Serological Tests ◽  
Cross Sectional

BACKGROUND Scrub typhus is a febrile disease, the clinical diagnosis of which is difficult due to its vague symptoms. Scrub typhus is diagnosed mainly via serological tests. Sensitivity of Weil Felix was found to be poor, but the specificity of Weil Felix was variable in different studies. Enzyme linked immunosorbent assay (ELISA) IgM is known to be a sensitive test, but its specificity was variable in different studies. Therefore, in this study we have compared these two tests with the gold standard IFA. METHODS The study was performed as a cross-sectional study. Among the suspected scrub typhus cases, fifty consecutive IFA scrub typhus positive and fifty consecutive IFA negative samples were taken for comparison of Weil Felix and ELISA tests. The indirect fluorescent antibody test (IFA) was taken as the gold standard. RESULTS The sensitivity of ELISA and Weil Felix at a titre of 1 : 160 was found to be 96 % and 40 % respectively. The specificity of ELISA and Weil Felix at 1 : 160 and was found to be 88 % and 94 % respectively. CONCLUSIONS Scrub typhus should be kept in mind as a possible diagnosis in acute febrile illnesses. Weil - Felix was found to have a good specificity but low sensitivity. Hence, if the results by Weil Felix are negative, scrub typhus cannot be ruled out and may require further testing. ELISA showed good sensitivity making it a preferable screening test but is not highly specific and confirmation with IFA may be required when feasible. KEYWORDS Scrub Typhus, ELISA, Weil Felix, IFA, Laboratory Diagnosis

scholarly journals SCRUB TYPHUS INFECTION AMONG PUO CASES IN THE PEDIATRIC POPULATION IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 137-139
Author(s):  
ANUPRIYA A ◽  
RAJKUMAR B ◽  
PRABHUSARAN N ◽  
PRIYA BANTHAVI S
Keyword(s):  
Scrub Typhus ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Rapid Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Predisposing Factor ◽  
Igm Elisa ◽  
Study Population ◽  
Card Test

Objectives: Scrub typhus is an acute, febrile, exanthematous illness. This disease is underdiagnosed in India due to its non-specific and varied clinical presentation, low index of suspicion among clinicians, and lack of diagnostic facilities. This study was carried out to know the seroprevalence of scrub typhus in children with PUO and to compare a rapid test with IgM enzyme-linked immunosorbent assay (ELISA) for the diagnosis of scrub typhus. Methods: This cross-sectional analytical study was conducted for a period of 1 year. The study population comprised mainly 280 young children attending pediatric OP and in patients admitted to a tertiary care teaching hospital with fever and related symptoms. The serum samples were tested for Weil-Felix reaction, IgM ELISA, and rapid card test. Results: The mean age group of the study population was 7–9 years, of which 20 cases were positive. The major predisposing factor for scrub typhus infection was vegetation around houses. The sensitivity and specificity of both, card test and IgM ELISA, were 100%. Conclusion: In this study, 7.1% of febrile children were positive for scrub typhus. Leptospirosis, dengue, and typhoid were the common coinfections found in scrub typhus, positive children. Early identification of cases and treatment at the earliest will prevent complications.

scholarly journals Prevalence and clinical correlation of hepatitis E virus antibody in the patients’ serum samples from a tertiary care hospital in Thailand during 2015–2018

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Atiporn Boonyai ◽  
Anchalee Thongput ◽  
Thidarat Sisaeng ◽  
Parisut Phumchan ◽  
Navin Horthongkham ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Organ Transplant ◽  
Hospital Setting ◽  
Antibody Detection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Serum Samples ◽  
Igm Antibodies

Abstract Background Prevalence and incidence of hepatitis caused by HEV infection are usually higher in developing countries. This study demonstrated the HEV seroprevalence and incidence of HEV infection in patients with clinical hepatitis in a tertiary hospital in Thailand. Methods A laboratory-based cross-sectional study was conducted using 1106 serum samples from patients suspected of HEV infection sent to the Serology laboratory, Siriraj Hospital, for detecting HEV antibodies during 2015–2018. Prevalence of anti-HEV IgG and IgM antibodies in general patients, including organ transplant recipients and pregnant women in a hospital setting, were determined using indirect enzyme-linked immunosorbent assay (ELISA) kits. Comparison of laboratory data between groups with different HEV serological statuses was performed. Results HEV IgG antibodies were detected in 40.82% of 904 serum samples, while HEV IgM antibodies were detected in 11.75% of 1081 serum samples. Similar IgG and IgM antibody detection rates were found in pregnant women. Interestingly, anti-HEV IgM antibodies were detected in 38.5% of patients who underwent organ transplantation. Patients who tested positive for anti-HEV IgM antibodies had higher alanine aminotransferase levels than those who had not. In contrast, patients who tested positive for anti-HEV IgG had more elevated levels of total bilirubin than those who tested negative. Conclusions HEV seroprevalence and incidence in patients with clinical hepatitis were relatively high in the Thai population, including the pregnancy and organ transplant subgroups. The results potentially benefit the clinicians in decision-making to investigate HEV antibodies and facilitating proper management for patients.

scholarly journals Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

2018 ◽  
Vol 7 (6) ◽  
pp. 2283
Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

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