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 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.

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 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 Seroprevalence of Scrub Typhus among Pyrexia of Unknown Origin Patients: A Study from Tertiary Care Hospital in Eastern Odisha, India

2020 ◽  
Author(s):  
Shreekant Tiwari ◽  
Monalisah Nanda
Keyword(s):  
Differential Diagnosis ◽  
Dengue Fever ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Clinical Samples ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Pyrexia Of Unknown Origin ◽  
Igm Elisa

Introduction: Scrub typhus is a fatal rickettsial infection. It is caused by mite-borne bacterium Orientia tsutsugamushi which is transmitted by the bite of mite larvae called chiggers. It usually presents with acute febrile illness. Clinicians usually do not consider it as differential diagnosis as it is still an unknown entity. Aim: To assess the seroprevalence of scrub typhus among the pyrexia of unknown cases in Eastern part of Odisha, India. Materials and Methods: This was a cross-sectional study involving 260 serum samples obtained from clinically suspected cases of scrub typhus. Detection of antibodies was done on the samples by Immunochromatography (ICT) and IgM ELISA (Enzyme Linked Immunosorbent Assay). Samples were also processed for dengue fever, malaria, typhoid and leptospirosis which are the other causes of febrile illness in this region and excluded from the study once they come positive. Among these febrile cases which were excluded from study, malaria was predominant (44%) followed by typhoid (34.4%), dengue (15%) and leptospirosis (6.45%). Descriptive statistical analysis was applied to evaluate the results. Results: Out of 260 clinical samples, 74 (28.46%) were positive by IgM ELISA. There was good correlation (98.6%) between ICT and IgM ELISA. Fever was the most common clinical symptom followed by abdominal pain. Pathognomonic feature such as eschar was seen in one patient only. Scrub typhus should be considered as one of the differential diagnosis of Pyrexia of Unknown Origin (PUO) cases, along with dengue fever, malaria typhoid and leptospirosis. Conclusion: IgM ELISA is simple, rapid and economical test and should be used as reference diagnostic test for the diagnosis of scrub typhus.

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 Burden of scrub typhus among patients with acute febrile illness attending tertiary care hospital in Chitwan, Nepal

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e034727
Author(s):  
Sangita Thapa ◽  
Pradip Hamal ◽  
Navin Kumar Chaudhary ◽  
Lokendra Bahadur Sapkota ◽  
Jaya Prasad Singh
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
College Teaching ◽  
Febrile Illness ◽  
Care Hospital ◽  
Acute Febrile Illness ◽  
Medical College ◽  
Igm Elisa ◽  
High Prevalence ◽  
And Control

ObjectivesScrub typhus is an emerging neglected tropical disease, reported from many parts of Asia including Nepal. This study aims to determine the seroepidemiology of scrub typhus among febrile patients attending Chitwan Medical College Teaching Hospital (CMC-TH), Bharatpur, Nepal.Study design and settingThis was a hospital laboratory-based prospective study conducted in CMC-TH (a 750-bed hospital) located in Bharatpur, Chitwan district of Nepal.ParticipantsA total of 1797 patients visiting CMC-TH with acute febrile illness (temperature more than 38°C) were enrolled in this study.MethodsA total of 1797 blood samples were collected from patients presenting with acute febrile illness. The samples were processed for detection of antibody for scrub typhus by ELISA for specific IgM antibody and Weil-Felix test.ResultsOut of 1797 serum sample of febrile patients, 524 (29.2%) were scrub typhus positive. Maximum seropositive cases were from Chitwan district, 271 (51.7%) with predominance among women, 314 (35.9%). Scrub typhus was common among age group 51–60 years (37.2%) and farmers, 182 (37.8%). Highest seropositivity was found in July, 60 (57.7%). Fever was common clinical symptom. Thrombocytopenia was seen in 386 (73.7%) and raised transaminase aspartate aminotransferase, 399 (76.1%) among seropositive cases. Weil-Felix test positive were 397 (22.1%) and IgM ELISA positive were 524 (29.2%). The correlation between IgM ELISA and Weil-Felix test showed statistically significant association (r=0.319, p<0.001).ConclusionHigh prevalence of scrub typhus implies that patients with acute febrile illness should be investigated for scrub typhus with high priority. There is utmost need of reliable diagnostic facilities at all levels of healthcare system in Nepal. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. More sustain and vigorous awareness programmes need to be promoted for early diagnosis, treatment and control.

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 Performance Analysis and Evaluation of Quantitative Real Time PCR for Diagnosis of Scrub Typhus in North East India

2020 ◽  
Author(s):  
Diptanu Paul ◽  
W Valarie Lyngdoh ◽  
Himesh Barman ◽  
Clarissa Jane Lyngdoh ◽  
Kryshanlang Lynrah ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
Specific Gene ◽  
Care Hospital ◽  
Diagnostic Dilemma ◽  
North East India ◽  
Qrt Pcr ◽  
North East ◽  
Igm Elisa ◽  
Pcr Targeting

Scrub typhus is a life-threatening infectious disease and always creating a diagnostic dilemma in terms of rapid turnaround time and accuracy, qRT PCR can become a very good option to achieve the desired result with the molecular level of accuracy and boost up the rapid patient management. This study was performed to evaluate the performance of qRT PCR in comparison to commonly used IgM ELISA and Weil-Felix tests to diagnose scrub typhus, as well as to look for the demographic and clinical profile of the disease in North-East India. It was a hospital-based prospective study conducted in a tertiary care hospital of north-east India, over a period of 1 year, in which all the samples from suspected scrub typhus cases were screened by Weil-Felix test as per institute&rsquo;s diagnostic protocol after which IgM ELISA for Scrub Typhus was performed. All the IgM positive samples and 20 highly suspected but ELISA negative samples were subjected to qRT PCR, targeting 56 kDa type-specific gene of O. tsutsugamushi. Statistical analysis was done by MS-Excel for Windows v2013&reg; and MedCalc&reg; v17.9 for Windows (MedCalc Software, Acacialaan 22, B-8400 Ostend, Belgium). In this study, we have successfully evaluated the performance of qRT PCR kit for diagnosis of scrub typhus. Out of 54 samples tested, 24 IgM ELISA positive samples and 3 IgM ELISA negative samples have shown the presence of bacterial DNA with quantification of DNA copies. It has also been observed that 21 out of 27 PCR positive samples (77.8%) were detected within the 1st 7 days of illness. All the demographic, as well as clinical data, were also analysed. The performance of the commercial qRT PCR kit used in our study is satisfactory, which provides the extra advantage of quantification of DNA copies and increases diagnostic accuracy within the 1st week of fever.

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.

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