scholarly journals Scrub typhus, a reemerging zoonosis – An Indian case series

2014 ◽  
Vol 5 (3) ◽  
pp. 108-111 ◽  
Author(s):  
Deepak Madi ◽  
Basavaprabhu Achappa ◽  
M Chakrapani ◽  
MR Pavan ◽  
Saaritha Narayanan ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Medical Science ◽  
Clinical Manifestations ◽  
Case Series ◽  
Febrile Illness ◽  
Rickettsial Disease ◽  
Study Results ◽  
Chest X Ray ◽  
High Index Of Suspicion ◽  
Rickettsial Diseases

Background: Rickettsial diseases are reemerging in many parts of our country. Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi. It is difficult to diagnose Scrub typhus because of nonspecific clinical presentation and lack of availability of specific tests (ELISA) in all centres. Aim: Our aim was to study the clinical features, lab parameters and outcome of patients diagnosed with Scrub typhus. Materials and Methods: A retrospective hospital based study was done in Mangalore (Karnataka) to identify cases of scrub typhus. Patients who had an acute febrile illness and IgM antibodies against O. tsutsugamushi were included in our study. Results: 10 cases of Scrub typhus were identified. Among them 7(70%) patients were females and 3(30%) were males. Major symptoms on admission were fever10(100%), dyspnea or cough-2(20%), rashes1(10%), altered sensorium1(10%). The major signs were fever10(100%), eschar 2(20%), and signs of meningial irritation in 1(10%). Lab parameters showed leukocytosis in 4(40%), thrombocytopenia in 3(30%), raised liver enzymes in 3(30%) and renal failure in 3(30%). Chest X-ray showed consolidation in 2(20%) patients. There was no mortality in our study. Conclusion: Scrub typhus can present with varying clinical manifestations and eschar can be absent in majority of cases as shown in our study. Therefore diagnosis should be based on a high index of suspicion and empirical treatment with doxycycline must be started whenever there is a strong suspicion of Scrub typhus. Asian Journal of Medical Science, Volume-5(3) 2014: 108-111 http://dx.doi.org/10.3126/ajms.v5i3.9213  

Cerebellitis as a rare manifestation of scrub typhus fever

2020 ◽  
Vol 13 (5) ◽  
pp. e233993
Author(s):  
Samiksha Gupta ◽  
Sahil Grover ◽  
Monica Gupta ◽  
Daljinderjit Kaur
Keyword(s):  
Scrub Typhus ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Neurological Complications ◽  
Uneventful Recovery ◽  
Cerebellar Dysfunction ◽  
Chigger Mite ◽  
Rickettsial Disease ◽  
Rare Manifestation ◽  
Typhus Fever

Scrub typhus is a mite-borne rickettsial disease caused by Orientia tsutsugamushi, a gram-negative coccobacilli transmitted through the bite of chigger mite. Scrub typhus has diverse clinical manifestations, often presenting either as a simple febrile illness or as a complicated multi-organ dysfunction. Neurological complications in scrub typhus are diverse but their exact incidence is unknown. Cerebellitis is another rare neurological manifestation associated with scrub typhus. Here, we report the case of a 26-year-old woman with serologically confirmed scrub typhus presenting with fever and gross cerebellar dysfunction. MRI was normal. She was managed with antimicrobials and made an uneventful recovery.

scholarly journals A Case Series on Neurological Insights of Scrub Typhus

2020 ◽  
Author(s):  
Puneet Saxena ◽  
Deepak Chadha ◽  
Rishika Goyal
Keyword(s):  
Scrub Typhus ◽  
Case Series ◽  
Febrile Illness ◽  
Multiple Organ ◽  
Asia Pacific ◽  
Acute Febrile Illness ◽  
Multiple Organ Dysfunction ◽  
Rickettsial Disease ◽  
Life Threatening ◽  
North Western

Scrub typhus is a rickettsial disease caused by gram negative coccobacilli and transmitted through the bite of larval stage of mite. The disease is notable in the Asia-Pacific belt with few sporadic and epidemic cases reported from India as well. The disease is well identified from North Western part of Rajasthan that are the areas with dense vegetation. The clinical scenario ranges from acute febrile illness to multiple organ dysfunction by virtue of haematogenous seedling. This case series highlights the neurological manifestations of scrub typhus that are diverse and life threatening but holding dearth of literature to convoy appropriately timed diagnosis and treatment.

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. 

scholarly journals A Brief History of the Major Rickettsioses in the Asia–Australia–Pacific Region: A Capstone Review for the Special Issue of TMID

2020 ◽  
Vol 5 (4) ◽  
pp. 165
Author(s):  
Daniel H. Paris ◽  
Daryl J. Kelly ◽  
Paul A. Fuerst ◽  
Nicholas P. J. Day ◽  
Allen L. Richards
Keyword(s):  
Scrub Typhus ◽  
Spotted Fever ◽  
Specific Antigen ◽  
Far East ◽  
Pacific Region ◽  
Special Issue ◽  
Rickettsial Disease ◽  
History Of ◽  
Rickettsial Diseases ◽  
The Impact

The rickettsioses of the “Far East” or Asia–Australia–Pacific region include but are not limited to endemic typhus, scrub typhus, and more recently, tick typhus or spotted fever. These diseases embody the diversity of rickettsial disease worldwide and allow us to interconnect the various contributions to this special issue of Tropical Medicine and Infectious Disease. The impact of rickettsial diseases—particularly of scrub typhus—was substantial during the wars and “police actions” of the last 80 years. However, the post-World War II arrival of effective antibiotics reduced their impact, when recognized and adequately treated (chloramphenicol and tetracyclines). Presently, however, scrub typhus appears to be emerging and spreading into regions not previously reported. Better diagnostics, or higher population mobility, change in antimicrobial policies, even global warming, have been proposed as possible culprits of this phenomenon. Further, sporadic reports of possible antibiotic resistance have received the attention of clinicians and epidemiologists, raising interest in developing and testing novel diagnostics to facilitate medical diagnosis. We present a brief history of rickettsial diseases, their relative importance within the region, focusing on the so-called “tsutsugamushi triangle”, the past and present impact of these diseases within the region, and indicate how historically, these often-confused diseases were ingeniously distinguished from each another. Moreover, we will discuss the importance of DNA-sequencing efforts for Orientia tsutsugamushi, obtained from patient blood, vector chiggers, and rodent reservoirs, particularly for the dominant 56-kD type-specific antigen gene (tsa56), and whole-genome sequences, which are increasing our knowledge of the diversity of this unique agent. We explore and discuss the potential of sequencing and other effective tools to geographically trace rickettsial disease agents, and develop control strategies to better mitigate the rickettsioses.

scholarly journals Searching and Finding the Hidden Treasure: A Retrospective Analysis of Rickettsial Disease Among Dutch International Travelers

2020 ◽  
Author(s):  
Sophia G de Vries ◽  
Louise E van Eekeren ◽  
Hans van der Linden ◽  
Benjamin J Visser ◽  
Martin P Grobusch ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Medical Records ◽  
Scrub Typhus ◽  
Spotted Fever ◽  
Febrile Illness ◽  
Empiric Antibiotic Therapy ◽  
Spotted Fever Group ◽  
Orientia Tsutsugamushi ◽  
Rickettsial Disease ◽  
Empiric Antibiotic

Abstract Background Rickettsial disease (RD) is a prevalent and underestimated cause of febrile illness worldwide, especially in the absence of an inoculation eschar. We attempted to quantify this underestimation at our clinic, by investigating past cases of febrile illness in travelers who had tested negative for leptospirosis, a disease that can initially present similarly to non-eschar RD, and which we routinely consider when other important causes of unspecified febrile illness have tested negative. Methods We performed a retrospective analysis in febrile returned travelers from Asia, Africa, or the Americas between 2010 and 2017, who had tested negative for leptospirosis. Serologic immunofluorescence assays were performed for Orientia tsutsugamushi (scrub typhus), typhus group, and spotted fever group RD. We performed a medical records review of all patients who tested positive. In case of a fitting medical history, cases were deemed either confirmed (based on convalescent serology) or suspected (based on single serology). Results Among 97 patients, convalescent serology was available in 16 (16.5%) patients, and a single serology in 81 (83.5%) patients. RD was the likely diagnosis in 8 of 16 (50.0%) patients with convalescent serology, and in 8 of 81 (9.9%) with single serology. Of the 16 confirmed/suspected cases, 11 (69%) had been missed and 7 (44%) had not received adequate empiric antibiotic therapy. Conclusions This study shows that non-eschar RD is an important and poorly recognized cause of illness in travelers, even in a specialized travel clinic. A lower threshold to test and treat for RD is warranted in returning travelers with febrile illness.

Scrub Typhus with Varied Clinical Presentations

2017 ◽  
Vol 13 (04) ◽  
pp. 319-322
Author(s):  
Susrita Banerjee ◽  
Satyabrata Roychowdhuri ◽  
Mihir Sarkar
Keyword(s):  
Scrub Typhus ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Case Series ◽  
Dengue Shock Syndrome ◽  
Tertiary Care Center ◽  
Eastern India ◽  
Clinical Presentations ◽  
Diagnostic Difficulties

AbstractWe present four cases of pediatric scrub typhus from a tertiary care center of eastern India, emphasizing on varied unusual clinical manifestations posing diagnostic difficulties. A low index of suspicion is required to prevent under diagnosis. We report a case series of four patients with scrub typhus having uncommon clinical manifestations (two patients with hemophagocytic lymphohistiocytosis, one patient with myocarditis, and one patient presenting with shock reminiscent of dengue shock syndrome). The response to doxycycline was good, with fever subsiding within 48 to 72 hours of starting the treatment. Three out of four cases completely recovered once appropriate medication was given.

scholarly journals Threat of scrub typhus in post-earthquake Nepal

2017 ◽  
Vol 6 (4) ◽  
pp. 1-6 ◽  
Author(s):  
S Thapa ◽  
L B Sapkota ◽  
P Hamal
Keyword(s):  
Fever Of Unknown Origin ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Serum Samples ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Recent Outbreak ◽  
High Index Of Suspicion ◽  
A Prospective Study

Scrub typhus is a potentially fatal zoonotic infection, reported from many parts of Asia including Nepal. There is in­creasing reports of outbreak of Scrub typhus, after the earthquake hit Nepal on April 25, 2015. The recent outbreak of Scrub typhus posed problems in diagnosis and treatment of the disease. It may be related to poor awareness of the disease or lack of suspicion for Scrub typhus which often presents with clinical features indistinguishable from typhoid fever. Since, various parts of Nepal appeared to be suitable hubs for Scrub typhus, the clinical suspicion of Scrub typhus in the differential diagnosis of fever of unknown origin (FUO) is of utmost importance to prevent mortality and morbidity. This is a prospective study conducted in Chitwan Medical College (CMC), Chitwan, Nepal. This study was carried out over a period of 4 months extending from June 2016 to September 2016. A total of 410 serum samples were collected from all patients visiting CMC, clinically suspected of having Scrub typhus infec­tion. The samples were processed for the detection of IgM antibodies for Scrub typhus by ELISA. Results: A total of 410 samples from patients suspected with Scrub typhus infection were processed which included 200 males and 210 females. Out of total 410 samples tested, 181 (44.1%) were seropositive for Scrub typhus. Seropositivity was highest 25.9% among the age group 11-20 years of age. Females were infected more than males. This study implies the re-emergence of Scrub typhus in different regions of Nepal. Although the disease is endemic in our country, it is grossly underdiagnosed owing to non-specific clinical presentation and lack of diagnostic facilities. It is thus suggested that high index of suspicion should be maintained for cases presenting with febrile illness. Infection with Scrub typhus was found high and this calls for an urgent need to introduce vaccine against Scrub typhus. 

scholarly journals Scrub Typhus in Children

2018 ◽  
Vol 38 (1) ◽  
pp. 59-62
Author(s):  
Madiha Zainab ◽  
Atul Kumar Gupta ◽  
Suparna Guha
Keyword(s):  
Acute Kidney Injury ◽  
Scrub Typhus ◽  
Kidney Injury ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Common Complication ◽  
Orientia Tsutsugamushi ◽  
Pain Abdomen ◽  
One Year ◽  
High Index Of Suspicion

Introduction: Scrub typhus is an acute febrile illness caused by infection with rickettsial bacilli Orientia tsutsugamushi. This was a retrospective observational study to study the clinical profile of paediatric scrub typhus, its associated complications and response to treatmentMaterial and Methods: Record files of all patients diagnosed with positive Weil felix (OXK>1:80) and Scrub IgM positive over a period of one year were analysed. Total of 10 cases were diagnosed as scrub with median age of presentation 4.1 years.Results: Fever was present in all followed by pain abdomen (50%), rash. Anaemia (90%), lymphadenopathy (70%) hepatomegaly (100%), Leukopenia was present in those cases with fever <1 week while leucocytosis was found thereafter. Most common complication were hepatitis (100%) shock (50%), acute kidney injury (AKI) 30%, DIC in 20% cases. Secondary HLH was found in 20% and pancarditis in one case. All the cases showed dramatic response to doxycycline.Conclusion: So a high index of suspicion is required to diagnose scrub and early initiation of treatment is essential to prevent mortality from the disease.

scholarly journals Cryptococcus laurentii (Non Cryptococcus neoformans/gatti) infections – Immunocompromised or Immunocompetent -Who is at risk? – Systematic review

2020 ◽  
Vol 2 (8) ◽  
pp. 01-03
Author(s):  
Twinkle Dhamecha
Keyword(s):  
Clinical Manifestations ◽  
Cell Mediated Immunity ◽  
Cryptococcus Laurentii ◽  
Cns Involvement ◽  
X Ray ◽  
Mortality Risks ◽  
Appropriate Treatment ◽  
Chest X Ray ◽  
High Index Of Suspicion ◽  
Human Infections

Non neoformans cryptococci are usually regarded as saprophytes and human infections are rare. C.laurentii is rare of the non neoformans Cryptococci that can cause human infections. Incidence of human infections with Cryptococcus laurentii and albidus has increased over last couple of decades. The risk factors for C. laurentii infections usually include diminished Cell mediated immunity and presence of invasive devices, while mortality risks increases with CNS involvement and age above 45 years. Clinical manifestations are indistinguishable from other invasive yeast infections. High index of suspicion with any yeasts associated with raised inflammatory biomarkers and presence of neutrophils in the specimen’s stained smear is important in the diagnosis and prompt initiation of appropriate treatment since C. laurentii shows low susceptibility to fluconazole. We report here a case of lower respiratory infection due to Cryptococcus laurentii in a 57 years old female patient with bronchiectasis. The patient was admitted with complaints of fever, dyspnoea with productive cough. She was on antibiotic treatment. Her chest x-ray report revealed infiltrative opacities at right upper mid zone of the lungs and pleural effusion at left lower zone. The patient later also developed quadruparesis and urinary incontinence.

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.  

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