A CASE SERIES ON SCRUB TYPHUS

Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi. It is transmitted to humans via infected chiggers (larva of trombiculid mite). Eschar is a characteristic feature for the diagnosis of scrub typhus and other mite or tick-borne rickettsiosis. Immunofluorescence Antibody (IFA) test is the gold standard for the diagnosis, and doxycycline is the drug of choice for treatment of scrub typhus. We present a case series of scrub typhus in three patients from South India. All three patients presented with high grade fever and IgM scrub typhus was positive status in all cases. Doxycycline 100 mg twice daily for 7 days along with supportive care was effective in all the cases. Serum creatinine levels dropped to normal and renal status of all patients improved well with antimicrobial treatment. Early diagnosis of the infection is necessary as the disease as it can have multiple system involvement and serious complications.

Download Full-text

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

Clinical Infectious Diseases ◽

10.1093/cid/ciaa091 ◽

2020 ◽

Cited By ~ 1

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.

Download Full-text

Reversible Unilateral Abducens Nerve Palsy in a patient with Scrub Typhus - A Clinical Diagnostic Dilemma

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v40i3.29468 ◽

2020 ◽

Vol 40 (3) ◽

pp. 278-281

Author(s):

Rahul Choudhary ◽

Gaurav Katoch ◽

Garima Sachdeva ◽

Sweta Kushwah

Keyword(s):

Nerve Palsy ◽

Scrub Typhus ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Pathological Feature ◽

Orientia Tsutsugamushi ◽

Cranial Nerve Involvement ◽

Sixth Cranial Nerve ◽

Diagnostic Dilemma ◽

Rickettsial Disease

Scrub typhus is an acute febrile rickettsial disease caused by Orientia tsutsugamushi. It infects endothelial cells and causes vasculitis, the predominant clinico-pathological feature of the disease. This results in disseminated inflammatory perivascular lesions leading to damage to the blood vessels affecting multiple end organs. Abducens nerve palsy is a known but extremely rare and reversible complication of scrub typhus. We present a case of scrub typhus with sixth cranial nerve involvement which responded to treatment with doxycycline.

Download Full-text

Scrub typhus, a reemerging zoonosis – An Indian case series

Asian Journal of Medical Sciences ◽

10.3126/ajms.v5i3.9213 ◽

2014 ◽

Vol 5 (3) ◽

pp. 108-111 ◽

Cited By ~ 1

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

Download Full-text

Detection of Orientia tsutsugamushi in Novel Trombiculid Mite Species in Northern Tamil Nadu, India: Use of Targeting the Multicopy traD Gene

Journal of Medical Entomology ◽

10.1093/jme/tjab180 ◽

2021 ◽

Author(s):

John Antony Jude Prakash ◽

Kannan Kamarasu ◽

P Philip Samuel ◽

Renu Govindarajan ◽

Punitha Govindasamy ◽

...

Keyword(s):

Nested Pcr ◽

Tamil Nadu ◽

Scrub Typhus ◽

Specific Antigen ◽

Single Copy ◽

Mite Species ◽

The Novel ◽

Orientia Tsutsugamushi ◽

Potential Vector ◽

Trombiculid Mite

Abstract Detection of Orientia tsutsugamushi DNA in a trombiculid mite chigger species suggests that it might be a potential vector of scrub typhus in an endemic area. Over a period of 20 mo, 85 rats were trapped, 57 had chiggers that were identified by standard morphometric techniques. The chigger pools were assessed by performing PCR assays targeting fragments of the single-copy genes 56 kDa type-specific antigen gene (TSA56) by nested PCR and the 47 kDa (htrA) quantitative real-time PCR (qPCR). The novel traD SYBR green assay that detects a multicopy gene was also performed. In total, 27 chigger pools were positive by traD qPCR, of which only 7 were positive by 47 kDa qPCR and in 3 of these, 56 kDa gene was amplified by nested PCR. Orientia tsutsugamushi-specific DNA was detected in Ascoschoengastia spp., Schoengastiella ligula, Leptotrombidium rajasthanense, Leptotrombidium deliense, and Leptotrombidium jayawickremei chigger pools. Therefore, they could be potential vectors of scrub typhus in Southern India. The three 56 kDa sequences belonged to TA716 genotype and Kato genogroup. Further studies are needed to confirm these chigger species as scrub typhus vectors in Northern Tamil Nadu.

Download Full-text

A Case Series on Neurological Insights of Scrub Typhus

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/46481.14263 ◽

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.

Download Full-text

Evidence of natural infection of Orientia tsutsugamushi in vectors and animal hosts – Risk of scrub typhus transmission to humans in Puducherry, South India

Indian Journal of Public Health ◽

10.4103/ijph.ijph_130_19 ◽

2020 ◽

Vol 64 (1) ◽

pp. 27 ◽

Cited By ~ 1

Author(s):

Panneer Devaraju ◽

Bhuvaneswari Arumugam ◽

Iswaryalakshmi Mohan ◽

Mariselvam Paraman ◽

Mathivanan Ashokkumar ◽

...

Keyword(s):

South India ◽

Scrub Typhus ◽

Natural Infection ◽

Orientia Tsutsugamushi ◽

Animal Hosts

Download Full-text

Case Report of Scrub Typhus

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v36i3.37037 ◽

2018 ◽

Vol 36 (3) ◽

pp. 123-127

Author(s):

Safia Binte Rabbani ◽

Md Iqbal Hossain ◽

Afsana Begum

Keyword(s):

Scrub Typhus ◽

Supportive Therapy ◽

Febrile Illness ◽

High Grade ◽

Orientia Tsutsugamushi ◽

High Grade Fever ◽

Elevated Transaminase ◽

History Of ◽

Endemic Typhus ◽

The Tropics

Scrub typhus is an acute, febrile, infectious illness that is caused by Orientia tsutsugamushi. Scrub and murine endemic typhus infections are under-diagnosed causes of febrile illness across the tropics, and it is not known how common they are in Bangladesh. Here reporting a case who presented with high grade fever for 7 days associated with headache, abdominal discomfort, cough and receiving inj ceftriaxone for 2 days considering as a case of enteric fever. Forty-eight hours after admission, the presence of continued high grade fever, conjunctival congestion, headache, loose motion, cough, low platelet, elevated transaminase raised the possibility of a different aetiology. The two most likely differentials being dengue and malaria. Finally, typhus was discovered due to history of field visit, presence of eschar and raised titre of WF OXK antigen. All other causes of fever were ruled out by history, clinical examination and relevant investigations. Patient was treated with capsule doxycycline and other supportive therapy and become afebrile within 48 hours. This uncommon clinical scenario should be taken into account in the management of patients with high fever on admission.J Bangladesh Coll Phys Surg 2018; 36(3): 123-127

Download Full-text

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

International Journal of Bioassays ◽

10.21746/ijbio.2016.09.0021 ◽

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.

Download Full-text

Scrub Typhus and Molecular Characterization of Orientia tsutsugamushi from Central Nepal

Pathogens ◽

10.3390/pathogens10040422 ◽

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.

Download Full-text