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Burden of scrub typhus: a systematic review

By Madhukar Pai Moderator | 25 Sep, 2017

Please see this new paper in PLoS NTDs: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005838

The review suggests that scrub typhus is a severely underappreciated tropical disease, affecting mainly rural populations, but increasingly urban areas as well.


scrub typhus



Sandeep Saluja Replied at 7:23 AM, 27 Sep 2017

Dr.Madhu very appropriately says that the problem is under recognised.It may be a good idea for GHD to host a webinar on the disease with best people teaching various facets of diagnostics,clinical presentation,management etc.
There are various CME programmes and webinars available but almost all cater to new drugs etc. which have the backing of the industry whereas not much happens on important issues like this.

Elisabetta Leonardi Replied at 8:51 AM, 30 Sep 2017

I agree with Sandeep, it would be great for GHD to host a webinar with experts teaching from a clinical perspective for people working in the field with little or no diagnostic tools. I have been working for many years with Karen displaced population on the Thai-Burma border and we often suspect scrub typhus and treat empirically when patients have a fever and have a negative malaria test. The old doxycycline seem to be a great antibotic in this case, also very effective for other causes of fever common in the tropics as leptospirosis.

RENEE ORIE Replied at 9:39 AM, 30 Sep 2017

There are conferences teaching this very material in Wilderness and Travel Medicine or even Emergency Medicine every year and it's awesome. I have the fortunate opportunity to attend one in my undergraduate years and I loved it and intend on attending more. Webinars are good for these but theses were somethings I loved learning hands on. I found a course in Tropical Medicine to be of great value as well under those circumstances, especially in England.

ABRAHAM OPIKOLI Replied at 10:58 AM, 30 Sep 2017

Infact it is what is actually taking place in my country Uganda and even
love the programmes. There are many health programs and promotion about
communicable diseases and non communicable diseases more so HIV/AIDS as the
killing diseases in Uganda but are community members at least look for the
way forward to control this diseases.

Anurag Bhargava Replied at 12:14 PM, 30 Sep 2017

Our understanding of the epidemiology is being revised. It is clearly not only a "rural zoonosis" limited to the tsutsugamushi triangle that we have made it out to be. A new strain of Orientia , Orientia chuto was isolated from a patient in Dubai ,(Blacksell SD etal . Journal of Clinical Microbiology. 2010;48(12):4404-9. while last year cases were reported from an island in Chile in the NEJM. We have reported our experience with 284 cases with scrub typhus in the northern Indian states of Uttarakhand and Uttar Pradesh ( http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2016;volume=144;issue=...) and this paper highlights its clinical presentations, and the high morbidity and mortality driven by the low index of suspicion amongst practitioners and lack of appropriate diagnostics. I was struck by the variation in the clinical presentations, the tempo of progression of illness. In some we had patients with mild X-ray abnormalities progressing to white lungs in 2 days. Reliable and affordable point of care tests are desperately required, and there has been recent progress in the field.

Scrub typhus is however simply the most common rickettsioses seen in South Asia. We have murine typhus, spotted fevers which are more difficult to confirm, but respond to doxcycline.

MARYAM BIBI RUMANEY Replied at 4:03 PM, 30 Sep 2017

Hi all

Have you considered hosting a Project ECHO? This has been successfully employed for many disease areas.

Kind regards


Sandeep Saluja Replied at 9:20 PM, 30 Sep 2017

All would agree on the value of such courses.In this age webinars are
surely better especially for those of us working in low resource or remote
areas as funds and travel are both difficult

I would go as far as to suggest weekly webinars on clinical topics of
relevance to such areas.Industry would never be interested in such topics
and organisations like GHD will need to lead.

Sandeep Saluja

Elisabetta Leonardi Replied at 10:27 PM, 30 Sep 2017

Thank you dr. Anurag for sharing your very interesting and informative article. To have a reliable rapid test for scrub typhus in the field at an affordable price: what a dream!

Luunga Ziko Replied at 2:47 AM, 1 Oct 2017

This is an interesting read. Its an eye opener especially for some of us in
malaria endemic areas of subsaharan Africa. Its possible we could be
missing some of these scrub typhus cases even here. We need to raise
awareness and gather data on this topic.

RENEE ORIE Replied at 9:13 AM, 1 Oct 2017

I agree this day and age has better webinars than it use to and I think them a great asset to have and be apart of. I even think some aspects of global diagnosis could be taught through webinars but I also believe a practical class is necessary just as residency in medicine is necessary. In fact I could view all my classes at a distance, on a webinar or online except for anatomy and physiology and residency because they are fields that need physical presence. Actually the classes in England I know cater especially for remote areas and the charitable efforts in England have had a great footprint across the globe to the extent if you can't afford to go to the classes. Even in the US there are programs held in various countries by representatives from the US in places like in Haiti with the University Hospital or in Rwanda where there is a similar program. It may be a matter of difference of opinion or preference and I respect the preferences of others. But I believe where there is a will there is a way.

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