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Diagnosis of scrub typhus and rickettsial infections

By Madhukar Pai Moderator | 15 Feb, 2017

Please see the attached free, recent review articles that might be useful.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029442/pdf/coidi-29-433.pdf

http://www.icmr.nic.in/guide/DHR-ICMR%20Guidelines%20on%20Ricketesial%20Disea...

I am aware of colleagues in this community with expertise and first-hand experience in managing scrub typhus, and look forward to their input how the diagnostics landscape is evolving.

Best
Madhu

Replies

 

Pratibha Narang Replied at 4:08 AM, 16 Feb 2017

Thanks Madhu for sharing all good literature with us. Under the ICMR
Zoonosis project Dr Rahul Narang been working on Scrub typhus now in the
Deptt. for almost two years. Unlike what we were taught and what we have
been teaching for many years to our students, it is not all uncommon.
Probably we were just not looking for it then.

Sujatha Chandrasekaran Replied at 4:44 AM, 16 Feb 2017

Scrub typhus is not uncommon at all in and around Chennai,Southern India. We started testing for Scrub typhus from 2007 using IgM ELISA, after a few samples that we sent to CMC,Vellore tested positive. Thereafter, it was part of FUO protocol. We could also find eschar in most of the cases, though it is considered difficult in dark-coloured skins. No active reporting to public health was done since this was not notifiable.

LAKSHMI VEMU Replied at 8:27 AM, 16 Feb 2017

This is the same situation in Hyderabad, Andhra Pradesh. We too diagnose a
lot of scrub typhus cases and successfully treat them. Eschar is very hard
to find in the dark skinned persons.

Subbalaxmi Malladi Replied at 7:57 PM, 16 Feb 2017

Scrub typhus is commonly seen in
and around hyderabad,
predominantly a rural disease.
Clinically presents as atypical
pneumonia, arf, encephalitis,
hepatitis. Prognosis is good.
Dr subbalaxmi

Hanh Tran Replied at 10:41 AM, 22 Jan 2018

Dear colleagues,

Yes, it is not common diseases, and now I propose a proposal to estimate it based on community study. Could some ones help me to know how to diagnosis an active infection cases in last year ?
Many thanks
Hanh

Md. Sarawarul Islam Replied at 11:23 AM, 22 Jan 2018

Scrub typhus disease is very common in Bangladesh.
High grade fever, rash are common presentation.
Weil–Felix test may help to diagnose the disease.
Treatment is easy and prognosis is excellent.
Dr. Md. Sarawarul Islam Mukta.
Medicine Specialist.
Bangladesh.

Subbalaxmi Malladi Replied at 11:57 AM, 22 Jan 2018

We at Hyderabad suspect
when a Pt from a rural background
presents with fever with or without
Localization.
They have lower resp tract
involvement, occasionally alt
sensorium or Arf. Most of them will
have hepatitis.
Diagnostic test is IgM scrub or
weil felix
Treat empirically with doxy
Dr subbalaxmi
Additional prof
Nizam’s institute of medical sciences
Hyderabad

Luunga Ziko Replied at 9:25 AM, 30 Jan 2018

Good summary there. Thanks

Anurag Bhargava Replied at 8:29 PM, 30 Jan 2018

Dear colleagues,
Scrub typhus is frequently missed as a diagnosis, so I don't think it is rare in most parts of South east Asia as Hahn believes.
Subbalaxmi mentioned that they suspect it in people from rural areas. Though it is believed to be a "rural" zoonosis, this was not borne out in our study of nearly 300 patients with scrub typhus seen over 18 months. Urban dwellers were affected almost equally in our series. In fact in China activities in the park emerged as a risk factor and in India's cities, scrub typhus was also seen in affluent sections of society with lawns and kitchen gardens, where they may indulge in activities exposing them to mites. A helpful epidemiologic clue to scrub typhus is its seasonality, which differs according to the region. In north India, the cases are seen mostly between July and December.

Serologic diagnosis of scrub typhus is not satisfactory still, since the IgM ELISA is often negative early in the illness, and reports are not available on an immediate basis as it is a 96 well ELISA. Weil Felix is not satisfactory in terms of sensitivity. The search for an eschar is rewarding, as it is almost pathognomonic for scrub typhus in South Asia. Almost half of our patients presented as a bilateral community acquired pneumonia. In terms of prognosis, the severity of illness varies, and we have seen patients progressing to multi-organ failure within 8-10 days of fever. In patients with ARDS, the mortality was almost 40%.

You might find our study on scrub typhus in north India of interest.

Anurag Bhargava

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