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Scrub typhus re-emerging in parts of India

September 12, 2018

Infection can prove fatal to life if not diagnosed and treated on time

New Delhi, September 12, 2018:

About 48 cases of scrub typhus, a bacterial infection that killed 16 people and hospitalized 70 in Nagpur, have been treated in four large hospitals in Delhi since July 2018. Diagnosis of this condition is often missed as the infection mimics symptoms of common monsoon infections, such as dengue and chikungunya. The infection can be fatal if not treated on time with antibiotics, which are not prescribed for dengue and chikungunya.

Scrub typhus is mite-borne disease caused by Orientia tsutsugamushi, which was earlier called Rickettsia tsutsugamushi. It is a re-emerging zoonotic disease in India and is prevalent in many parts of India particularly in the sub-Himalayan belt, from Jammu to Nagaland. Outbreaks are frequent during the rainy season.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Humans are accidental hosts for scrub typhus. The trombiculid mite is the reservoir of infection. Humans can acquire the infection through the bite of the infected larva of the trombiculid mite while walking, sitting, or lying on the infested ground. The larva (chigger) feeds on the vertebrate hosts and acquires the infection. The larval stage of the mite acts as both the reservoir and the vector for infecting the humans and rodents. Human to human transmission does not occur. The infection can range from a mild, self-limiting disease to a fatal infection, leading to multiorgan failure, if not diagnosed and treated in time.”

Symptoms are acute in onset and non-specific in nature with high fever and chills, headache, malaise, myalgia, cough and breathlessness, diarrhea, vomiting and a nonpruritic maculopapular rash. The rash typically begins on the abdomen and spreads to the extremities.

An eschar at the site of chigger bite is diagnostic of scrub typhus. It is a punched out ulcer with a black necrotic center and an erythematous border on the exposed body parts like legs, neck, axilla, chest, abdomen and groin along with enlarged regional lymph nodes. A fever with black patch on the skin should not be ignored.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “There is currently no vaccine for scrub typhus and prevention is the only solution. Several studies have demonstrated that chemoprophylaxis with a long-acting tetracycline is highly effective when used by no immune individuals living or working in areas where scrub typhus is endemic. The use of insect repellants and miticides are highly effective when applied to both clothing and skin. Permethrin and benzyl benzoate are also useful agents when applied to clothing and bedding.”

The following tips can help to prevent scrub typhus.

  • Avoid traveling to places where mites are known to be present in large numbers.
  • Wear protective clothing when traveling to an endemic area. Long sleeved clothes can prove helpful.
  • Apply mite repellents to exposed skin.
  • Those with risk factors and who work in an endemic area can be given once weekly dose of doxycycline.

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