Published Date: 2003-09-24 23:50:00
Subject: PRO/EDR> Scrub typhus - India (Himachal Pradesh)
Archive Number: 20030924.2413

SCRUB TYPHUS - INDIA (HIMACHAL PRADESH)
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Wed, 24 Sep 2003
From:ProMED-mail <promed@promedmail.org>
Source:Indian Express.com 24 Sep 2003 [edited]
<http://www.indianexpress.com/full_story.php?content_id=32139>

3rd year in Himachal: Typhus claims 19
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Yesterday, the NICD called up Indira Gandhi Medical College and
Hospital authorities to convey that [the unidentified disease
associated with the onset of monsoon season] had been identified as
scrub typhus, a form of rickettsial disease which is transmitted by
mites. Though the mystery behind the mystery fever has now been
unravelled, it continues to grip pockets of half of the 12 districts
of Himachal Pradesh and has claimed 19 lives this year, adding up to
36 in the past 3 years. While more than 225 people have been admitted
to various hospitals, there is no count of those being treated by
private doctors.
The first symptoms of the high-grade fever were noticed in July 2001,
and experts were at a loss to explain what it was, how it was caused,
or its diagnoses. Experts from the National Institute of Communicable
Diseases (NICD), New Delhi, also kept visiting Shimla and took blood
samples but failed to identify the disease.
The disease strikes each year during the monsoon, and it has been
observed that heavier the rains, the higher the incidence of disease.
[Byline: Dharmendra Rataul]
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ProMED-mail
<promed@promedmail.org>
[Scrub typhus is spread to humans as a zoonosis by the bite of the
larval stage of trombiculid mites (chiggers). The term scrub comes
from the type of local vegetation, scrub, between forests and cleared
areas where the vector is found, and the disease is also referred to
as tsutsugamushi fever. The organism, _Rickettsia tsutsugamushi_ or
_Orientia tsutsugamushi_, causes natural disease in eastern Asia and
the western Pacific. In any area, because of high rates of
transovarian transmission in the mite, highly focal areas of high
risk exist.
Symptoms are often nonspecific, but severe headache and myalgias
(common in rickettsioses) and an eschar with regional lymphadenopathy
can be helpful to diagnosis in endemic areas. The diagnosis can be
made serologically, although early treatment (doxycycline) may blunt
the antibody response. - Mod.LL]

See Also

Undiagnosed deaths - India (Himachal Pradesh) (02): RFI 20030922.2385
Undiagnosed deaths - India (Himachal Pradesh): RFI 20030918.2364
1999
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Scrub typhus - Denmark ex South Africa 19990117.0076
1998
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Scrub typhus - Taiwan (02) 19980720.1372
Scrub typhus - Taiwan 19980716.1338
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