Published Date: 2004-08-23 23:50:00
Subject: PRO/AH/EDR> Scrub typhus - India (Himachal Pradesh)
Archive Number: 20040823.2344
SCRUB TYPHUS - INDIA (HIMACHAL PRADESH)
A ProMED-mail post
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International Society for Infectious Diseases
Date: Sun 22 Aug 2004
From: ProMED-mail <email@example.com>
Source: Hindustan Times, 23 Aug 2004 [edited]
8 admitted to IGMC with fever diagnosed with scrub typhus
As many as 8 patients, suffering from a "high-grade fever," admitted to
Indira Gandhi Medical College (IGMC) yesterday [Sat 21 Aug 2004], are
suspected to be afflicted with scrub typhus disease.
A 25-year-old resident of Sirmaur, who was referred to IGMC from Rajgarh
Government Hospital yesterday [Sat 21 Aug 2004], tested positive for scrub
typhus, and, is in very critical condition. He had been suffering from a
high fever for the past 6 days.
When contacted, IGMC principal Prof. L.S. Pal said that no new patients
with high fevers had been admitted today [Sun 22 Aug 2004]. He confirmed
that 8 patients, who had been admitted, were suspected as having scrub
typhus, and, repeated that Weil-Felix tests would be conducted to confirm
Date: 22 Aug 2004
From: ProMED-mail <firstname.lastname@example.org>
Source: Hindustan Times 21 Aug 2004 [edited]
Mystery fever breaks out again
Scrub typhus, which had been a mystery disease for the Indira Gandhi
Medical College (IGMC) in 2003, has struck again, taking 2 lives,
including one in Bilaspur. As many as 18 others have been hospitalized with
high-grade fever, a symptom typical of scrub typhus.
8 patients with such symptoms were reportedly admitted to IGMC today, Sat
21 Aug 2004, including a 30-year-old from Sarkaghat in Mandi. She had been
suffering from a high-grade fever for the past 15 days and was referred
from Government Hospital, Hamirpur.
IGMC Principal L.S. Pal, when contacted, confirmed that patients suffering
from high-grade fever had been admitted to the hospital. He said that, of
the 10 patients admitted prior to Fri 20 Aug 2004, 2 had tested positive
for the scrub fever vector. [It is unclear what is meant here. - Mod.LL]
He said adequate arrangements have been made for the Weil-Felix test, which
will be conducted to confirm the disease. He cautioned that the number of
patients was likely to increase due to heavy and prolonged rains, a
favorable condition for allowing the disease to spread.
Last year , fear of the mystery disease had attained alarming
proportions -- with as many as 25 patients, out of 100 hospitalized,
succumbing to the disease -- before a team of doctors from the National
Institute of Communicable Diseases (NICD), New Delhi, confirmed that it was
scrub typhus. There have been outbreaks of the disease in the state now for
almost 5 years.
[Byline: Bhawani Negi]
[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. The disease is also referred to as tsutsugamushi fever.
The organism, _Rickettsia tsutsugamushi_, or _Orientia tsutsugamushi_,
causes natural disease in eastern Asia and in 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
Weil and Felix described the classical assay for rickettsial antibody
detection in 1916. The methodology took advantage of heterophilic
(cross-reacting) antigens of members of the genus Rickettsia and several
species of the Gram negative bacillus Proteus. In the Weil-Felix test,
bacteria of Proteus vulgaris OX-19 agglutinate with sera of the infected
with the typhus group organisms as well as from the Rocky Mountain Spotted
Fever (RMSF) organism _Rickettsia rickettsii_. Cells of P. vulgaris OX-2,
on the other hand, agglutinate with sera from individuals with spotted
fever infection, except RMSF. The OX-19 agglutination is seen in epidemic
typhus, but, usually not in Brill-Zinsser recrudescent disease. P.
mirabilis OX-K can be similarly used in the serological diagnosis of scrub
typhus. Because of the relatively poor sensitivity, and specificity, of
this test, more specific assays can be used for diagnosis, including
complement fixation antibodies. Dip-stick ELISA assays (1) and PCRs (2)
have now been added to potential diagnostic tests.
1. Pradutkanchana J, Silpapojakul K, Paxton H, et al: Comparative
evaluation of 4 serodiagnostic tests for scrub typhus in Thailand. Trans R
Soc Trop Med Hyg. 1997;91:425-8.
2. Manosroi J, Chutipongvivate S, Auwanit W, Manosroi A: Early diagnosis of
scrub typhus in Thailand from clinical specimens by nested polymerase
chain reaction. Southeast Asian J Trop Med Public Health. 2003
Dec;34(4):831-8. - Mod.LL]