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Published Date: 2011-09-17 23:30:50
Subject: PRO/AH/EDR> Scrub typhus - India (02): (NL)
Archive Number: 20110917.2834

SCRUB TYPHUS - INDIA (02): (NAGALAND)
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International Society for Infectious Diseases
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Date: Fri 16 Sep 2011
Source: The Morung Express [edited]
http://www.morungexpress.com/frontpage/70829.html

The Department of Health and Family Welfare has informed that it had
received a telephone message on 12 Sep 2011 of an outbreak of fever of
unknown cause leading to 3 deaths at Poilwa village, Peren District
[India]. Immediately the State Rapid Response Team (RRT) of Integrated
Disease Surveillance Project (IDSP), Nagaland, comprising of Dr. John
Kemp (State Surveillance Officer), Dr. Sao Tunyi (epidemiologist), Dr.
Kevisevolie Sekhose (epidemiologist), and Venezo Vasa (entomologist)
conducted an outbreak investigation at Poilwa village.

The team collected 3 samples from suspected cases. All 3 were tested
positive for scrub typhus. To date, there are 9 cases with 3 deaths.
This was stated in an official press note issued by Dr. Imtimeren
Jamir, the Principal Director, Directorate of Health and Family
Welfare, Kohima.

Scrub typhus is rickettsial disease caused _Orientia tsutsugamushi_
and transmitted by the bite of mite called _Leptotrombidium deliense_.
In Nagaland, it was formerly detected by IDSP with Central
Surveillance Team in Longsa village Mokokchung in 2006, and in Porba
village of Phek District in 2007.

Signs and symptoms [of scrub typhus]:
- After the bite of infected mite larvae called chiggers, a papule
develops at the biting site which ulcerates and eventually heals with
the development of a black eschar.
- Patients develop sudden fever with headache, weakness, myalgias,
generalized enlargement of lymph nodes, photophobia, and dry cough.
- A week later, a rash appears on the trunk, then on the extremities,
and turns pale within a few days.
- Symptoms generally disappear after 2 weeks even without treatment.
However, in severe cases with pneumonia and myocarditis, mortality may
reach 30 percent.

The most commonly used test for diagnosis is Weil-Felix test, which is
available at State IDSP laboratory, Kohima. More specific serological
tests like detection of IgM [immunoglobulin M antibody] can also be
done for diagnosis. IFA [indirect immunofluorescence antibody assay]
is the gold standard.

Scrub typhus responds well to the antibiotic doxycycline or
chloramphenicol. In resistant cases, rifampicin can be used. In
children and pregnant women, azithromycin is the drug of choice.
Sulfonamide group of drugs are contraindicated.

As scrub typhus is found in distinct areas (typhus islands), control
measures can be carried out by treating the ground and vegetation with
residual insecticides, reducing rodent populations, and destroying
limited amounts of local vegetation. Protective clothing, applying of
mite repellent to exposed skin, and chemoprophylaxis can be considered
for persons in infested terrains. No effective vaccine has been
developed to date.

The State RRT team carried out the outbreak investigation along with
doing and entomological survey. The patients were treated with
appropriate medicines and awareness and preventive measures were
communicated with the villagers. The concerned local health
authorities and programs are informed for further necessary action.
The mop-up operation is being carried out by the National Vector Borne
Disease Control Program.

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[For a discussion of scrub typhus, see ProMED-mail post Scrub typhus -
India: (HP) 20110319.0872.

Nagaland is a state in the far northeastern part of India. It borders
the state of Assam to the west, Arunachal Pradesh and part of Assam to
the north, Burma to the east and Manipur to the south. Peren is one of
its eleven districts (for a map of the districts of Nagaland, see
http://en.wikipedia.org/wiki/File:Nagalandmap.png). Most of the
inhabitants belong to the Zeliang and Kuki tribes
(http://en.wikipedia.org/wiki/Peren_District). Poilwa is a Zeliang
tribe village
(http://www.incredibleindia.org/newsite/cms_page.asp?pageid=381). A
HealthMap/ProMED-mail interactive map of India that shows the state of
Nagaland can be found at http://healthmap.org/r/010T. - Mod.ML]

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