SCRUB TYPHUS – INDIA (09): (HARYANA, PUNJAB)

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Date: Mon 1 Oct 2012
Source: The Indian Express [edited]
http://www.indianexpress.com/news/scrub-typhus-a-fever-found-in-hilly-regions-spreads-to-plains/1010163/
After malaria, dengue and swine flu, now the residents of the tricity also need to watch out for scrub typhus, warn doctors. [Chandigarh, Mohali, and Panchkula are collectively referred to as the Tricity.] A fever known to only spread in the hill regions has now started spreading to the plains as well owing to various climatic reasons. The scrub typhus patients earlier only found in hilly regions of the Himalayas including Shimla, Assam, West Bengal are now reporting at PGI [Postgraduate Institute, Chandigarh] from Chandigarh, Panchkula, and the surrounding areas.
“This year [2012] in August and September, 62 blood samples were received from adults as well as children in PGI. Out of these, 50 were found positive for scrub typhus by Weil Felix assay,” says Dr Sunil Sethi, Department of Medical Microbiology, PGIMER [Postgraduate Institute of medical Education and Research]. Most of the patients had fever, cough, and myalgia, he adds.
Says Dr Rajesh Kumarm, head of the Department of Community Medicine, PGIMER, “There can be various reasons for the disease to spread here in [the] plains. First, there are climatic changes. Secondly, the agricultural practices in Punjab and Haryana have also changed and the habitat may have been conducive for the mite to breed here and thus find a favourable habitat. Also, residents keep migrating from one place to another and someone infected with the disease came in contact of the mite here and then the infection spread from one mite to another. Indeed it is an unusual finding in the past few years.”
The disease recently took lives of 14 patients from different regions in Himachal Pradesh, says Dr Ramesh, deputy medical superintendent, Indira Gandhi Medical College and Hospital, Shimla. “At present, we have 30 patients admitted to the hospital, and on average, we had been receiving over 100 cases a day from various districts of Himachal Pradesh in our hospital in the past couple of days,” he adds.
Explaining its health complications, Dr Sethi says severe scrub typhus usually presents as multiple-organ damage including carditis, acute respiratory distress syndrome, hepatitis, renal failure. encephalitis, disseminated intravascular coagulopathy (DIC), and septic shock.
The disease is caused by bacteria known as _Orientia tsutsugamushi_ that live primarily in mites (the primary reservoir) belonging to the species _Leptotrombidium akamushi_ (chigger mite).
The infection is called scrub typhus because it generally occurs after exposure to areas with secondary (scrub) vegetation. It has recently been found, however, that the disease can also be prevalent in such areas as sandy beaches, mountain deserts, and equatorial rain forests, according to Dr Sethi.
Human beings are infected accidentally, usually during the rainy season. [An eschar is formed on the site of the mite bite.] It resembles a skin burn caused by a cigarette butt. The lesions are painless and without any itching sensation in most cases, causing the infection to be undetected by most patients.

Commentary: This really becomes an important differential diagnosis for me, since I am practicing in Mohali, a part of the Tricity alongwith Chandigarh & Panchkula. Since we do not routinely use tetracyclines like Doxycycline in children, having a high index of suspicion and ordering a Weil-Felix test becomes important in cases of fever, cough, and myalgia, becomes important in case they are not responding to ‘usual’ treatment.