Diagnosis and treatment of scrub typhus--the Indian scenario.
نویسنده
چکیده
11 S crub Typhus, or tsutsugamushi disease is a febrile illness caused by bacteria of the family rickettsiaceae and named Orientia tsutsugamushi. Scrub typhus is endemic to a geographically distinct region, the so-called tsutsugamushi triangle, which includes Japan, Taiwan, China, and South Korea. 1 It also occurs in nepal, northern Pakistan, Papua new Guinea, and the Australian states of Queensland and northern new South Wales. 2 In India, the disease had occurred among troops during World War II in Assam and West Bengal, and in the 1965 Indo-Pak war. There was a resurgence of the disease in 1990 in a unit of an army deployed at the Pakistan border of India. 3 It is known to occur all over India, including Southern India 4 and northern India. 5 However, the reported number of cases of Scrub typhus from different parts of the country particularly from large tertiary care hospitals do not give a true picture of prevalence of scrub typhus in the country. As yet there are not many community based studies in our country. One such community based study involving several districts in Tamil nadu showed that scrub typhus and rickettsial diseases were widely distributed in the state. 6 In this context the report of outbreak of scrub typhus in Pondicherry and in the current issue of the Journal 7 is meaningful. In this report the diverse clinical and laboratory manifestations of scrub typhus are described. The diagnosis was based on the presence of eschar and/or positive Weil Felix test with a titre of > 1:80. In scrub typhus, an eschar approximately 5 to 20 mm in diameter is formed at the site bitten by trombiculid mites, and this may be considered the most important clinical finding for the diagnosis of scrub typhus. The site bitten by chiggers is initially a papule followed by a blistered ulcer, and this is then covered with a black crust; the border of the eschar is surrounded by reddish erythema. Such a typical eschar is formed at the time when symptoms are manifested. 8 In the past, the clinical diagnosis of scrub typhus was dependent on detecting eschar and rash and on the history of outdoor activity. 8-10 nevertheless, under actual clinical conditions, only eschar without rash may be seen in some cases. As was shown in one previous case report, for febrile patients showing a lesion similar to eschar, distinguishing whether such …
منابع مشابه
IAP Guidelines on Rickettsial Diseases in Children.
OBJECTIVE To formulate practice guidelines on rickettsial diseases in children for pediatricians across India. JUSTIFICATION Rickettsial diseases are increasingly being reported from various parts of India. Due to low index of suspicion, nonspecific clinical features in early course of disease, and absence of easily available, sensitive and specific diagnostic tests, these infections are diff...
متن کاملRare concurrent infection with scrub typhus, dengue and malaria in a young female.
scrub typhus and many other vector borne diseases are commonly seen in South Asia including Indian subcontinent. These infections have overlapping clinical manifestations and season of presentation. Scrub typhus or tsutsugamushi disease is a febrile illness caused by bacteria Orientia tsutsugamushi of the family Rickettsia. It is being reported from all parts of the Indian subcontinent though i...
متن کاملDiagnostic evaluation of rapid tests for scrub typhus in the Indian population is needed
BACKGROUND Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is being described as a re-emerging infectious disease in India. Differentiating scrub typhus from other endemic diseases like malaria, leptospirosis, dengue fever, typhoid, etc. is difficult due to overlapping clinical features and a lower positivity for eschars in Asian populati...
متن کاملEschar is associated with poor prognosis in scrub typhus
Scrub typhus occurs in almost all parts of India and is endemic1. Many researchers have reported the profile of scrub typhus from various parts of India with diagnosis based on IgM ELISA2-4. Eschar is pathognomonic for rickettsiosis including scrub typhus, but its presence has not been reported as a marker of disease severity. Kim et al5 found absence of eschar to have prognostic significance i...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- The Journal of the Association of Physicians of India
دوره 58 شماره
صفحات -
تاریخ انتشار 2010