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Scrub typhus

Posted by: Philip Alex | Posted on: September 2nd, 2013 | 0 Comments

From the last year, we have been seeing scrub typhus (presumably) in Manali. Patients present to us with fever, chills, respiratory difficulty, with or without jaundice. They may also have central nervous system symptoms, with confusion and headache. The characteristic eschar alerts us to the possibility of typhus. They invariably have a low platelet count and may also have leucopenia and anemia. The respiratory distress is usually progressive when diagnosed late or when they present to us late. They often need ventilation and are very sick. They may also go into renal failure. The presence of jaundice and altered liver enzymes often compounds the seriousness of the disease. Early initiation of doxycycline therapy, blood transfusion if appropriate and steroids with early ventilation saves lives. A four percent hospital mortality has been described.

Transmitted by the trombiculid mite, chigger bites transmit the Orientia tsutsugamushi. The disease can occur a week after being bitten and the eschar by this time is a characteristic central dark necrosed area often well circumscribed and circular in appearance.

Diagnosis is by the indirect fluorescent antibody test or PCR, or biopsy of the eschar. We have been informed that the Weil Felix test is available in the Kullu zonal hospital.

The clinical and laboratory picture is pretty characteristic to allow the early initiation of therapy.

Scrub typhus is becoming a problem both to diagnose and treat in time in Himachal and other areas of North India as these links to newspapers suggest.

http://articles.timesofindia.indiatimes.com/2013-09-03/india/41725012_1_test-facility-scrub-typhus-kangra

http://www.ibtimes.co.in/articles/503396/20130903/scrub-typhus-trombiculid-mites-leptotrombidium-deliense.htm

 

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