A Menace without Specific Feature - Scrub Typhus a Reemerging Disease.

INTRODUCTION: Scrub typhus is a re-emerging infectious disease. Though considered as disease of rural areas, this disease has been urbanized and the prevalence has broadened further. Disease has been reported with increasing frequency from various parts of India and has resurgence in north east. It is a disease with multi organ involvement, with or without characteristic eschar and early detection and initial specific treatment is important.

MATERIAL: An observational hospital-based study in patients >18years admitted to a tertiary care center in eastern India. Scrub typhus was diagnosed on basis of symptoms with or without eschar and Scrub IgM. Treated with doxycycline (azithromycin in 3 pregnant patients) & clinical course was monitored. An appropriate correlation measure, based on the natures of the variable under study, (e.g.: rank correlation / Pearson correlation/ point biserial correlation) was estimated and subsequently tested at alpha =0.05 level of significance. A p value <0.05 was taken as significant.

OBSERVATIONS: A total of 105 patients of scrub typhus were included in present study. It had 66%male and 39% female with the most common age group being 46-60 years. Eschar was found in 33% patients. Neurological manifestation was found in 18% of the patients. Hyponatremia and raised liver enzymes were significantly noticed. 9% patients had Acute respiratory distress syndrome. 4% patients died because of multiorgan dysfunction. Three pregnant patients included in study were treated with azithromycin showed good response and pregnancy outcome was uneventful.

CONCLUSIONS: Scrub typhus is no longer a disease of rural India. Physician should have strong suspicion and needs early attempt to diagnose and treat as mostly the disease is featureless and can be treated easily, but delay in starting treatment raises chances of severe complications like encephalitis, ARDS, Macrophage Activation Syndrome. Disease mostly responded with Azithromycin, Doxycycline.