Scrub typhus – atypical presentations: a case series from the state of Sikkim
Keywords:
Scrub typhus
Abstract
Scrub typhus is caused by Orientia tsutsugamushi and is transmitted to humans by an arthropod vector of the Thrombiculidae family. It is one of the most common re-emerging ricketssial infection in India and other South east Asian countries. Nearly a billion people are at risk with at least a million cases being reported from this region every year. It is distributed in the tsutsugamushi triangle which is distributed over a wide area of 13 million km2. Eschar is the characteristic lesion that starts as a vesicular lesion at the site of mite feeding.
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References
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15. Tandon R, Kumar A, Kumar A. Long-Segment Myelitis, Meningoencephalitis, and Axonal Polyneuro-pathy in a Case of Scrub Typhus. Ann Indian Acad Neurol. 2019;22(2):237-240. doi: 10.4103/aian. AIAN_ 66_18.
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20. Kim DM, Kim SW, Choi SH, Yun NR. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis. 2010;10:108. doi: 10.1186/1471-2334-10-108.
21. Rathi NB, Rathi AN, Goodman MH, Aghai ZH. Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatr. 2011;48(11):867-872.
22. Yen TH, Chang CT, Lin JL, Jiang JR, Lee KF. Scrub typhus: a frequently overlooked cause of acute renal failure. Ren Fail. 2003;25(3):397-410. doi:10. 1081/ jdi-120021152
23. Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, et al. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci. 2003;990(1):359-364.
24. Jung YeonChin,Ki-Woon Kang, Kyung Min Moon, Jongwoo Kim, Yu Jeong Choi. Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea. Korean J Intern Med. 2018;33(2):323–330. doi: 10.3904/ kjim. 2016.303
25. Takhar RP, Bunkar ML, Arya S, Mirdha N, Mohd A. Scrub typhus: A prospective, observational study during an outbreak in Rajasthan, India. Natl Med J India. 2017;30(2):69-72.
26. Khan SA, Bora T, Laskar B, Khan AM, Dutta P. Scrub Typhus Leading to Acute Encephalitis Syndrome, Assam, India. Emerg Infect Dis. 2017;23(1):148-150. doi: 10.3201/eid2301.161038. Epub 2017 Jan 15.
27. Rizvi M, Sultan A, Chowdhry M, Azam M, Khan F, Shukla I, et al. Prevalence of scrub typhus in pyrexia of unknown origin and assessment of interleukin-8, tumor necrosis factor-alpha, and interferon-gamma levels in scrub typhus-positive patients. Indian J Pathol Microbiol. 2018;61(1):76-80. doi: 10.4103/IJPM.IJPM_ 644_16.
28. Oberoi A, Varghese SR. Scrub typhus-an emerging entity: a study from a tertiary care hospital in North India. Indian J Public Health. 2014;58(4):281-283. doi: 10.4103/0019-557X.146299.
29. Peesapati N, Lakkapraga R, Sunitha S, Sivaram PV. Clinical manifestations and complications of scrub typhus- A hospital-based study from North Andhra. Astrocyte 2015;2(3):116-120. doi: 10.4103/2349-0977. 181508
30. Bhargava A, Kaushik R, Kaushik RM, Sharma A, Ahmad S, Dhar M, Mittal G, Khanduri S, Pant P, Kakkar R. Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality. The Indian J Med Res. 2016; 144(6):901-909. doi: 10.4103/ijmr.IJMR_1764_15
2. Roy BC. Typhus fever; with special reference to its incidence in India. J Indian Med Assoc. 1945-1946; 15:135-146.
3. Sayen JJ, Pond HS, Forrester JS, Wood FC. Scrub typhus in Assam and Burma: a clinical study of 616 cases. Med. 1946; 25(2):155-214. doi: 10.1097/ 0000 5792 -194605000-00003
4. Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, et al. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci. 2003;990:359-364. doi:10.1111/j.1749-6632. 2003.tb07391.x
5. Mahajan SK, Rolain JM, Kashyap R, Bakshi D, Sharma V, Prasher BS, et al. Scrub typhus in Himalayas. Emerg Infect Dis. 2006;12(10):1590-1592. doi:10.3201/eid1210.051697
6. Aggarwal P, Mahesh DM, Ravi Kumar V, Himral P, Kaushal SS, Verma BS. Atypical eschar sites in scrub typhus in sub-Himalayas. J Assoc Physicians India. 2009;57:154.
7.Bhalwar R,Vaidya R, editors.Textbook of public health and community medicine. Department of Com-munity Medicine, Armed Forces Medical College; 2009
8. Mean monthly meteorological parameters of gangtok period:1971-2000 Available from: http://imdsikkim. gov. in/ monthlymetparam. Html [Last accessed on 2012 Oct 16].
9. Frances SP, Watcharapichat P, Phulsuksombati D, Tanskul P, Linthicum KJ. Seasonal occurrence of Leptotrombidium deliense (Acari: Trombiculidae) attached to sentinel rodents in an orchard near Bangkok, Thailand. J Med Entomol. 1999;36(6):869-874. doi:10. 1093 /jmedent/ 36.6.869
10. Emergence of Schoengastiella ligula as the vector of scrub typhus outbreak in Darjeeling: has Leptotrom-bidium deliense been replaced? Indian J Public Health. 2011;55(2):92-99. doi: 10.4103/0019-557X.85239.
11. Mahajan SK. Scrub typhus. J Assoc Physicians India. 2005;53:954-958.
12. Gurung S, Pradhan J, Bhutia PY. Outbreak of scrub typhus in the North East Himalayan region-Sikkim: an emerging threat. Indian J Med Microbiol. 2013;31 (1): 72-74. doi: 10.4103/0255-0857.108729.
13. Sayen Jj, Pond HS, Scrub typhus in Assam and Burma; a clinical study of 616 cases. Medicine (Baltimore). 1946;25:155-214. doi:10.1097/00005792-194605000-00003
14. Dhakal M, Dhakal OP, Bhandari D. Pancreatitis in scrub typhus: a rare complication. BMJ Case Rep. 2014; 2014. pii: bcr2013201849. doi: 10.1136/bcr-2013-201849.
15. Tandon R, Kumar A, Kumar A. Long-Segment Myelitis, Meningoencephalitis, and Axonal Polyneuro-pathy in a Case of Scrub Typhus. Ann Indian Acad Neurol. 2019;22(2):237-240. doi: 10.4103/aian. AIAN_ 66_18.
16. Chi WC, Huang JJ, Sung JM, Lan RR, Ko WC, Chen FF. Scrub typhus associated with multiorgan failure: a case report. Scand J Infect Dis. 1997;29 (6):634-635. doi:10.3109/00365549709035911
17. Yi SY, Tae JH. Pancreatic abscess following scrub typhus associated with multiorgan failure. World J Gastroenterol: WJG. 2007;13(25):3523-3525. doi: 10. 3748/ wjg.v 13.i25.3523
18. Sivarajan S, Shivalli S, Bhuyan D, Mawlong M, Barman R. Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India. Infect Dis Poverty. 2016;5(1):91. doi: 10.1186/s40249-016-0186-x
19. Tamura A, Ohashi N, Urakami H, Miyamura S. Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen. nov., as Orientia tsutsugamushi comb. nov. Int J Syst Bacteriol. 1995;45(3):589-591. doi:10.1099/00207713-45-3-589
20. Kim DM, Kim SW, Choi SH, Yun NR. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis. 2010;10:108. doi: 10.1186/1471-2334-10-108.
21. Rathi NB, Rathi AN, Goodman MH, Aghai ZH. Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatr. 2011;48(11):867-872.
22. Yen TH, Chang CT, Lin JL, Jiang JR, Lee KF. Scrub typhus: a frequently overlooked cause of acute renal failure. Ren Fail. 2003;25(3):397-410. doi:10. 1081/ jdi-120021152
23. Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, et al. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci. 2003;990(1):359-364.
24. Jung YeonChin,Ki-Woon Kang, Kyung Min Moon, Jongwoo Kim, Yu Jeong Choi. Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea. Korean J Intern Med. 2018;33(2):323–330. doi: 10.3904/ kjim. 2016.303
25. Takhar RP, Bunkar ML, Arya S, Mirdha N, Mohd A. Scrub typhus: A prospective, observational study during an outbreak in Rajasthan, India. Natl Med J India. 2017;30(2):69-72.
26. Khan SA, Bora T, Laskar B, Khan AM, Dutta P. Scrub Typhus Leading to Acute Encephalitis Syndrome, Assam, India. Emerg Infect Dis. 2017;23(1):148-150. doi: 10.3201/eid2301.161038. Epub 2017 Jan 15.
27. Rizvi M, Sultan A, Chowdhry M, Azam M, Khan F, Shukla I, et al. Prevalence of scrub typhus in pyrexia of unknown origin and assessment of interleukin-8, tumor necrosis factor-alpha, and interferon-gamma levels in scrub typhus-positive patients. Indian J Pathol Microbiol. 2018;61(1):76-80. doi: 10.4103/IJPM.IJPM_ 644_16.
28. Oberoi A, Varghese SR. Scrub typhus-an emerging entity: a study from a tertiary care hospital in North India. Indian J Public Health. 2014;58(4):281-283. doi: 10.4103/0019-557X.146299.
29. Peesapati N, Lakkapraga R, Sunitha S, Sivaram PV. Clinical manifestations and complications of scrub typhus- A hospital-based study from North Andhra. Astrocyte 2015;2(3):116-120. doi: 10.4103/2349-0977. 181508
30. Bhargava A, Kaushik R, Kaushik RM, Sharma A, Ahmad S, Dhar M, Mittal G, Khanduri S, Pant P, Kakkar R. Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality. The Indian J Med Res. 2016; 144(6):901-909. doi: 10.4103/ijmr.IJMR_1764_15
CITATION
DOI: 10.17511/jopm.2019.i08.10
Published: 2019-08-31
How to Cite
Dr. Aroop Mohanty, Dr. Ankita Kabi, Dr. Mithilesh Kumar Jha, Dr. Sasi Rekha, Dr. Anusha K R, & Dr. Pratima Gupta. (2019). Scrub typhus – atypical presentations: a case series from the state of Sikkim. Tropical Journal of Pathology and Microbiology, 5(8), 568-573. https://doi.org/10.17511/jopm.2019.i08.10
Section
Case Series
OAI - Open Archives Initiative
