This story is from September 14, 2016

Doctors warn citizens of Scrub Typhus infection

Doctors warn citizens of Scrub Typhus infection
(Representative image)
Nagpur: Private as well as government physicians are issuing warnings to people to beware of ‘Scrub Typhus or ST’, a zoonotic disease (transmitted from animals to man) caused by bite of mites. It results in very high fever. In acute cases, the disease can even affect multiple organs. Doctors have already been seeing some cases in the last fortnight in city and have called upon people to consult their doctors if they see any suspected sign of the disease.
The most common symptom is eschars (rash or scars like cigarettes burns on skin). The professor and head of medicine at the Indira Gandhi Government Medical College and hospital (IGMCH) Dr P P Joshi told TOI he had treated about half a dozen cases in the last 15 days. “This is the season for it. Though IGMCH doesn’t have the diagnostic testing facility, we are immediately putting the patient with ST like symptoms on doxycycline. Mostly ST patients respond very well to this antibiotic and hence even with empirical treatment there is no issue of giving right treatment,” said Dr Joshi.
ST patients generally can be identified with symptoms of fever, cough, atypical pneumonia. Involvement of other organs mainly liver, kidney is common and can be identified by increased enzyme levels of these organs. Dr Joshi, who was the first doctor to diagnose ST in rural patient a few years back at Government Medical College and Hospital (GMCH), stated that even platelet count could fall substantially. One has to differentiate between other diseases with similar symptoms like dengue, leptospirosis and falciparum malaria.
People working in grassy areas or mud like those in paddy fields in this season and the sanitary workers working in sewage drains etc are prone to get disease like leptospirosis and ST in this month. Walking barefoot on grass could also result in a mite bite and ST. Dr Joshi said that the testing facility was available with the G M Taori CIIMS hospital under an Indian Council of Medical Research (ICMR) programme along with Nagpur Veterinary College besides certain private hospitals.
Dr Anup Marar from the Orange City Hospital and Research Institute (OCHRI) said since the disease had non-specific clinical presentation, it remained grossly undiagnosed. OCHRI doctors have seen patients of ST. Dr Devayani Buche, OCHRI physician, said the diagnosis of ST was based on a high index of suspicion and careful clinical, laboratory and epidemiological evaluation.
Dr Rajesh Atal and Dr Nikhil Balankhe, also physicians from OCHRI, said the disease was caused by Orientia tsutsugamushi transmitted to humans by the bite of trombiculid mites larvae. It resulted in inflammatory lesions resulting in vascular and end organ injury and gastrointestinal symptoms. Dr Upendra Kumar and Dr
Ashish Shukla called for more awareness to take preventive measures as a better strategy to handle disease that had high risks but was not easy to diagnose.
OCHRI pathologist Dr Milind Pande stated the disease could be diagnosed with deranged functions of liver and kidney. An Elisa test is used to diagnose the disease. Dr Ganesh Bhure, intensivist, said that in extreme cases intensive care could be required in handling patients with symptoms of acute respiratory syndrome. Some might be needed to put on dialysis and some require correction of hepatological abnormalities.
SIGNS AND SYMPTOMS
* Fever, headache, muscle pain, cough, and gastrointestinal symptoms
* More virulent strains of O. tsutsugamushi can cause haemorrhaging and intravascular coagulation
* Morbilliform rash, eschar, splenomegaly, and lymphadenopathies are typical signs
* Leukopenia and abnormal liver function tests are commonly seen in the early phase of the illness. Pneumonitis, encephalitis, and myocarditis occur in the late phase of illness
* In absence of a vaccine awareness and preventive measure are the only methods to prevent the disease from taking epidemic form
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