AES deaths: scrub typhus culprit, says scientists

Medical scientists have collected more evidence favouring scrub typhus as the killer pathogen behind Gorakhpur’s Acute Encephalitis Syndrome (AES) cases that lead to the death of hundreds of children each year.

Even though the disease has been around since 1978, researchers were unable to identify the exact causative agent, compelling doctors to treat the symptoms.

Studies in the last two years seem to suggest that a large number of AES cases are caused by scrub typhus (also known as bush typhus), which is a form of the disease caused by the parasite Orientia tsutsugamush.

A group 10 Indian researchers have now provided additional evidence to establish the role of this dangerous parasite in perpetuating the AES.

They examined the blood samples of 46 AES-affected kids between the age of 3 and 9, and compared the results with another 151 samples. An overwhelming majority of the children carry the antibody against scrub typhus.

The tests were for two types of antibodies -- proteins released by the body to fight foreign pathogens. In one case, 63% of the infected kids had the antibody, compared to the control group, in which only 4.6% had it. In the second case, 82.6% infected children carried the antibody against the 42.4% in the control group.

Six out of eight
In six out of eight fatal cases, the children had the antibodies against scrub typhus, research team reported in the journal Emerging Infectious Disease, published by the Centre for Disease Control and Prevention, Atlanta, USA.

The team consists of researchers from BRD Medical College, Gorakhpur, National Institute of Epidemiology, Chennai, Christian Medical College, Vellore, National Institute of Virology, Gorakhpur and the Indian Council of Medical Research (ICMR).

Doctors and scientists have blamed Japanese encephalitis and enterovirus as the culprit in the deaths in the past.

Not concrete
However, even the new research findings do not provide all the required proof. “If it is scrub typhus, then azithromycin would have worked. But that was not the case. There are questions on whether enough cases are reaching hospitals and whether they are detected early enough,” Vipin Vashishtha, a Bijnor-based paediatrician, who closely follows the AES cases told DH.

The ICMR had recommended the use of the antibiotic doxycycline, but it is not clear at the moment whether the recommendation has been put to use by the state government.