Kumbha Thulasiram, Koka Hazirunnisa
BACKGROUND Fever is defined as temperature above 37.2oC @ 6 AM and temperature recording above 37.7 C @ 6 PM. Malaria is caused by 5 species of Plasmodium (P.falciparum, P.ovale, P.malariae, P.kowlesi and P.vivax). It is widely distributed in tropics and sub tropics of Africa, Asia and Latin America, and is also most common in South India. Scrub typhus is a mite borne infectious disease caused by Orientia tsutsugamushi. Scrub typhus is a significant and widespread disease in Asia. In India, cases of scrub typhus were reported during world war–II from Assam and West-Bengal; later the presence of this disease was found throughout India; from South India isolated case reports are seen from Kerala, Tamilnadu and Karnataka. Many cases were reported in Andhra Pradesh, but no documentation is available, and those cases might exist in other states of India. MATERIALS AND METHODS Study Population: Patients admitted in medical wards of S.V.R.R.G.G.H. Study Place: Department of General Medicine, S. V. Medical College, Tirupati. Study Period: June 2017 to January 2018. Methods: From June 2017 to January 2018. Patients admitted at S.V.R.R.G.G.H who had obscure fever for >5 days were tested for IgM antibody against Orientia tsutsugamushi, the causative organism of scrub typhus. Scrub typhus was diagnosed on the basis of ELISA for IgM antibody against Orientia and also tested for MP (QBC)- the lab investigation for malaria. Institutional review board/ethics committee decided approval was not required for this study. RESULTS Presence of IgM antibodies against Orientia tsutsugamushi was demonstrated in 67 cases which indicate recent infection of scrub typhus. Majority of the cases belonged to Chittoor district of Andhra Pradesh. Majority of the cases were from the rural belts; 36 patients (64%) were involved in some sort of farm work at the time of infection, and for malaria most of them were treated as clinical malaria. Peak incidence for scrub typhus is seen in the age group of 30-40 years with male to female ratio nearly 2:1. CONCLUSION Recurrence of scrub typhus in Andhra Pradesh confirms that scrub typhus prevalence is high in the state which requires high degree of clinical suspicion, knowledge about clinical manifestations of various diseases and use of rapid immunological test in suspected cases to allow early diagnosis. This helps in initiating appropriate treatment with antibiotics. This study highlights the need for further research on epidemiology of scrub typhus and also highlights active preventive measures that have to be taken before it transforms into an endemic disease. We also recommend physicians to consider scrub typhus in their differential diagnosis of fever with altered sensorium as its presentation can vary widely.
