scholarly journals Serological Detection and Epidemiological Factors Associated with Scrub Typhus among Undifferentiated Febrile Illness Patients in a Tertiary Care Hospital

2021 ◽  
Author(s):  
V.M. Somasunder ◽  
K. Akila ◽  
S. Sijimol ◽  
S. Senthamarai ◽  
S. Sivasankari ◽  
...  
Keyword(s):  
Rural Areas ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Laboratory Diagnosis ◽  
P Value ◽  
Care Hospital ◽  
Serum Samples ◽  
Serological Tests ◽  
Igm Elisa

Scrub typhus is an arthropod-borne zoonotic bacterial infection caused by Orientia tsutsugamushi. It presents clinically as a non-specific febrile illness that needs a high index of clinical suspicion for diagnosis. The mortality rate can be as high as 30% if not treated appropriately. Laboratory diagnosis is therefore important for confirming the cause of illness prior to initiating appropriate therapy. Hence we aimed to detect scrub typhus in serum samples of undifferentiated febrile illness patients and to correlate with the socioeconomic status of these individuals. We also aimed to study the seasonal variation associated with the disease. Serum samples from 143 febrile patients who were negative for other febrile illnesses were subjected to scrub typhus IgM ELISA. Scrub typhus IgM antibodies were found in 14 (9.8%) individuals of which 41-60 years being the most affected age group. Scrub typhus positivity was high during the months of October to December (P-value 0.0056) with the individuals from the rural areas being the most affected (P-value 0.027). To conclude, this study emphasises the importance of serological tests to detect scrub typhus and to include it as a differential diagnosis among undifferentiated febrile illnesses.

scholarly journals Serological evidence of human leptospirosis in patients with acute undifferentiated febrile illness from Uttarakhand, India: A pilot study

2019 ◽  
Vol 11 (01) ◽  
pp. 011-016
Author(s):  
Mohit Bhatia ◽  
Pradeep Kumar ◽  
Pratima Gupta ◽  
Puneet Kumar Gupta ◽  
Minakshi Dhar ◽  
...  
Keyword(s):  
Pilot Study ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Immunoglobulin M ◽  
Serological Evidence ◽  
Serum Samples ◽  
Malaria Parasites ◽  
Human Leptospirosis ◽  
Igm Elisa

Abstract CONTEXT: To the best of our knowledge, there are no reports of serological evidence of human leptospirosis from Uttarakhand state in India. AIMS: The aim of this study was to screen for serological evidence of leptospirosis in patients with acute undifferentiated febrile illness at a tertiary care teaching hospital in Uttarakhand. SETTINGS AND DESIGN: A pilot study was conducted from March to November 2017. SUBJECTS AND METHODS: Fifty-three adult patients who presented in Medicine outpatient Department with a history of fever of ≥7 up to 14 days duration with or without other associated symptoms such as a headache, rashes, myalgia, arthralgia, and conjunctival suffusion were enrolled in the study using convenience sampling technique. Blood samples of these patients were collected and subjected to peripheral smear examination for malaria parasites, dengue immunoglobulin M (IgM) immunochromatographic card test, IgM Typhidot, Leptospira and Scrub typhus IgM ELISA, respectively. Aerobic blood culture was performed in 24 cases. Relevant clinico-epidemiological details were obtained as per the pro forma formulated in accordance with the modified Faine’s criteria. STATISTICAL ANALYSIS USED: Descriptive statistics. RESULTS: The study population consisted of 50.94% of males and 49.06% of females with a mean age ± standard deviation of 34.2 ± 15.2 years. Fifty febrile patients had additional symptoms of which myalgia was the most common (81.1%) followed by arthralgia (22.6%). Peripheral smears of all patients were negative for malaria parasites. Dengue and Typhidot IgM positivity was observed in two and eight patients, respectively. Six and five patients were tested positive by leptospira and scrub typhus IgM ELISA, respectively. Salmonella Typhi was isolated from blood sample of only one patient. Serum samples of two patients showed dual positivity. All six leptospira seropositive patients satisfied modified Faine’s criteria. CONCLUSIONS: Leptospirosis is a seemingly unexplored infection in Uttarakhand and should be considered as a differential diagnosis in patients with acute undifferentiated febrile illness.

scholarly journals Burden of scrub typhus among patients with acute febrile illness attending tertiary care hospital in Chitwan, Nepal

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e034727
Author(s):  
Sangita Thapa ◽  
Pradip Hamal ◽  
Navin Kumar Chaudhary ◽  
Lokendra Bahadur Sapkota ◽  
Jaya Prasad Singh
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
College Teaching ◽  
Febrile Illness ◽  
Care Hospital ◽  
Acute Febrile Illness ◽  
Medical College ◽  
Igm Elisa ◽  
High Prevalence ◽  
And Control

ObjectivesScrub typhus is an emerging neglected tropical disease, reported from many parts of Asia including Nepal. This study aims to determine the seroepidemiology of scrub typhus among febrile patients attending Chitwan Medical College Teaching Hospital (CMC-TH), Bharatpur, Nepal.Study design and settingThis was a hospital laboratory-based prospective study conducted in CMC-TH (a 750-bed hospital) located in Bharatpur, Chitwan district of Nepal.ParticipantsA total of 1797 patients visiting CMC-TH with acute febrile illness (temperature more than 38°C) were enrolled in this study.MethodsA total of 1797 blood samples were collected from patients presenting with acute febrile illness. The samples were processed for detection of antibody for scrub typhus by ELISA for specific IgM antibody and Weil-Felix test.ResultsOut of 1797 serum sample of febrile patients, 524 (29.2%) were scrub typhus positive. Maximum seropositive cases were from Chitwan district, 271 (51.7%) with predominance among women, 314 (35.9%). Scrub typhus was common among age group 51–60 years (37.2%) and farmers, 182 (37.8%). Highest seropositivity was found in July, 60 (57.7%). Fever was common clinical symptom. Thrombocytopenia was seen in 386 (73.7%) and raised transaminase aspartate aminotransferase, 399 (76.1%) among seropositive cases. Weil-Felix test positive were 397 (22.1%) and IgM ELISA positive were 524 (29.2%). The correlation between IgM ELISA and Weil-Felix test showed statistically significant association (r=0.319, p<0.001).ConclusionHigh prevalence of scrub typhus implies that patients with acute febrile illness should be investigated for scrub typhus with high priority. There is utmost need of reliable diagnostic facilities at all levels of healthcare system in Nepal. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. More sustain and vigorous awareness programmes need to be promoted for early diagnosis, treatment and control.

scholarly journals Dengue Viral Augmentation among the Population of Few Districts of Assam and Neighbourhood Visiting Tezpur Medical College & Hospital

2021 ◽  
Vol 6 (2) ◽  
pp. 25-36
Author(s):  
Samrat Biswas ◽  
Jyoti Hazarika ◽  
Mihirjyoti Pathak
Keyword(s):  
Tertiary Care ◽  
Febrile Illness ◽  
Hemorrhagic Fever ◽  
Severe Bleeding ◽  
Care Hospital ◽  
Serum Samples ◽  
Epidemic Disease ◽  
College Hospital ◽  
Diagnostic Laboratory ◽  
Medical College

Dengue virus (DENV) has rapidly expanded its range through tropical and subtropical regions in recent years. This pathogen causes acute febrile illness (dengue fever, DF) and severe bleeding disease (dengue hemorrhagic fever, DHF) in humans. In this study we are trying to analyze the data obtained from the diagnosis conducted upon the Dengue suspected patients visiting tertiary care hospital, Sonitpur, Assam and to give a scientific evaluation to the pattern or spread of this epidemic disease. A total of 361 serum samples are analysed from suspected dengue cases during this study period. This study basically gives our research team to go more investigating the dengue viral expansion in coming days as we were able to discriminate among the patients on the basis of primary and secondary infections, what they were previously not examined for. Significant clue for the presence of secondary dengue viral infections (17.3%) among 10 different districts is found. Keywords: Dengue, Viral Research and Diagnostic Laboratory (VRDL), Tezpur Medical College & Hospital (TMCH).

scholarly journals Incidence of scrub typhus in a tertiary care hospital in Kolkata, India

2020 ◽  
Vol 7 (5) ◽  
pp. 825
Author(s):  
Kausik Munsi ◽  
Sayonee Das ◽  
Ramiz Islam ◽  
Parvez Shahide Biswas ◽  
Satyabrata Ganguly ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Female Ratio ◽  
Gi Symptoms ◽  
Ns1 Antigen ◽  
Morbilliform Rash ◽  
Almost All

Background: Authors aimed to identify incidence of scrub typhus among patients of fever. Scrub typhus is an endemic disease in India caused by Orientia tsutsugamushi, transmitted by trombiculid mites. It is an important cause of acute febrile illness in India. Signs and symptoms include fever, headache, myalgia and GI symptoms and is generally associated with morbilliform rash (<40%), eschar (<50%) which is due to bite of the mite. Abnormal LFTs and lymphocytosis are commonly seen in early phase of illness. It’s often labelled as PUO. Early diagnosis and prompt administration of therapy mostly leads to complete recoveryMethods: Authors screened 100 patients presenting with fever, malaise, headache, with or without rash for more than a week from the month of May to December 2019. Routine blood investigations with fever profile (Dengue NS1 antigen, MP, MPDA, TyphidotM) and cultures were done. Patients in whom no cause of fever could be established, having lymphocytosis, hyponatremia and transaminitis, they were tested for Scrub typhus by using Indirect immunofluorescence & detection of IgM antibody.Results: Total 22 patients were found positive for scrub typhus by using the aforementioned method (22%). Male: Female ratio was 3:4 (9 vs 12). Patients were in the age group of 16-76 years. Lymphocytosis, hyponatremia and transaminitis were cardinal features seen in almost all patients diagnosed with Scrub Typhus.Conclusions: This study will help clinicians to have a stronger suspicion of scrub typhus in undiagnosed febrile patients.

scholarly journals Clinical and Sero Immunological Profile of Scrub Typhus in Bengaluru, Southern India

2020 ◽  
Author(s):  
JV Shwetha ◽  
Sneha K Chunchanur ◽  
R Ambica
Keyword(s):  
Phylogenetic Analysis ◽  
Scrub Typhus ◽  
Ethylenediaminetetraacetic Acid ◽  
Severe Disease ◽  
Tertiary Care ◽  
Laboratory Diagnosis ◽  
Southern India ◽  
Strain Typing ◽  
Care Hospital ◽  
Pcr Rflp

Introduction: Scrub typhus is a common but neglected cause of Acute Febrile Illness (AFI) in India. Under diagnosis of this severe disease with protean manifestations, can negatively influence the treatment and outcome. Early laboratory diagnosis by appropriate means is therefore important. In addition, as antigenically diverse variants of Orientia tsutsugamushi (O.tsutsugamushi)are known to exist and evolve, information regarding the strain types is also crucial. Aim: To know the clinical spectrum, laboratory diagnosis by different modalities, outcome and strain variation of scrub typhus in Southern India. Materials and Methods: A prospective cross-sectional study was conducted in a Tertiary Care Hospital in Bengaluru, Southern India from June 2015 to May 2017. Hundred clinically suspected cases of scrub typhus (rickettsioses) were enrolled. Serum and EDTA (Ethylenediaminetetraacetic acid) blood samples were subjected to serodiagnosis for scrub typhus and Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) respectively. Strain characterisation was done by Microimmunofluorescence (MIF), PCR-RFLP and phylogenetic analysis. Patients were followed-up for four weeks. Data was entered in Microsoft Excel spreadsheet and analysed using Statistical Package for the Social Sciences (SPSS) software. Results: Laboratory evidence of scrub typhus was showed by 38% of the cases. Seropositivity was more in comparison to PCR. Paediatric preponderance and seasonal trend was evident. Strain typing showed presence of different strain types, with no correlation between clinical features and strain types. PCR-RFLP results correlated well with phylogeny, while MIF results did not match. All the patients responded to doxycycline, except for 12% who succumbed. Conclusion: Different strain types of O. tsutsugamushi are known to cause scrub typhus in Southern India. PCR-RFLP can be a useful preliminary tool for strain typing in resource poor settings, where phylogenetic analysis is not possible. Early diagnosis and treatment helps in improved outcome.

Seroprevalence and clinical profile of scrub typhus in patients presenting with undifferentiated acute febrile illness in a tertiary care centre

2021 ◽  
Vol 12 (4) ◽  
pp. 54-60
Author(s):  
Reena Anie Jose ◽  
Hyma Jose ◽  
Anjali Anne Jacob ◽  
Pramod Thomas ◽  
Renu Mathew ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Laboratory Finding ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Febrile Illness ◽  
Clinical Profile ◽  
Bivariate Analysis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Rickettsial Infections ◽  
Igm Elisa

Background: Scrub typhus (ST) is a common Rickettsial infection which has been increasingly reported from the various states of southern part of India. Aims and Objective: With very few reports from Central Kerala, we aimed to study the seroprevalence of scrub typhus and its clinical profile. Materials and Methods: Patients presenting with acute undifferentiated febrile illness and other symptoms and signs of Rickettsial infections during a period of two years were included in this prospective study. Serodiagnosis of ST was based on a positive Scrub typhus IgM Enzyme Linked Immunosorbent Assay (ELISA) and/or agglutination for OXK in Weil Felix test. The cut-off for ELISA was calculated. The clinical and laboratory details of the positive patients were obtained and bivariate analysis was performed. Results: The cut-off for ST IgM ELISA was calculated and found to be 0.38. Of the 636 samples screened, 34 (5.3%) were positive for ST IgM ELISA. Out of the 34 positive samples, only 5 (0.8%) were positive by Weil Felix test. Most of the ST patients presented during the months of May to January. Rashes were observed in 8.8% of the ST patients and none had signs of eschar. The commonest clinical features included fever, myalgia (52.9%), nausea & vomiting (32.4%), headache (29.4%) and hepatosplenomegaly (29.4%). The commonest abnormal laboratory finding and complication observed were elevated serum transaminases (52.9%) and acute respiratory distress syndrome (17.6%) respectively. Conclusion: The seroprevalence of ST in Central Kerala was 5.3% using Weil Felix test and ST IgM ELISA.

scholarly journals Clinico-Laboratory Profile, Complications and Therapeutic Outcome of Scrub Typhus in Children

2020 ◽  
Vol 18 (2) ◽  
pp. 282-287
Author(s):  
Ram Hari Chapagain ◽  
Sumit Agrawal ◽  
Sunita Pokharel ◽  
Madhusudhan Kayastha ◽  
Susan Bhattrai ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Febrile Illness ◽  
Abdominal Distension ◽  
Therapeutic Outcome ◽  
Care Hospital ◽  
Middle Income ◽  
Increased Risk ◽  
Laboratory Profile

Background: Scrub typhus, an important cause of undifferentiated fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to describe the clinico-laboratory profile, drug used in treatment, predictor of PICU admission and therapeutic outcome of serologically confirmed scrub typhus among Nepalese children.Methods: A prospective observational study was carried out in children aged up to 14 years with serologically (IgM ELISA) diagnosed Scrub typhus, admitted in a tertiary care hospital of central Nepal between Jan 2019 to Dec 2019.Results: All 100 children with scrub typhus presented with fever. Other symptoms and sign were cough (29%), abdominal distension (22%) hepatomegaly (45%), splenomegaly (28%), crepitation (10%) and eschar (6%). Similarly, thrombocytopenia (72%), and increased liver enzymes SGPT (51%) and SGOT (62%) were found. Co-infection with dengue (5%) brucella (5%) and UTI (5%) were seen. Thirty six percent has some form of complication. Fifty eight percent of children were treated with azithromycin and 25% treated with doxycycline. The mean length of hospital stay was 6.68 ±2.97 days with a mean duration of defervescence being 30.07 ± 26.65 hours. The increased risk of PICU admission was found in those children with crepitation in chest (OR: 15.17, 95% CI: 3.4-66.8) during presentation and those children not getting azithromycin as treatment (OR: 3.8, 95% CI: 1.2-11.7)Conclusions: Scrub typhus should be considered as a differential diagnosis in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Sepsis, meningitis and pneumonia are important complications. Child having crepitation on presentation has an increased chance admission in critical care unit. The child receiving azithromycin has less chance to land in PICU.Keywords: Clinico-laboratory profile; complications; fever; scrub typhus.

scholarly journals Seroprevalence of Scrub Typhus among Pyrexia of Unknown Origin Patients: A Study from Tertiary Care Hospital in Eastern Odisha, India

2020 ◽  
Author(s):  
Shreekant Tiwari ◽  
Monalisah Nanda
Keyword(s):  
Differential Diagnosis ◽  
Dengue Fever ◽  
Scrub Typhus ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Clinical Samples ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Pyrexia Of Unknown Origin ◽  
Igm Elisa

Introduction: Scrub typhus is a fatal rickettsial infection. It is caused by mite-borne bacterium Orientia tsutsugamushi which is transmitted by the bite of mite larvae called chiggers. It usually presents with acute febrile illness. Clinicians usually do not consider it as differential diagnosis as it is still an unknown entity. Aim: To assess the seroprevalence of scrub typhus among the pyrexia of unknown cases in Eastern part of Odisha, India. Materials and Methods: This was a cross-sectional study involving 260 serum samples obtained from clinically suspected cases of scrub typhus. Detection of antibodies was done on the samples by Immunochromatography (ICT) and IgM ELISA (Enzyme Linked Immunosorbent Assay). Samples were also processed for dengue fever, malaria, typhoid and leptospirosis which are the other causes of febrile illness in this region and excluded from the study once they come positive. Among these febrile cases which were excluded from study, malaria was predominant (44%) followed by typhoid (34.4%), dengue (15%) and leptospirosis (6.45%). Descriptive statistical analysis was applied to evaluate the results. Results: Out of 260 clinical samples, 74 (28.46%) were positive by IgM ELISA. There was good correlation (98.6%) between ICT and IgM ELISA. Fever was the most common clinical symptom followed by abdominal pain. Pathognomonic feature such as eschar was seen in one patient only. Scrub typhus should be considered as one of the differential diagnosis of Pyrexia of Unknown Origin (PUO) cases, along with dengue fever, malaria typhoid and leptospirosis. Conclusion: IgM ELISA is simple, rapid and economical test and should be used as reference diagnostic test for the diagnosis of scrub typhus.

scholarly journals Hyperferritinemia in children hospitalized with scrub typhus

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Vijai Williams ◽  
Nisha Menon ◽  
Prateek Bhatia ◽  
Manisha Biswal ◽  
Sreejesh Sreedharanunni ◽  
...  
Keyword(s):  
Organ Dysfunction ◽  
Scrub Typhus ◽  
Tertiary Care ◽  
Secondary Analysis ◽  
Febrile Illness ◽  
Late Presentation ◽  
North India ◽  
Risk Scores ◽  
Early Presentation ◽  
Igm Elisa

Abstract Background Hyperferritinemia is increasingly associated with mortality in sepsis. Studies estimating the prevalence of hyperferritinemia in pediatric scrub typhus are limited. Methods This was a secondary analysis of a prospective observational study (FERRIS) from a tertiary care teaching hospital in North India where 72 children with confirmed scrub typhus, 4 (5.5%) PCR positive, 55 (76.4%)-IgM ELISA positive, and 13 (18.1%)-both PCR and ELISA positive, were analyzed. Serum ferritin was measured in 62 children to identify the prevalence of hyperferritinemia and determine its association with mortality. Results Hyperferritinemia (> 500 μg/L) was seen in 72.6% [n = 45] children; 26 (41.9%) were mild (500–2000 μg/L), 13 (21%) were moderate (2000–10,000 μg/L), and 6 (9.7%) were severe (> 10,000 μg/L). Early presentation to hospital (≤ 7 days of febrile illness) had more survivors than late presentation (> 7 days). Non-survivors had significantly higher PRISM III, PELOD-2, hyperlactatemia, hypoalbuminemia, organ dysfunction, need for mechanical ventilation, and need of RRT. Ferritin had poor sensitivity and specificity in predicting survival with AUC of 0.56. Organ dysfunction and risk scores as PRISM III, PELOD 2, and VIS at admission were better predictors with AUC (95% CI) of 0.72 (0.56, 0.89), 0.77 (0.63, 0.92), and 0.90 (0.78, 1.0) respectively. Conclusions Hyperferritinemia is common in scrub typhus but it did not predict survival. Organ dysfunction and risk scores were better predictors of mortality than ferritin.

Sign in / Sign up

Export Citation Format

Share Document