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2013•Japanese Journal of Infectious DiseasesOpen access

Scrub Typhus in South India: a Re-Emerging Infectious Disease

Selvaraj Stephen, Gandhi Kandhakumari, Jothimani Pradeep, Shanmugam M. Vinithra, Pakirsamy K. Siva, Mohamed Hanifah, Elangovan Vanithadevi

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Abstract

Scrub typhus (ST) caused by Orientia tsutsugamushi and transmitted by chiggers of trombiculid mites is an important emerging infectious disease in India.Without early intervention, ST is known to cause serious complications and high morbidity; thus, awareness of this disease among physicians and availability of serological kits can contribute to the control of this rickettsiosis.A serological survey conducted in the 1970s revealed the prevalence of ST in few parts of India (1); however, outbreaks and cases of ST started to appear in several states during the last 10 years, some of which occurred in unanticipated areas (2-18).ST outbreak in 28 adults from October 2001 to February 2002 was first reported in Vellore, Tamil Nadu (3).From the Union Territory of Pondicherry (South India), 50 cases of ST (mostly adults) were recorded by Vivekanandan et al. (13) during a 2year period (April 2006-April 2008) based on clinical features and results of the Weil-Felix (WF) test.After a gap of 4 years, we encountered 26 presumptive ST cases in adults during 5-month period (November 2011-March 2012).During the same period, we encountered 40 presumptive ST cases in children (19).Hence, there exists a possibility of the re-emergence of ST in this part of South India.This preliminary communication of 26 presumptive adult ST cases within a short period of 5 months is aimed at alerting physicians so that these cases in the Asian community are not dismissed as cases of fever of unknown origin (FUO).During 5 relatively cooler months (November 2011-March 2012), 58 adults with FUO from Pondicherry and neighboring Tamil Nadu were screened for ST.The patients were admitted to Mahatma Gandhi Medical College & Research Institute, Pondicherry, a super specialty tertiary care teaching hospital.This work was scrutinized and approved by the institutional research and human ethical committees of Mahatma Gandhi Medical College & Research Institute.Of the 26 ST cases positive for IgM by ELISA, 9 were aged 21-30 years, 5 were aged 31-40 years, 7 were aged 41-50 years, 2 were aged 51-60 years, and 3 were aged 61 years or more.The youngest patient was 21 years old and the eldest was 75.All the patients presented with a history of fever for 1-3 weeks and clinical features, in-

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Scrub typhus (ST) caused by Orientia tsutsugamushi and transmitted by chiggers of trombiculid mites is an important emerging infectious disease in India.Without early intervention, ST is known to cause serious complications and high morbidity; thus, awareness of this disease among physicians and availability of serological kits can contribute to the control of this rickettsiosis.A serological survey conducted in the 1970s revealed the prevalence of ST in few parts of India (1); however, outbreaks and cases of ST started to appear in several states during the last 10 years, some of which occurred in unanticipated areas (2-18).ST outbreak in 28 adults from October 2001 to February 2002 was first reported in Vellore, Tamil Nadu (3).From the Union Territory of Pondicherry (South India), 50 cases of ST (mostly adults) were recorded by Vivekanandan et al. (13) during a 2year period (April 2006-April 2008) based on clinical features and results of the Weil-Felix (WF) test.After a gap of 4 years, we encountered 26 presumptive ST cases in adults during 5-month period (November 2011-March 2012).During the same period, we encountered 40 presumptive ST cases in children (19).Hence, there exists a possibility of the re-emergence of ST in this part of South India.This preliminary communication of 26 presumptive adult ST cases within a short period of 5 months is aimed at alerting physicians so that these cases in the Asian community are not dismissed as cases of fever of unknown origin (FUO).During 5 relatively cooler months (November 2011-March 2012), 58 adults with FUO from Pondicherry and neighboring Tamil Nadu were screened for ST.The patients were admitted to Mahatma Gandhi Medical College & Research Institute, Pondicherry, a super specialty tertiary care teaching hospital.This work was scrutinized and approved by the institutional research and human ethical committees of Mahatma Gandhi Medical College & Research Institute.Of the 26 ST cases positive for IgM by ELISA, 9 were aged 21-30 years, 5 were aged 31-40 years, 7 were aged 41-50 years, 2 were aged 51-60 years, and 3 were aged 61 years or more.The youngest patient was 21 years old and the eldest was 75.All the patients presented with a history of fever for 1-3 weeks and clinical features, in-

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Available abstract

Scrub typhus (ST) caused by Orientia tsutsugamushi and transmitted by chiggers of trombiculid mites is an important emerging infectious disease in India.Without early intervention, ST is known to cause serious complications and high morbidity; thus, awareness of this disease among physicians and availability of serological kits can contribute to the control of this rickettsiosis.A serological survey conducted in the 1970s revealed the prevalence of ST in few parts of India (1); however, outbreaks and cases of ST started to appear in several states during the last 10 years, some of which occurred in unanticipated areas (2-18).ST outbreak in 28 adults from October 2001 to February 2002 was first reported in Vellore, Tamil Nadu (3).From the Union Territory of Pondicherry (South India), 50 cases of ST (mostly adults) were recorded by Vivekanandan et al. (13) during a 2year period (April 2006-April 2008) based on clinical features and results of the Weil-Felix (WF) test.After a gap of 4 years, we encountered 26 presumptive ST cases in adults during 5-month period (November 2011-March 2012).During the same period, we encountered 40 presumptive ST cases in children (19).Hence, there exists a possibility of the re-emergence of ST in this part of South India.This preliminary communication of 26 presumptive adult ST cases within a short period of 5 months is aimed at alerting physicians so that these cases in the Asian community are not dismissed as cases of fever of unknown origin (FUO).During 5 relatively cooler months (November 2011-March 2012), 58 adults with FUO from Pondicherry and neighboring Tamil Nadu were screened for ST.The patients were admitted to Mahatma Gandhi Medical College & Research Institute, Pondicherry, a super specialty tertiary care teaching hospital.This work was scrutinized and approved by the institutional research and human ethical committees of Mahatma Gandhi Medical College & Research Institute.Of the 26 ST cases positive for IgM by ELISA, 9 were aged 21-30 years, 5 were aged 31-40 years, 7 were aged 41-50 years, 2 were aged 51-60 years, and 3 were aged 61 years or more.The youngest patient was 21 years old and the eldest was 75.All the patients presented with a history of fever for 1-3 weeks and clinical features, in-

Key concepts: Scrub typhus, Infectious disease (medical specialty), Typhus, Emerging infectious disease, Virology, Disease, Medicine, Outbreak

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