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TYPHUS
Introduction
Acute
infectious
illness,
under
diagnosed
and
underreported
Zoonotic
disease,
Humans
are
accidental
hosts
1
million
cases/
year
Tsutsugamushi
triangle
INDIA:
Prevalent,
Sub
Himalayan
belt
(J&K,
NG,
HP,
SK,
WB,
TN,
PY)
Problems:
Non
specific
presentation,
Limited
awareness,
Low
index
of
suspicion,
Lack
of
diagnostic
facilities
Pathogenesis
Caused
by
Orientia
tsutsugamushi,
obligate
intracellular
gram-negative
bacterium,
IP:
5-10
days
Transmitted
by
arthropod
vector
larval-stage
trombiculid
mite
or
chigger.
The
mites
have
a
four-stage
lifecycle:
egg,
larva,
nymph
and
adult.
Chigger
(larva
of
trombiculid
mite
Humans
acquire
scrub
typhus
when
an
infected
chigger
(larva)
bites
them
and
inoculates
O
tsutsugamushi
pathogens.
The
bacteria
multiply
at
the
inoculation
site,
and
a
papule
forms
that
ulcerates
and
becomes
necrotic,
evolving
into
a
pathognomonic
eschar,
with
regional
LN
enlargement.
Damage
endothelial
integrity
(Vasculitis)
causes
fluid
leakage,
platelet
aggregation,
polymorphs
and
monocyte
proliferation,
leading
to
focal
occlusive
endarteritis.
Clinical
Features
Wide
disease
spectrum:
from
mild
and
self-limiting
to
fatal
disease.
Eschar:
Pathognomonic
if
present,
usually
at
groin,
axilla,
neck
LNE+
Eschar
Acute
Febrile
Illness:
Fever,
Maculopapular
Rash,
Severe
Headache,
myalgia,
cough,
Suffused
conjunctiva
and
Hepatosplenomegaly
(mimics
acute
abdomen)
References:
1. Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect
Dis. 2003;16(5):429-36.
2. Lerdthusnee K, Khuntirat B, Leepitakrat W, et al. Scrub typhus: vector
competence of Leptotrombidium chiangraiensis chiggers and transmission
efficacy and isolation of Orientia tsutsugamushi. Ann N Y Acad Sci.
2003;990:25-35.
3. Walker JS, Chan CT, Manikumaran C, et al. Attempts to infect and
demonstrate transovarial transmission of R. tsutsugamushi in three species of
Leptotrombidium mites. Ann N Y Acad Sci. 1975;266:80-90.
4. Kamarasu K, Malathi M, Rajagopal V, et al. Serological evidence for wide
distribution of spotted fevers & typhus fever in Tamil Nadu. Indian J Med
Res. 2007;126(2):128-30.
5. Sharma A, Mahajan S, Gupta ML, et al. Investigation of an outbreak of scrub
typhus in the Himalayan region of India. Jpn J Infect Dis. 2005;58(4):208-10.
6. Vivekanandan M, Mani A, Priya YS, et al. Outbreak of scrub typhus in
Pondicherry. J Assoc Physicians India. 2010;58:24-8.
7. Watt G, Chouriyagune C, Ruangweerayud R, et al. Scrub typhus infections
poorly responsive to antibiotics in northern Thailand. Lancet.
1996;348(9020):86-9.
8. Panpanich R, Garner P. Antibiotics for treating scrub typhus. Cochrane
Database Syst Rev. 2000;(2):CD002150.
Thank
you!
Questions/Comments/Feedback
Lakshay
Chanana
drlakshay_em@yahoo.com
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