Clinico-demographic profile of scrub typhus in uttarakhand

BACKGROUND: Scrub typhus(ST) a rickettsial infection caused by Orientia tsutsugamushi and transmitted by trombiculid mites“chiggers” particularly Leptotrombidium deliense. It is one of the differential diagnoses of haemorrhagic fevers, especially if associated with acute respiratory distress syndrome and/or jaundice. A necrotic eschar at the inoculating site of the mite is pathognomic of ST.The western Himalayan regions of India, has been witnessing increased incidence of acute febrile illnesses over the years. AIM & OBJECTIVES : 1) To determine the frequency of ST in a tertiary health care hospital in Uttarakhand. 2) To understand the clinical spectrum and associated complications. 3) To analyze the demographic prole of ST cases. MATERIAL & METHODS: The retrospective study was carried out, over a period of 24 months (August 2015 to July 2017), which included cases of AFI, clinically suspected of ST. Serological testing was carried out by using commercial ELISA for specic IgM antibodies against O.tsutsugamushi. RESULTS: Out of the total 3854 cases of AFI attending the tertiary care hospital, the microbiology laboratory received a total of 760 clinically suspected cases of ST for serological testing, 494 cases (12.81%) were found positive for IgM antibodies against O.tsutsugamushi.The common symptoms noted were fever with headache, myalgias, gastrointestinal intolerance, followed by breathlessness, rash and jaundice. Eschar was seen only in 69 patients. The most common complication noticed was ARDS (8.29%) followed by hepatitis (6.88%), petechial heamorrhagic spots (38.3%) and sepsis (6.07%). Mortality rate was found to be 1.8%. The cases were mainly seen in the months between August to October which correlates the infection with the rainy season. CONCLUSION: ST should be considered as one of the differential diagnosis of AFI. Timely diagnosis and management becomes crucial to decrease/limit the diease burden, thus thwarting the onset of complications and mortality