Scrub typhus: an underestimated endemic disease of Northwestern Himalayas, India

Jump To Abstract / References Section

Authors

  • Department of Veterinary Public Health and Epidemiology, DGCN College of Veterinary and Animal Sciences, CSK-Himachal Pradesh Agriculture University, Palampur 176 062, India

DOI:

https://doi.org/10.18520/cs/v121/i7/899-905

Keywords:

Acute febrile illness, fever of unknown origin, Himachal Pradesh, meningitis, scrub typhus, Uttarakhand

Published

Downloads

Issue & Section & Categories

Volume 121, Issue 7, 2021 || Review Article

How to Cite

Thakur, S. D. (2021). Scrub typhus: an underestimated endemic disease of Northwestern Himalayas, India. Current Science, 121(7), 899–905. https://doi.org/10.18520/cs/v121/i7/899-905

 

Scrub typhus is a vector-borne rickettsial zoonotic disease, endemic to South Eastern and Far Eastern Asian countries and northern Australia. It is an acute febrile illness, associated with rash and often an eschar, a black crust-like skin lesion. Orientia tsutsugamushi, etiological agent of scrub typhus infects the endothelial cells causing vasculitis, multiple organ dysfunction, life threatening complications and mortalities. Scrub typhus is endemic in Himalayan/sub-Himalayan regions. This review summarizes the status of scrub typhus in mountainous states of India, i.e. Himachal Pradesh, Uttarakhand and Jammu and Kashmir, located in Northwestern Himalayas. Scrub typhus is a major cause of acute febrile illness, fever of unknown origin and febrile jaundice in this region. Disease has been reported both as mono-infection and co-infections with dengue, leptospirosis, malaria and hepatitis from these states. Pediatric scrub typhus cases with neurological complications are common in this region. Agricultural or farming activities are the primary risk factors for the occurrence of scrub typhus in both rural and urban population. Early presentation of the cases and timely diagnosis and treatment of patients is crucial to prevent life threatening complications and deaths. Scrub typhus mimics epidemiology and clinical course of commonly reported infectious diseases and requires differential diagnosis. Therefore, it is imperative to make health workers aware about its manifestations for early diagnosis and treatment and accurate prevalence estimations.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Xu, G., Walker, D. H., Jupiter, D., Melby, P. C. and Arcari, C. M., A review of the global epidemiology of scrub typhus. PLoS Negl. Trop. Dis., 2017, 11, e0006062; doi:10.1371/journal.pntd.0006062.

Watt, G. and Parola, P., Scrub typhus and tropical rickettsioses. Curr. Opin. Infect. Dis., 2003, 16, 429–436.

Ahmad, S., Srivastava, S., Verma, S. K., Puri, P. and Shirazi, N., Scrub typhus in Uttarakhand, India: a common rickettsial disease in an uncommon geographical region. Trop. Doct., 2010, 40, 188–190.

Luce-Fedrow, A. et al., A review of scrub typhus (Orientia tsutsugamushi and related organisms): then, now, and tomorrow. Trop. Med. Infect. Dis., 2018, 3, 8; doi:10.3390/tropicalmed3010008.

Elliott, I., Pearson, I., Dahal, P., Thomas, N. V., Roberts, T. and Newton, P. N., Scrub typhus ecology: a systematic review of Orientia in vectors and hosts. Parasit. Vectors, 2019, 12, 513; doi: 10.1186/s13071-019-3751-x

Traub, R. and Wisseman Jr, C. L., Current concepts of the ecology of chigger borne rickettsiosis (scrub typhus). Jpn. J. Med. Sci. Biol., 1974, 27, 1–5.

Muul, I. and Chai, K. S., Distribution of rats infected with Rickettsia tsutsugamushi (scrub typhus) in an edge habitat. Southeast Asian J. Trop. Med. Public Health, 1978, 9, 489–593.

Rajapakse, S., Rodrigo, C. and Fernando, D., Scrub typhus: pathophysiology, clinical manifestations and prognosis. Asian Pac. J. Trop. Med., 2012, 5, 261–264.

Singh, P., Scrub Typhus, a case report: military and regional significance. Med. J. Armed Forces India, 2004, 60, 89–90.

Park, J. I. et al., Outbreak of hepatitis by Orientia tsutsugamushi in the early years of the new millennium. Korean J. Hepatol., 2003, 9, 198–204.

Mahajan, S. K. et al., Pattern of clinical presentation, laboratory findings and mortality risk among patients of scrub typhus in Western Himalayas. J. Assoc. Phys. India, 2016, 64, 26–30.

Gaba, S., Gaba, N., Gupta, M. and Sharma, S., Hepatic and renal profile of scrub typhus patients at a tertiary care center in India. Cureus, 2020, 12, e7925; doi:10.7759/cureus.7925.

Balcells, M. E. et al., Endemic scrub typhus-like illness, Chile. Emerg. Infect. Dis., 2011, 17, 1659–1663.

Izzard, L. et al., Isolation of a novel Orientia species (O. chuto sp. nov.) from a patient infected in Dubai. J. Clin. Microbiol., 2010, 48, 4404–4409.

Weitzel, T. et al., Endemic ccrub typhus in South America. N. Engl. J. Med., 2016, 375, 954–961.

Mahajan, S. K. and Mahajan, S. K., Neuropsychiatric manifestations of scrub typhus. J. Neurosci. Rural Pract., 2017, 8, 421–426.

Sharma, A., Mahajan, S., Gupta, M. L., Kanga, A. and Sharma, V., Investigation of an outbreak of scrub typhus in the Himalayan region of India. Jpn. J. Infect. Dis., 2005, 58, 208–210.

Mahajan, S. K. et al., Scrub typhus in Himalayas. Emerg. Infect. Dis., 2006, 12, 1590–1592.

Mittal, G., Ahmad, S., Agarwal, R. K., Dhar, M., Mittal, M. and Sharma, S., Aetiologies of acute undifferentiated febrile illness in adult patients – an experience from a tertiary care hospital in Northern India. J. Clin. Diagn. Res., 2015, 9, DC22–DC24; doi:10.7860/JCDR/2015/11168.6990.

Singh, R., Singh, S. P. and Ahmad, N. A., Study of etiological pattern in an epidemic of acute febrile illness during monsoon in a tertiary health care institute of Uttarakhand, India. J. Clin. Diagn. Res., 2014, 8, MC01–MC03; doi:10.7860/JCDR/2014/8965.4435.

Raina, S., Raina, R. K., Agarwala, N., Raina, S. K. and Sharma, R., Coinfections as an aetiology of acute undifferentiated febrile illness among adult patients in the sub-Himalayan region of north India. J. Vector Borne Dis., 2018, 55, 130–136.

Sonthayanon, P. et al., Association of high Orientia tsutsugamushi DNA loads with disease of greater severity in adults with scrub typhus. J. Clin. Microbiol., 2009, 47, 430–434.

Bhat, N. K. et al., Scrub typhus in children at a tertiary hospital in north India: clinical profile and complications. Iran J. Pediatr., 2014, 24, 387–392.

Silpapojakul, K., Scrub typhus in the Western Pacific Region. Ann. Acad. Med. Singapore, 1997, 26, 794–800.

Mahajan, S. K., Rolain, J. M., Sankhyan, N., Kaushal, R. K. and Raoult, D., Pediatric scrub typhus in Indian Himalayas. Indian J. Pediatr., 2008, 75, 947–949.

Kaushik, R. M., Kaushik, R. and Bhargava, A., Multiple eschars in scrub typhus. Trop. Med. Health, 2014, 42, 65–66.

Koraluru, M., Nandigam, M., Bairy, I., Vidyasagar, S. and Varma, M., Multiple eschars in scrub typhus: a case report. Trop. Doct., 2017, 47, 67–69.

Mokta, J., Ranjan, A. and Mokta, K., Early clinical suspicion and early use of doxycycline reduces scrub typhus associated complications. J. Assoc. Phys. India, 2019, 67, 26–27.

Kumar, R., Thakur, S., Bhawani, R., Kanga, A. and Ranjan, A., Clinical profile and complications of scrub typhus: hospital-based study in Sub-Himalayan region. J. Assoc. Phys. India, 2016, 64, 30–34.

Wang, C. C., Liu, S. F., Liu, J. W., Chung, Y. H., Su, M. C. and Lin, M. C., Acute respiratory distress syndrome in scrub typhus. Am. J. Trop. Med. Hyg., 2007, 76, 1148–1152.

Mahajan, S. K., Kaushik, M., Raina, R., Sharma, R. C., Thakur, P. and Sharma, B., Scrub typhus with visual hallucinations. J. Trop. Doct., 2015, 45, 146–147; doi:10.1177/0049475514565426.

Viswanathan, S., Muthu, V., Iqbal, N., Remalayam, B. and George, T., Scrub typhus meningitis in South India – a retrospective study. PLoS ONE, 2013, 8, e66595; doi:10.1371/journal.pone.0066595.

Kang, Ji-In., Kim, D. M. and Lee, J., Acute sensorineural hearing and severe otalgia due to scrub typhus. BMC Infect. Dis., 2009, 9, 173; doi:10.1186/1471-2334-9-173.

Premaratna, R., Chandrasena, T. G., Dassayake, A. S., Loftis, A. D., Dasch, G. A. and de Silva, H. J., Acute hearing loss due to scrub typhus: a forgotten complication of a reemerging disease. Clin. Infect. Dis., 2006, 26, 42, e6–e8; doi.org/10.1086/498747.

Bhardwaj, B., Panda, P., Revannasiddaiah, S. and Bhardwaj, H., Abducens nerve palsy in a patient with scrub typhus: a case report. Trop. Biomed., 2013, 30, 706–709.

Lee, Y. H., Yun, Y. J. and Jeong, S. H., Isolated abducens nerve palsy in a patient with scrub typhus. J. Am. Assoc. Pediatr. Opthalmol. Strabismus, 2010, 14, 460–461.

Chauhan, V., Thakur, A. and Thakur, S., Eschar is associated with poor prognosis in scrub typhus. Indian J. Med. Res., 2017, 145, 693–696; doi:10.4103/ijmr.IJMR_1888_15.

Deepak, N. A. and Patel, N. D., Differential diagnosis of acute liver failure in India. Ann. Hepatol., 2006, 5, 150–156.

Mathai, E. et al., Outbreak of scrub typhus in southern India during the cooler months. Ann. N. Y. Acad. Sci., 2003, 990, 359–364.

Ahmad, S. et al., A comparative hospital-based observational study of mono- and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever. Eur. J. Clin. Microbiol. Infect.

Dis., 2016, 35, 705–711.

Bhargava, A. et al., Scrub typhus in Uttarakhand and adjoining Uttar Pradesh: Seasonality, clinical presentations and predictors of mortality. Indian J. Med. Res., 2016, 144, 901–909.

Guleria, V. S., Sharda, C., Sood, A. K. and Kumar, V., Scrub typhus: atypical presentation in sub-Himalayan region. Med. J. Armed Forces India, 2018, 74, 180–182.

Pathania, M., Amisha, Malik, P. and Rathaur, V. K., Scrub typhus: Overview of demographic variables, clinical profile, and diagnostic issues in the sub-Himalayan region of India and its comparison to other Indian and Asian studies. J. Family Med. Prim. Care, 2019, 8, 1189–1195.

Bhat, N. K., Pandita, N. and Dhar, M., Scrub typhus eschar. Indian Pediatr., 2020, 57, 93.

Varghese, G. M. et al., Scrub typhus among hospitalised patients with febrile illness in South India: magnitude and clinical predictors. J. Infect., 2006, 52, 56–60; doi:10.1016/j.jinf.2005.02.001. 46. Yen, T. H., Chang, C. T., Lin, J. L., Jiang, J. R. and Lee, K. F., Scrub typhus: a frequently overlooked cause of acute renal failure. Ren. Fail., 2003, 25, 397–410.

Bhat, N. K., Jindal, R. and Dhar, M., Eschar of scrub typhus hidden in umbilicus. Indian J. Pediatr., 2018, 85, 247–248.

Bhat, N. K. et al., Scrub Typhus: a clinico-laboratory differentiation of children with and without meningitis. J. Trop. Pediatr., 2016, 62, 194–199.

Mahajan, S. K., Scrub typhus. J. Assoc. Phys. India, 2005, 53, 954–958.

Kumar, R., Thakur, S., Bhawani, R., Kanga, A. and Ranjan, A., Factors for severe outcome in scrub typhus: a hospital based study in sub Himalayan region. J. Assoc. Phys. India, 2018, 66, 36–38.

Sharma, R., Mahajan, S. K., Singh, B., Raina, R. and Kanga, A., Predictors of severity in scrub typhus. J. Assoc. Phys. India, 2019, 67, 35–38.

Sinha, P., Gupta, S., Dawra, R. and Rijhawan, P., Recent outbreak of scrub typhus in North Western part of India. Indian. J. Med. Microbiol., 2014, 32, 247–250.

Farhana, A., Bali, N., Kanth, F., Farooq, R., Haq, I. U. and Shah, P., Serological evidence of scrub typhus among cases of PUO in the Kashmir valley – a hospital based study. J. Clin. Diagn. Res., 2016, 10, DC24–DC26.

Bhatia, M., Kumar, P., Gupta, P., Gupta, P. K., Dhar, M. and Kalita, D., Serological evidence of human leptospirosis in patients with acute undifferentiated febrile illness from Uttarakhand, India: A pilot study. J. Lab. Phys., 2019, 11, 11–16; doi:10.4103/JLP.JLP_ 121_18.

Mahajan, S. K., Babu, S., Singh, D., Kanga, A. and Kaushal, S. S., Scrub typhus and leptospirosis co-infection in Himalayan region. Trop. Doct., 2012, 42, 176–177.

Park, S. W. et al., Urbanization of scrub typhus disease in South Korea. PLoS Negl. Trop. Dis., 2015, 9, e0003814; doi:10.1371/journal.pntd.0003814; eCollection 2015.

Thapliyal, D. C. and Thakur, S. D., Livestock diseases in Himalayan region: a public health perspective. In Proceedings of Livestock Production Systems for Sustainable Food Security and Livelihoods in Mountain Areas, Department of Animal Sciences, GB Pant University of Agriculture and Technology, Pantnagar,

Uttrakhand, India, 2003, pp. 139–148.

Kumar, K., Saxena, V. K., Thomas, T. G. and Shiv Lal, Outbreak investigation of scrub typhus in Himachal Pradesh (India). J. Commun. Dis., 2004, 36, 277–283.

Rana, A., Mahajan, S. K., Sharma, A., Sharma, S., Verma, B. S. and Sharma, A., Neurological manifestations of scrub typhus in adults. Trop. Doct., 2017, 47, 22–25.

Sood, S., Sharma, S. and Khanna, S., Role of advanced MRI brain sequences in diagnosing neurological complications of scrub typhus. J. Clin. Imaging Sci., 2015, 5, 11; doi:10.4103/2156-7514.152340.

Mahajan, S. K. et al., Scrub typhus presenting as acute cerebellitis. J. Assoc. Phys. India, 2016, 64, 69–70.

Himral, P., Sharma, K. N., Kudial, S. and Himral, S., Scrub meningitis complicated by multiple cranial nerve palsies and cerebellitis. J. Assoc. Phys. India, 2019, 67, 88–89.

Mahajan, S. K. and Bakshi, D., Acute reversible hearing loss in scrub typhus. J. Assoc. Phys. India, 2007, 55, 512–514.

Mahajan, S. K., Babu, S. N., Sharma, D., Singh, D., Kanga, A. and Kaushal, S. S., Scrub typhus presenting as acute abdomen. Trop. Doct., 2011, 41, 185–186.

Mokta, J., Yadav, R., Mokta, K., Panda, P. and Ranjan, A., Scrub Typhus – the most common cause of febrile jaundice in a tertiary care hospital of Himalayan state. J. Assoc. Phys. India, 2017, 65,

–50.

Vikrant, S., Gupta, D. and Singh, M., Epidemiology and outcome of acute kidney injury from a tertiary care hospital in India. Saudi J. Kidney Dis. Transpl., 2018, 29, 956–966.

Sood, A. K., Chauhan, L. and Gupta, H., CNS manifestations in Orientia tsutsugamushi disease (Scrub Typhus) in North India. Indian J. Pediatr., 2016, 83, 634–639.

Mittal, G., Ahmad, S., Agarwal, R. K., Dhar, M., Mittal, M. and Sharma, S., Aetiologies of acute undifferentiated febrile illness in adult patients – an experience from a tertiary care hospital in Northern India. J. Clin. Diagn. Res., 2015, 9, DC22–DC24; doi:10.7860/JCDR/2015/11168.6990.

Rawat, V., Singh, R. K., Kumar, A., Saxena, S. R., Varshney, U. and Kumar, M., Epidemiological clinical and laboratory profile of scrub typhus cases detected by serology and RT-PCR in Kumaon,

Uttarakhand: a hospital-based study. Trop. Doct., 2018, 48, 103–106.

Mehta, V., Bhasi, A., Panda, P. K. and Gupta, P. A., Coinfection of severe leptospirosis and scrub typhus in Indian Himalayas. J. Family Med. Prim. Care, 2019, 8, 3416–3418.

Menon, R. D., Padbidri, V. S. and Gupta, N. P., Sero-epidemiological survey of scrub typhus. J. Hyg. Epidemiol. Microbiol. Immunol., 1978, 22, 306–311.

Watt, G., Jongsakul, K. and Suttinont, C., Possible scrub typhus coinfections in Thai agricultural workers hospitalized with leptospirosis. Am. J. Trop. Med. Hyg., 2003, 68, 89–91.