Scrub typhus: as it stands today

Scrub typhus is one of the three most common causes of prolonged fever in Southeast Asia and Pacific affecting almost 1 million people annually worldwide out of 1 billion exposed. Scrub typhus is a rickettsial infection caused by Orientia Tsutsugamushi transmitted through bite of Chiggers (larval stage of trombiculid mite). It is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure and death. Deaths are attributable to late presentation, delayed diagnosis, and drug resistance. Scrub typhus, though endemic in India; yet is under reported. It should be considered as an important differential diagnosis in a febrile patient with thrombocytopenia, deranged liver or renal functions, and B/L chest opacities. Relapse is not uncommon. Presumptive treatment with Doxycycline can be a suitable option in febrile patients from Typhus pockets. Alert physician should keep an eye on deviation from usual presentation to changing spectrum of the disease. Early diagnosis and appropriate treatment is rewarding and prevents morbidity and mortality.

Analysis of chikungunya outbreak of 2016 in Rajasthan: a clinico-epidemiological study

Background: To describe the diversity of clinical manifestations, laboratory findings and outcome of chikungunya fever in patients attending SMS Hospital, Jaipur during the epidemic of 2016 (September to November).Methods: All cases of febrile illness with polyarthralgia/polyarthritis diagnosed as chikungunya were analyzed. Diagnosis was made by ELISA based IgM serology and RT PCR assay.Results: A total of 200 cases were studied. All of them presented with fever, severe crippling joint pain & tenderness, headache, anorexia and body rash. On examination, there was periarticular edema, erythema, and tenderness in joints with post auricular and cervical lymphadenopathy. Unusual manifestations were hyper pigmentation of face and forehead and scrotal ulcers. On investigations patient had leucopenia with elevated level of SGOT, SGPT with normal bilirubin levels. Other complications observed were encephalopathy, encephalitis, myocarditis and hepatitis. There was no mortality in this group.Conclusions: Chikungunya though prevalent is under-reported. The diagnostic certainty is mandated by presence of febrile transiently crippling polyarthragias / arthritis. On analyzing a large series, unusual clinical features may emerge