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Background & objectives: Scrub typhus is a rickettsial infection seen along the Asian-Pacific rim and imposes a considerable burden on affected people in low- and middle-income countries. The present study was aimed to determine the direct cost of hospitalization of scrub typhus and its trend over six years. Methods: This was a retrospective, observational, hospital based study of individuals admitted to the hospital, diagnosed with scrub typhus over six years, from January 2013 to December 2018. The potential out of pocket expenditure was evaluated. Results: A total of 198 patients were included in the study. The median cost of admission (adjusted to INR 2020) for the six years (2013 to 2018) was found to be ? 37,026 (US $ 490) [interquartile range (IQR) 22,996-64,992]. The median cost for patients admitted to the intensive care unit (ICU) was ? 128,046 (US $ 1695) (IQR 71,575-201,171), while the cost for patients admitted to the ward-alone was ? 33,232 (US $ 440) (IQR 19,609-45,373). The multivariable analysis showed that ARDS and SOFA score were the independent predictors of ICU admission. Interpretation & conclusions: Hospitalisation for scrub typhus is associated with a substantial healthcare expense. The predictors of increased cost were the presence of acute respiratory distress syndrome (ARDS), shock, increasing sequential organ failure assessment (SOFA) score and duration of hospital stay
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Objective: To compare scrub typhus meningitis with bacterial and tuberculous meningitis.Methods: Children aged<15 years admitted with meningitis were screened and those who fitcriteria for diagnosis of scrub typhus meningitis (n=48), bacterial meningitis (n=44) andtuberculous meningitis (n=31) were included for analysis. Clinical features, investigationsand outcomes were compared between the three types of meningitis. Results: Mean age,duration of fever at presentation, presence of headache and, altered sensorium and presenceof hepatomegaly/splenomegaly were statistically significantly different between the groups.Scrub typhus had statistically significant thrombocytopenia, shorter hospital stay and a betterneurological and mortality outcome. Conclusions: Sub-acute presentation of meningitis inolder age group children, and good outcome is associated with scrub typhus when comparedto bacterial and tuberculous meningitis
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OBJECTIVE: To identify the etiology and risk factors of undifferentiated fever in a cluster of patients in Western Province, Solomon Islands, May 2014. METHODS: An outbreak investigation with a case control study was conducted. A case was defined as an inpatient in one hospital in Western Province, Solomon Islands with high fever (> 38.5 °C) and a negative malaria microscopy test admitted between 1 and 31 May 2014. Asymptomatic controls matched with the cases residentially were recruited in a ratio of 1:2. Serum samples from the subjects were tested for rickettsial infections using indirect micro-immunofluorescence assay. RESULTS: Nine cases met the outbreak case definition. All cases were male. An eschar was noted in five cases (55%), and one developed pneumonitis. We did not identify any environmental factors associated with illness. Serum samples of all five follow-up cases (100%) had strong-positive IgG responses to scrub typhus. All but one control (10%) had a moderate response against scrub typhus. Four controls had low levels of antibodies against spotted fever group rickettsia, and only one had a low-level response to typhus group rickettsia. DISCUSSION: This outbreak represents the first laboratory-confirmed outbreak of scrub typhus in the Western Province of Solomon Islands. The results suggest that rickettsial infections are more common than currently recognized as a cause of an acute febrile illness. A revised clinical case definition for rickettsial infections and treatment guidelines were developed and shared with provincial health staff for better surveillance and response to future outbreaks of a similar kind.
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Background: Co-infections with scrub typhus have been described quite frequently in adults but less frequently in children. Case characteristics: An adolescent girl with varicella infection who had persistent fever. Associated clinical features like pain abdomen, vomiting, and features of third space losses made us suspect a co-infection. IgM and IgG antibodies by ELISA in acute and convalescent serum were suggestive of scrub typhus. Outcome: She recovered following a course of oral doxycycline. Message: In unexplained prolonged fever or atypical clinical manifestations not explainable by the primary disease process, coinfection needs to be considered.
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In a tropical country like India, fevers are caused by different etiological agents. Rickettsial infections, which have a global distribution is one of the differential diagnosis in such cases and are reported from almost all parts of India. Rickettsial diseases widely vary in severity from self-limited mild illnesses to fulminating life-threatening infections. They are obligate intracellular gramnegative coccobacillary forms that multiply within eukaryotic cells which makes it difficult to culture them on artificial culture medium. With globalization there is rapid spread of disease across the continents and therefore, skills for diagnosis and management of the disease attains global importance. Rickettsial diseases can be clinically classified as Spotted Fever group, typhus group, distinctive clinical rickettsiae and emerging rickettsiae. The clinical course will have incubation period, stage non-specific clinical signs and symptoms followed by typical/classical features depending on the type of rickettsiae infecting a person. However the clinical manifestation varies from one geographical area to another area for same species. The rickettsial diseases once thought to have been eradicated from India are re-emerging in many parts of our country. Their presence has recently been documented in at least eleven states of our country. Greater clinical awareness, a higher index of suspicion, better use of available diagnostic tools would increase the frequency with which rickettsial diseases are diagnosed.