Study of the clinical manifestations and risk factors in people affected during the first Kyasanur Forest Disease outbreak in Goa, India: A mixed method study.

BACKGROUND OBJECTIVES: Kyasanur Forest Disease (KFD) is a tick-borne, zoonotic viral hemorrhagic fever, previously known to be endemic to the state of Karnataka, India. The first outbreak of KFD in Goa state was reported in the Sattari taluka, in North Goa in 2015. This study aimed to investigate the outbreak and report the clinical manifestations and risk factors in people diagnosed with KFD. METHODS: A mixed methods approach was used, which included a case series report and 19 in-depth interviews (IDIs) conducted with people diagnosed with KFD. The recorded IDIs were transcribed and translated and themes were coded for the analysis. RESULTS: There were 73 suspected cases of which 30 were confirmed to have KFD using RT-PCR. There were four suspected deaths of which two were confirmed by RT-PCR. Most of the affected individuals were found to be dependent on the forest for their livelihood. Most of the people in the region were engaged in cashew plantations and had to travel to the forest to fetch firewood and cashew, hence were at a higher risk. They lived near the forest. The lack of hemorrhagic manifestation was noteworthy in the current outbreak. INTERPRETATION CONCLUSION: The 'One Health' approach should be implemented to control KFD. Tick bite prevention measures coupled with vaccination of high-risk groups and intensive health education should be carried out, especially before the transmission season. There is a need to have high clinical suspicion for KFD in the region bearing in mind the non-hemorrhagic manifestation in this outbreak.

Scrub typhus in patients reporting with acute febrile illness at a tertiary health care institution in Goa.

BACKGROUND & OBJECTIVES: Scrub typhus is one of the differential diagnoses of haemorrhagic fevers especially if associated with jaundice and/or renal failure. Goa State in the western region of India has been witnessing increased incidence of such fevers, therefore, the present study was undertaken to identify whether scrub typhus is the aetiological agent. METHODS: Adult patients presenting with undiagnosed febrile illness between June 2009 to October 2010, were evaluated. Testing was done using a commercial ELISA kit for specific IgM antibodies against Orientia tsutsugamushi. RESULTS: Of the 44 patients included in the study, 15 (34%) were found to be positive for IGM antibodies against O. tsutsugamushi. The cases were seen mainly in the months between July to November. The common symptoms noted were fever, myalgias, gastrointestinal complaints, followed by breathlessness, rash and jaundice. The pathognomonic features such as eschar and lymphadenopathy were seen only in two patients. Nearly two third of the patients had leukocytosis (67%) and low serum albumin (60%). The most common complication noticed was hepatitis (80%) followed by acute respiratory distress syndrome (ARDS) (60%), thrombocytopenia (40%) and acute renal failure (33%). Five patients died in the course of illness. INTERPRETATION & CONCLUSIONS: Our results showed that scrub typhus should be considered in the differential diagnosis of acute febrile illness associated with gastrointestinal symptoms, rash, myalgia , including those with organ dysfunctions such as hepatorenal syndrome, coagulopathy or ARDS. Empirical treatment with doxycycline or macrolides may be given in cases with strong suspicion of scrub typhus.