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Scrub Typhus; Know About The Cause, Symptoms And Prevention Of The Mystery Fever Reported In UP

As per recent reports, Mathura in western Uttar Pradesh has reported cases of a mystery fever. Identified as scrub typhus, it is a bacterial disease caused by Orientia tsutsugamushi. The disease is also termed bush typhus and is commonly reported in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia.

In the recent cases reported in Uttar Pradesh, more than two dozen people contracted the disease. Medical teams had taken samples from people in Koh village of Mathura district, and the same was found to be infected with scrub typhus [1].

What Is Typhus? Causes, Symptoms, Treatment And Prevention

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What Is Scrub Typhus?

Also termed as the tsutsugamushi disease and bush typhus, trombiculid mites carry scrub typhus. Scrub typhus is most commonly found in Australia, Asia, Papua New Guinea and the Pacific Islands.

An acute, febrile, infectious illness, scrub typhus, was first described in China in 313 AD. The disease was also a problem for US troops stationed in Japan after WWII. It was variously known as Shichitō fever by troops stationed in the Izu Seven Islands or Hatsuka fever [2].

In the modern world, scrub typhus was first reported in Chile in 2006.

What Causes Scrub Typhus?

The Orientia tsutsugamushi bacteria cause scrub typhus. The carriers contrive the bacteria while feeding on the infected blood of a person (epidemic typhus) or a rodent. You can get infected with scrub typhus in disparate ways, such as sleeping on a sheet infested with mites through small openings in your skin (wounds) and also the faeces of the mites [3].

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What Are The Symptoms Of Scrub Typhus?

The symptoms of scrub typhus begin to show within the first ten days of being bitten. A bit more extreme than the other two types, scrub typhus can be fatal for people suffering from any severe illness, resulting in bleeding and organ failure. The symptoms include the following [4]:

  • Rashes
  • Enlarged lymph nodes
  • Confusion
  • Body and muscle pain
  • Fever and chills
  • Severe headache
  • A dark, scab-like formation in the bitten area
  • In some cases, a coma
  • In severe cases, people with scrub typhus may develop organ failure and bleed, fatal if left untreated [5].

    Who Is At Risk Of Scrub Typhus?

    Anyone living in or travelling to areas where scrub typhus is found could get infected. In any scrub typhus infected area, certain activities such as farming and gardening and behavioural factors such as not changing garments after returning from work are associated with a higher risk of contracting the scrub typhus infection [6].

    What Are The Complications of Scrub Typhus?

    In severe cases, without treatment, scrub typhus can cause the following complications:

    • Interstitial pneumonia
    • Pulmonary oedema
    • Congestive heart failure
    • Circulatory collapse
    • Signs and symptoms of central nervous system dysfunction, including delirium, confusion, and seizures
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How Is Scrub Typhus Diagnosed?

In case you suspect the development of typhus in you, the doctor will need a detailed description of the symptoms and a physical examination. Providing your medical history is important as it will help the doctor to analyse your condition on an easier note.

It is preferable to inform your doctor about your living condition, that is, if you are residing in a crowded setting, if there are any typhus outbreaks in your locality or if you have travelled recently [7].

Also, the diagnosis of typhus is a bit tricky and difficult as it possesses similar symptoms as malaria, brucellosis and dengue.

How Is Scrub Typhus Treated?

There are no specific ways to prevent the outbreak and occurrence of typhus. Even though a vaccine for epidemic typhus was developed during World War II, the declining number of typhus cases resulted in ceasing the manufacturing of the vaccine [8].

Currently, antibiotics are used for the treatment, and the application varies according to the individuals affected. Antibiotics are most effective if given soon after symptoms begin.

  • Scrub typhus must be treated with doxycycline, and it can be given to people of any age. Doxycycline is the most proffered treatment. Doxycycline has been found to incur the most efficient result in a short period.
  • Chloramphenicol is mostly used in individuals who are not pregnant or breastfeeding. It is mostly applicable for epidemic typhus.
  • Ciprofloxacin is issued for individuals who are unable to receive the antibiotic doxycycline.
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How Is Scrub Typhus Prevented?

There are no vaccines present for treating scrub typhus. Here are some ways through which you can prevent the onset of the disease [9]:

  • One of the easiest prevention methods is to avoid breeding pests and lice that spread the disease.
  • Always maintain personal hygiene.
  • Avoid travelling to overpopulated regions with low hygiene quality.
  • Use insect repellents.
  • In cases of extreme emergency, consume chemoprophylaxis with doxycycline as a preventive measure.
  • Be careful not to use the repellents on babies or children.
  • Cover yourself on travelling to vegetated areas.
  • Apply permethrin (kills chiggers) or purchase permethrin induced boots, camping gear etc.
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Is Typhus Deadly?

Before the 20th century, there have been reports of death from typhus, especially epidemic typhus. As people are becoming increasingly aware of the need to maintain hygiene, fewer and fewer deaths have been reported in the current era. Endemic typhus is rarely deadly, even if the affected person is not subjected to any treatment [10].

Children diagnosed with typhus mostly recover. Only a reported 4 per cent of deaths have been reported in the case of endemic typhus.

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On A Final Note…

The best way to prevent the scrub typhus infection is to follow hygienic practices and make children wear clothing that covers their arms and legs.

1. Is there a vaccine available for scrub typhus?

No. Antibiotics are being used for the treatment currently, which help manage the symptoms.

2. How is scrub typhus infection treated?

It is treated using antibiotics.

3. Is scrub typhus curable?

Doctors say the disease is curable using antibiotics; however, timely intervention is critical as delayed treatment can result in death.

4. Can scrub typhus cause death?

In severe cases where treatment is delayed, death can occur.

5. How long does scrub typhus last?

Scrub typhus lasts for 14 to 21 days without treatment.

6. How is scrub typhus diagnosis?

The diagnosis of scrub typhus is carried out through measures like the Weil-Felix test, indirect Immunofluorescence assays, indirect immunoperoxidase assays, enzyme-linked immunosorbent assay (ELISA) and immunochromatographic tests (ICT) etc.

7. How common is scrub typhus?

According to data, an estimated 1 billion people worldwide are at risk for scrub typhus, and an estimated 1 million cases occur each year.

8. What does typhus rash look like?

The rashes look like fine erythematous papules (skin lesions) on the abdomen, spreading to the trunk and extremities.

 

9. What is the cause of scrub typhus?

Scrub typhus is caused by a bacteria called Orientia tsutsugamushi.

10. Is scrub typhus common in India?

Yes. There have been outbreaks in areas located in the sub-Himalayan belt, from Jammu to Nagaland. Outbreaks were also reported from Rajasthan. There were reports of scrub typhus outbreaks in Himachal Pradesh, Sikkim and Darjeeling during 2003-2004 and 2007.

11. How do you catch typhus?

An individual can catch typhus if infected lice, mites or fleas bite them.

12. Is typhus rash contagious?

No. typhus is not contagious as it does not spread from person to person.

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