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Scrub typhus is key encephalitis cause in eastern U.P
Why in the news ?
- The data collected over 3 years from Gorakhpur’s Baba Raghav Das (BRD)Medical College has confirmed that the majority of Acute Encephalitis Syndrome (AES) patients admitted to the hospital between August and October each year have scrub typhus.
What is Scrub typhus?
- Scrub typhus is a miteborne bacterial disease caused by Orientia tsutsugamushi.
- Clinical features generally include fever, headache, and myalgia, with or without eschar/rash.
- In severe forms, pneumonia, myocarditis, azotemia, shock, gastrointestinal bleed, and meningoencephalitis are known to occur.
- Relative unawareness of presentation of scrub typhus makes a prompt diagnosis difficult, resulting in significant morbidity and mortality.
- In India context, scrub typhus was first reported in Assam during World War II (1944–1945) across the India–Myanmar border .
- The northeastern region of India then experienced decades without the disease until it reemerged in 2010 .
- Assam, a northeastern state in India, is recognized as an endemic zone for acute encephalitis syndrome (AES), especially that caused by Japanese encephalitis virus (JEV).
Acute encephalitis Syndrome (AES) :
- Acute encephalitis syndrome (AES) is characterized by an acute onset of fever and clinical neurological manifestation that includes mental confusion, disorientation, delirium, or coma.
- Viruses have been mainly attributed to be the cause of AES in India although other sources such as bacteria, fungus, parasites, spirochetes, chemical, and toxins have been reported over the past few decades.
- Apart from viral encephalitis, severe form of leptospirosis and toxoplasmosis can cause AES.
- The causative agent of AES varies with season and geographical location, and predominantly affects population below 15 years
- The history of AES in India has paralleled with that of the Japanese encephalitis virus (JEV) since the first report in 1955 from Vellore, Tamil Nadu.
More on news
- The first indication of scrub typhus’ role came during a 2014 study at BRD by researchers from Karnataka’s Manipal Centre for Viral Research. But there was much scepticism about this hypothesis then.
- In the following years, however, other researchers reported similar findings.
- In 2015, a team led by the director of Chennai’s National Institute of Epidemiology, found that out of 370 AES patients tested during September-October, 63% had antibodies to scrub typhus.
- The findings were reported in the Journal of Infection. In 2016, out of 407 AES patients during the same period, 65% had the illness.
- Also, when all AES patients were given azithromycin, a treatment for scrub typhus, 35% of non-scrub-typhus patients died, while only 15% of scrub patients died, indicating that azithromycin was effective.
- These findings were published in the Pediatric Infectious Disease Journal in May this year.
- Finally, in 2017, over 50% of patients admitted to BRD in August-September were positive for scrub typhus, according to data shared by the Indian Council of Medical Research.
Source
The Hindu, NCBI