Scrub Typhus fever- causes, symptoms and treatment.

Scrub Typhus fever- causes, symptoms and treatment.

Question:-Scrub typhus fever, a type of ricketssial disease, more restricted to rural regions or forests is now entering cities due to urbanization. Write in detail about the causes, symptoms and treatment of scrub typhus fever.

- Scrub typhus fever is a type of mite borne, rickettsial disease that is infectious. It is also known as tsutsugamushi fever. A blood test can confirm the infection. This can be cured with only one particular type of antibiotic, however it may go out of control in case of a delayed diagnosis or if a regular antibiotic is used.

- The disease spreads with chiggers, mites found in forests which now are also found in urban shrubs. With their bite, a microorganism called rickettsial tsutsugamushi is injected into the blood.

- Symptoms- A case of scrub typhus, most common of the rickettsial diseases shows high fever, rash all over body particularly on palms and soles, regional lymph node enlargement, increased white cell count, decreased platelet count and affection of the liver and kidney function tests. A close examination reveals a black necrotic mark or eschar on lower limbs caused due to the tick's bite marking the entry point of the infecting organism. A delayed diagnosis is common if patients lack the rash and this could result in a fatality in some cases. It is rarely seen as a self resolving disease.

- Urbanization as a prime cause- Farmers, mountaineers and shepherds are generally at a high risk of getting infected by this where it is transmitted from animals to humans. The reason for spread of this disease can be assigned to urbanization where there is an increase in transport, a continuous influx of people and city limits are being expanded into rural areas. Availability of the diagnostic test and increasing awareness among physicians is helping diagnose more cases.

- Availability of tests- Fluroscent antigen is the gold standard test for diagnosing rickettsial infections which is not widely available. Christian Medical College, Vellore has been conducting this test. Weil-Felix is another test which is available in Pune, which can diagnose with good sensitivity, however may falter due to urinary tract infection.

- Spread of typhus fever- Areas in the interior of Marathwada are the endemic ones in Maharashtra along with Solapur. Areas of south India particularly Tamil Nadu too are affected, however northern India is comparatively less affected. Tick typhus is another form of rickettsial infection and cases of this come from Shreerampur belt in Ahmednagar. The analysis shows contact with cattle as a reason and the cases from Pune show a contact with dogs. Patients are clinically tested with rickettsial infection if the fever refuses to respond to normal antibiotics and a rash all over the body.

- Treatment- Only the tetracycline group of antibiotics work in this case and if diagnosed on time, a seven days dose is sufficient. A rapid response with resolution of fever within 48 hours of therapy is a characteristic.

Facts and figures:

- Scrub typhus is a one of the forms of ricketsial infection and such Weil-Felix positive cases could be about 12 to 15 per year.

- Tsutsugamushi is derived from two Japanese words- tsutsuga, means something small and dangerous, and mushi, meaning creature),
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