Scrub typhus: Why a disease that has been around since World
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A potentially deadly bacterial infection known as scrub typhus was again in the news in August. On 16 August, the Hindustan Times reported that five people had died and at least 291 had tested positive for the infection in Himachal Pradesh.

Scrub Typhus is an infectious disease caused by Orientia tsutsugamushi - a bacteria that lives in the salivary gland of mites like L. deliense and Leptotrombidium akamushi. The infection spreads when larval mites feed on human blood - rather than biting or piercing the skin, mite larvae usually insert a part of their mouths down the hair follicles or into pores on human skin. (Adult mites do not feed on human blood.) Wild and field rodents also play a key role in the spread of disease - they are carriers of the disease but don’t get the infection themselves.

Seeing the rising instance of scrub typhus infections in the Indian subcontinent, the health ministry recently issued an alert for the prevention, recognition and prompt treatment of the disease.

History repeats

The first case of scrub typhus came to light in Japan in 1899. India saw its first case of the infection in the Assam and West Bengal region, during World War II. The disease has become endemic in a few regions of India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand. Globally, 1 million people suffer from scrub typhus every year. This is despite it being easily treated with antibiotics like doxycycline.

Tricky diagnosis

The difficulty lies not so much in treating scrub typhus, as diagnosing it early enough. Consider the problems: first, it takes 7 to 14 days for the symptoms to appear in a person bitten by an infected mite. As the disease progresses, the person might feel mental confusion and enlarged lymph nodes. If there’s been no intervention until this stage, scrub typhus can turn into a life-threatening disease - in some cases, it can lead to death by multiple organ failure.

Further, early diagnosis and prompt treatment with doxycycline, tetracycline or chloramphenicol can keep the mortality rate under 1%. Failure to treat in time, however, can take the mortality up to 50%. Immunofluorescence is a gold standard diagnostic aid for scrub typhus.

Prevention is the best cure

Scrub typhus is a portmanteau of 'scrub' — a type of vegetation inhabiting the mites — and 'typhus' which means 'fever with stupor (state of near-unconsciousness or insensibility)'.

Every year in the monsoon, the scrub typhus mites grow in great numbers in limited areas - they form so-called typhus islands where the risk of disease transmission is the highest. Just avoiding these bushy, forested areas and using insect repellent on clothes and skin can help prevent infection.

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