Main Article Content

Santosh kumar
Sohan lal
Suraj Yadav
Ankur Pandey
Sapna Kushwah


Scrub typhus disease, MP, Orientia tsutsugamushi


 Background and objectives: Scrub typhus, a vector – borne zoonotic disease is produced through
bacteria Orientia tsutsugamushi, a potentially lethal re-emerging infectious disease in India. Scrub
typhus, produce severe multiorgan failure and has a circumstance fatality rate of up to 70% if not
treated properly. The geographical burden of the disease remains unclear in this region. Our goal is to
present the geographical burden and prevalence of scrub typhus in Madhya Pradesh Central India with
the management of scrub typhus in both long standing endemic regions and newly identified infection
foci and to identify the integration with the effectiveness of various available serological diagnostic
methods, ELISA, rapid immunochromatography test, weil Felix test, clinical and medical laboratory
results to support the diagnosis of scrub typhus patients.
Methodology: A total 524 patients undiagnosed acute undifferentiated febrile illness (AUFI) >5 days
with the age of 3 yrs to 75 yrs included in the study with suspected scrub typhus. Various serological
diagnostic methods rapid immunochromatography test, ELISA, Weil Felix test applied for the
detection of scrub typhus cases with the clinical features, medical laboratory parameter and final result
Principal findings: Scrub typhus epidemiology varies due to Climate conditions, etiological agents
and arthropod vectors involved in transmission. Scrub typhus is a disease with a unique epidemiology
in MP and its regional distribution were found to be varied in this study, with the highest percentage
of cases recorded (66.6%) in Mandsaur (22.2%)in Ratlam and (11.1%) in Betul districts of Madhya
Pradesh, Central India.Theseroprevealencewas increases during the month of August (48.1%),
September (40.7%) and October (11.1%). The study shows that 5.1% (n=524) positive cases of scrub
typhus through the various serological diagnostic methods.
Conclusion: Our study revealed an increasing trend of scrub typhus in MP, Central India, Morbidity
and Mortality will be reduced if diagnosed early through ICT, ELISA and treated appropriately. The
general population's awareness of the patterns of disease transmission and the implementation of
preventive measures like insect repellents and protective clothing are crucial in decreasing the
prevalence of disease.

Abstract 216 | pdf Downloads 77


1.Ram Mohan Mylavarapu Venkata Naga Lakshmi1*, Teja Vijay Dharma1, Sukanya Sudhaharan1, Subbalaxmi Malladi Venkata Surya2, Rajkiran Emmadi2, Satyanarayana Raju Yadati2, Nageswara Rao, Modugu2, Aparna Jyotsna1 Prevalence of scrub typhus in a tertiary care centre in Telangana, south India Volume 12 Number 3 (June 2020) 204-208 Iranian journal of microbiology.

2. Aung AK, Spelman DW, Murray RJ, Graves S. Rickettsial infections in Southeast Asia: implications for local populace and febrile returnedtravelers. Am J Trop MedHyg 2014; 91:451-460.
3. Pote K, Narang R, Deshmukh P. Diagnostic performance of serological tests to detect antibodies against acute scrub typhus infection in central India. Indian J Med Microbiol 2018; 36:108-112.
4.Mahajan, S.K. Rickettsial diseases. J Assoc Physicians India2012, 60, 37–44.
5.Rathi, N.B.; Rathi, A.N.; Goodman, M.H.; Aghai, Z.H. Rickettsial diseases in central India: proposed clinical scoring system for early detection of spotted fever. Indian Pediatric2011, 48, 867–872.
6. La Scola, B.; Raoult, D. Laboratory diagnosis of rickettsioses: current approaches to diagnosis of old and new rickettsial diseases. J Clin Microbiol1997, 35, 2715–2727.
7. Bakshi, D.; Singhal, P.; Mahajan, S.K.; Subramaniam, P.; Tuteja, U.; Batra, H.V. Development of a real-time PCR assay for the diagnosis of scrub typhus cases in India and evidence of the prevalence of new genotype of O. tsutsugamushi. Acta Tropica2007, 104, 63–71, doi: 10.1016/j.actatropica.2007.07.013.
8. Usha, K.; Kumar, E.; Kalawat, U.; Kumar, B.S.; Chaudhury, A.; Gopal, D.V.R.S. Molecular characterization of Orientia tsutsugamushi serotypes causing scrub typhus outbreak in southern region of Andhra Pradesh, India. Indian J Med Res2016, 144, 597– 603, doi:10.4103/0971-5916.200886
9.Kocher, C.; Jiang, J.; Morrison, A.C.; Castillo, R.; Leguia, M.; Loyola, S.; Ampuero, J.S.; Cespedes, M.; Halsey, E.S.; Bausch, D.G.; et al. Serologic Evidence of Scrub Typhus in the Peruvian Amazon. Emerg. Infect. Dis. 2017, 23, 1389–1391, doi:10.3201/eid2308.170050.
10 Vivekanandan, M.; Mani, A.; Priya, Y.S.; Singh, A.P.; Jayakumar, S.; Purty, S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India2010, 58, 24–28.
11. Siraj Ahmed Khan Re-emergence of scrub typhus in northeast India. International Journal of Infectious Diseases2012, 16, 889–890.
12. Tilak, R.; Wankhade, U.; Kunwar, R.; Tilak, V. Emergence of Schoengastiella ligula as the vector of scrub typhus outbreak in Darjeeling: Has Leptotrombidiumdeliense been replaced? Indian Journal of Public Health2011, 55, 92, doi:10.4103/0019-557X.85239.
14. M. Chauhan; S. Mahajan; Manish S Scrub typhus: An emerging scourge. Indian Journal of Basic and Applied Medical Research2015, 4, 394–401.
15. Sankhyan, N.; Saptharishi, L.G.; Sasidaran, K.; Kanga, A.; Singhi, S.C. Clinical profile of scrub typhus in children and its association with hemophagocytic lymphohistiocytosis. Indian Pediatr2014, 51, 651–653.
16.Rajneesh Joshi; SP Kalantri Acute Undifferentiated Fever: Management Algorithm. In Update on Tropical Fever; Association of Physicians of India, 2015.
17. Chrispal, A.; Boorugu, H.; Gopinath, K.G.; Chandy, S.; Prakash, J.A.J.; Thomas, E.M.; Abraham, A.M.; Abraham, O.C.; Thomas, K. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors – an experience from a tertiary care hospital in South India. Trop Doct2010, 40, 230–234, doi:10.1258/td.2010.100132.
18. Laskar, A.R.; Suri, S.; Acharya, A.S. Scrub Typhus: Re-emerging Public Health Problem in India. Journal of Communicable Diseases2015, 47, 19–25.
19. Annual Report 2014 -15 2016.
20. Singh, S.I.; Devi, K.P.; Tilotama, R.; Ningombam, S.; Gopalkrishna, Y.; Singh, T.B.; Murhekar, M.V. An outbreak of scrub typhus in Bishnupur district of Manipur, India, 2007. Trop Doct2010, 40, 169–170, doi:10.1258/td.2010.090468.
21. Dass, R.; Deka, N.M.; Duwarah, S.G.; Barman, H.; Hoque, R.; Mili, D.; Barthakur, D. Characteristics of Pediatric Scrub Typhus during an Outbreak in the North Eastern Region of India: Peculiarities in Clinical Presentation, Laboratory Findings and Complications. Indian J Pediatr2011, 78, 1365–1370, doi:10.1007/s12098-011-0470-5.
22. Prakash, J. a. J.; Kavitha, M.L.; Mathai, E. Nested polymerase chain reaction on blood clots for gene encoding 56 kDa antigen and serology for the diagnosis of scrub typhus. Indian Journal of Medical Microbiology 2011, 29, 47, doi:10.4103/0255-0857.76524. Peter JV, Sudarsan TI, Prakash JA, Varghese GM. Severe scrub typhus infection: Clinical features, diagnostic challenges and management. World J Crit Care Med 2015;4:244 50.
23. Bonell A, Lubell Y, Newton PN, Crump JA, Paris DH. Estimating the burden of scrub typhus: A systematic review. PLoSNegl Trop Dis 2017;11:e0005838.
24. Roopa KS, Karthika K, Sugumar M, Bammigatti C, Shamanna SB, Harish BN. Serodiagnosis of scrub typhus at a tertiary care hospital from Southern India. J Clin Diagn Res 2015;9:C05 7.
25. Sugita Y, Nagatani T, Okuda K, Yoshida Y, Nakajima H. Diagnosis of typhus infection with Rickettsia tsutsugamushi by polymerase chain reaction. J Med Microbiol 1992;37:357 60.
26.Kim DM, Yun NR, Yang TY, Lee JH, Yang JT, Shim SK, et al. Usefulness of nested PCR for the diagnosis of scrub typhus in clinical practice: A prospective study. Am J Trop Med Hyg 2006;75:542 5.
27.Xu G, Walker DH, Jupiter D, Melby PC, Arcari CM. A review of the global epidemiology of scrub typhus. PLoSNegl Trop Dis 2017;11:e0006062.
28.Rahi M, Gupte MD, Bhargava A, Varghese GM, Arora R. DHR ICMR guidelines for diagnosis and management of rickettsial diseases in India. InRickettsiales. Cham Switzerland; Springer International Publishing; 2016. p. 125 33.
29.Shivalli S. Diagnostic evaluation of rapid tests for scrub typhus in the Indian population is needed. Infect Dis Poverty 2016;5:40.
30.CD alert monthly newsletter of national centre for disease control, directorate general of health services, government of India. Scrub Typhus and Other Rickettsioses 2009;13:1 8.
31.Venkategowda PM, Rao SM, Mutkule DP, Rao MV, Taggu AN. Scrub typhus: Clinical spectrum and outcome. Indian J Crit Care Med 2015;19:208 13.
32.Issac R. Scrub Typhus: Prevalence and diagnostic issues in rural southern India. Clin Infect Dis 2004;39:1395 6.
33.Pradutkanchana J, Silpapojakul K, Paxton H, Pradutkanchana S, Kelly DJ, Strickman D. Comparative evaluation of four serodiagnostic tests for scrub typhus in Thailand. Trans R Soc Trop Med Hyg 1997;91:425 8.
34.Koraluru M, Bairy I, Varma M, Vidyasagar S. Diagnostic validation of selected serological tests for detecting scrub typhus. Microbiol Immunol 2015;59:371 4.
35. Mahajan SK, Kashyap R, Kanga A, Sharma V, Prasher BS, Pal LS. Relevance of Weil Felix test in diagnosis of scrub typhus in India. JAPI 2006;54:619 21.
36. Pote K, Narang R, Deshmukh P. Diagnostic performance of serological tests to detect antibodies against acute scrub typhus infection in central India. Indian J Med Microbiol 2018;36:108 12.
37.Anitharaj V, Stephen S, Pradeep J, Park S, Kim SH, Kim YJ, et al. Serological diagnosis of acute scrub typhus in Southern India: Evaluation of InBios scrub typhus detect IgM rapid test and comparison with other serological tests. J Clin Diagn Res 2016;10:C07 10.
38.Watthanaworawit W, Turner P, Turner C, Tanganuchitcharnchai A, Jintaworn S, Hanboonkunupakarn B, et al. Diagnostic accuracy assessment of immunochromatographic tests for the rapid detection of antibodies against Orientia tsutsugamushi using paired acute and convalescent specimens. Am J Trop Med Hyg 2015;93:1168 71.
39.Rawat V, Singh RK, Kumar A, Singh Y, Chaturvedi P, Saxena SR, et al. Diagnostic validation of IgM and IgG ELISA and real time PCR in detecting scrub typhus infection in endemic regions. J Vector Borne Dis 2018;55:165 7.
40.Lim C, Paris DH, Blacksell SD, Laongnualpanich A, Kantipong P, Chierakul W, et al. How to determine the accuracy of an alternative diagnostic test when it is actually better than the reference tests: A re evaluation of diagnostic tests for scrub typhus using bayesian LCMs. PLoS One 2015;10:e0114930.
41. Kingston HW, Blacksell SD, Tanganuchitcharnchai A, Laongnualpanich A, Basnyat B, Day NP, et al. Comparative accuracy of the inbios scrub typhus detect IgM rapid test for the detection of IgM antibodies by using conventional serology. Clin Vaccine Immunol 2015;22:1130 2.
42.Gupta N, Chaudhry R, Thakur CK. Determination of cutoff of ELISA and immunofluorescence assay for scrub typhus. J Glob Infect Dis 2016;8:97 9.
43. Blacksell SD, Tanganuchitcharnchai A, Nawtaisong P, Kantipong P, Laongnualpanich A, Day NP, et al. Diagnostic accuracy of the InBios scrub typhus detect enzyme linked immunoassay for the detection of IgM antibodies in northern Thailand. Clin Vaccine Immunol 2016;23:148 54.
44.Kelly DJ, Forest PA, Ching WM, Richards AL. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin InfectDis 2009;48 Suppl 3:S203-230.
45.Varghese G, Abraham O, Mathai D, Thomas K, Aaron R, Kavitha ML, et al. Scrub typhus among hospitalised patients with febrile illness in South India: magnitude and clinical predictors. J Infect 2006;52:56-60.
46. Sinha P, Gupta S, Dawra R, Rijhawan P. Recent outbreak of scrub typhus in North Western part of India. Indian J Med Microbiol2014;32:247-250.
47.Dass R, Deka NM, Duwarah SG, Barman H, Hoque R, Mili D, et al. Characteristics of paediatric scrub typhus during an outbreak in the North Eastern region of India: peculiarities in clinical presentation, laboratory findings and complications. Indian J Pediatr 2011;78:1365-1370.
48.Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, Abraham OC, et al. Scrub typhus: an unrecognized threat in South India—clinical profile and predictors of mortality. Trop Doct2010;40:129-133.
49.Khan SA, Dutta P, Khan AM, Topno R, Borah J, Chowdhury P, et al. Re-emergence of scrub typhus in northeast India. Int J Infect Dis 2012;16(12):e889-890.
50. Jung HC, Chon SB, Oh WS, Lee DH, Lee HJ. Etiologies of acute undifferentiated fever and clinical prediction of scrub typhus in a non-tropical endemic area. Am JTrop Med Hyg2015;92:256-261.
51. Taylar AC, Hill J, Kelly DJ, Davis DR, Lewis GE Jr. A serological survey of scrub, tick, and endemic typhus in Sabah, East Malaysia. Southeast Asian J Trop MedPublic Health 1986;17:613-619.
52. Anitharaj V, Stephen S, Pradeep J, Park S, Kim SH, Kim YJ, et al. Serological diagnosis of acute scrub typhus in Southern India: evaluation of InBios Scrub typhus detect IgM rapid test and comparison with other serological tests. J Clin Diagn Res 2016;10:DC07- DC10.