Published December 31, 2022 | Version https://impactfactor.org/PDF/IJPCR/14/IJPCR,Vol14,Issue12,Article18.pdf
Journal article Open

Prediction of Scrub Typhus in Tertiary Care Centre of Northern Bihar

  • 1. PGT, Department of Microbiology, MGM Medical College & LSK Hospital, Kishanganj, Bihar, India
  • 2. Professor & Head, Department of Microbiology, MGM Medical College & LSK Hospital, Kishanganj, Bihar, India

Description

Objectives: This present study was to evaluate the severity of scrub typhus in various age group in tertiary care centre of northern Bihar. Methods: ELISA for IgM antibody was performed to detect Scrub Typhus IgM by following instructions. The antigen used to coat the wells was a recombinant 56-kDa type-specific antigen. The absorbance was read at 450 nm and an optical density of > 0.5 was considered positive. A nested polymerase chain reaction (PCR) was also performed for scrub typhus. DNA was extracted from the whole blood, blood clot, or eschar material by the phenol–chloroform method, and was amplified to detect scrub typhus according to nested PCR protocol. The oligonucleotide primers used were based on the nucleotide sequences of a gene encoding for the 56-kDa antigen of a Gilliam strain of O. tsutsugamushi. The specific PCR products of size 484 base pairs were sequenced in a few representative samples to confirm the diagnosis. Results: A total of 50 scrub typhus patients with age group 18 to 60 years were enrolled. Most of the cases 30(60%) were in age group of 40-60 years. Most of the cases 18(36%) were males. Most of the common symptoms 47(94%) of scrub typhus was high grade fever with chills and rigor followed by 41(82%) shortness of breath, 17(34%) jaundice, 15(30%) abdominal pain, 13(26%) headache. Most common signs of scrub typhus were 29(58%) hepatomegaly followed by 21(42%) splenomegaly, 15(30%) hypotension, 14(28%) pneumonitis, 11(22%) pallor, 9(18%) eschar. thrombocytopenia was the most common laboratory findings of scrub typhus patients followed by 32(64%) increased SGOT/SGPT ratio, 23(46%) hyperbilirubinemia, 29(58%) anemia. Conclusions: Scrub typhus was more prone in middle age male population. High-grade fever with chills and rigor and shortness of breath, hepatomegaly and splenomegaly were the most common symptom and sign of scrub typhus. Thrombocytopenia and SGPT/SGOT (≥ 2 times normal) were the most common laboratory findings of scrub typhus patients.

 

 

 

Abstract (English)

Objectives: This present study was to evaluate the severity of scrub typhus in various age group in tertiary care centre of northern Bihar. Methods: ELISA for IgM antibody was performed to detect Scrub Typhus IgM by following instructions. The antigen used to coat the wells was a recombinant 56-kDa type-specific antigen. The absorbance was read at 450 nm and an optical density of > 0.5 was considered positive. A nested polymerase chain reaction (PCR) was also performed for scrub typhus. DNA was extracted from the whole blood, blood clot, or eschar material by the phenol–chloroform method, and was amplified to detect scrub typhus according to nested PCR protocol. The oligonucleotide primers used were based on the nucleotide sequences of a gene encoding for the 56-kDa antigen of a Gilliam strain of O. tsutsugamushi. The specific PCR products of size 484 base pairs were sequenced in a few representative samples to confirm the diagnosis. Results: A total of 50 scrub typhus patients with age group 18 to 60 years were enrolled. Most of the cases 30(60%) were in age group of 40-60 years. Most of the cases 18(36%) were males. Most of the common symptoms 47(94%) of scrub typhus was high grade fever with chills and rigor followed by 41(82%) shortness of breath, 17(34%) jaundice, 15(30%) abdominal pain, 13(26%) headache. Most common signs of scrub typhus were 29(58%) hepatomegaly followed by 21(42%) splenomegaly, 15(30%) hypotension, 14(28%) pneumonitis, 11(22%) pallor, 9(18%) eschar. thrombocytopenia was the most common laboratory findings of scrub typhus patients followed by 32(64%) increased SGOT/SGPT ratio, 23(46%) hyperbilirubinemia, 29(58%) anemia. Conclusions: Scrub typhus was more prone in middle age male population. High-grade fever with chills and rigor and shortness of breath, hepatomegaly and splenomegaly were the most common symptom and sign of scrub typhus. Thrombocytopenia and SGPT/SGOT (≥ 2 times normal) were the most common laboratory findings of scrub typhus patients.

 

 

 

Files

IJPCR,Vol14,Issue12,Article18.pdf

Files (284.7 kB)

Name Size Download all
md5:efbc1100421489cb51753ae469cef2e5
284.7 kB Preview Download

Additional details

Dates

Accepted
2022-12-15

References

  • 1. Kim, Dong-Min, et al. "Distribution of eschars on the body of scrub typhus patients: A prospective study." The American Journal of Tropical Medicine and Hygiene 2007; 76(5): 806-09. 2. Xu G, Walker DH, Jupiter D, Melby PC, Arcari CM. A review of the global epidemiology of scrub typhus. PLoS Negl Trop Dis. 2017;11: e0006062. 3. Phongmany S, Rolain JM, Phetsouvanh R, Blacksell SD, Soukkhaseum V, Rasachack B, et al. Rickettsial infections and fever, Vientiane, Laos. Emerg Infect Dis. 2006; 12:256–62. 4. Manosroi J, Chutipongvivate S, Auwanit W, Manosroi A. Determination and geographic distribution of Orientia tsutsugamushi serotypes in Thailand by nested polymerase chain reaction. Diagn Microbiol Infect Dis. 2006; 55:185–90. 5. Bonell A, Lubell Y, Newton PN, Crump JA, Paris DH. Estimating the burden of scrub typhus: a systematic review. PLoS Negl Trop Dis. 2017;11:e0005838 6. Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD. Diagnosis of scrub typhus. Am J Trop Med Hyg 2010; 82:368–370.7. Saraswati K, Day NP, Mukaka M, Blacksell SD. Scrub typhus point-ofcare testing: a systematic review and meta-analysis. PLoS Negl Trop Dis 2018;12: e0006330. 8. Shivalli S. Diagnostic evaluation of rapid tests for scrub typhus in the Indian population is needed. Infect Dis Poverty 2016; 5:1–3. 9. Phetsouvanh R et al. Inter- and intraoperator variability in the reading of indirect immunofuorescence assays for the serological diagnosis of scrub typhus and murine typhus. Am J Trop Med Hyg 2013; 88:932–936. 10. Furuya Y, Yoshida Y, Katayama T, Yamamoto S, Kawamura A Jr. Serotype-specific amplification of Rickettsia tsutsugamushi DNA by nested polymerase chain reaction. J Clin Microbiol 1993; 31: 1637–1640. 11. . Kelly DJ, Fuerst PA, Ching WM, Richards AL (2009) Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis 2009; 48(3): S203–230. 12. Sinha P, Gupta S, Dawra R, Rijhawan P. Recent outbreak of scrub typhus in North Western part of India. Indian J Med Microbiol 2014; 32: 247–250. 13. Varghese G, Abraham O, Mathai D, Thomas K, Aaron R, et al. Scrub typhus among hospitalised patients with febrile illness in South India: magnitude and clinical predictors. Journal of Infection 2006; 52: 56–60. 14. Dass R, Deka NM, Duwarah SG, Barman H, Hoque R, et al. 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 Pediatr 2011; 78:1365-1370. 15. Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, et al. Scrub typhus: an unrecognized threat in South India—clinical profile and predictors of mortality. Trop Doct 2010; 40: 129–133. 16. Khan SA, Dutta P, Khan AM, Topno R, Borah J, et al. Re-emergence of scrub typhus in northeast India. Int J Infect Dis 2012; 16: e889–890. 17. Md Jamil, KG Lyngrah, Monaliza Lyngdoh, Masaraf Hussain. Clinical Manifestations and Complications of Scrub Typhus: A Hospital Based Study from NorthEastern India. J Assoc Physicians India. 2014 Dec; 62 (12):19-23. 18. Oberoi A, Varghese SR. Scrub typhus-an emerging entity: A study from a tertiary care hospital in North India. Indian J Public Health 2014; 58:281-3. 19. Peesapati N, Lakkapragada R, Sunitha S, Sivaram PV. Clinical manifestations and complications of scrub typhus: A hospital-based study from North Andhra. Astrocyte 2015; 2:116-20. 20. Anurag Bhargava, Reshma Kaushik, Rajeev Mohan Kaushik, Anita Sharma, Sohaib Ahmad, Minakshi Dhar. Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality. Indian J Med Res.2016; 144:901-909. 21. Kedareshwar P.S. Narvencar, Savio Rodrigues, Ramnath P. Nevrekar, Lydia Dias, Amit Dias, Marina Vaz. Scrub typhus in patients reporting with acute febrile illness at a tertiary health care institution in Goa. Indian J Med Res. 2012; 136:1020-1024. 22. Meng Zhang, Zhong-Tang Zhao, XianJun Wang, Zhong Li, Lei Ding, and Shu-Jun Ding. Scrub Typhus: Surveillance, Clinical Profile and Diagnostic Issues in Shandong, China. Am. J. Trop. Med. Hyg. 2012;87(6):1099–1104. 23. Kim, Dong-Min, et al. Clinical and laboratory findings associated with severe scrub typhus. BMC Infectious Diseases 2010; 10(1): 108. 24. Lee, Chang-Seop, et al. Risk factors leading to fatal outcome in scrubtyphus patients. The American Journal of Tropical Medicine and Hygiene 2009; 81(3): 484-88. 25. Karanth, Suman Suryanarayana, et al. Predictors of severity of scrub typhus in the Indian subcontinent. Asian Pacific Journal of Tropical Disease 2014; 4: 674-78. 26. Varghese, George M., et al. Clinical profile and improving mortality trend of scrub typhus in South India. International Journal of Infectious Diseases 2014; 23: 39-43. 27. Arellano A., Arellano A., & Arellano D. Gluteoplasty Implants and Lipotransfer Technique. Journal of Medical Research and Health Sciences. 2022; 5(11): 2329–2338.