Nepal | July 05, 2020

Rise of scrub typhus: Urgent action required

Dr Sher Bahadur Pun
Share Now:

Of late Nepal is seeing a steep rise in scrub typhus cases, with the disease spreading to half of the country. There is a need to pay attention to the sudden rise in the cases of this bacterial disease that can be fatal if not treated on time

Illustration: Ratna Sagar Shrestha/THT

“Got a fever?” “It could be a typhoid fever.” This is a very common conversation among us. When an individual develops a fever, a doctor usually starts empirical treatment with anti-microbial agents against a typhoid fever. Nevertheless, in recent years, statistics show that scrub typhus cases have been significantly rising compared to typhoid in febrile patients in Nepal.

At present, dozens of febrile patients from different hospitals are being sent to Sukraraj Tropical & Infectious Disease Hospital (STIDH) to identify the causes. Of them, on an average, at least half a dozen febrile patients (sometimes even over dozens) are being diagnosed with scrub typhus on a daily basis, indicating that sooner or later scrub typhus is going to take over typhoid fever—or it could even become the most common causes of febrile illnesses in Nepal.

Scrub typhus first attracted nationwide attention back in 2015 due to its association with unexplained and sudden deaths among febrile children despite treatment by experts. At least 108 scrub typhus cases were reported from 16 districts—of them eight cases were fatal. In 2016, scrub typhus cases were reported from 47 districts and deaths doubled to 14. More than half of the cases were reported among people below 30 years of age.

In general, fatality rate can be as high as 30 per cent. In India, overall mortality varies from 7 per cent to 30 per cent—only next to malaria among infectious diseases. To date, there has been no reliable and accurate data on deaths to scrub typhus complications in Nepal. It can be, however, assumed that patients with scrub typhus complications such as pneumonia, acute respiratory distress syndrome, meningitis, cardiac problem and gastroenteritis may have been visiting different speciality hospitals in Kathmandu and may not be receiving appropriate antibiotic therapy.

In some of the cases, people with acute gastroenteritis were earlier treated accordingly. But when there was no response to treatment, it was found to be a scrub typhus infection.

Similarly, meningitis, an unusual complication of scrub typhus, has also dramatically increased among patients.

Last year, nearly 20 per cent of people infected with scrub typhus treated at STIDH were found to have developed acute encephalitis syndrome (AES). Cases of meningitis/ encephalitis due to scrub typhus are also increasing.

Researchers showed that AES is still found in Nepal despite the introduction of Japanese encephalitis vaccine.

There is still a lack of confirmatory laboratory tests in remote rural areas of Nepal. As a result, almost all health care providers usually prescribe antibiotics for typhoid fever.

They usually suspect typhoid fever based on Widal test, a popular laboratory test which is affordable and readily and easily available compared to other tests. However, a false positive of Widal test is quite common and usually represents past infection, especially in the regions where typhoid fever is common.

Despite this limitation, what usually happens is that nearly all patients who develop fever almost always first get treatment for typhoid fever and so they receive various—but inappropriate—antibiotics before they arrive at central hospitals for further evaluation. Consequently, most of them experience complications, which can be life-threatening.

Hence, in the absence of confirmatory lab tests, to avoid possible complications or deaths health care providers must have knowledge about clinical manifestations of scrub typhus, its seasonal patterns, updated geographical distribution and use of short course accurate antibiotics.

A severe headache, high-grade fever (up to 104 degrees Fahrenheit), sweating, red eyes, lymphadenopathy, rash, painless and a black eschar at the site of insect bite and breathing difficulty are the main signs and symptoms of scrub typhus.

In Nepal, cases of scrub typhus are seen between July and September. According to a retrospective study done by Nepal Health Research Council, scrub typhus has already spread over half the areas of the country.

If its signs and symptoms, seasonal patterns, and current geographical distributions are known, then it is wise to use of antibiotics for a short period of time (at least for two days), meaning if the fever gradually or rapidly subsides 24 to 48 hours after the treatment with antibiotic doxycycline, it is possibly a scrub typhus infection.

This can be helpful in reducing or preventing scrub typhus related complications or deaths, especially in remote rural areas where a confirmatory test is not available.

In a nutshell, scrub typhus is becoming the most common cause of febrile illnesses in Nepal. Many patients with scrub typhus are being admitted to the ICU in recent years, although it is an easily curable infectious disease. But prompt treatment is the must.

It is always to know scrub typhus symptoms. If you have a fever, severe headache, red eyes, a hard crust or scab on the skin (eschar), sweating and breathing difficulty, then it could be scrub typhus.

Pun is chief of Clinical Research Unit at Sukraraj Tropical & Infectious Disease Hospital, Kathmandu

 


A version of this article appears in print on September 17, 2018 of The Himalayan Times.


Follow The Himalayan Times on Twitter and Facebook

Recommended Stories:

More from The Himalayan Times:

Bajhang Landslide Update: Four bodies recovered

BAJURA: Four persons, who were missing in the landslide that occurred at 2:00 am on Saturday in Mallesi of Kedarsyun Rural Municipality in Bajhang district, have been found dead. Bodies of 40-year-old Rammati Jethara and her 12-year-old son Prayag Jethara were found buried in the debris of the la Read More...

Prime Minister Oli visits Prez Bhandari; motive of meet undisclosed

KATHMANDU: Prime Minister and Nepal Communist Party (NCP) co-chair KP Sharma Oli paid a visit to President Bidya Devi Bhandari at her official residence in Sheetal Niwas amid the ongoing political strain in the country, on Saturday. The meeting between the Prime Minister and the President lasted Read More...

Greenwood shines as five-star Man United crush Bournemouth

MANCHESTER: Manchester United's three-pronged attack combined to devastating effect as they crushed Bournemouth 5-2 in the Premier League on Saturday to move into the top four and stretch their unbeaten run to 16 games in all competitions. Mason Greenwood shone with two superb goals whil Read More...

Six killed, one missing in Bajhang landslide

Bajura, July 4 Six persons died in a landslide in Mallesi of Kedarsyun Rural Municipality, Bajhang, last night. One person is missing. A police team from Bisauna of Durgathali Rural Municipality and locals retrieved the bodies from the landslide debris today. According to Kedarsyun Rural Mu Read More...

NCP standoff continues

Kathmandu, July 4 The ruling Nepal Communist Party (NCP) postponed its Standing Committee meeting till Monday in an attempt to reconcile differences among party co-chairs Prime Minister KP Sharma Oli and Pushpa Kamal Dahal and senior leader Madhav Kumar Nepal. The rival faction of the NCP has Read More...

Bayern thrash Leverkusen 4-2 to win 20th German Cup title

BERLIN: Bundesliga champions Bayern Munich kept their hopes of a treble alive after a dominant 4-2 win over Bayer Leverkusen to lift the German Cup for a record-extending 20th time at the Olympiastadion on Saturday. Bayern sealed their 13th domestic double as Hansi Flick, who took ove Read More...

Fertiliser crunch hits farmers in Siraha district

SIRAHA, JULY 4 Farmers, who have started paddy plantation, are facing shortage of chemical fertiliser in Siraha. Agriculture cooperatives are supposed to sell fertiliser supplied by the Agriculture Materials Company Limited and Salt Trading Corporations. But, farmers are facing paucity of fert Read More...

Govt turns deaf ears to demands of youths staging hunger strike

KATHMANDU, JULY 4 Two youths of ‘Enough Is Enough’ movement have been staging a fast-unto-death hunger strike for the past nine days, but the government has turned a deaf ears to their demands. Iih, 26, of Kathmandu and Pukar Bam, 30, of Kailali, who began their hunger strike from a Sattal Read More...