Recently a disease known as scrub typhus is threatening human lives in many parts of our country.

Although it is not a new disease, it has been repeatedly reported from various parts of Nepal. Scrub typhus is an acute febrile illness caused by orientiatsutsugamushi, transmitted to humans by the bite of mites.

It is most common during monsoon but the disease can also be seen during winter. Clinicians as well as general public must be aware of its early signs and symptoms.

The illness begins with a sudden onset of high fever, chills, dry cough, flu-like symptoms, joint pain, rashes, red eye and swelling lymph nodes.

A wound lesion of skin is often seen at the site of the mite bite.

Symptoms usually appear 5-20 days (average 10 days) after the bite of infected mite. Thus, finding mites and rats can be helpful in confirming scrub typhus or identifying the source of the disease.

In untreated patients, high fever may last for more than two weeks. With specific therapy, the fever breaks within 36 hours with prompt and uneventful recovery of patients.

Lack of diagnostic facilities is a major reason for the under diagnosis of Scrub Typhus in our country. Laboratory diagnosis is mainly reliant on serological tests that are not widely available in public and private hospitals.

Precise diagnosis outside the capital is not possible. Weil-Felix, a serological test, is considered as cheap but has poor accuracy. X-ray can be helpful for patients having complications of respiratory illnesses.

Untreated cases may lead to serious complications or even death. Worries include heart related diseases (myocarditis), and encephalitis, jaundice, pneumonia, renal failure and respiratory illnesses.

Since human to human transmission of this disease has not been detected yet there is no need to be terrified. It can easily be treated with antibiotics and can only be transmitted through infected mite bites.

However, the risk of outbreak should not be undervalued as scrub typhus has already been established as an endemic disease in Nepal.

There is no vaccine against scrub typhus.

Precaution is the best option which includes wearing protective clothing to avoid mite bite, rat control and avoiding sitting on the ground or grass.

People who sleep outdoors during the monsoon without adequate bed sheets, bring them into contact with infected mites.

Thus, the government in coordination with different organizations must be better prepared to prevent future outbreaks by rats/mice control programme and public awareness.