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Scrub typhus, reemerging after decades

A disease that seemingly all but disappeared since World War II, is returning at an alarming rate. It was associated with Assam but is now being diagnosed across many parts of North India.  

Copyright: <a href=''>jarun011 / 123RF Stock Photo</a>Scrub typhus, an exotic disease spread by mites, had disappeared from the public eye for many decades. The disease is typically limited to rural areas. Uncommon, or undiagnosed, it has managed to, for the most part, slip under the radar.

The disease once again made public attention during the 1990s. A number of cadets of the Indian Military Academy in Dehradun became infected with the disease following treks into the surrounding hills. These infections led to multiple fatalities.

Scrub typhus saw a much broader degree of media attention in 2016. Last year, 700 cases were reported in the northern state of Himachal Pradesh. These cases resulted in 20 deaths. Though the disease was largely isolated to rural communities, there were also several cases of the disease occurring in Delhi.

The disease is caused by the Rickettsia bacteria, transmitted to humans via bites from infected mites, fleas and ticks. The disease does not typically penetrate further into urban areas as it cannot be transmitted between human hosts. A small number of cases have been occurring in cities such as Delhi, though this is likely due to transportation of the mites themselves.

The initial symptoms of the disease are very similar to what would be expected of a viral fever, despite being caused by bacteria. This leads to misdiagnosis, as the disease can be mistaken for other vector borne diseases such as malaria or dengue fever, or even the flu. A fever, headaches, a cough, and a rash near the bite are common symptoms.

The disease can be detected relatively simply, either through a blood test, or via techniques such as western blotting or immunofluorescent testing to detect specific sections of DNA corresponding to the bacteria in either a mucous sample or skin biopsy.

Scrub typhus has the potential to be life threatening. If left untreated there is the potential for respiratory distress, pneumonitis (inflammation of lung tissue), encephalitis (inflammation of the brain), kidney failure and possibly multiple organ failure.

Because it can kill, it is important that doctors and potential patients in affected areas be able recognise signs of the disease that differentiate it from other illnesses. A scab typically appears at the site of the bite which appears similar to a blackened cigarette burn. Appearance of this black scab should warrant a doctor’s appointment for further analysis.

The disease is entirely treatable with a course of antibiotics. There is no issue with regards to curing the condition: some antibiotics such as doxycycline will rid a person of the disease over a 48 hour period. The issue, and reason behind the fatalities associated with the disease, is the lack of diagnosis due to a person not being aware of the condition. If awareness campaigns were made a priority, this may massively reduce the danger the disease poses.

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