title: Outbreak of scrub typhus in southern India during the cooler months.
abstract: Orientia tsutsugamushi, the agent of scrub typhus, is a strict intracellular bacterium which is found in many parts of Asia including India. During the past few years, the number of patients with rickettsial infection and scrub typhus has increased, especially during the cooler months. We report in this study a recent outbreak of scrub typhus recorded during the cooler months (October 2001 to February 2002) in patients admitted to our hospital with acute febrile illness associated with diverse signs and symptoms. Overall, 28 patients were clinically and serologically confirmed to have scrub typhus. Fever for more than one week was the only common manifestation. Myalgias was the next most common feature (52%), and rash was observed in only 22% of the cases. Seventeen patients treated with doxycycline recovered in 1 to 3 days, as well as two patients who received chloramphenicol. In five patients who received ciprofloxacin, fever subsided only after five days. Finally three patients (10.7%) died, including one patient treated with doxycycline. These data indicate that scrub typhus is a reemerging infectious disease in India with a possibility of drug resistance. This reemergence emphasizes the need for further prospective studies to design effective control measures.
authors.affiliation: Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India.
authors.forename: E
authors.initials: E
authors.lastname: Mathai
authors.forename: J M
authors.initials: JM
authors.lastname: Rolain
authors.forename: G M
authors.initials: GM
authors.lastname: Verghese
authors.forename: O C
authors.initials: OC
authors.lastname: Abraham
authors.forename: D
authors.initials: D
authors.lastname: Mathai
authors.forename: M
authors.initials: M
authors.lastname: Mathai
authors.forename: D
authors.initials: D
authors.lastname: Raoult
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002980:Climate; D004196:Disease Outbreaks; D005260:Female; D005334:Fever; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012285:Orientia tsutsugamushi; D012612:Scrub Typhus / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012621:Seasons; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents