title: Recent outbreak of scrub typhus in North Western part of India.
abstract: BACKGROUND
  Scrub typhus usually affects previously healthy active persons and if undiagnosed or diagnosed late, may prove to be life-threatening. Diagnosis of scrub typhus should be largely based on a high index of suspicion and careful clinical, laboratory and epidemiological evaluation.
  
  
  OBJECTIVE
  To describe the diverse clinical and laboratory manifestations of scrub typhus diagnosed in Mahatma Gandhi Medical College and Hospital, Jaipur.
  
  
  METHODS
  All cases of febrile illness diagnosed as scrub typhus over a period of 3 months were analysed. Diagnosis was based on ELISA test for antibody detection against 56 kDa antigen.
  
  
  RESULTS
  Forty-two cases of scrub typhus were seen over a period of 3 months (October, 2012-December, 2012). Common symptoms were high grade fever of 4-30 days duration, cough, haemoptysis and breathlessness. Eschar was not seen even in a single patient. Liver enzymes were elevated in nearly all cases (95.9%). Multiple organ dysfunction syndrome (MODS) was present in 16.66% of our patients (7 out of 42). Hypotension (6 patients, 14.2%), renal impairment (9 out of 15 patients, 60%), acute respiratory distress syndrome (4 patients, 9.52%) and meningitis (4 patients, 9.52%) were some of the important complications. There was a dramatic response to doxycycline in nearly all the patients, but initially when the disease was not diagnosed, seven patients had died.
  
  
  CONCLUSIONS
  Scrub typhus has emerged as an important cause of febrile illness in Jaipur. Empirical treatment with doxycycline is justified in endemic areas.
authors.forename: Parul
authors.initials: P
authors.lastname: Sinha
authors.affiliation: Department of Microbiology, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India.
authors.forename: Sweta
authors.initials: S
authors.lastname: Gupta
authors.forename: Romika
authors.initials: R
authors.lastname: Dawra
authors.forename: Puneet
authors.initials: P
authors.lastname: Rijhawan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004318:Doxycycline / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012285:Orientia tsutsugamushi / Q000276:immunology*; D012612:Scrub Typhus / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D012698:Serologic Tests; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D004318:Doxycycline