More than 150 cases of scrub typhus in Mizoram: Revisiting scrub typhus

At least 150 people have been diagnosed with the scrub typhus disease at Thenzawl town in Serchhip district, Mizoram health department officials said on Wednesday. The officials said that the scrub typhus outbreak began in November 2018, as reported by NDTV.

Scrub typhus, also known as tsutsugamushi disease or Bush typhus, presents as an acute febrile illness.

Here are few salient points about scrub typhus

  • Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi (previously called Rickettsia tsutsugamushi).
  • It is a gram-negative coccobacillus.
  • Scrub typhus may begin insidiously with headache, anorexia, and malaise, or start abruptly with chills and fever. As the illness evolves, most patients develop high fever, worsening of headache severity, and myalgias. An eschar or rash may develop in a subset of patients.
  • The severity of infection can range from mild symptoms and signs to multiorgan failure.
  • Elderly patients and those with delays in therapy are more likely to develop complications.
  • Scrub typhus may cause spontaneous abortions in pregnant women.
  • Diagnostic methods for confirmation of O. tsutsugamushi infection include serology, biopsy, culture and polymerase chain reaction (PCR).
  • The differential diagnosis of scrub typhus includes malaria, dengue, leptospirosis and other rickettsial diseases.
  • Doxycycline shortens the clinical illness and the incidence of relapse of infection.
  • Azithromycin is an alternative drug to treat scrub typhus, which has an acceptable safety profile in pregnant women.
  • Chemoprophylaxis with doxycycline is effective when used by nonimmune individuals living or working in areas in which scrub typhus is endemic.
  • Insect repellants and miticides are highly effective when applied to both clothing and skin.
  • Permethrin and benzyl benzoate are also useful agents when applied to clothing and bedding.

Scrub typhus is a re-emerging zoonotic disease in India. It is endemic in the country and is especially prevalent in the sub-Himalayan belt, from Jammu to Nagaland.

Suspect scrub typhus in all cases of fever around that area.

Doxycycline is the empirical antibiotic of choice in cases of fever with scrub typhus as differential diagnosis.

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Doctors should be knowledgeable about the criteria for gender-affirming treatment

Dr KK Aggarwal, Padma Shri Awardee

The Endocrine Society has updated its guidelines for providing managing gender-dysphoric/ gender-incongruent persons, or simply transgender individuals published in the Journal of Clinical Endocrinology & Metabolism.

According to the guidelines, “Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender.” …read more