Scrub Typhus-A Re-Emerging Infectious Disease of India

Rickettsial diseases in the past have taken more lives than all the wars combined together. They are still a source of severe illness and death in spite of the availability of low cost, effective antimicrobial therapy. Scrub typhus is one of the most common rickettsial diseases. Scrub typhus was first documented from Japan in 1899 and in India since 1930. The causative agent is Orientia tsutsugamushi which is transmitted to the human beings by bite of infected mite called chiggers. The people at risk are agriculturist, horticulturist, labourer working in fields, orchard and other recreational activities. There is the development of an ulcer at the site of chigger's bite that later becomes a black eschar. The general symptoms are sudden fever (>40°C) with relative bradycardia, severe headache, myalgia, apathy, generalized lymphadenopathy, a dry cough, photophobia and maculopapular rash. Interstitial pneumonia, myocarditis and meningoencephalitis are common complications. It is diagnosed by Weil- Felix test, complement-fixation test, Indirect Immunofluorescence Antibody (IFA), Qualitative enzymelinked immunosorbent assay (ELISA) and other supportive investigations. The drug of choice is Doxycycline (100 mg twice daily for 5-7 days). In case of intolerance, Azithromycin (500 mg in a single oral dose for 3-5 days) can be given. The preventive measures include avoidance of mite infested areas, use of rodenticides, mitecides, mite repellants, protective clothes, high shoes, thorough bath with soap and water. Nursing interventions will include thorough assessment, history taking, education, and provision of bed rest, comfort measures, safety, adequate hydration, nutrition, skin care, and management of fever, pain, cough and other complications.