Scrub Typhus: Re-emerging Public Health Problem in India

Scrub Typhus is emerging as an important cause of fever of unknown origin and needs to be differentiated from other causes of febrile illnesses. During March to June 2014, a systematic search on ‘Scrub typhus’ was conducted to determine epidemiology and factors causing re-emergence of this disease in India. Scrub typhus is an acute, febrile, infectious illness caused by Orientia tsutsugamushi, transmitted to humans through bites of the trombiculid mites. The infection can range from a mild, self-limiting disease to a fatal illness in 35-50% of cases, with multi-organ dysfunction, if not promptly diagnosed and appropriately treated. The reports of the disease were rare for several decades, but currently a clear re-emergence has been documented from several states in India. This resurgence may be attributed to changes in the human behavior-unplanned urbanization, deforestation and rapid transport leading to displacement of vectors as well the rodents from one place to another. There is an urgent need for awareness generation among the medical and para-medical professionals especially at the peripheral levels. Standard treatment guidelines for timely diagnosis and treatment of Scrub Typhus should be available, especially in rural areas, where the disease remains undiagnosed, and this should be in accordance with the facilities available at sub-centers, PHCs, and CHCs. Active surveillance of rickettsial diseases is required to be carried out to know exact magnitude and distribution of the disease.