Scrub typhus in a primary health care center of Nepal: A case series. (March 2022)

• Record Type: Journal Article
• Authors: Gurung, Shekhar; Karki, Saurab; Pokharel, Subashchandra; Bhatta, Kishor
• Is Part Of: Annals of medicine and surgery. Volume 75(2022)
• Publication Date: 2022-03
• Subjects: Case series -- Scrub typhus -- Orientia tsutsugamushi -- Eschar -- Doxycycline; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2022.103490
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: Scrub typhus is endemic in most parts of Southeast Asia including Nepal. Fever, rash, headache, myalgia, eschar are the common clinical features. Though endemic, scrub typhus is grossly underdiagnosed in our country due to the lack of diagnostic tools and non-specific presentation of the disease. Here we present a series of 23 cases of scrub typhus from a primary healthcare center of Nepal. Method: This is a retrospective case series done among 23 patients diagnosed with scrub typhus and admitted to Aaruchanaute Primary health care center between August 15, 2021 to September 14, 2021. Epidemiological, clinical features and clinical outcomes of all the patients are described. Results: Among 23 patients admitted to the primary health care center, 78% were of age group 20–60 with 47% male patients. Fever was reported by all patients followed by headache (65%), cough (43%) and eschar (8%). All patients were diagnosed by rapid diagnostic kit. 95% of patients had complete recovery whereas 1 patient was referred to a higher center due to complications he developed during the period of hospital stay. Conclusion: We conclude that when a patient presents with fever and eschar, there should be a high index of suspicion for scrub typhus, though eschar may not be present in many of the cases. Early diagnosis and prompt treatment with antibiotics is the key as the disease entity shows a good response to treatment while preventing potentially fatal complications. Highlights: Scrub typhus is a mite-borne, acute, febrile illness caused by Orientia tsutsugamushi. Fever, rash, headache, myalgia, gastrointestinal symptoms and eschar are the usual clinical presentation. Mostly underdiagnosed in Nepal because of lack of specialized diagnostic tools. Can also be missed while trying to exclude COVID-19 during this pandemic. This case series analyses the clinical presentation and management in a resource-limited setting.