MAGNITUDE OF SCRUB TYPHUS IN ACUTE UNDIFFERENTIATED FEBRILE ILLNESS: A RETROSPECTIVE ANALYSIS OF FIVE YEARS DATA FROM RAJASTHAN, INDIA

Abstract

Intro: An undifferentiated acute febrile illness (AUFI) is the most common symptom of scrub typhus, a rickettsial infection caused by Orientia tsutsugamushi. Scrub typhus can manifest clinically in a variety of ways, from asymptomatic illness to multi-organ failure and death. It is an infectious disease that is on the rise elsewhere in the world, but India is where it is under reported. Scrub typhus has recently returned to India, particularly in northern parts of Rajasthan. In order to determine the magnitude of scrub typhus in AUFI in Rajasthan, five years' worth of retrospective data were evaluated in the current study. Methods: Data were acquired from the tertiary care hospital data base in Kota, Rajasthan, for this retrospective, observational analysis that spanned five years (Jan 2018–Aug 2022). A total of 8843 people with AUFI symptoms and signs visited the hospital and had their scrub typhus tested. Commercially available ELISA kits were used to identify IgM antibodies against O. tsutsugamushis specific IgM antibodies (Inbios, USA). Clinico-epidemiological baseline information was recorded. Data was statistically analyzed. Findings: Data of total 8443 AUFI patients were analyzed, 629 patients with age ranges from 3-80 years (Mean+SD:43.9+17.16) were found positive for Scrub typhus (7.4%, Ranged 1.7%-21.5%). Among these 359 (57%) patients were male while 270 (43%) patients were female. Significantly higher proportion of patients (79.9%, ‘p’<0.001, 95% CI-1.4-1.7) belonged to rural area in comparison to urban area. Majority of scrub typhus positive patients required hospitalization (79%, ‘p’<0.001, 95% CI-1.4-1.6) while 21% patients recovered without hospitalization. Discussion: Study demonstrated that scrub typhus largely contributed in development of AUFI and it is predominant in rural area. Study also suggested that scrub typhus is major cause of hospitalization. Conclusion: Scrub typhus is underreported entity and a cause of concern in AUFI patients particularly in rural areas of Rajasthan, India.