Scrub Typhus's first caseconfirmed from Central India

 

 

By Vikas Vaidya

WHEN 45 year-old Kusum Wankhede
of Kolhu village, Katol tehsil came to
Indira Gandhi Government Medical
College and Hospital (IGGMCH),
nobody thought that her case would
throw a light on new disease as far as
medical fraternity of Central India is
concerned. She had multi-organ dysfunction
with involvement of liver, kidneys,
lungs and meningitis and her
platelets were reduced. Malaria and
Dengue were suspected and ruled out
by specific blood tests. Scrub Typhus
was suspected when careful examination
revealed a black mark (left by mite’s
bite) called eschar was noticed over the
patient’s right side of the chest. The
eschar, which occurs at the site where
the mite bites is the single most clinical
diagnostic clue. Dr Prashant Joshi,
Professor and Head, Department of
Medicine, IGGMCH checked her and
identified that she was suffering from
Scrub Typhus, a new disease in human.
It was identified earlier in other parts
of the country but not in Central India.
Dr Joshi who first identified
Tripanosomiasis in the year 2005 which
was the world’s first case, said, “Kusum
Wankhede came to IGGMCH on October
8. Because of her condition, she was
kept in ICCU. Her test for Malaria,
Dengue, Leptospirosis all came negative.
We were confused. Then we found
a mark or eschar near her chest. The
eschar begins at the bite site as a papule
and enlarges, the central papule undergoes
necrosis and becomes black with
an erythematous hallow surrounding it
and typically resembles a cigarette burn.
This mark is important characteristic
clinical diagnostic for Scrub Typhus.
The diagnosis of Scrub typhus was confirmed
by blood test which was positive
for IgM antibodies to shrub typhus.
The test was performed at the National
Centre for Disease Control (NCDC),
New Delhi. This is a highly specific
and sensitive test for shrub typhus is not
available in Nagpur, which along with
eschar confirmed the diagnosis of Scrub
Typhus.
The characteristic eschar is not found
in 40% cases and the diagnostic facilities’
are not available in Nagpur.”
Dr Abhijit Nugurwar, Dr Siddharth
Turkar, Dr Amol Dube and Dr Preeti
More assisted Dr Prashant Joshi in this
new finding.
First confirmed case of Scrub Typhus from Central India
¡ A case of unsuspected
and unrecognised
cause of fever identified
at IGGMCH
Trombiculid Mite whose bite
spread the disease.
Typical Eschar found on patients
chest.

Several cases

near Katol?

KUSUM Wankhede who was cured
of Scrub Typhus said that her fellow
villagers are also suffering
from the same problem. Doctors
feel that the people residing nearby
Katol may have been suffering
from this disease. There is a dense
forest near the fields where the
patient works, from where the
patient may have come in contact
with mites. The patient responded
dramatically to Doxycyline, which
is considered the drug of choice
for typhus fever.

No awareness among doctors too

NAGPUR is recently witnessing a sharp rise of cases of fever. This is a
Dengue fever season. So no doctor think of Scrub Typhus because of lack
of awareness. However, Dr Joshi and his team confirmed Kusum’s case as
Scrub Typhus. This disease is usually not suspected and hence not diagnosed
as a cause of fever with multi-organ involvement in Nagpur. This is
a rare case of Zoonotic (human being suffering from disease that causes
animal) disease and is spread by bites of trombiculid mites called Chiggers,
which are found in the forest, urban shrubs, and grass. Unfortunately, the
awareness about the disease even in the medical fraternity is very low. Even
there is no laboratory in Nagpur to test the blood sample for Scrub Typhus.