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This case presentation describes a 25-year-old male who presented with fever, body aches, and lymphocytosis. His symptoms began after trekking in an endemic area. Scrub typhus was suspected based on his symptoms and history. Diagnosis was confirmed with a positive IgM ELISA test for Orientia tsutsugamushi. Doxycycline is the treatment of choice for scrub typhus. Symptoms typically resolve within a week of doxycycline treatment. Prevention involves public education, rodent control, and chemoprophylaxis with antibiotics in endemic areas.
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The document provides information on several COVID-19 vaccines that are currently in development or have received emergency use authorization. It discusses the technology behind mRNA vaccines such as Moderna and Pfizer/BioNTech, viral vector vaccines like AstraZeneca/Oxford and Sputnik V, DNA vaccines including Zydus Cadila's ZyCoV-D, and inactivated whole virus vaccines like Bharat Biotech's Covaxin. It also summarizes trial results, dosing schedules, storage requirements, manufacturing processes, and safety profiles of these vaccine candidates. The document aims to inform readers about the different approaches being used globally in the race to end the COVID-19 pandemic.
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Case presentation
- 1. A case presentation Dr Monica Jain Senior Professor Department of Pharmacology SMS Medical College,Jaipur
- 2. History • A young male 25 years old was having fever 100 degree F without any chills with bodyache without rash, he was given paracetamol 500mg SOS but he continue have fever intermittent particularly evening rise for another 4to 5 days • CBC count was advice which WBC -17,000 and showed lymphocytosis and decrease neutrophil • ESR NORMAL , Hb normal PBF atypical /reactive lymphocytes
- 3. Diagnosis ? • Malaria • Typhoid fever • Leptospirosis • Tuberculosis • Scrub typhus • Infectious mononucleosis
- 4. More history • History of trekking few days back and little itching felt on that day • on examination no rash or black eschar • There was mild heaptosplenomegaly • Raised SGOT AND SGPT
- 5. Diagnosis • The Scrub Typhus Detect IgM ELISA test is an ELISA assay system for the detection of IgM antibodies in human serum to Orientia tsutsugamushi (OT; formerly Rickettsia) derived recombinant antigen (1-10). This test is to aid in the diagnosis of human exposure to OT species.
- 6. Scrub typhus • Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called Orientia tsutsugamushi. • Tsutsu means small and dangerous and mushi means insect or mite • Humans are accidental host in this zoonotic disease. Scrub typhus was described from Japan in 1899. • Scrub typhus is spread to people through bites of infected chiggers (larval mites).
- 8. Sign and symptoms • Symptoms of scrub typhus usually begin within 10 days of being bitten. Signs and symptoms may include: • Fever and chills • Headache • Body aches and muscle pain • A dark, scab-like region at the site of the chigger bite (also known as eschar) • Mental changes, ranging from confusion to coma • Enlarged lymph nodes • Rash develops on the trunk during the 5th to 8th day of fever, often extending to the arms and legs.
- 10. Diagnosis The laboratory-based diagnosis of scrub typhus relies on serological assays l The Weil–Felix test Indirect Immunofluorescence assays Indirect immunoperoxidase assays enzyme-linked immunosorbent assay (ELISA) and immunochromatographic tests (ICT) Among all serological assays, IgM ELISA-based method is most reliable for the diagnosis of scrub typhus
- 11. Treatment • Doxycycline 200 mg daily or tetracycline 500 mg 6 hrly is treatment of choice. • The duration of treatment is 7- 14 days. Treatment of less than a week is initially curative but may be followed by relapse • Chloramphenicol 500mg qid is an alternative. Telithromycin has also been shown to be effective in the treatment of scrub typhus
- 12. • Azithromycin has been shown to be effective in the treatment of scrub typhus in pregnancy and has shown favorable outcome in pregnancy. • 500 mg has been used as single dose or for three to five days • Rifampicin than Doxycycline, however it is only recommended where doxycycline resistance is suspected.
- 13. Prevention • Case detection, public education, rodent control and habitat modification are aimed at controlling the infection of scrub typhus in human population. • Chemoprophylaxis is recommended under special circumstances in certain areas where disease is endemic. Oral chloramphenicol or tetracycline given once every five days for 35 days, or weekly dose of doxycycline 200mg have both been shown to be effective regimens.