Scrub typhus is caused by the bacteria Orientia tsutsugamushi, which is transmitted through the bites of infected trombiculid mites. It causes an acute febrile illness with symptoms such as fever, headache, and rash. If left untreated, it can lead to complications affecting multiple organs and the case fatality rate is 7%. Diagnosis is made through serologic tests detecting antibodies or PCR detecting bacterial DNA. Treatment involves doxycycline or azithromycin antibiotics, with fever typically resolving within 1-2 days. Prevention involves wearing protective clothing, using insect repellent, and clearing vegetation to limit mite habitats.
Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called ORIENTIA TSUTSUGAMUSHI.
Scrub typhus is spread to people through bites of infected chiggers (larval mites).
Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or travelling to areas where scrub typhus is found could get infected
Scrub typhus is not transmitted directly from person to person; it is only transmitted by the bites of vectors
Chiggers are abundant in locales with high relative humidity (60%–85%), low temperature (20°C–30°C), low incidence of sunlight, and a dense substrate-vegetative canopy.
Occupational risk is higher in farmers (aged 50–69 years), females.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called ORIENTIA TSUTSUGAMUSHI.
Scrub typhus is spread to people through bites of infected chiggers (larval mites).
Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or travelling to areas where scrub typhus is found could get infected
Scrub typhus is not transmitted directly from person to person; it is only transmitted by the bites of vectors
Chiggers are abundant in locales with high relative humidity (60%–85%), low temperature (20°C–30°C), low incidence of sunlight, and a dense substrate-vegetative canopy.
Occupational risk is higher in farmers (aged 50–69 years), females.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Please find the power point on Typhus and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
Tetanus Presentation
77 slides
Including drip rates of muscle relaxants
PDF : http://www.mediafire.com/download/k00ciibf73d7y6p/
For more, visit www.medicalgeek.com
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Please find the power point on Typhus and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
Tetanus Presentation
77 slides
Including drip rates of muscle relaxants
PDF : http://www.mediafire.com/download/k00ciibf73d7y6p/
For more, visit www.medicalgeek.com
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
A mosquito-borne viral disease occurring in tropical and subtropical areas.
Those who become infected with the virus a second time are at a significantly greater risk of developing severe disease.
Symptoms include high fever, headache, rash and muscle and joint pain. In severe cases there is serious bleeding and shock, which can be life threatening.
Treatment includes fluids and pain relievers. Severe cases require hospital care.
Scrub typhus is a mite-borne disease caused by Orientia tsutsugamushi (formerly Rickettsia tsutsugamushi). Symptoms are fever, a primary lesion, a macular rash, and lymphadenopathy. (See also Overview of Rickettsial and Related Infections.) Scrub typhus is related to rickettsial diseases.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Introduction
• Scrub typhus is a mite borne acute febrile infectious
illness that is caused by Orientia tsutsugamushi.
• Gram-negative coccobacillus that is antigenically distinct
from the typhus group rickettsiae
• O. tsutsugamushi is maintained by transovarial
transmission in trombiculid mites.
• Three strains of O.tsutsugamushi- Karp, Gilliam and
Kato
3. • The mites are both the vector and reservoir of
the disease.
• The mite is very small (0.2 –0.4mm) and can be
seen through a microscope or magnifying glass.
• The infected larval mites (chiggers, the only
stage that feeds on a host) inoculate organisms
into the skin.
• There is no human to human transmission.
4.
5.
6. • Infected chiggers are particularly likely to be found in
areas of heavy scrub vegetation during the wet season,
when mites lay eggs
• Humans are accidental hosts
7.
8. Historical perspective
• Historically, in 313 AD, a clinical manual by Hong
Ge called “Zhouhofang” had mentioned the
clinical description of disease and morphological
description of mites.
• 1596 AD, well-known Chinese physician Shizen
Li described the characteristics of the disease.
• Japanese researcher started research on this
disease in 1879.
9. • The name Rickettsia tsutsugamushi was
first used in 1930.
• The word “tsutsugamushi” is derived from
a Japanese word tsutsuga meaning
something small and dangerous,
mushi, meaning creature, so it was
known as small dangerous creature.
10. During World War II
• There were 18,000 recorded scrub typhus cases.
• At that time,scrub typhus was the third most common
infectious disease in Pacific theater after malaria and
dengue.
• During the US involvement in World War II, 337 US army
personnel died from scrub typhus.
• Similarly in 1972, the US Armed Forces Epidemiology
Board reported that 20-30% of pyrexia of unknown origin
(PUO) cases were scrub typhus.
11. • Scrub typhus is endemic to a part of the world known as
the “tsutsugamushi triangle”
12.
13. • Infections are prevalent in these regions; in some areas,
>3% of the population is infected or re-infected each
month.
• Immunity wanes over 1–3 years, and the organism
exhibits remarkable antigenic diversity.
14. Nepalese scenario
• In 1981, a study had revealed the high possibility of
scrub typhus in Nepal by showing high antibody titers
among healthy adults (10%).
• 2004 a serological investigation of scrub typhus earlier
carried out in Patan hospital found a small number of
febrile patients (28/876) positive for scrub typhus
antibodies.
15. • Another report in 2007, also indicated the presence of
scrub typhus in Nepal.
• No clear evidence of apparent outbreak (and fatality) of
scrub typhus in Nepal before 2014
• No systematic investigation/surveillance was conducted
by the government.
• No scrub typhus case reported to Epidemiology and
Disease Control Division (EDCD) until 2014.
16. • The 2015 scrub typhus outbreak ,Three months after the
devastating earthquake in Nepal (August 2015), BP Koirala Institute
of Health Sciences (BPKIHS), Dharan had alerted EDCD that
children with fever and severe respiratory features had not been
responded with usual course of treatment.
• This clinical anomaly was initially hypothesized to be Hanta virus
infection as a potential etiology.
• Serum samples were brought to National Public Health Laboratory
(NPHL), Kathmandu and tested for a panel of viral diseases which
turned out to be negative.
• Scrub typhus specific IgM enzyme-linked immunosorbent assay
(ELISA) was performed and it came out to be positive.
17. • To further confirm the diagnosis, representative samples were sent
to Armed Forces Research Institute of Medical Sciences (AFRIMS),
Bangkok, Thailand.
• The samples were confirmed with the gold standard IFA at AFRIMS.
• To this end, the scrub typhus fatal episodes of outbreak magnitude
have officially been confirmed in Nepal in 2015.
• A total of 101 confirmed scrub typhus cases were reported from 16
districts in 2015 . Out of them, eight cases died, accounting for a
crude case fatality rate of 8%.
• By the end of August 2016, more than 500 confirmed cases and six
additional deaths were reported from the various districts of the
country.
18.
19.
20.
21.
22. • A total of 830 cases of scrub typhus cases including 14
deaths have been reported from 47 districts of Nepal
since July ,2016 out of which 535 cases are from
Chitwan and 194 from Kailali.
– EWARS WEEKLY BULLETIN 26, DECEMBER 2016
23.
24.
25. Pathogenesis
• Chigger inoculates O tsutsugamushi pathogens
• Bacteria multiply at the inoculation site, and a papule
forms that ulcerates and becomes necrotic, evolving into
an eschar, with regional lymphadenopathy that may
progress to generalized lymphadenopathy within a few
days
• Perivasculitis of the small blood vessels occurs. The
endothelium is involved;
• O Tsutsugamushi stimulates phagocytosis by the
immune cells, and then escapes the phagosome. It
replicates in the cytoplasm and then buds from the cell
26. Clinical Manifestations
COURSE OF ILLNESS
• Mild and self-limiting to fatal.
• incubation period of 6–21 days
• Scrub typhus lasts for 14 to 21 days without
treatment.
• Death may occur end of 2nd week due to
complications.
27. • Fever is high grade (>104 *F)
• Severe headache, Profuse sweating,
Conjunctival injection
• myalgia, cough, and gastrointestinal symptoms
(Nausea, vomiting, and/or diarrhea are
prominent)
• Fever Lasts for long periods in untreated
patients .
Median 14.4 days, range 9 to 19 days
28. Symptoms and Signs
• The classic case description includes an eschar (fewer
than 50%)where the chigger has fed, regional
lymphadenopathy, and a transient maculopapular rash.
– fewer than 40% develop a rash (on day 4–6 of
illness).
– comprises 5 to 40 macular, then papular and
vesicular spots.
– Non-pruritic
– The rash typically begins on the abdomen and
spreads to the extremities. The face is also often
involved.
– Rarely, petechiae may develop.
29. • Eschar
– Painless papule often at the site of the
infecting chigger bite
– Subsequent central necrosis then occurs
forming eschar with black crust
30.
31. Signs
• Relative bradycardia
• Lymphadenopathy - Tender lymph node, usually
proximal to site of mite bite
• Hepatomegaly and splenomegaly can be observed.
32. • Respiratory-
– Cough
– Acute Respiratory Distress Syndrome
– Pathogenesis of ARDS in scrub typhus not known, thought to be
immunological response of the lung to the infection without direct
invasion of the organism and diffuse alveolar damage without
evidence of vasculitis.
• Neurological
– Involvement of blood vessels in the central nervous system may
produce meningitis
– Mental changes are usual and range from slight intellectual
blunting to coma or delirium
• In severe cases, evolution to a multiple-organ dysfunction syndrome
with hemorrhage can be observed
• Relapse is usually less severe than the first attack
35. Neurological findings may suggest meningo-
encephalitis.
Delirium, confusion, seizures
Multi-organ failure
Death may occur as a result of these complications
Spontaneous abortion may occur during pregnancy if
infected
Acute hearing loss or tinnitus
36. • Some patient recover spontaneously.
• Case-fatality rate for untreated classic cases is 7%
(the fatality rate ranges from 0 to 30%.)
• Scrub typhus is not more severe in HIV-infected
patients, and surprisingly, HIV suppressive factors
appear to be produced during infection.
37. Indian Journal of Nephrology · November 2017 ,April to December 2016
38.
39. Differential Diagnosis
• The most common signs are similar to a variety of other
infectious diseases
• typhoid fever
• Malaria
• leptospirosis
• dengue fever
• Brucelosis
• Chickenguenia etc.
40. Lab Parameters
• Leucocytosis or leucopenia may be present, but
mostly normal WBC count .
• Lymphocyte count is decreased
• Liver enzyme levels are increased in 60% of cases.
• Thrombocytopenia may be sufficient to cause
bleeding.
• Hyperbilirubinemia and increased Creatinine
41. • The most common radiologic
abnormalities includes
– Bilateral reticular opacities (49%)
– Cardiomegaly (29%)
– Congestive heart failure (19%)
42. Diagnosis
• Serologic assays
– indirect fluorescent antibody (gold standard)
– indirect immunoperoxidase
– enzyme immunoassays
– Serological methods are most reliable when a four-fold rise in
antibody titre is looked for.
– When a single measurement is performed, the most common
cut off titre is 1:50
• PCR amplification of Orientia genes from eschars, lymphnodes
and blood
• O.tsutsugamushi specific gene (56-kDa protein-encoding gene)
43. Case Definition
• Suspected/clinical case: Acute undifferentiated febrile
illness (UFI) of 5 days or more
• with or without eschar should be suspected as a case of
Rickettsial infection. (If eschar is present, fever of less
than 5 days duration should be considered as scrub
typhus.)
• Probable case: A suspected clinical case with an IgM
titer > 1:32 and/or a four-fold increase of titers between
two sera confirm a recent infection.
44. • Confirmed case:
• The one in which:
• Rickettsial DNA is detected in eschar samples or whole blood by PCR OR,
• Rising antibody titers on acute and convalescent sera detected by Indirect
ImmuneFluorescence Assay (IFA) or Indirect Immunoperoxidase Assay
(IPA)
Supportive laboratory investigations:
• Total Leucocytes Count during early stages may be normal but may be
elevated to more than 10,000/cu mm later in the course of disease.
• Thrombocytopenia (low platelet count), usually <1,50,000/cu mm is seen in
majority of patients.
• Elevated liver transaminases (AST, ALT) is also seen in many patients.
45. WEIL FELIX TEST
• The Weil-Felix test detects cross-reacting antibodies to
Proteus mirabilis OX-K. The Weil- Felix test is still used
because of its low cost.
– notoriously unreliable and no longer advised.
– Fifty per cent of patients have a positive test result
during the second week
• Weil felix test is based on cross reactions which occur
between antibodies produced in acute rickettsial
infections with antigens of OX (OX19, OX 2 and OX K )
strains of proteus.
– Typhus group (R.prowazekii, R typhi) react with P.vulgaris OX 19
– Scrub typhus reacts with P.mirabilis OX K
– Spotted fever group react with OX2 and OX19.
46. • Biopsy of an eschar or generalised rash
– Pathological hallmark- lymphohistiocytic vasculitis
– Endothelial injury causes loss of vascular integrity.
Egress of plasma and plasma proteins and
microscopic and macroscopic hemorrhages.
– Histologic change in biopsies of eschars shows focal
areas of cutaneous necrosis surrounded by a zone of
intense vasculitis with perivascular collection of
lymphocytes and macrophages
47. • Isolation of O. tsutsugamushi can be done in cell culture
or in inoculated mice.
• Chest radiography may reveal pneumonitis especially in
the lower lung fields.
• In meningitis, there is a predominant mononuclear
response
48. Treatment
• Pediatric treatment: Azithromycin for less
than 8 years: 10mg/kg orally single dose
• For more than 8 years: Doxycycline
2.2mg/kg orally twice daily for 3 days after
resolution of fever (usually 5-10 day
course)
49. Adult treatment:
• Doxycycline (100 mg bid orally for 7–15 days),
– but can also be given in a single dose or for short periods (3 to 7
days), although relapse can occur .
• Azithromycin (500 mg orally for 3 days) especially for the
pregnant patients.
• Alternatives:
• Ciprofloxacin 10 mg/kg twice daily for 5-10 days
• Chloramphenicol 25 mg/kg/dose 6 hourly for 5-10 days
50. Treatment
• Rifampin (600 to 900 mg/day) may be used especially in
doxycycline resistant areas and a combination therapy is
recommended.
– Known to have a good CNS penetration, hence
valuable in Scrub Meningitis.
51. • Rapid defervescence after antibiotic treatment is so
characteristic that it is used as a diagnostic test for O.
tsutsugamushi infection ( resolution of fever expected
within 24-36 hours.)
• Failure of defervescence should lead to suspicion of
other diseases like Malaria.
52. • Prophylaxis:
• Single oral dose of chloramphenicol or
tetracycline given every five days for a
total of 35 days, with 5- day non-treatment
intervals (for endemic regions).
• No vaccine is available for scrub typhus.
53. • Prevention/Control/Precautions:
• Early case detection by healthcare workers is needed.
• Other strategies are to make public aware and give preventive information
like:
• Wear protective clothing including boots
• Insect repellents containing benzyl benzoate, DEET, permethrin, diethyl
toluamide, during travel in rural areas of endemic countries.
• Do not sit or lie on bare ground or grass; use a suitable ground sheet or
other ground cover
• Clear vegetation spray insecticides on the soil to break up the cycle of
transmission