Emerging Rickettsial Diseases: an Analysis of Undifferentiated Acute Febrile Illness Cases from a Tertiary Care Hospital in New Delhi

Abstract

Rickettsial infections are being increasingly recognized as a cause of acute febrile illnesses and patients presenting with suggestive clinical features should be considered a distinct possibility. 1 It includes three major groups: Scrub typhus, spotted fever group and the typhus group.A total of 11 rickettsial outbreaks have been reported in India between 2000-2011. Of the 11 outbreaks, four were reported from Himachal Pradesh (Kangra, Shimla, Solan, and Sirmapur districts), two from Manipur (Bishnupur and Senapti districts), and one each from Jammu and Kashmir (Rajouri district), Tamil Nadu (Vellore), Pondicherry, West Bengal (Darjeeling), and Meghalaya (Shillong). 2 Most recent outbreak of Scrub Rickettsial diseases are an important cause of undifferentiated acute febrile illness. The lack of classical manifestations can make their diagnosis difficult. Even though the diseases are endemic in India, they are less reported from New Delhi and surrounding regions. Aim is to estimate the seropositivity of Rickettsial infections in cases of undifferentiated acute febrile illness from a tertiary care hospital in New Delhi and to analyze their clinical profile. This prospective observational study was conducted from November 2016 to March 2018. Samples were first screened for Typhoid, Dengue, Chikungunya and Malaria. Samples seronegative for these diseases were tested further by Weil-Felix test (WFT) and clinical findings were recorded on a pre designed proforma. Data was analyzed using statistical software SPSS version 21. A total of 370 seronegative samples were tested. Out of 370 cases, 12.4% (46) cases were positive by Weil-Felix reaction and most of the cases showed titre between ≥1:80-≥1:160. Of the positive cases, 7.29% were positive for scrub typhus (OXK) and 3.78% cases were positive for tick typhus (OX2) whereas only 1.35% cases were found positive for typhus group (OX19). The most common presentation was fever with headache and pulmonary manifestations or rashes. The most common laboratory findings were increase in AST/ALT, anaemia and thrombocytopenia. The findings of our study indicate significant presence of rickettsial diseases in cases of undifferentiated febrile illness in Delhi population.

A Review of Rickettsial Diseases Other Than Scrub Typhus in India

“…The edema or anasarca were not clinically present in most of the cases, but marked congestion of most of the internal organs may be reported in fatal cases during autopsy [ 69 ]. Other clinical features were nausea or vomiting (11.1% to 80%) [ 13 , 26 ], respiratory symptoms (21% to 80%) [ 26 , 32 ], meningeal signs (2.8% to 39.1%) [ 9 , 35 ], altered sensorium (3.9% to 23%) [ 9 , 68 ], seizure (7% to 36%) [ 32 , 66 ], conjunctival effusion (12% to 52%) [ 42 , 66 ], myalgia (32.5% to 80%) [ 27 , 37 ], arthralgia (4.3% to 43%) [ 34 , 35 ], jaundice (10.5% to 33.3%) [ 26 , 49 ], abdominal pain (14% to 36.6%) [ 9 , 34 ], and bleeding manifestation (12% to 27.7%) [ 37 , 66 ]. Less common manifestations included vesicular rash (11.1%), vasculitis (39.1%), diarrhea (22.2%), and loss of appetite (11.1%) [ 13 , 35 ].…”