Epidemiology, clinical characteristics, diagnosis, and complications of scrub typhus infection in Nepal: a systematic review

Abstract

Introduction: Scrub typhus (ST) is a neglected tropical disease of serious concern in Nepal. This systematic review aims to describe the burden of disease, clinical presentation, and complications of ST infection in Nepal. Methods: A systematic search of PubMed, EMBASE, Google Scholar, and national databases was conducted for any literature published in English between January 2000 and January 2023. Any type of study design (observational studies, case series, and interventional studies) that reported laboratory-confirmed ST and was conducted in Nepal among patients of all age groups was included. The seroprevalence of ST among acute undifferentiated febrile illness (AUFI) cases, geographical distribution, monthly distribution, clinical presentations, complications, and treatment were assessed by the study. Result: A total of 15 studies with 10, 977 participants were included in the review. The seroprevalence of ST among the AUFI cases in Nepal was 19.31%. Young people at or below 20 years of age were mostly affected. The maximum number of cases were reported from Bagmati province (59.46%) and in the month of August (26.33%). Fever, headache, cough, shortness of breath, nausea, and abdominal pain were the clinical characteristics in decreasing order of occurrence. The most common complication was acute kidney injury, followed by respiratory problems, cardiac issues, and neurological manifestations. The case fatality rate of ST in Nepal was 2.56%. Conclusion: The authors findings showed a significant burden of ST among AUFI cases in Nepal. Improved surveillance, general public awareness, and early detection post-calamities could help reduce the disease burden and improve patient outcomes.

Seroprevalence and Clinical Features of Scrub Typhus Among Febrile Patients in a Tertiary Care Hospital

“…The present study revealed fever, myalgia, and headache as the predominant symptoms in Scrub typhus-positive patients. The Lamichhane P et al [22] study shows fever, headache, cough, shortness of breath, nausea, and abdominal pain were the clinical characteristics in decreasing order of occurrence.…”

Unravelling the Enigma of Scrub Typhus: A Critical Review and Insights Into Epidemiology, Clinical Features, Diagnostic Advances, and Emerging Trends

“…The ST incidence follows a seasonal pattern that shows a spike in May, a peak in October, and a decline in November; in both the 1980-1989 and the 2006-2016 periods, 94% of cases occurred during this time [ 35 ]. Lamichhane et al reported a high seroprevalence of scrub typhus among AUFI patients in Nepal, with a case fatality rate of 2.56% [ 36 ].…”

“…The seroprevalence of scrub typhus among the AUFI cases in Nepal was 19.31%. The seroprevalence of scrub typhus among AUFI cases ranged from 5.37% to 40.32% in Nepal [ 36 ]. Alam et al examined cases in the UK, focusing on clinical features of scrub typhus-associated encephalitis syndromes [ 38 ].…”

“…The ST incidence follows a seasonal pattern that shows a spike in May, a peak in October, and a decline in November; in both the 1980-1989 and the 2006-2016 periods, 94% of cases occurred during this time[35]. Lamichhane et al reported a high seroprevalence of scrub typhus among AUFI patients in Nepal, with a case fatality rate of 2.56%[36].Won et al identified confirmed cases of scrub typhus using real-time PCR, with various clinical presentations observed[37]. Alam et al found that the most common clinical features were altered sensorium, fever, headache, myalgia, and the variable presence of eschar of ST-associated encephalitis syndromes, with a pooled case fatality rate ranging from 1.5% to 6.4%[38].…”

Scrub typhus manifesting with Temporal lobe hemorrhage: a Case report

“…The population is universally susceptible to orientia tsutsugamushi [2], and the incubation period for this disease ranges from 1 to 3 weeks. The disease is characterized by eschar formation, along with other clinical manifestations including fever, headache, cough, shortness of breath, myalgia, nausea, abdominal pain, enlarged lymph nodes, and a skin rash [3]. The severity of the disease can vary from mild fever to multisystem involvement.…”