Seroprevalence of Scrub Typhus in Patients Attending Dhulikhel Hospital, Kavre

Abstract

Background Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness. It is caused by Orientia tsutsugamushi. Scrub Typhus is frequently observed in South Asian countries. However, clear epidemiological information of this disease is lacking in case of Nepal. Nepal has shown steady increase in cases of Scrub Typhus since 2015. The epidemiological data related to this disease would support the decision making and surveillance design for early outbreak detection and immediate responses including prevention and treatment of scrub typhus in Nepal.
 Objective To understand prevalence of Scrub Typhus in subjects who had visited outpatient department at Dhulikhel Hospital.
 Method In this study, we have studied antibody test data (n=784) for Scrub Typhus from 2019 to 2021. The tests were performed on serum samples of patients who had visited OPD at Dhulikhel Hospital with fever lasting more than 5 days. The kit used in analysis was Scrub Typhus Detect™ IgM ELISA Kit from InBios International.
 Result Out of the total subjects (n=784), 133 were positive (16.9%) for IgM antibody of Scrub Typhus. The positivity in female (18.6%) was higher than the male subjects (15.3%). The positivity rate was variable among the different age groups, with highest positivity for age group 0-14 years (25%). The seasonal variation was also observed among the seropositive cases.
 Conclusion Scrub Typhus being a neglected tropical disease has high prevalence. It can be postulated that female subjects and subjects of age group 0-14 years are vulnerable to the infection with Scrub Typhus. There is need to increase the surveillance of Scrub Typhus to add the knowledge for diagnosis and treatment.

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

“…Specifically, the samples were collected between July and November, which coincides with the rainy monsoon and post-monsoon seasons and the peak growth of vegetation and mite populations. Notably, the majority of studies included in our review consistently reported higher seroprevalence (over 90% of total cases) during the period of July–November 14 , 16 , 17 , 19 , 20 , 24 .…”

“…Females were found to be more affected than males in this review. This could be attributed to the higher exposure of women to mites while working in scrub-prone areas, such as agricultural fields during harvesting or cultivation of crops, or in forests 16 , 17 , 19 , 48 . Conversely, most men were less exposed to mites as they were predominantly engaged in indoor work, such as office jobs, factory work, or employment in companies 16 .…”

Scrub Typhus among Febrile Patients Admitted to the Department of Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…This finding is similar to a study done in Dhulikhel Hospital, Nepal. 7 Severe scrub typhus showed involvement in one or the other systems like acute hepatitis, sepsis, cardiac failure, ARDS, encephalitis, DIC and death. These complications were encountered in 7 (18.42%) cases.…”

Rickettsial Infection amongst Febrile Illness Patient in a Tertiary Care Hospital: A Retrospective Cross-sectional Study

“…A study conducted in Dhulikhel Hospital earlier and Kathmandu valley reported similar prevalence of the Scrub typhus. 16,17 However, the studies had some differences in duration, sample size and the types of departments the patient were examined. Also, the changes in the living standard and the lifestyle might have contributed to the increasing number of cases in Nepal.…”