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Chiggers and Scrub Typhus

Hello fellow bloggers!

My name is Yuvaram, and, as of June 2016, I am a PGY-2 at Boston Medical Center. I’m in the global health pathway, and, am currently in Hyderabad (South India!) with Andrea, Ed and Jocelyn.

While on our trip, I will be blogging about various global health topics and personal whims.

My current whim, is scrub typhus.

Why would I be interested in scrub typhus?

Well, we spent our first two days in Hyderabad at NIMS [The Nizam Institute of Medical Sciences], and came back from rounding on inpatient wards today. We saw several patients with dengue and scrub typhus.

When I was an intern in India in 2013, we had just started to test for scrub typhus, but, I had never really thought too much about it, other than that it was an infectious characterised by an eschar [a black necrotic thing that I had never really seen in my life] and that it was treated with doxycycline.

Anyway, for those of you that don’t immediately recall scrub typhus [shame on you! but, not really], scrub typhus is an odd rickettsial disease caused by chiggers.

What are chiggers?

images.jpeg

That ugly thing up there. [Don’t you want to squish it?] Apparently their bite is painless, but, leaves a nasty necrotic scar, called an eschar.

Anyway, it seems like scrub typhus was originally described in Japan. There were small outbreaks of disease during war, and there were predominantly localised outbreaks of scrub typhus in North India.

Over the last decade or two, it appears that it has become more prevalent in South India, and lurks around in the monsoon season.

Curiously, I haven’t been able to find clear data on when it became a seasonal disease in South India. I was able to find a  few studies that suggest that in the right prodrome, there is a reasonably strong sero-positive rate for scrub typhus in Andhra Pradesh in 2015. [1] But, I wasn’t able to find much else.

I’m not sure how chiggers came to carry the disease in South India. But, it appears that chiggers can transmit the disease to their offspring [for up to 20 generations!]. Since they can maintain the chain of infectivity for long periods of time, it is harder to eliminate because it can act as the vector of transmission and the reservoir for disease.  What a strange bug.

TL,DR. Scrub typhus is a disease transmitted by squishy mites that causes fevers and arthralgias. They classically leave an eschar at the site of bite, and, doxycycline is the drug of choice.

P.S: Ed made me create a twitter account, so, follow me on twitter @Yuv90 or look for our hashtag #BMCGlobalHealth [Don’t follow him, he likes NK cells and is a nerd]

1. Ramyasree A, Kalawat U, Rani ND, Chaudhury A. Seroprevalence of Scrub typhus at a tertiary care hospital in Andhra Pradesh. Indian J Med Microbiol. 2015 Jan-Mar;33(1):68-72. doi: 10.4103/0255-0857.148381.

 

Next Topic: The Brave Biryani Battle – High Stakes, No Reward

This entry was posted in BMC.
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