The death toll in a hospital here from a disease caused by infected mites has risen to 10, a doctor said on Saturday [22 Sep 2012]. Two more people have died due to scrub typhus at the Indira Gandhi Medical College and Hospital, the doctor told a news agency. One patient belonged to Bilaspur district and the other to Solan. Scrub typhus is a disease caused by the bite of an infected mite. Its symptoms are fever, headache, muscle pain, cough and gastroenteritis. A total of 155 people have tested positive for the disease, the doctor said. Rodents may serve as reservoirs, although transovarial transmission in mites is the dominant mechanism for maintenance of _O. tsutsugamushi_ (http://www.cdc.gov/ncidod/EID/vol9no12/03-0212.htm). Humans become infected when they accidentally encroach in an area where the chigger-rodent cycle is occurring, most often areas of low-lying scrub brush or transitional vegetation. Patients with severe scrub typhus can develop multiorgan failure and disseminated intravascular coagulopathy with hemorrhage. Establishing the diagnosis and initiating prompt antimicrobial drug therapy are important, because death rates for untreated scrub typhus patients are 1-30 per cent (http://wwwnc.cdc.gov/eid/content/12/2/pdfs/v12-n2.pdf). Scrub typhus is effectively treated with doxycycline, and treatment should begin immediately upon suspicion of illness without awaiting laboratory confirmation.
Commentary: This may be an important differential diagnosis for travelers to rural Himachal & patients coming into Chandigarh from the affected areas. Since Doxycycline is not the first line antibiotic in cases of fever, headaches and gastroenteritis, a high index of suspicion can help prevent unwanted casualties.