After 30 deaths were recorded in three months this year, veterinary researchers have warned of a second wave of scrub typhus in Vidarbha, expected during the harvest season in late January. In its first ever outbreak in Vidarbha, 200 cases of scrub typhus were reported between August and October. Even as the infection is on the decline, veterinary researchers expect it to resurface during the harvest season.
Thirty-five deaths have been reported across Maharashtra while over 300 cases have been recorded with the maximum in Nagpur (101) and Nagpur Rural (60). Twenty-seven of the 35 deaths were reported from the two areas between August and October.
Scrub typhus is a bacterial infection spread by mites in agricultural and shrubby land. The first such case in the state this year was suspected in the Government Medical College (GMC), Nagpur, when doctors saw ischar- cigarette butt-like blackish marks- on the skin of a few patients. The first death was of a Madhya Pradesh resident undergoing treatment at GMC.
“In the last 10-15 years I’ve seen only 15 such cases. But in last three months, we have treated over 120 patients,” said Dr Yogendra Bansod, head of medicine department, GMC.
“It is the larvae that attacks. It takes three months for the larvae to reach the adulthood stage. During the harvesting season beginning February, farmers will visit fields. We expect a second outbreak of infection then,” said Dr Sandeep Chaudhari, head of veterinary public health department, Nagpur Veterinary College. Chaudhari’s research in the last two years shows the club typhus infection is not just spread by chiggers but also by tropical rat mite.
The public health department has trained over 100 private and public hospital doctors in diagnosing the disease and its treatment in anticipation of the second outbreak. According to Dr Pradeep Awate, state epidemiologist, unlike Himachal Pradesh and Uttar Pradesh, Maharashtra only recorded scattered cases of scrub typhus until 2017. Awareness about diagnosing the symptoms still remains low among doctors. “This is the first time the vector-borne infection took such proportions,” he said.
Nagpur district health officer Dr Milind Ganvir said the cases surged after heavy rains were recorded in a short span in July in Vidarbha. “The rains flooded and disrupted rat burrows. The vector on rat came in contact with domestic and urban rats. That is how the infection spread from rural to urban areas,” Ganvir said.
The outbreak’s epicentre was in Jalalkheda, in the Narkheda block. The veterinary public health department trapped rats near houses where deaths were reported. “The dissection of rats showed there were traces of DNA of the vector in their organs. We got similar results in rats trapped in other regions where death was reported,” Chaudhari added.
The Indian Council of Medical Research (ICMR) in 2015 released guidelines for treatment and diagnosis of the infection, stating that the infection remains undiagnosed in several patients. Researchers said that doctors mostly test for dengue, malaria, H1N1 and leptospirosis infection when presented with classic fever, cough and cold symptoms, delaying possible diagnosis of scrub typhus.
“In 20 per cent patients of scrub typhus, we see classical symptoms of ischar marks. In the rest, we can only diagnose the disease through other clinical manifestations like fever, cough, cold. Now that the disease has spread, doctors will actively test for scrub typhus,” said Bansod.
According to him, the vector enters through the skin and leaves behind a mark.
The disease is diagnosed through enzyme-linked immunosorbent assay (ELISA) or a polymerase chain reaction (PCR) test. When the outbreak was reported, only veterinary college had PCR kits. Treatment involves doxycycline medication. In severe cases where treatment is delayed, a patient enters into acute respiratory distress syndrome and develops pneumonia.