What is scrub typhus disease that took two lives in Kerala? Causes, symptoms and treatment

Amid many viral infections, Kerala is on alert after it reported a second death of a 38-year-old woman due to scrub typhus in the last three days.

The woman from Thiruvananthapuram passed away on the morning of Sunday due to scrub typhus in a hospital. She was reportedly suffering from the disease for the past 15 days.

Earlier, a 15-year-old girl died in Varkala in Thiruvananthapuram district due to the disease. The girl had given her Class 10 Board exams this year and had contracted the disease few days ago. The state health department is on guard and steps are being taken to destroy the ticks in the affected areas, Health Minister Veena George said.

Even as concerns grow among natives, here’s a look at what scrub typhus disease is all about, its symptoms and treatment and how one should remain alert and avoid getting infected. But first let us understand what is the disease.

What is scrub typhus?

The scrub typhus disease is also known as chellu pani locally. It is caused by a mite-borne bacterium Orientia tsutsugamushi, according to Centers for Disease Control and Prevention (CDC), United States. The disease is transmitted by chigger mites, the larval stage, from animals such as rats, squirrels and rabbits, to humans.

Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or travelling to these areas could get infected. The scrub typhus epidemic broke out during World War II in Myanmar and Sri Lanka (then Burma and Ceylon, respectively).

The disease also spread in Japan, where it was known as the ‘Shichitō fever’ or the ‘Hatsuka fever’. There have been scrub typhus outbreaks in Himachal Pradesh, Sikkim, and Darjeeling (West Bengal) during 2003-2004 and 2007.

Scrub typhus fever occurs in people exposed to areas with scrub vegetation where rodents live, such as forest clearings, riverbanks, grassy areas, deserts, and rain forests, especially in parts of Asia and Australia. Scrub typhus fever is not spread from person-to-person. Disease is spread to people by the bite of a mite infected with the bacteria that causes scrub typhus fever.

Symptoms of scrub typhus fever

The symptoms of scrub typhus are similar to symptoms of many other vector-borne diseases and usually begin within 10 days of being bitten.

Symptoms may include a sore on the skin with a ‘punched out’ appearance (skin ulcer that becomes dark in the centre) at the site where the mite attached.

Other symptoms may develop which include fever, headache, sweating, blood-shot eyes, swollen lymph nodes, rash, lung infection, vomiting, and diarrhea.

Symptoms usually appear within 10 to 12 days after exposure, but may appear anywhere from 6 to 21 days after exposure.

After contracting the infection, a person can experience mental changes, ranging from confusion to coma, according to CDC.

The infection can lead to respiratory distress, inflammation of the brain and the lungs, kidney failure and then multi-organ failure, ultimately leading to death.

Mortality rates for scrub typhus range from one per cent to 50% depending on proper antibiotic treatment, status of the individual infected and the strain.

Symptoms can worsen and complications may develop in some cases.

Treatment, prevention and cure

Scrub typhus fever is treated with antibiotics. Healthcare providers choose the antibiotic based on the patient’s symptoms and the results of laboratory tests.

The Centers for Disease Control and Prevention (CDC), United States prescribes antibiotic doxycycline to treat scrub typhus.

There is no vaccine for the disease. However, one can avoid contracting the disease by avoiding areas with lots of vegetation where chiggers may be found.

When visiting or working in areas where the disease occurs, take steps to avoid being bitten by a mite like wearing long sleeves, not sitting directly on the grass.

The CDC says that one must use insect repellents containing DEET or other active ingredients registered for use against chiggers, on exposed skin and clothing.

Additionally, one must dress their child in clothing that covers arms and legs, or cover crib, stroller, and baby carrier with mosquito netting.