By Our Reporter
SHILLONG, Nov 15: Scrub typhus infection has claimed the lives of two people while many are undergoing treatment at the Dr H Gordon Roberts Hospital, Jaiaw.
Scrub typhus spreads through the bites of infected chiggers or berry bugs.
The hospital has received infected patients from several districts in the Khasi and Jaintia Hills. These include South West Khasi Hills, East Khasi Hills, West Khasi Hills, and Ri Bhoi.
Speaking to some reporters here on Wednesday, a medical specialist at the hospital, Meban Aibor Kharkongor said scrub typhus has only recently attracted the attention of the public and health systems in Meghalaya with more and more cases being diagnosed in the last few years.
“With peak cases seen in November, the scrub typhus season spreads from July to December almost every year,” he said.
Dr Kharkongor said there are a few patients who are in critical condition and are admitted to the ICU of the hospital. The situation is quite alarming, he added.
“The treatment for patients in a critical condition may take three months. In some cases, the patients may not survive,” he said.
The treatment costs about Rs 100 if the infection is detected early, the doctor said.
Scrub typhus is an acute febrile illness caused by the Orientia tsutsugamushi bacteria introduced to the human host following the bite of a mite, a very small insect found in areas with sparse vegetation.
“It can present with a varied number of symptoms, ranging from fever that lasts for a few days to a full-blown illness with multi-organ failure, requiring ICU-level care and resulting in significant medical expenses and sometimes even loss of life,” Dr Kharkongor said.
He said the illness has been encountered for many decades throughout the Indian subcontinent.
“Most cases will present with fever (more than 98%). About 30% of patients will also have an ‘Eschar’, which is the site at which the mite gains entry or penetrates the skin. This lesion resembles a cigarette burn on the skin,” he said.
According to the doctor, multiple studies have shown that patients with an Eschar are more likely to develop severe illness and have higher chances of dying from the disease. More severe forms of the illness will develop hepatitis, acute renal failure, meningitis, septic shock, and acute respiratory distress syndrome.
“In short, severe forms of this illness will affect all internal organs and is indeed a very serious disease. The overall mortality is seen to be at approximately 5% of all patients admitted with scrub typhus,” he said.
Dr. Kharkongor further said that the key to fighting this illness, which is now endemic to the state, lies on a few things – understanding the nature of spread so that all precautions can be taken to prevent people from contracting the infection, and early detection so that treatment can be made easily thereby preventing unnecessary medical expenses and loss of life.
The doctor said young men and women who frequent areas with dense vegetation for work and pleasure are at the highest risk of contracting the illness.
“These small insects will cling to our clothes and make their way to the skin and ultimately take refuge in areas where the skin folds, like axillae, groin, under the breasts, behind the ear lobes, etc., and then penetrate the skin,” he said.
He said that this would allow the microorganism to gain access to the body and cause clinical syndrome.
“Having understood this nature of spread, modifying some behaviour on our part will go a long way in preventing this illness at the community level. Encouraging everyone to change clothes and take a bath after every visit to a forested area, drying clothes on a wire rather than on bushes by the side of a riverine, are a few ways in this direction,” Dr Kharkongor said.
As far as early detection of the illness is concerned, he said that diagnostic tools for confirmation are still not easily available across the State.
“Most still rely on rapid tests which are good screening tests, based on which, under appropriate clinical presentations, treatment can be done quite effectively. However, at a community level, all patients who develop fever lasting for more than a few days should be encouraged to search for the presence of the Eschar, which is a very specific sign of this illness,” he said.
According to him, this has been rather a difficult task for both the general public and the healthcare community as the Eschar is most often located in the deep corners of the body.
“But having worked with this illness for many years now, I cannot stress this enough, that we all need to look for the Eschar whenever we are dealing with any acute febrile illness,” Dr. Kharkongor said.
He said there is always a fear of something that people do not fully understand, and the same applies to illnesses as well.
“Understanding this illness will be the first step as this will go a long way to fight such an illness that is now becoming endemic in our area,” he added.