Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 23, Number 8—August 2017
Letter

Acute Encephalitis Syndrome and Scrub Typhus in India

On This Page
Altmetric
3
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: I read with interest the article by Khan et al. (1). The National Vector-borne Disease Control Program reported >60,000 cases of acute encephalitis syndrome (AES) in India during 2010–2016; 8 states (Assam, Uttar Pradesh, West Bengal, Odisha, Tamil Nadu, Karnataka, Manipur, and Tripura) accounted for most cases (2). In many states, outbreaks of AES occur during the rainy season and are associated with high mortality rates. Following the national surveillance algorithm, AES cases are investigated for IgM against Japanese encephalitis, which accounted for <15% AES cases. Khan et al. reported 20% of AES cases were due to scrub typhus (Orientia tsutsugamushi infection) (1). In Gorakhpur, Uttar Pradesh, 62.7% of AES patients had O. tsutsugamushi IgM, with a case-fatality rate of 16.2% (3). Studies have reported central nervous system (CNS) involvement among a substantial number of scrub typhus patients from Dehradun, Uttarakhand; Vellore, Tamil Nadu; Puducherry; and Lucknow, Uttar Pradesh (4,5). Given these findings, managers of the national program should consider investigations for scrub typhus as part of the surveillance algorithm for AES cases.

Higher mortality rates among patients with AES could be attributed to delayed care. In Gorakhpur, where outbreaks of AES occur seasonally, the median interval between fever onset and hospitalization was 7 days (IQR 5–10 days) (3). Although intravenous azithromycin has been recommended for AES patients in Gorakhpur since 2014, fatality rates continue to be high, indicating low response to treatment after CNS involvement. Early treatment of patients with acute febrile illness with antimicrobial drugs such as doxycycline before CNS manifestations is critical. Assessing the contribution of scrub typhus among patients with acute febrile illness, developing algorithms for administering appropriate antimicrobial drugs, and educating healthcare providers about the use of doxycycline are crucial for reducing deaths among patients with AES in scrub typhus–endemic areas.

Top

Manoj V. MurhekarComments to Author 

Author affiliation: National Institute of Epidemiology, Chennai, India

Top

References

  1. Khan  SA, Bora  T, Laskar  B, Khan  AM, Dutta  P. Scrub typhus leading to acute encephalitis syndrome, Assam, India. Emerg Infect Dis. 2017;23:14850. DOIPubMed
  2. National Vectorborne Disease Control Program. Ministry of Health and Family Welfare, Government of India. Statewise number of AES/JE cases and deaths from 2010–2017 [cited 2017 May 26]. http://www.nvbdcp.gov.in/Doc/je-aes-cd-April17.pdf
  3. Murhekar  MV, Mittal  M, Prakash  JA, Pillai  VM, Mittal  M, Girish Kumar  CP, et al. Acute encephalitis syndrome in Gorakhpur, Uttar Pradesh, India - Role of scrub typhus. J Infect. 2016;73:6236. DOIPubMed
  4. Peter  JV, Sudarsan  TI, Prakash  JA, Varghese  GM. Severe scrub typhus infection: Clinical features, diagnostic challenges and management. World J Crit Care Med. 2015;4:24450.PubMed
  5. Kumar Bhat  N, Dhar  M, Mittal  G, Shirazi  N, Rawat  A, Prakash Kalra  B, et al. Scrub typhus in children at a tertiary hospital in north India: clinical profile and complications. Iran J Pediatr. 2014;24:38792.PubMed

Top

Cite This Article

DOI: 10.3201/eid2308.162028

Related Links

Top

Table of Contents – Volume 23, Number 8—August 2017

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Manoj V. Murhekar, National Institute of Epidemiology–ICMR, R-127, Tamil Nadu Housing Board, Chennai, India

Send To

character(s) remaining.

Comment submitted successfully, thank you for your feedback.

Top

Page created: July 17, 2017
Page updated: July 17, 2017
Page reviewed: July 17, 2017
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external