The Indian Council of Medical Research (ICMR) has issued a set of draft guidelines for diagnosis & management of Rickettsial diseases which are considered some of the most covert, emerging and re-emerging diseases and are being increasingly recognized. Acute fever is the most common presenting symptom often associated with breathlessness, cough, nausea, vomiting, mylagia and headache.
Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have fatality rates as high as 30-45% with multiple organ dysfunction, if not promptly diagnosed and appropriately treated . The vast variability and non-specific presentation of this infection have often made it difficult to diagnose clinically.
According to the draft guidelines, acute undifferentiated febrile illness of 5 days or more with or without eschar should be suspected as a case of Rickettsial infection. (If eschar is resent, fever of less than 5 days duration should be considered as scrub typhus.) Other presenting features may be headache and rash (rash more often seen in fair persons), lymphadenopathy, multi-organ involvement like liver and kidney involvement and acute respiratory distress. The differential diagnosis of dengue, malaria, pneumonia, leptospirosis and typhoid should be kept in mind.
Rickettsial diseases have been documented in India since the 1930s with reports of scrub typhus from Kumaon region, Assam in soldiers in the second world war, scrub and murine typhus from Jabalpur area in Madhya Pradesh and of murine typhus from Kashmir. Surveillance in animals and in humans in different parts of India has documented significant levels of exposure to infections. Rickettsiosis has been clearly reported from several states in India including Himachal Pradesh, Tamil Nadu, Kerala, Maharashtra, Bihar, Karnataka, Jammu and Kashmir, Uttaranchal, Rajasthan, West Bengal and Meghalaya.
In some regions scrub typhus accounts for upto 50% of undifferentiated fever presenting to hospital.
Rickettsial infections are caused by a variety of obligate intracellular, gram- negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma, belonging to the Alphaproteobacteria. Rickettsia are classically divided into the typhus group and spotted fever group (SFG), although the genus has been subdivided further based on phylogenetic analysis. Orientia spp. makes up the scrub typhus group.16 Rickettsial diseases are zoonoses where human beings are accidentally involved in a chain of transmission between trombiculid mites (chiggers), ticks or fleas and animals (most commonly rodents).
Among the major groups of rickettioses, commonly reported diseases in India are scrub typhus, murine flea-borne typhus, Indian Tick Typhus and Q fever. ICMR has invited suggestions and comments from the stakeholders.
Source:Pharmabiz
Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have fatality rates as high as 30-45% with multiple organ dysfunction, if not promptly diagnosed and appropriately treated . The vast variability and non-specific presentation of this infection have often made it difficult to diagnose clinically.
According to the draft guidelines, acute undifferentiated febrile illness of 5 days or more with or without eschar should be suspected as a case of Rickettsial infection. (If eschar is resent, fever of less than 5 days duration should be considered as scrub typhus.) Other presenting features may be headache and rash (rash more often seen in fair persons), lymphadenopathy, multi-organ involvement like liver and kidney involvement and acute respiratory distress. The differential diagnosis of dengue, malaria, pneumonia, leptospirosis and typhoid should be kept in mind.
Rickettsial diseases have been documented in India since the 1930s with reports of scrub typhus from Kumaon region, Assam in soldiers in the second world war, scrub and murine typhus from Jabalpur area in Madhya Pradesh and of murine typhus from Kashmir. Surveillance in animals and in humans in different parts of India has documented significant levels of exposure to infections. Rickettsiosis has been clearly reported from several states in India including Himachal Pradesh, Tamil Nadu, Kerala, Maharashtra, Bihar, Karnataka, Jammu and Kashmir, Uttaranchal, Rajasthan, West Bengal and Meghalaya.
In some regions scrub typhus accounts for upto 50% of undifferentiated fever presenting to hospital.
Rickettsial infections are caused by a variety of obligate intracellular, gram- negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma, belonging to the Alphaproteobacteria. Rickettsia are classically divided into the typhus group and spotted fever group (SFG), although the genus has been subdivided further based on phylogenetic analysis. Orientia spp. makes up the scrub typhus group.16 Rickettsial diseases are zoonoses where human beings are accidentally involved in a chain of transmission between trombiculid mites (chiggers), ticks or fleas and animals (most commonly rodents).
Among the major groups of rickettioses, commonly reported diseases in India are scrub typhus, murine flea-borne typhus, Indian Tick Typhus and Q fever. ICMR has invited suggestions and comments from the stakeholders.
Source:Pharmabiz
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