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India Must Pay More Attention to Silent Killer Scrub Typhus

While scrub typhus is curable, it is also dangerous if it festers too long. When undetected, its mortality rate is around 13 percent. Owing to poor awareness, and due to the fact that both of them occur during the same seasons, many people mistake scrub typhus for dengue and end up mistreating it.

Through the first half of November, I was ill. It started with an unexplained mark on my right forearm, with a reddish trail that travelled upwards to my right bicep. It appeared to be an insect bite. The bite mark and the trail did not particularly hurt. There was only slight stiffness which couldn’t be classified as pain. I dismissed the red mark as a mosquito bite that I might have scratched off.

Initially, I had the bite checked out at a clinic when I contracted fever, although it was low. The doctor had told me that there’s nothing to worry about, unless the fever does not go away, in which case it could be dengue. Soon began the escalation of fever, going as high as 104.4°F. No amount of Paracetamol 650 mg pills could bring it down. Even at 800 mg, it would buy me only a small window of around two hours during which my fever was a tolerable 101°F.

Everyone, including me, was under the assumption that it is dengue. Platelet count began to drop off. After a visit to a local hospital, the doctor had said that my symptoms were consistent with dengue and that there would be no need to hospitalise unless there was a problem with my appetite and digestive system, which thankfully were intact.

Only after the fever refused to subside over a week did we all realise that something was wrong. By that time, my face had sunk and my feet had begun to show swelling. I also had rashes all over my body. It was becoming gradually difficult to walk due to the constantly high fever. The bug bite area was still not healing. My platelet count was dropping. I was hospitalised and admitted to the intensive care unit (ICU) because of my severe fever and dropping platelet count. After some in-depth investigation, the doctors supervising me arrived at the conclusion that my illness was something else: scrub typhus.

I somewhat recovered after spending six nights and seven days in the ICU, and two more nights in the general ward. But the infection has been severely draining for me; my liver is still recovering and my body feels weak and drained.

I caught this disease when dengue was doing rounds all across northern India and the National Capital Region. Caused by the bite of a chigger mite, its symptoms can be much like dengue – high fevers, drop in platelet count, rashes, etc. But the difference is that it attacks the body severely and can infect organs. It also takes much longer to recover from and needs heavy antibiotics.

The statistics for scrub typhus in India are rather low. A study of 138 hospitals, carried out over a decade, yields only 18,781 cases. A medical journal article from 2017 describes it as an “emerging threat”, also termed by another study as a “neglected threat”. Several news articles have also highlighted the threat of scrub typhus, which has caused fever deaths in the state of Uttar Pradesh.

In an important article, Aradhna Wal writes that diagnosed cases of scrub typhus are on the rise due to environmental changes such as deforestation. This disease could be travelling around even more, undetected, because its emergence often occurs at the same time as diseases like dengue and malaria.

Scrub typhus is a serious threat. As a person with reasonable economic privilege, I was able to avail proper medical treatment. I was also fortunate that it got detected at the right time when most of the symptoms pointed towards dengue, especially during a dengue outbreak. But not everyone can be both privileged and lucky.

When one thinks of disease seasons in India, dengue and malaria come to mind. They are common household names. When their seasons arrive, most people are aware that they could fall ill to them, should a mosquito bite them. The same type of commonplace awareness is required for scrub typhus. It too must enter the public consciousness as a serious threat. This disease, which is more prevalent in rural areas, can also become equally prevalent in urban areas due to increasing urbanisation.

It is high time that there is a comprehensive public awareness campaign about scrub typhus due to the intense risk that this disease poses to public health. From its side, the government could issue outbreak warnings to public hospitals, fund more research into the disease and ensure the supply of the antibiotic doxycycline which is used to treat the disease.

It must be kept in mind that while this disease is curable, it is also dangerous if it festers too long. Undetected, its mortality rate is around 13 percent. Added to that is the fact that its occurrence increases around the same time as dengue, which means that it can go undetected.

There are no vaccines for scrub typhus. The best way forward for the public at large is through awareness and precautionary measures such as avoiding dense vegetation, being well-covered and using insect repellents.

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Shivam Bahuguna is currently pursuing a PhD in International Relations from South Asian University. His academic interests include geopolitics, politics of culture and media. He also likes to occasionally strum on his guitar and sing.