THIRUVANANTHAPURAM: The recent death of a teen girl and a woman in Thiruvananthapuram of scrub typhus, which is mostly reported in bushy areas, has highlighted how the disease spread by mites can also spread in urban settings. The 15-year-old girl died in Varkala on June 9 and and 38- year-old woman in Neyyattinkara on June 12.
Scrub typhus is one of the common re-emerging infectious diseases with a history of slowing down military expeditions including that of Netaji Subhas Chandra Bose-led Indian National Army. The disease, however, is not restricted to soldiers marching in the scrub vegetation on the borders.
It was first reported in the state at Nedumangad in Thiruvananthapuram in 2002. It has been affecting people’s lives since then aided by favourable environmental conditions here. In the last decade, 4,500 people tested positive for scrub typhus, caused by the bite of an infected larval mite or ‘chiggers’, and 67 of them died.
While the infected larval mites are blamed for causing the disease in humans, the fact that mites are carried by pets and other domestic animals along with rodents and squirrels increases the chances of catching the infection even in urban settings. The cases have been reported from the city area and rural parts of Thiruvananthapuram, which has emerged as an epicentre of the disease.
“Most scrub typhus cases have been reported from areas where there is scrub vegetation. The eggs of chigger mites dropped on soil become larvae and find their way to the tip of grass and find a suitable host which includes human beings. But there have been instances where the larvae reached the human body from the floor of the house,” said Dr Althaf A, an epidemiologist and associate professor at Government Medical College Hospital, Thiruvananthapuram. He conducted epidemiological and ecological study of scrub typhus covering different parts of Thiruvananthapuram when he was working at Government Medical College Hospital here during 2002-2005. Scrub typhus is a treatable disease. But the mortality is up to 40% in untreatable cases.
“There is no need to suspect scrub typhus in all fever cases. The presence of eschar (a scab) in the body is a sure sign for the disease. But eschar is found only in 40-80% patients. The treating doctor can start giving doxycycline even before the lab tests to confirm the disease. The antibiotic will give relief in the first 48 hours itself and it is used as a method to confirm the disease as well,” said Dr Althaf. The health department started prescribing doxycycline along with paracetamol to all fever patients coming from areas mapped for scrub typhus prevalence in 2005.
Thiruvananthapuram contributes 75% of the scrub typhus cases in the state, followed by Wayanad (10%), Kozhikode (5%), Kannur, Malappuram and Palakkad. Health experts have pointed out the degradation of the environment as the underlying cause of the emergence and re-emergence of infectious diseases.
Cases in state*
Year Cases Deaths
2012 39 4
2013 68 0
2014 433 6
2015 1,149 15
2016 633 3
2017 340 5
2018 400 6
2019 579 14
2020 423 8
2021 438 6
Source: DHS