THIRUVANANTHAPURAM: A Gulf Keralite’s impulsive decision to return home to treat a persistent fever turned out to be life-saving after he was diagnosed with scrub typhus — a potentially fatal infection that requires early treatment.
This has become the first documented case of scrub typhus contracted in the Gulf and diagnosed in India, according to a case study published in the peer-reviewed journal Mass Gathering Medicine. The report warns that scrub typhus, once thought to be confined to parts of Southeast Asia and the Western Pacific, may now be emerging in the Middle East and recommends testing for the disease in patients with unexplained fever, even in non-endemic areas.
The disease was detected in a 52-year-old Thiruvananthapuram man, who had been living in Dubai.
After four days of high fever, chills, vomiting, and severe fatigue that did not respond to broad-spectrum antibiotics, he flew to Kerala and went straight from the airport to a super-specialty hospital in Thiruvananthapuram. “Some types of fever can only be cured back home,” he told doctors, echoing a common belief among his expatriate friends.
The disease is seen rarely in the Gulf, making diagnosis there unlikely.
However, scrub typhus is familiar to hospitals in Kerala, with nearly 1,000 cases reported annually. The patient was diagnosed within three days and responded quickly to the antibiotic, doxycycline, making a full recovery.
“In Dubai, scrub typhus is rarely recognised, and though doxycycline is available, doctors may not think to use it since the disease is not commonly reported there,” explained Dr A Althaf, professor at Government Medical College, Thiruvananthapuram, and co-author of the report. “The patient had been in Dubai for the past year, so it’s almost certain the infection occurred there. This case reminds us that doctors should consider scrub typhus in fever cases, even from areas where it’s not usually found,” he said.
Dr Althaf, who diagnosed Kerala’s first scrub typhus case in Nedumangad in 2003, noted that the disease has a 50% mortality rate if untreated, but is easily curable with early doxycycline therapy.
Scrub typhus, first reported in India in 1932, is caused by the bacterium Orientia tsutsugamushi and spread by mite bites. Globally, about one million cases occur each year.
According to the state’s health data, 70% of cases occur in Thiruvananthapuram district, though Kozhikode, Wayanad, Idukki, and Kollam also report the disease. In 2024, the state recorded 981 cases and 19 deaths. So far this year, 699 cases and 13 deaths have been reported.
Know the disease
Infection caused by bacteria named Orientia Tsutsugamushi
Bacteria enters human body through the bites of larval mites
Incubation period: 6-20 days
Symptoms: High grade fever, chills and rigorous, myalgia and body ache, intense headache. Throat pain, dry cough and chest pain
Diagnostic findings: Eschars (less than 1cm in diameter) in concealed and moist areas of the body (groins, armpits)
Scrub antibody test: IgM Elisa
Prevention: Protective clothing and use of insect repellents
