Delayed diagnosis led to scrub typhus deaths: Central team
BHUBANESWAR: Late diagnosis and delayed treatment led to death of scrub typhus patients in western Odisha districts while the cases saw an exponential growth due to behavioural exposure of people in the region, indicated a report submitted by the central team.A multi-disciplinary central team had visited Jharsuguda, Bargarh, Sundargarh, Sambalpur and Bhubaneswar to conduct a situational analysis of scrub typhus in the state, which reported over 2,800 cases and eight deaths.
In its interim report to the government, the team said in some cases there was a delay in testing, hospital admission and initiation of treatment while some patients with organ involvement and other complications of scrub typhus were diagnosed late. On reviewing the admitted case sheets, they found that complications such as pneumonia and acute respiratory distress syndrome, myocarditis and kidney involvement were observed in some admitted and death cases.
“Patients, who were tested, diagnosed and treated timely, recovered well, but delay in diagnosis and initiation of treatment led to complications in some cases,” the team said and pointed out that occupational and behavioural risk factors that are associated with illness could be the reason behind the sudden spike in cases.
The team observed that a majority of patients are residing in close proximity to forests or farms with presence of rodents, pets or livestock, cattle shed in their houses. They walk barefoot, do not use fully covered clothing or maintain proper personal hygiene. “The practice of open defaecation was seen in many cases as a possible exposure factor for contacting the disease,” it said.
As per the epidemiology of cases in Sundargarh district where 416 tested positive and four died, half of the cases reported sitting/lying on grass, walking barefoot on ground and 96 per cent (pc) reported not wearing fully covered protective clothing while being outdoors and 49 pc reported practising open defecation, 60 pc reported bathing and 52 pc reported changing clothes after returning from field work.
The central team has recommended to conduct regular orientation of medical officers and field health staff to emphasise on early diagnosis and testing to prevent possible complications. Besides suggesting to strengthen syndromic surveillance for fever and referral system of critically ill patients, the team advised to ensure accessible and affordable sanitation options.