Introduction
Scrub typhus is a zoonotic and a rickettsial disease causing acute
febrile illnesses. It is causedby a bacterium called Orientia
tsutsugamushi. Scrub typhus rank among the foremost cause of suffering
and death in developing countries1.The disease is
transmitted by infected chigger mites to humans. It is characterized by
fever, nausea, vomiting, myalgia, lymphadenopathy, eschar, cough,
headache, gastrointestinal symptoms and many other severe
complications1&2. Diagnosis of scrub typhus is based
on clinical manifestations and history of environmental exposure.Within
first week of bite by infected mites, symptoms like chills, fever,
rashes and lymphadenopathy will occur and serious complications of
pneumonitis, pleural effusion, hepatomegaly, edema, acute kidney injury,
acute respiratory distress syndrome and meningitis may follow in
untreated patients3.
Geographically, subtropical climate has highest incidence of Scrub
typhus and was endemic disease to Taiwan in the year 2000-2004. It is
commonly found in Asian countries like Pakistan, Afghanistan, Maldives,
Bangladesh, India and Japan4. Outdoor activities,
agricultural works, and living near grassland and fields are associated
high risk of exposure to Scrub typhus with overall fatality rate of
13.6%5.Scrub
typhus is the leading infectious diseases in Northern India during
monsoon and post monsoon seasons6.The transplacental
spread of Scrub typhus was reported in India in a pregnant woman who has
delivered preterm baby with other multi-organ failure like
hepatosplenomegaly, meningitis and sepsis. Scrub typhus re-emergence in
Maldives in 2002 has recorded 168 suspected with 10 confirmed deaths.
Fatality rates range from 6% to 35% in untreated and missed diagnosis.
In Bhutan, the case was first detected at Geduin 2009. The case
re-emerged in 2014 at one of the rural primary schools of Bhutan
claiming two lives7. Scrub typhus is prevalence in
Bhutan currently stands to 62 per 100000 population at
risk8.
Zhemgang experiences a mildly warm and temperate climate and lies in
subtropical region. The people of the district depend on agriculture and
livestock farming. The district had 17763 populations as far the 2017
national survey report. The district has twelve primary healthcare
centres (PHCs), four sub posts and three hospitals. Only those three
hospitals have laboratory services to diagnose Scrub typhus.
Investigating the patterns of scrub typhus tests in the three higher
level health centres of the district and crucial in understanding the
disease pattern, as well as physicians prescribing pattern. This will
help to obtain deeper level of the disease picture in Zhemgang and is
expected to help public health intervention in the district. There are
few studies conducted on Scrub typhus in Bhutan but lacks data on region
wise and district wise presentation.
This study aimed to: (1) assess patterns of tests prescribed for Scrub
Typhus within the Zhemgang District across different health facilities,
seasons, year and age of the study participants.
Methodology