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