Title: RICKETTSIOSIS : AWARENESS OF PREVALENCE, DIAGNOSIS AND EVALUATION OF CYTOKINE PROFILE
Co-Author(s): Madhav Chowdhry, Priyanka Chowdhry
INTRODUCTION: Rickettsial infection is responsible for considerable morbidity and mortality in India. The problem is under-recognized and under- treated due to lack of community based data owing to the non-specific signs and symptoms and non-availability of confirmatory laboratory tests. The aim of this study was to determine the prevalence of scrub typhus in North India, compare the results of slide agglutination with IgM ELISA in the diagnosis and assess TNF-alpha levels for its impact on the course of disease. We also assessed knowledge, attitude and practices (KAP) of medical practitioners towards rickettsiosis.
METHODS: In this descriptive study, 357 consecutive patients with fever of at least a week’s duration associated with or without other acute symptoms were recruited.After screening for Malaria, Enteric Fever and Leptospirosis, patients were analyzed for Scrub Typhus. Their TNF-alpha levels were assessed. 30 healthy controls were taken to find the prevalence of infection and normal cytokine levels in general population. Comparison between slide agglutination test(SAT) and IgM ELISA test was done, taking IgM ELISA as gold standard. KAP among doctors was assessed using a questionnaire to design an awareness program.
RESULTS: 91 out of 357 patients were diagnosed with Scrub Typhus disease. Slide agglutination test was found to have high sensitivity but lower specificity than IgM ELISA. Mean TNF-alpha levels in Scrub Typhus positive patients were slightly but not significantly raised as compared to normal population.Analysis of KAP revealed that only 2 out of 20 doctors considered Rickettsiosis as differential diagnosis.
CONCLUSION: Active surveillance of rickettsial diseases is necessary to assess the exact magnitude and distribution. Scrub Typhus detection by slide agglutination is a relatively cheaper alternative and can be utilized as part of initial investigation to guide the clinicians treatment. KAP was poor among the clinicians for Scrub Typhus which could be the factor in the under diagnosis of this disease.