Rickettsial infections: Indian perspective
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Underdiagnosed and misdiagnosed rickettsial infections are important public health problems. They also lead to extensive investigations in children with fever of undetermined origin contributing to financial burden on families. The present review addresses the epidemiology, clinical features, diagnosis and management issues of these infections, primarily for a practicing clinician.
We did a PubMed, Medline and Cochrane library search for literature available in last 40 years.
Rickettsial infections are re-emerging and are prevalent throughout the world. In India, they are reported from Maharashtra, Tamil nadu, Karnataka, Kerala, Jammu and Kashmir, Uttaranchal, Himachal Pradesh, Rajasthan, Assam and West Bengal. In view of low index of suspicion, nonspecific signs and symptoms, and absence of widely available sensitive and specific diagnosic test, these infections are notoriously difficult to diagnose. Failure of timely diagnosis leads to significant morbidity and mortality. With timely diagnosis, treatment is easy, affordable and often successful with dramatic response to antimicrobials. As antimicrobials effective for rickettsial disease are usually not included in empirical therapy of nonspecific febrile illnesses, treatment of rickettsial disease is not provided unless they are suspected. Knowledge of geographical distribution, evidence of exposure to vector, clinical features like fever, rash, eschar, headache and myalgia alongwith high index of suspicion are crucial factors for early diagnosis.
Key wordsRickettsia Spotted fever Typhus fever Vasculitis Weil-Felix test
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- 2.Jayaram Paniker CK. Ananthanarayan and Paniker’s Textbook of Microbiology. 7th ed. University Press Pvt Ltd; 2008; 412–421.Google Scholar
- 3.Kelly DJ, Richards A, Temenak J, Strickman D, Dasch GA. The past and present threat of rickettsial disease to military medicine and international public health. Clin Infect Dis 2002; 34(suppl 4): S 145–169.Google Scholar
- 4.Chapman AS, Bakken JS, Folk SM, Paddock CD, Bloch KC, Krusell A, et al. Diagnosis and management of tickborne rickettsial diseases. MMWR Recomm Rep 2006; 55: 1–27.Google Scholar
- 6.Mahajan SK, Kashyap R, Kanga A, Sharma V, Prasher BS, Pal LS. Relevance of Weil-Felix test in diagnosis of scrub typhus in India. J Assoc Phys India 2006; 54: 619–621.Google Scholar
- 10.Centre of Disease Control and Prevention (CDC). Rickettsial Diseases. Available at http://www.cdc.gov/ncidod/diseases/sunmenus/sub_rickettsial.htm. Accessed 30 May, 2009.
- 11.Gregory AD, Jennifer HM. Other rickettsia species. In: Sarah SL, Larry KP, Charles GP, editors. Principles and Practice of Pediatric Infectious Diseases. 2nd ed. Philadelphia: Churchill Livingstone; 2003. p. 945–951.Google Scholar
- 12.Siberry GK, Dumler JS. Rickettsial infections. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson Textbook of Pediatrics, 18th ed. Pennsylvania, Saunders; 2007. p. 1289–1301.Google Scholar
- 14.Sreeja P, Elizabeth M, Prabhakar DM. Scrub typhus. Indian Pediatr 2004; 41: 1254–1257.Google Scholar
- 15.Somashekar HR, Prabhakar DM, Sreeja P, Elizabeth M, Didier R, Jean MR. Magnitude and features of scrub typhus and spotted fever in children in India. J Trop Pediatr 2006; 52: 229.Google Scholar
- 16.Christopher DP, James EC. Rickettsia rickettsii. In: Sarah SL, Larry KP, Charles GP, editors. Principles and Practice of Pediatric Infectious Diseases. 2nd ed. Philadelphia: Churchill Livingstone; 2003. p. 942–945.Google Scholar
- 17.Walker DH, Raoult D. Rickettsia rickettsii and other spotted fever group rickettsiae. In: Mandell GL, Bennet JE, Doalin R, Editors. Principles and Practice of Infectious Diseases. Philadelphia: Churchill Livingstone; 2000. p. 2035–2042.Google Scholar
- 24.Kaplowitz LG, Fischer JJ, Sparling PF. Rocky Mountain spotted fever: a clinical dilemma. Curr Clin Top Infect Dis 1981; 2: 89–108.Google Scholar
- 26.Fernandez AD, Johan-lian R. Scrub typhus. Emedicine J, 2002; March@www.emedicine.com.Google Scholar
- 27.Suzuki T, Eto M. The value of Weil-Felix test in the diagnosis of tsutsugamushi disease. Jpn Med News 1980; 2956: 43–47.Google Scholar
- 30.CDC. Consequences of delayed diagnosis of RMSF in children. MMWR 2000; 49: 885–888.Google Scholar
- 37.AAP Committee on Infectious Diseases. Rocky Mountain Spotted Fever. In: Red Book. 27th Ed. Elk Grove Village, IL: AAP; 2006. p. 570–572.Google Scholar