what you need to know about Scrub Typhus in Chitwan, Nepal Oct 11th 2016


http://emedicine.medscape.com/article/971797This caught my eye yesterday:

RATNANAGAR, Oct 10: As many as 59 new cases of scrub typhus infection have been reported in Chitwan district in Asoj, pushing the number of patients in the district to 264 in the last six months.

According to the Insect Controller Inspector at the District Public Health, Chitwan, Ram Kumar KC, this bacterial disease has already claimed two lives in the district so far.

A total of eight persons have been reported dead due to the infection since its outbreak in the eastern part of the country, shared Resham Lamicchane, Public Health Officer at the Epidemiology and Disease Control Division under the Ministry of Health.

According to him, scrub typhus cases have been reported from 37 districts. RSS from Republika http://www.myrepublica.com/news/7173

Is That It?!?!?!

Yes. Normally I only excerpt a longer article – but that’s the whole enchilada right there.

Okay, it’s Dasain, and nobody is reading the papers and nobody is really writing any actual journalism it seems.  (this blog gets noticeably fewer hits as well). Here is my  problem. The article tells us there is an outbreak  – that is good. But it tells nothing about what the symptoms are, how to prevent exposure, whether the treatment works, etc.  They  reported it, yes; but they could have also done a public service.

Fortunately we have the internet.

Here, as a public service, is some info about scrub typhus. Now, I am a person who reads about deadly infectious diseases just “for fun” and enjoyment. ( I think I need to get out more). Next, the other name for scrub typhus is – Tsutsugamushi disease. I laughed out loud, because I always loved that word. An MD friend of mine once did a locum tenans job in Brownsville Texas and told me it was endemic there – about the only place in the USA he said.

scrub-typhus-eschar

from http://emedicine.medscape.com/article/971797-overview this lesion is very closely associated with scrub typhus. When you find it, go to the hospital for antibiotics. It may be under the clothes in an uninspected area.

Preventive measures?

Preventive measures in endemic areas include the following:

For those who do not know the location, it is Ratnanagar – just east of Bharatpur/Narayangarh. You go through Ratnanagar to get to Chitwan National Park.

IMG_20150418_174642

(my photo) Rush hour in Sauraha, next to Chitwan National Park. This is what the tourists see. Most cities do not actually have these.

People go through Ratnanagar but (the tourists anyway) do not stop.  In Chitwan national Park one popular activity for tourists is to take a nature hike. Use insect repellant if you do.

Chloramphenicol

Interestingly, it is treatable with antibiotics. One option is Chloroamphenicol, an antibiotic no longer in use in USA. There is no vaccine.

An excellent monograph from USA’s NIH

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829893/ this gives a technical analysis of the “laboratory bench” diagnostic tools. In the meantime, if you have a patient with febrile illness, look for the eschar; and consider the possibility of scrub typhus. In Nepal, it seems more likely in Terai, but at this time of year, people travel for Dasain, the big homecoming holiday.

something every nurse and doctor who reads this, can do.

use your smartphone to show the picture of the eschar to all your  colleagues, esp if you work in a clinic or emergency room.

If your patient has recently travelled to Terai and returned to Kathmandu, be on the lookout!

About Joe Niemczura, RN, MS

Experienced nursing educator and problem-solver. I have fifteen years of USA nursing faculty background. Add it with fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. I travel outside of Kathmandu Valley as well. When the recent violence happened, I knew the cities - I had trained people in those locations. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011. Global Health Nursing is not all sweetness and light; not solely milk & honey and happy moms and babies.
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