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REVIEW ARTICLE
Year : 2014  |  Volume : 7  |  Issue : 6  |  Page : 249-254

Rickettsial disease outbreaks in India: A review


1 Department of Biology, University of Pennysylvania, Philadelphia, Pennsylvania, USA
2 Department of Health Systems Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India
3 Department of Epidemiology, National Institute of Epidemiology, Chennai, Tamil Nadu, India

Correspondence Address:
Dr Prabhdeep Kaur
National Institute of Epidemiology, Indian Council of Medical Research (ICMR), # R-127, 3rd Avenue, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.155018

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Rickettsial infections are caused by bacteria of the Rickettsiae family. Several reports in the past decade indicated the presence of disease in various parts of India. We reviewed the rickettsial outbreaks to describe the epidemiology, clinical features, laboratory investigations, entomological investigations, risk factors and treatment. We searched the literature about rickettsial diseases outbreaks in India using web databases. We included research papers about the investigation of rickettsial disease outbreaks during 2000-2011. We included 11 outbreaks from seven Indian states of which four were in a community setting rest were hospital based. There were more than 900 cases and forty two deaths with case fatality ratios 5%-17%. The clinical manifestations were fever, eschar, headache, myalgia, cough and lymphadenopathy. The laboratory diagnosis in 9 outbreaks was based on Weil Felix test either singly (n = 5) or in combination with Micro-immunofluorescence (n = 2) or ELISA (n = 2). Only IgM ELISA was used in 2 outbreaks. Only one of the outbreaks was due to Indian Tick Typhus while the remaining 10 were due to Scrub Typhus. Risk factor and entomological investigations were conducted in few studies. The review of rickettsial outbreaks in the last decade indicates its continued presence in several parts of the India. We recommend use of uniform case definition, capacity building for laboratory confirmation and entomology surveys. Doctors practicing in areas prone to these diseases need to be sensitized to have high index of suspicion while evaluating patients with fever and community should be educated to seek early treatment.


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