Scrub typhus a life-threatening infection caused by Orientia tsutsugamushi bacteria is a major public health threat in South and Southeast Asia.
- As per estimates, nearly one million cases are reported from South and Southeast Asia with 10% mortality.
- India is one of the hotspots with at least 25% of the disease burden; in CMC Vellore alone, 500-1,000 patients are treated each year, of which 250-300 have severe disease.
About Scrub typhus and its treatment
- Scrub typhus is transmitted to humans by bites from tiny infected larvae of mites; mites breed during July-March.
- Only the larval stage of the mite requires a blood meal, which is usually from rodents.
- The larvae are invisible to the naked eye and the bite is not painful.
- So people don’t realise they have been bitten by an insect and possibly infected.
- The infection does not cause typical symptoms, thus, making correct and early diagnosis difficult.
- Till date, monotherapies using either doxycycline or azithromycin was the commonly used treatment.
- A trial carried out now in seven centres in India where patients were randomly assigned to receive a combination therapy of both doxycycline and azithromycin showed faster resolution of complications compared with two other arms where patients were given monotherapy of either doxycycline or azithromycin.
- The frequencies of respiratory, renal, hepatic, and central nervous system complications were lower in the combination-therapy group than in either of the monotherapy groups.
- Though oral doxycycline was routinely used as a monotherapy, the drug has to be administered intravenously for severe disease.
- This made treatment with azithromycin attractive as the intravenous formulation of the drug was widely available.
- However, even the largest trial so far, comparing doxycycline and azithromycin, included only less than 100 patients with milder disease.
- In contrast, the superiority of combination therapy for severe scrub typhus has been demonstrated by clinical evidence from the largest ever randomised, controlled trial. Second, the combination therapy was able to achieve faster clearance of the bacteria compared with monotherapies.
- The faster clearance in the combination therapy arm may be due to the complementary effect of the drugs.
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