Epidemiology and distribution of Eschar in Rickettsial_fever.pptx

Brief Description of Epidemiology and distribution of Eschar in Rickettsial fever in India

1. Reported in India from Jammu & Kashmir Himachal Pradesh Uttaranchal Uttar Pradesh Hariyana Rajasthan Assam West Bengal Maharashtra Karnataka Tamilnadu Kerala Pondicherry Odisa EPIDEMIOLOGY

2. SCRUB TYPHUS INDIAN TICK TYPHUS EPIDEMIOLOGY

3. LABORATORY INVESTIGATIONS Diagnostic procedures for rickettsiosis Reference lab IFA ELISA Weil Felix 2 nd week Eschar or ticks Reference lab PCR WESTERN BLOT 1 st week 1 st week

4. LABORATORY INVESTIGATIONS Weil Felix IgM and IgG ELISA Principle Heterophile antibody test Basis :- sharing of the antigens between rickettsia and proteus Demonstrates agglutinins to proteus vulgaris strain ox19, ox2 and proteus mirabilis oxk Immunoglobulin capture Assays When to do? 5-7 days after onset of fever IgM at the end of 1 st week IgG at the end of 2 nd week When to consider Significant Titre of > 1:80 Optical Density of 0.5. Sensitivilty & specificity low High Cost inexpensive Higher than weil felix

5. SCRUB TYPHUS INDIAN TICK TYPHUS ORAGANISM O. tsutsugamushi Rickettsia conorii AGENT Trombiculid mites Various tick genera(Rhipicephalus, ixodes, boophilus) VECTOR Rodents Dogs, rodents EPIDEMIOLOGY Endemic entire India Maharashtra Karnataka Tamil nadu RASH Transient Seen in 40 cases Seen in > 90% cases Gangrene and necrotic rash is more common ESCHAR 5-88% pathognomonic 3-5% unusual DIAGNOSIS ELISA FOR SCRUB TYPHUS OX K ELISA FOR ITT WEIL FELIX :- OX 2 OX 19

6. TREATMENT Doxycyxline and chloramphenicol Two time tested drugs to effectively treat rickettsial infections in patients of all ages including children Recommended treatment regimens Doxyclyclin : 2.2mg/kg/dose BD PO/IV (Max 200 mg/day) Chloramphenicol 50-100mg/kg/day Q6H (Max 3gm/day) Other drugs Azithromycin, Clarithromycin, Fluoroquinolones, Rifampicin Duration of the treatment: 5-7 days or at least 3 days until patient is afebrile

7. DRUG DOSE AND DURATION COMMENT DOXYCYCLIN 2.2 mg /kg dose BD per oral (max 200mg) 5 to 7 days or for atleast 3 days until the patient is afebrile Drug of choice Rapid defervesce within 48 hours I.V. formulation for sick patients TETRACYCLIN 25-50 mg/kg/ doses every 6 hourly per oral Maximum dose is 2gm/day 5 to 7 days or for atleast 3 days until the patient is afebrile Rapid defervesce within 48 hours I.V. formulation for sick patients CHLORAMPHENICHOL 50-100mg /kg/day every 6 hourly maximum is 3gm / day 5 to 7 days or for atleast 3 days until the patient is afebrile Most common altenative for tetracyclin C/I in pregnancy

8. DRUG DOSE AND DURATION COMMENT AZITHROMYCIN 10mg/kg/day od 5 to 7 days or for atleast 3 days until the patient is afebrile Preferred drug in pregnancy. In mild case, symptom duration similar when compared with doxycycline Recommanded when doxycycline resistant is present CLARITHROMYCIN 15mg/kg/day bd 5 to 7 days or for atleast 3 days until the patient is afebrile As effective as Azithromycin RIFAMPICIN 10mg/kg Maximum is 300mg 5 to 7 days or for atleast 3 days until the patient is afebrile Can be used in doxy resistant case Shorter duration of fever with rifampicin in northn thialand when compare with doxycline caution in TB endemic area FLUROQUINOLONES Not recommended in pediatric age group

9. Doxycycline Use it to treat suspected rickettsial infections in patients of all ages Now research shows NO evidence of pediatric dental staining when used in short course of time