Researchers from Kerala identify a rare case of scrub typhus in a Dubai-returned man from Thiruvananthapuram

A team of medical researchers from Kerala has identified a rare case of scrub typhus in a native of Thiruvananthapuram who recently returned from Dubai in the United Arab Emirates, a country which is not endemic to the disease.

In a recent article published in Mass Gathering Medicine, a peer-reviewed, open-access journal, the researchers pointed out that the case underscored the possibility of transmission of the disease in non-endemic regions.

Study highlights

It highlighted the need for enhanced epidemiological studies to know how it was occurring in different groups of people in that region and entomological studies on the insect population there. Ongoing surveillance was also required in the area, they said.

The authors of the study are Althaf Ali and K.J. Anu of the Department of Community Medicine, Government Medical College, Thiruvananthapuram; Praseeda Chandran of the Department of Community Medicine, Government Medical College, Kannur; Zinia Thajudeen Nujum of the Department of Community Medicine, Kollam; Shahul H. Ebrahim of the University of Sciences and Techniques, and Technology, Bamako, Mali; and Shaffi Muhammed of the Global Institute of Public Health, Thiruvananthapuram.

Scrub typhus is caused by the bacteria called Orientia tsutsugamushi and it is spread to people through bites of infected chiggers (larval mites). The illness was earlier reported only once in Dubai, in 2006, in an Australian traveller. According to official figures, around thousand scrub typhus cases are reported each year in Kerala, 70% of which are from Thiruvananthapuram and the rest are from Kozhikode, Wayanad, Idukki and Kollam. Of the 981 cases and 19 deaths reported in 2024, 733 cases and eight deaths were in Thiruvananthapuram.

Dr. Althaf Ali said that clinicians should maintain a high index of suspicion for scrub typhus in patients with compatible symptoms—regardless of the presence or absence of an eschar (lesion on the skin). The symptoms include febrile illnesses (a history of sudden and temporary rise in body temperature).

Appropriate laboratory testing may be advised to confirm the diagnosis and timely and effective treatment should be initiated, he said.

The 52-year-old male had a history of four days of fever, chills, vomiting, and profound fatigue. His symptoms persisted despite initial treatment from abroad with broad-spectrum antibiotics that deal with a range of bacteria. Subsequently, he returned to his home town, where he was hospitalised.

Tests for dengue, malaria, leptospirosis, and viral hepatitis turned out to be negative, while he tested positive for scrub typhus. Treatment with doxycycline led to marked clinical improvement in three days.