# Emerging Burden of Scrub Typhus: A Comprehensive Analysis of Clinical, Demographic, and Occupational Risk Factors in a Tertiary Care Center in Rajasthan, India

## TL;DR

Scrub typhus is becoming more common in Rajasthan, India, with specific risk factors like rural living and agriculture work, and it often shows up without the usual skin lesion.

## Contribution

This study identifies key demographic and clinical features of scrub typhus in a specific Indian region, highlighting at-risk groups and diagnostic challenges.

## Key findings

- Scrub typhus was the most common cause of undifferentiated febrile illness in the study, affecting 29.5% of patients.
- The disease predominantly affected women, rural residents, and agricultural workers, with a seasonal peak in March-April.
- Thrombocytopenia was more common in hospitalized patients, and eschars were absent in all cases.

## Abstract

Introduction

Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging public health threat in India. The detailed characterization of its local epidemiology and clinical presentation is essential for timely diagnosis and effective public health intervention.

Methods

A cross-sectional, observational study was conducted from January to April 2024. A total of 156 patients with acute undifferentiated febrile illness were screened, of which 46 IgM enzyme-linked immunosorbent assay (ELISA)-confirmed scrub typhus cases were included for analysis. Data on demographic characteristics, geographical distribution, occupation, clinical features, and laboratory parameters were systematically collected and analyzed.

Results

Scrub typhus was the leading cause of acute undifferentiated febrile illnesses (AUFI) (46/156, 29.5%), showing a significant predilection for women (29, 63.0%), rural residents (32, 69.6%), and agricultural workers (25, 54.3%), with a distinct seasonal peak in March-April (39, 84.8%). The most common symptoms were fever (46, 100%), myalgia (30, 65.2%), and headache (28, 60.9%); notably, an eschar was absent in all patients. Thrombocytopenia was significantly more prevalent in hospitalized (inpatient department {IPD}) patients compared to outpatients (outpatient department {OPD}) (five, 45.5%, versus four, 11.4%; p=0.010).

Conclusion

The distinct demographic profile and frequent hepatic dysfunction, in the absence of an eschar, are critical features that should guide early diagnosis and empiric treatment in this endemic region. Public health efforts should target at-risk populations through awareness and vector control measures.