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Seroepidemiology of Spotted Fever Rickettsiosis in Uttar Pradesh: A Prospective Study
Chandra Dev Pati Tripathi1, Mastan Singh2, Jyotsna Agarwal3
1Ph.D. Student, Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Introduction:
Spotted Fever Rickettsiosis (SFR), an acute febrile illness caused by Rickettsia rickettsii, R. conorii and R. akari which is associated with considerable morbidity and mortality. SFR is one of the most covert emerging infections of the present time which is prevalent in various parts of India as shown by the increase in the number of clinically diagnosed patients in various states except Uttar Pradesh.
Aim:
To diagnose SFR in clinically suspected patients using serological tests and recognition of common epidemiologic situations and clinical manifestations of SFR in the state of Uttar Pradesh.
Materials And Methods:
Patients of all age groups presented with a diagnosis of Pyrexia of Unknown Origin (PUO) from May 2013 to February 2015 were evaluated. Testing was done using a nonspecific Weil felix test followed by more specific Enzyme Linked Immunosorbent Assay (ELISA) and a gold standard Immunofluorescence Assay (IFA) test for specific IgM antibodies against Rickettsia conorii. The data was statistically analysed on Graph Pad Prism (5.0) software by using Chi-square test.
Results:
Of the 432 patient samples tested by non specific Weil felix test, 200 (46.29 %) samples showed titre 1:80 or more and were taken as positive. Similarly out of the 432 blood samples tested by both ELISA and IFA based test against Rickettsiaconorii IgM antibody, only 115 (26.62%) samples were found to be positive and these samples were also positive by Weil felix. The common symptoms noted were fever, hepatomegaly, thrombocytopenia, lymphadenopathy and rashes, nausea followed by icterus, cyanosis, headache, oedema and abdominal pain. Eschar was found in only four (3.4%) patients. We also found that 31 patients with SFR also had associated co-infections like typhoid, malaria, dengue and hepatitis.
Conclusion:
Our findings demonstrated that Weil Felix test can fill in as an underlying yet not sole strategy to perceive and analyse rickettsial ailments, as it needs specificity. So, it may be used to assess the burden in the area and later on other tests like ELISA or IFA can be added, as these are more specific diagnostic tests. Further, our results also showed that if a patient tests positive for the more common endemic infections, we must test for rickettsiosis so that appropriate treatment could be administered.
Insights
Spotted Fever Rickettsiosis (SFR) is an emerging infection in India. This study highlights the utility of serological tests like ELISA and IFA for diagnosing SFR in Uttar Pradesh, identifying key clinical signs and co-infections.
Area of Science:
- Infectious Diseases
- Medical Microbiology
- Epidemiology
Background:
- Spotted Fever Rickettsiosis (SFR) is a severe febrile illness caused by Rickettsia species, presenting a significant public health challenge.
- Emerging evidence indicates a rising prevalence of SFR across India, necessitating improved diagnostic strategies.
Purpose of the Study:
- To establish serological diagnostic methods for SFR in suspected patients within Uttar Pradesh.
- To identify common epidemiological features and clinical presentations of SFR in the region.
Main Methods:
- Evaluation of patients with Pyrexia of Unknown Origin (PUO) using Weil Felix, Enzyme Linked Immunosorbent Assay (ELISA), and Immunofluorescence Assay (IFA) for Rickettsia conorii IgM antibodies.
- Statistical analysis of data using Graph Pad Prism software and Chi-square test.
Main Results:
- Out of 432 samples, 46.29% were positive by Weil Felix test, while 26.62% showed positive results for Rickettsia conorii IgM antibodies via ELISA and IFA.
- Common clinical manifestations included fever, hepatomegaly, thrombocytopenia, lymphadenopathy, and rashes; eschar was observed in only 3.4% of cases.
- Co-infections such as typhoid, malaria, dengue, and hepatitis were noted in 31 patients with SFR.
Conclusions:
- The Weil Felix test serves as a preliminary screening tool for rickettsial diseases but lacks specificity.
- Enzyme Linked Immunosorbent Assay (ELISA) and Immunofluorescence Assay (IFA) are crucial for specific SFR diagnosis.
- Testing for rickettsiosis is recommended in patients with common endemic infections to ensure timely and appropriate treatment.
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