ArticlePLoS neglected tropical diseases2019
Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study.
Article in PLoS neglected tropical diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 21 citations in OpenAlex.
- Leptotrombidium imphalum Chiggers as Vector for Scrub Typhus in Human Settlements, India, 2022-2023.Emerging infectious diseases · 2026Article
- Cost of illness of scrub typhus in South India - a population-based, mixed-methods study.PLoS neglected tropical diseases · 2026Article
- Risk factors for scrub typhus infection in South India: population-based cohort study.Epidemiology and infection · 2025Observational
- Incidence of Scrub Typhus in Rural South India.The New England journal of medicine · 2025Observational
- Humoral Immune Response toZoonoses (Shannon, Ireland) · 2025Article
- Estimating the Seroincidence of Scrub Typhus using Antibody Dynamics after Infection.The American journal of tropical medicine and hygiene · 2024Article
- Scrub typhus in urban areas of Wardha district in central India.The Indian journal of medical research · 2022Article
- The incidence ofEpidemiology and infection · 2022Article
- Scrub typhus in two COVID-19 patients: a diagnostic dilemma.Future microbiology · 2022Article
- Misdiagnosis of scrub typhus as hemorrhagic fever with renal syndrome and potential co-infection of both diseases in patients in Shandong Province, China, 2013-2014.PLoS neglected tropical diseases · 2021Article
- High initial IgG antibody levels against Orientia tsutsugamushi are associated with an increased risk of severe scrub typhus infection.PLoS neglected tropical diseases · 2021Article
- Risk Factors for Scrub Typhus, Murine Typhus, and Spotted Fever Seropositivity in Urban Areas, Rural Plains, and Peri-Forest Hill Villages in South India: A Cross-Sectional Study.The American journal of tropical medicine and hygiene · 2020Article
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Authors and funding
5 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundThe burden of scrub typhus in endemic areas is poorly understood. This study aimed at estimating the proportion of hospitalisations and outpatient visits for undifferentiated fever in the community that may be attributable to scrub typhus. METHODOLOGY AND PRINCIPAL
findingsThe study was a retrospective cohort with a nested case-control study conducted in the South Indian state of Tamil Nadu. We conducted house-to-house screening in 48 villages (42965 people, 11964 households) to identify hospitalised or outpatient cases due to undifferentiated fever during the preceding scrub typhus season. We used scrub typhus IgG to determine past infection. We calculated adjusted odds ratios for the association between IgG positivity and case status. Odds ratios were used to estimate population attributable fractions (PAF) indicating the proportion of hospitalised and outpatient fever cases attributable to scrub typhus. We identified 58 cases of hospitalisation and 236 outpatient treatments. 562 people were enrolled as control group to estimate the background IgG sero-prevalence. IgG prevalence was 20.3% in controls, 26.3% in outpatient cases and 43.1% in hospitalised cases. The PAFs suggested that 29.5% of hospitalisations and 6.1% of outpatient cases may have been due to scrub typhus. In villages with a high IgG prevalence (defined as ≥15% among controls), the corresponding PAFs were 43.4% for hospitalisations and 5.6% for outpatients. The estimated annual incidence of scrub typhus was 0.8/1000 people (0.3/1000 in low, and 1.3/1000 in high prevalence villages). Evidence for recall error suggested that the true incidences may be about twice as high as these figures.
conclusionsThe study suggests scrub typhus as an important cause for febrile hospitalisations in the community. The results confirm the adequacy of empirical treatment for scrub typhus in hospitalised cases with undifferentiated fever. Since scrub typhus may be rare among stable outpatients, the use of empirical treatment remains doubtful in these.
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