SHIMLA/CHENNAI: A Team of researchers from Vellore, PGIMER, IGMC, Shimla, Rohtak, Pudducheri  have identified a better drug treatment for ‘Severe Scrub Typhus, a life-threatening infection caused by the bacteria, Orientia tsutsugamushi.

This infection, which primarily affects rodents, is transmitted to humans  by the larvae of trombiculid mites.

In Himachal Scrub Typhus is a major seasonal infection and new treatment has come as big relief for the patients. 

The Researchers found that a ‘Combination antibiotic treatment’ (using a combination of drugs) is more effective for treating severe scrub typhus than single-drug therapies. 

Scrub typhus is a major public health threat in India and other South Asian countries. It is estimated that in endemic regions, about a billion people are at risk of contracting the infection, while a million people get infected and 1.5 lakh people die from it every year. 

Prof.  George M Varghese, an infectious diseases physician and Researcher from Christian Medical College in Vellore, Tamil Nadu, and the INTREST trial investigators conducted a multi-centric, randomised controlled trial.

The trial was  funded by the DBT/Wellcome India Alliance to identify the best treatment option for patients with severe scrub typhus.

It demonstrated that treatment with intravenous doxycycline and azithromycin is more effective than using either drug on its own.

This new study, the largest ever randomised controlled trial on the treatment of severe scrub typhus, was published recently in The New England Journal of Medicine (DOI: 10.1056/NEJMoa2208449). 

The collaborating institutions included the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Indira Gandhi Medical College & Hospital (IGMC) Shimla, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, Christian Medical College, Vellore, SVIMS Tirupati and KMC Manipal.

Prof. George M Varghese, Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, said, “The implication of this study is that when using a combination of azithromycin and doxycycline to treat severe scrub typhus, more patients can be discharged from the hospital by day 7"

They would have fewer persisting complications, such as respiratory distress syndrome (ARDS), hepatitis, hypotension/shock, meningoencephalitis, and kidney failure.

This trial provides evidence that combination therapy with intravenous doxycycline and azithromycin is a better therapeutic option for the treatment of severe scrub typhus than monotherapies of either drug.

This new evidence will change treatment guidelines and save the lives of thousands of people with scrub typhus in the future.”

Prof. George M Varghese added that “Scrub typhus typically presents as a fever that may be associated with headaches, coughs, shortness of breath, and brain symptoms, like confusion and disorientation.

About six per cent of patients infected with scrub typhus could die in spite of diagnosis and treatment.

One-third of patients develop severe disease that affects multiple organs in the body and leads to lethally low blood pressure. Death rates in severe disease can reach up to 70 per cent without treatment and 24 per cent with treatment.