”Scrub typhus,” pronounced the doctor. “What's that?” I asked. It is spread by the larval stage of a large number of trombiculid mite species. These tiny devils target small mammals, like rodents, and birds, but accidentally get on humans.
Rom had just returned from Arunachal Pradesh complaining of a severe migraine-like headache and the shivers. I was convinced he had cerebral malaria but within hours of checking into emergency, he tested negative. Screening for dengue, leptospirosis and scrub typhus followed. By the time he tested positive for scrub typhus, he was talking gibberish. He didn't recognise me nor was he aware of his name. An MRI indicated encephalitis and the fluid from his spinal cord tested positive for meningitis. Even as the doctors started him on antibiotics, I feared for his life. Those were dark days. Finally, five days of delirium later, Rom's condition took a turn for the better and in another ten days, he was discharged.
Since the doctor insisted this was a disease of the “deep jungle,” I investigated further. ‘Scrub' is a misnomer as the disease appears to occur in sandy, semi-arid, mountain deserts, rice fields and even urban areas. In fact, junglies are not the only ones in danger of contracting the disease. A friend who lives on the beach, not far from us, contracted scrub typhus in her home of twenty-odd years.
The word ‘typhus' comes from the Greek ‘typhos' meaning “hazy,” referring to the state of mind of the patient. The villain of the piece is Orientia tsutsugamushi (in Japanese, ‘ tsutsuga' means ‘small and dangerous' and ‘ mushi' means ‘mite'), the parasite that causes scrub typhus. Written records of the disease date back to the 4th century in China and the early 1800s in Japan. Worrisome scientific reports say the disease is re-emerging in several countries, including India. Today, one billion people are exposed to the disease and one million are infected annually.
According to the World Health Organization's website, one can contract scrub typhus anywhere in the ‘tsutsugamushi triangle' – from Pakistan in the West, to Japan in the East and the islands of Indonesia in the South. In mid-September 2011, scrub typhus outbreaks were reported in Nagaland and Himachal Pradesh. Three people died in the former and more than 13 in the latter.
In all these years of visiting jungles around the country, we've always dismissed leeches and ticks as minor irritations. Anyone who fussed about getting bitten by them was clearly a novice or a wimp, and we had no patience for their complaints. None mentioned mites, maybe because you can't see them. Before setting out for the jungle, if we remembered, we'd douse ourselves with insecticide. Ignorant of scrub typhus' long history of debilitating humans, we were more concerned about the negative influences of chemicals than about diseases.
During the Second World War, an estimated 36,000 soldiers were incapacitated or died of scrub typhus, a disease even more dreaded than malaria. One report said that more troops were laid low by tsutsugamushi than direct wartime casualties. Between 1942 and 1946, the United States of America Typhus Commission made a major effort to prevent, control and treat the disease by using miticides, issuing insecticide-impregnated uniforms, and burning and clearing camp sites.
The Wellcome Foundation Laboratories in the U.K. produced a vaccine, and 268,000 cc. was dispatched to India between June and December 1945 to inoculate Allied Forces serving in Southeast Asia. However, little is known of its efficacy and there is no vaccine currently available. In those pre-antibiotic days, mortality was as high as 50%.
According to one study, meningo-encephalitis was found in all cases of mortality from scrub typhus. Since then, antibiotics have saved many people's lives, including Rom's.
You bet, we are going to be dousing ourselves in insecticide containing DEET (short-form of N,N-Diethyl-meta-toluamide) before setting out for the jungle hereafter. Better to be a wimp than knock on heaven's door.
