When a Mite Changed Everything: My Battle with Scrub Typhus

Hey guys, it's been quite long since I last wrote an article, thanks to a life-changing incident I went through. I would like to share that with all of you. You might have observed that my earlier articles presented a view of microbiology with microbes mentioned in general or relating to a broad group, but this time I would like to focus on one specific bacterium, i.e Orientia tsutsugamushi, which causes the disease Scrub Typhus.

Why this disease? Well, one obvious answer is that I was infected with it, and also that I want to raise awareness about it. I had thought it was just a fever. 13 days later, I was on a ventilator with 80% lung damage, battling a disease I had never even heard of. Scrub Typhus is not a common disease, and when one encounters it, normal flu-like symptoms are present, which makes it almost impossible to treat it as quickly as possible. That’s what happened to me, I was suffering from fever for about 10 days, accompanied by rashes. It was the month of April, and in Kharagpur, the weather was very unpredictable; sometimes it would rain, then it would be sunny, and it kept repeating. So I thought that it was a normal viral infection that would go away in a few days, but unfortunately, it didn’t.

When the fever couldn’t be controlled, my parents came, and I was admitted to the hospital there. After 2-3 days, somehow, the doctors were able to control the fever, but I was still quite unwell with nausea and no energy to even stand by myself. To investigate further, I was referred to a higher institution, and my parents brought me to my hometown, where I got admitted.

When a patient presents with a fever for more than 3 days, typhoid, dengue, and malaria are the first candidates that are considered. In both hospitals, these tests were done, and they came out to be negative. After almost 1 and ½ days that I was there in my hometown hospital, I started having breathing problems. The doctors put an oxygen mask on me and tried to investigate further, but my oxygen levels were drastically dropping, and it almost went to 35. Everyone was panicking, and I was again referred to a higher institution in Delhi, Fortis Escorts.

Well before transferring, I was intubated because my lungs couldn’t breathe on their own. Finally, when I was brought to the emergency in Delhi, they put me on the ventilator in the ICU. They had me sedated, so I woke up 3-4 days later, with absolutely no memory of how or why I was brought here. My initial burst of consciousness had me feeling like I had been transported to Dr. House ( a Netflix series). Although I couldn’t open my eyes yet, the smell of the ICU and the chatter of nurses almost made me believe that I was actually in Dr. House. I remember feeling so excited and nervous at the same time. Alas!! Slumber consumed me again, and my fantasy was short-lived.

Next, when I woke up, I was able to open my eyes and observe with a heavy heart that I was actually in a hospital, not in Dr. House. The last thing I could remember was that before my condition had worsened, my mother was sitting beside me and crying, and I was trying to console her, that it's just a fever and it will go away soon. According to everyone else, I was conscious till the moment, they had not sedated me, but even now after months, I don’t remember a damn thing.

So when I was unconscious, a series of tests were run on me. It still weirds me out when I come across my lung CT scan; those pictures are quite puzzling, and of course, I don’t understand a thing. According to the doctors, 80% of my lungs had been damaged, and I had developed Acute Respiratory Distress Syndrome ( ARDS), but the cause, still unknown. Honestly, the time was running out, and any normal test of a list of possible bacteria and viruses would take at least a day or two. Biofire test, which is quite costly but gives superfast results in just a few hours, was done, and Mr O. tsutsugamushi won the race. It was clear that I had contracted scrub typhus infection.

When initially doctors told me I had this disease, I thought it was just a fancy name for typhoid gone wrong. But later I came to know all about it, the microbiologist inside me couldn’t restrain itself from researching every single thing about it. It was quite comforting to read that the disease has a high fatality rate, because the infection causes multiple organ failure in later stages. Before that, it is accompanied by pulmonary ( relating to lungs), cardiac (heart), hepatic (liver), neurological, or renal (kidney) complications. [1]

Let’s understand more about the disease itself. Scrub Typhus is caused by a Gram-negative obligately (strict requirement for specific growth conditions) intracellular bacillus, O. tsutsugamushi. [2] The disease is spread through the bite of trombiculid mites infected with the bacterium. After 5–14 days following exposure to the bite of an infected vector, the person develops a flu-like illness with symptoms such as fever, rash, eschar at the bite site, headache, myalgia (muscle pain), cough, widespread lymphadenopathy (inflammation in the lymph nodes), nausea, vomiting, rash, and abdominal discomfort. [3]

There are so many strains of this bacterium, which makes it impossible to develop a vaccine against it. Even the immunity gained through the infection is short-lived (a few months). One more thing that is quite interesting for me is that there are a number of mobile transposable elements in the DNA of these bacteria. If you compare two genomes, there is a bare connection between the gene positions. [4]

The treatment usually involves antibiotics like chloramphenicol, tetracycline, doxycycline, and azithromycin. [5] It is not that this disease is untreatable; rather, the diagnosis is complex.

The gold standard for scrub typhus diagnosis is indirect fluorescent antibody [IFA], which is not available everywhere. [6] Due to its complex genetic structure, sometimes even IFA might miss it.

Well, this is it for now. It was quite the life-changing moment for me and my family. And a major lesson learnt here was do not take fevers lightly, especially if it has been there for 8-10 days. Prefer going to a multispeciality hospital for a checkup.

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