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LETTER TO THE EDITOR
Year : 2013  |  Volume : 57  |  Issue : 3  |  Page : 182-183  

Rickettsiosis: A cause of acute febrile illness and value of Weil-Felix test


1 Professor, Department of Microbiology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad - 580 009, India
2 Assistant Professor, Department of Microbiology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad - 580 009, India
3 Tutor, Department of Microbiology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad - 580 009, India
4 Professor and Head, Department of Microbiology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad - 580 009, India

Date of Web Publication14-Oct-2013

Correspondence Address:
Ganavalli Subramanya Ajantha
Professor, Department of Microbiology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad - 580 009
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.119817

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How to cite this article:
Ajantha GS, Patil SS, Chitharagi VB, Kulkarni RD. Rickettsiosis: A cause of acute febrile illness and value of Weil-Felix test. Indian J Public Health 2013;57:182-3

How to cite this URL:
Ajantha GS, Patil SS, Chitharagi VB, Kulkarni RD. Rickettsiosis: A cause of acute febrile illness and value of Weil-Felix test. Indian J Public Health [serial online] 2013 [cited 2019 Dec 6];57:182-3. Available from: http://www.ijph.in/text.asp?2013/57/3/182/119817

Sir,

Rickettsiosis is an underdiagnosed group of diseases presenting as acute febrile illness, with high mortality in untreated cases; the reported seropositivity in clinically suspected infections is up to 33%. Many cases have been reported from Maharashtra, Karnataka, Tamilnadu, Kerala, Jammu and Kashmir, Himachal Pradesh, Uttaranchal, Rajasthan, West Bengal, and Assam. [1],[2],[3] Widespread existence of the infection is suspected; however, only a few reports are available that provide a fragmented and incomplete picture. There is a need to undertake studies wherever possible to understand the Indian scenario in a better perspective.

Tests available to diagnose rickettsiosis are culture, serology including immunofluorescence, and molecular tests. Except serology, other tests are beyond the reach of most diagnostic laboratories. [4] Serological tests like Weil-Felix test (WFT), latex agglutination, indirect hemagglutination, immunoperoxidase assay, ELISA, and the 'gold standard' microimmunofluorescence are used in laboratory evaluation of suspected rickettsial infections. Because of logistics and other constrains, WFT proves to be a handy and affordable for the peripheral areas [5] ; moreover, it enables the laboratory physician to interpret the results in terms of titer for diagnosis and prognosis of the infection.

The present work was undertaken at SDM College of Medical Sciences and Hospital, Dharwad, Karnataka. The principal intention was to ascertain presence of rickettsial infections in this area using WFT and correlation of test results with clinical diagnosis and treatment outcome.

A total of 380 samples from clinically suspected rickettsial infections were subjected to WFT from March 2011 to April 2012. Serum samples, positive on screening by slide agglutination, were tested by tube agglutination. WFT was performed and interpreted as per manufacturer's instructions [PROGEN, Tulip Diagnostics, Goa]. Titers of more than 1:160 for OX-K and more than 1:80 for OX-2 and OX-19 were considered significant. The demonstration of a fourfold rise in titer was not possible in our study.

Forty-six samples were positive by WFT, with significant titers [Table 1]. Adult males were the commonly affected group (22/46). Prominent clinical features of WFT-positive cases included fever (100%), headache (34%), pain abdomen (28%), and rashes (15%). Such non-specific presentations make diagnosis difficult, thus endorsing the need for laboratory evidence. [1]
Table 1: Weil– Felix test results

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Rickettsiosis has been documented in southern India and must be considered in acute febrile illness. [6] WFT-positivity of 12% among suspected cases warrants concern. Of the 46 seropositive cases, 17 were finally diagnosed by the physicians as having rickettsiosis. However, all 46 cases received doxycycline. One case died, which was diagnosed as "rickettsial encephalopathy" based on clinical features, WFT positivity, and ruling out other causes.

Of the 17 clinically confirmed rickettsial cases, 12 were positive for OX-K only. A total of 37 cases showed significant titers against OX-K. This, for the first time, has revealed the presence of scrub typhus in this area. Of the 46 WFT-positive samples, only three samples were positive by other serological tests; one each for HBsAg (Hepacard by Diagnostic Enterprises), Widal test (Span Diagnostics Ltd), and Dengue IgM (Dengue Duo, SD Bio Standard Diagnostics Pvt Ltd). In our study, sensitivity or specificity of WFT could not be calculated as the gold standard test was not available at our center.

In conclusion, the present study gives the evidence of the presence of rickettsiosis to an unanticipated extent in this region of Karnataka. There is a definite need to launch a careful epidemiological investigation to understand the extent and attributes of scrub typhus and other rickettsial infections in this area.

 
   References Top

1.Rathi N, Rathi A. Rickettsial infections: Indian perspective. Indian Paediatr 2010;47:157-64.  Back to cited text no. 1
    
2.Mahajan SK, Kashyap R, Kanga A, Sharma V, Prasher BS, Pal LS. Relevance of weil-felix test in diagnosis of scrub typhus in India. J Assoc Physicians India 2006;54:619-21.  Back to cited text no. 2
    
3.Mittal V, Gupta N, Bhattacharya D, Kumar K, Ichhpujani RL, Singh S, et al. Serological evidence of rickettsial infections in Delhi. Indian J Med Res 2012;135:538-41.  Back to cited text no. 3
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4.Sharma A, Mahajan S, Gupta ML, Kanga A, Sharma V. Investigation of an Outbreak of Scrub Typhus in the Himalayan Region of India. Jpn J Infect Dis 2005;58:208-10.  Back to cited text no. 4
    
5.Kamarasu K, Malathi M, Rajagopal V, Subramani K, Jagadeeshramasamy D, Mathai E. Serological evidence for wide distribution of spotted fevers and typhus fever in Tamil Nadu. Indian J Med Res 2007;126:128-30.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Murali N, Pillai S, Cherian T, Raghupathy P, Padmini V, Mathai E. Rickettsial diseases in South India - How to spot the Spotted fever. Indian Pediatr 2001;38:1393-6.  Back to cited text no. 6
    



 
 
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