Article Epidemiological, clinical and laboratory profile of scrub typhus cases detected by serology and RT-PCR in Kumaon, Uttarakhand: a hospital-based study Vinita Rawat 1 , Rajesh Kumar Singh 2 , Ashok Kumar 3 , Sandip R Saxena 4 , Umesh Varshney 5 and Mukesh Kumar 6 Abstract We analysed the epidemiology, clinical and laboratory data of the 168 scrub typhus cases confirmed by a combination of anyone of the following: real time polymerase chain reaction (RT-PCR) and/or immunofluorescence assay (IFA) (IgM and/ or IgG). The peak season for scrub typhus is from July to October. By multivariate binary logistic regression analysis, the risk of scrub typhus was about four times in those working in occupation related to forest work. Major clinical mani- festations were fever (100%), myalgia (65%), cough (51%) and vomiting (46%); major complications were meningitis/ meningoencephatilitis (12.5%) and multi-organ failure (MOF) and pneumonia (5.3% each). Laboratory investigations revealed raised aminotranferase levels and thrombocytopenia in most confirmed cases. We conclude that scrub typhus is an important cause of febrile illness in the Kumaon hills of Uttarakhand where this disease had not previously been considered to exist. Keywords Scrub typhus, RT-PCR, Kumaon region Introduction Scrub typhus is an important cause of acute undiffer- entiated fever which is still underreported in many parts of India owing to a low index of clinical suspicion. 1 The disease is caused by Orientia tsutsugamushi (OT), an intracellular bacterium, transmitted by the bite of trom- biculid mite. 1,2 Diagnosis in India of a rickettsial illness is most often confirmed by serology, 2,3 but serologic analysis usually misses the early rickettesaemic period of the disease. Molecular assays are beneficial in detect- ing OT DNA even before antibody responses occur. A combination of molecular and antibody-based tests provides a strong diagnostic advantage. 4 Materials and methods Ethical approval for our study was given by the ethical committee of Government Medical College, Haldwani. Our study was conducted at a tertiary care hospital catering for the population of the Kumaon region of Uttarakhand, which consists of three zones: Bageshwar and Pithoragarh (upper hills), Almora and the hill region of Nainital (middle hills), and Haldwani town and Udham Singh Nagar (foothills). Patients with acute febrile illness were enrolled in the study from February to December 2015. Cases of mal- aria, dengue, enteric fever were excluded by the appro- priate tests. Sera and EDTA blood samples from 1 Associate Professor, Department of Microbiology, Government Medical College, Haldwani, Nainital, Uttarakhand, India 2 Associate Professor, Department of Community Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India 3 Associate Professor, Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India 4 Professor, Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India 5 Professor, Department of Microbiology, Government Medical College, Haldwani, Nainital, Uttarakhand, India 6 Assistant Professor, Department of Microbiology, Government Medical College, Haldwani, Nainital, Uttarakhand, India Corresponding author: Vinita Rawat, Associate Professor, Department of Microbiology, Government Medical College, Haldwani, Nainital, Uttarakhand 263129, India. Email: drvinitarawat31@rediffmail.com Tropical Doctor 0(0) 1–4 ! The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475517743891 journals.sagepub.com/home/tdo