Department of Clinical Microbiology, Christian Medical College, Vellore, India.
Immunology Laboratories, Department of Clinical Microbiology, Christian Medical College, Vellore, India.
Med Hypotheses. 2018 Jun;115:61-64. doi: 10.1016/j.mehy.2018.03.019. Epub 2018 Mar 31.
Scrub typhus is a mite borne infectious disease which has re-emerged in India in the 3rd millennium after years of quiescence. In this review, the authors hypothesize the various factors responsible for resurgence of this disease. The main drivers that could have contributed to the upsurge in scrub typhus cases in past two decades are changes in land use land cover (LULC) and urbanisation which are; as a result of the population explosion, causing a strain on sanitation and also increased diversion of forest land for agricultural use. In addition, the availability of better tests, changes in antimicrobial use, climate change also could have impacted the epidemiology, which is showing an upward trend as is evidenced by increasing reports and concomitant publications from India on scrub typhus. Scrub typhus cases are supposed to increase in the coming years as factors like global warming, urbanisation, changes in LULC and rise in AMR (anti-microbial resistance) will be difficult or impossible to control. Therefore, increasing awareness of public and health care professionals regarding scrub typhus coupled with availability of rapid diagnostic assays and implementation of appropriate treatment protocols for control of AFI (acute febrile illness) especially at the community level will help mitigate the scenario in the long run.
恙虫病是一种由恙螨传播的传染病，在经历多年的沉寂后，于 3000 年后的印度再次出现。在这篇综述中，作者假设了导致这种疾病再次流行的各种因素。过去二十年中导致恙虫病病例激增的主要驱动因素是土地利用和土地覆盖（LULC）以及城市化的变化；这是由于人口爆炸，导致卫生条件紧张，同时也增加了林地用于农业用途。此外，更好的检测手段的出现、抗生素使用的变化、气候变化也可能对流行病学产生影响，印度关于恙虫病的报告和相关出版物的增加就证明了这一点。随着全球变暖、城市化、土地利用和土地覆盖的变化以及抗微生物药物耐药性（AMR）的上升等因素的出现，恙虫病病例预计在未来几年将会增加，这些因素很难或不可能得到控制。因此，提高公众和医疗保健专业人员对恙虫病的认识，结合快速诊断检测方法的可用性以及实施适当的治疗方案来控制急性发热性疾病（AFI），特别是在社区层面，将有助于从长远来看缓解这种情况。
