{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:40:12Z","timestamp":1788374412105,"version":"build-2803163510"},"reference-count":42,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T00:00:00Z","timestamp":1600300800000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,7,30]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Scrub typhus is an emerging neglected tropical disease, reported from many parts of Asia including Nepal. This study aims to determine the seroepidemiology of scrub typhus among febrile patients attending Chitwan Medical College Teaching Hospital (CMC-TH), Bharatpur, Nepal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design and setting<\/jats:title>\n                    <jats:p>This was a hospital laboratory-based prospective study conducted in CMC-TH (a 750-bed hospital) located in Bharatpur, Chitwan district of Nepal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 1797 patients visiting CMC-TH with acute febrile illness (temperature more than 38\u00b0C) were enrolled in this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 1797 blood samples were collected from patients presenting with acute febrile illness. The samples were processed for detection of antibody for scrub typhus by ELISA for specific IgM antibody and Weil-Felix test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 1797 serum sample of febrile patients, 524 (29.2%) were scrub typhus positive. Maximum seropositive cases were from Chitwan district, 271 (51.7%) with predominance among women, 314 (35.9%). Scrub typhus was common among age group 51\u201360 years (37.2%) and farmers, 182 (37.8%). Highest seropositivity was found in July, 60 (57.7%). Fever was common clinical symptom. Thrombocytopenia was seen in 386 (73.7%) and raised transaminase aspartate aminotransferase, 399 (76.1%) among seropositive cases. Weil-Felix test positive were 397 (22.1%) and IgM ELISA positive were 524 (29.2%). The correlation between IgM ELISA and Weil-Felix test showed statistically significant association (r=0.319, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High prevalence of scrub typhus implies that patients with acute febrile illness should be investigated for scrub typhus with high priority. There is utmost need of reliable diagnostic facilities at all levels of healthcare system in Nepal. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. More sustain and vigorous awareness programmes need to be promoted for early diagnosis, treatment and control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-034727","type":"journal-article","created":{"date-parts":[[2020,9,18]],"date-time":"2020-09-18T04:40:34Z","timestamp":1600404034000},"page":"e034727","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Burden of scrub typhus among patients with acute febrile illness attending tertiary care hospital in Chitwan, Nepal"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2026-544X","authenticated-orcid":false,"given":"Sangita","family":"Thapa","sequence":"first","affiliation":[{"name":"Clinical Microbiology, Chitwan Medical College, Bharatpur, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradip","family":"Hamal","sequence":"additional","affiliation":[{"name":"Clinical Microbiology, Chitwan Medical College, Bharatpur, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navin Kumar","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Clinical Microbiology, Chitwan Medical College, Bharatpur, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lokendra Bahadur","family":"Sapkota","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Chitwan Medical College, Bharatpur, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaya Prasad","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Chitwan Medical College, Bharatpur, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,17]]},"reference":[{"key":"2026062608024912000_10.9.e034727.1","unstructured":"Walker DH , Dumler JS , Marrie T . Rickettsial diseases. In: Longo DL , Fauci AS , Kasper DL , et al , eds. Harrison's principle of internal medicine. 18th edn. USA: The McGraw-Hill Companies, 2012: 1064\u20135."},{"key":"2026062608024912000_10.9.e034727.2","first-page":"629","volume-title":"Oxford textbook of medicine","volume":"6","author":"Watt","year":"2003"},{"key":"2026062608024912000_10.9.e034727.3","first-page":"OR01","article-title":"A case series of scrub typhus in obstetrics","volume":"8","author":"Poomalar","year":"2014","journal-title":"J Clin Diagnostic Res"},{"key":"2026062608024912000_10.9.e034727.4","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2004.70.670"},{"key":"2026062608024912000_10.9.e034727.5","doi-asserted-by":"publisher","DOI":"10.1089\/vbz.2008.0199"},{"key":"2026062608024912000_10.9.e034727.6","doi-asserted-by":"publisher","DOI":"10.1086\/503680"},{"key":"2026062608024912000_10.9.e034727.7","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(81)90210-8"},{"key":"2026062608024912000_10.9.e034727.8","unstructured":"The Kathmandu Post . Rats causing scrub typhus: WHO team. Available: http:\/\/kathmandupost.ekantipur.com\/news\/2015-10-07\/rats-causingscrub-typhus-who-team.html"},{"key":"2026062608024912000_10.9.e034727.9","unstructured":"Poudel A . Three dead and 91 infected with scrub typhus so far. My Rep, 2016. 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