DHR-ICMR guidelines for diagnosis and management of rickettsial diseases in India

Abstract

Rickettsial diseases, caused by a variety of obligate intracellular, Gram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma, belong to the class Alphaproteobacteria, are considered some of the most covert emerging and re-emerging diseases and are being increasingly recognized. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45 % with multiple organ dysfunction, if not promptly diagnosed and appropriately treated especially in the developing and under-developed countries. The vast variability and non-specific presentation of this infection have often made it difficult to diagnose clinically. Prompt antibiotic therapy shortens the course of the disease, lowers the risk of complications, and in turn reduces morbidity and mortality due to rickettsial diseases. There is a distinct need for physicians and health care workers at all levels of care to be aware of the clinical features, available diagnostic tests and their interpretation, and the therapy of these infections.