Table of content

Scrub Typhus Cause, Symptoms, Signs, Investigations, Treatment

Infective organism: Orientia Tsutsugamushi is parasite of rodents & transmitted by bite of Chiggers (larval trombiculid mites).
humans infected when encounter infested vegetation (grass and brush), where mites live.
Bite will be unidentified and painless.
Vertical transmission present & blood transfusions may transmit pathogen.
Incubation period: 1 to 3 weeks.

Symptoms:

Illness vary from mild self-limiting to fatal
High grade fever (rises during first week of infection) with chills and rigor.
Maculopapular rash on trunk (4-6 day of illness), peaking at day 8, lasting up to 21 days after infection onset.
severe headache, backache, myalgia, body ache.
Throat pain, Dry cough, chest pain and breathlessness.
Nausea, vomiting, diarrhoea

Signs:

Maculopapular rash.
Regional Lymphadenopathy.
Presence of Eschar: painless (At bite site) a central necrotic black scab surrounded by a raised ring and erythema in moist areas axilla, inguinal region, under the breast.
Relative bradycardia- increase in heart rate less than 10 beats/min for a 1-degree Celsius temperature increase.
Acute kidney injury may be seen.

Investigations:

Blood Routine: Early leucopenia, late Lymphocytosis, Thrombocytopenia may be seen.
LFT: Elevated SGOT, SGPT, but hyperbilirubinemia is rare.
RFT: may be abnormal.
Indirect immunofluorescent assay & indirect immunoperoxidase assay- gold standard for diagnosis.
Scrub typhus antibody test: IgM detection by ELISA.
PCR from eschar or blood.
ECG: to rule out myocarditis.
Chest Xray: to rule out pneumonitis
EEG/MRI: to rule out encephalitis, CVA.

Complications:

pneumonitis, myocarditis, aseptic meningitis or encephalitis, ARDS, immune thrombocytopenia, peritonitis, granulomatous hepatitis, disseminated intravascular coagulation, peritonitis, granulomatous hepatitis, hemophagocytic syndrome, cranial nerve palsies, parkinsonian symptoms, cerebrovascular hemorrhage or infarction, or hemophagocytosis, may develop during second or third week.
Attack confers prolonged immunity- against homologous strains.
And transient immunity against heterologous strains.
Heterologous strains may produce mild disease, if infection develops within a year after first episode.

Scrub Typhus Treatment:

T. Paracetamol 500 mg SOS for fever, bodyache, etc
Tepid sponging and plenty of oral fluids.
Cap. Doxycycline 100mg BD × 7-15 days (Contraindicated in: Children<8yrs and pregnancy) Or
T. Azithromycin 500 mg OD × 3days or
T. Chloramphenicol 500 mg qid 7-15 days or
Intravenous minocycline 100 mg twice daily Or
T. Rifampin 600 mg daily.
No vaccine available to prevent scrub typhus.
Avoid contact with infected chiggers.

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