SCRUB TYPHUS

DR. K. S. S. HARSHITHA,
2 ND Y E A R R E S I D E N T ,
DEPT OF GENERAL MEDICINE.
 Caused by O.tsutsugamushi
“tsutsuga”-dangerous “mushi”-mite
Both VECTOR AND RESERVOIR.
 Occurs in South east asia, Australia and islands along the
Western Pacific coast.- TSUTSUGAMUSHI TRIANGLE.
 Disease transmitted by- larval form of Mite
(Leptotrombidium deliense)
 A RE-EMERGING infction in India.
Larval form is known as chiggers.
 Found in areas of suitable climate,
plenty of moisture and scrub
vegetation.
 Microbes are transmitted
transovarianlly in all
mites.
 Various rodents and birds also
act as reservoirs.
 Blood counts- normal wbc or leukocytosis,
thrombocytopenia
 LFT- Elevated transaminases and bilirubin,
hypoalbuminemia
 RFT- raise in creatinine in severe cases
 CXR- pnemonitis, effusion or bilateral infiltrates
 Usg abdomen- hepatosplenomegaly.
Serology

 Weil Felix- cheapest and most easily available.lacks

sensitivity and specificity
 IFA- gold standard. Fourfold rise in antibody is looked
for
 ELISA to look for IgM antibodies to O.tsusugamushi
 Culture- In tissue culture or mice from blood of
patients with scrub typhus. Median time required is
27days.
 PCR- skin rash or lymph node biopsies, blood.
Treatment

 DOC- Doxycycline 100mg BD

 Altenatives – Azithromycin 500mg OD
Chloramphenicol 500mg QID
 Children and pregnants- Azithromycin 500mg OD
 Drug resistant serotypes- Azithro+ rifampicin
Doxy+rifampicin
Recommended duraion – 7 to 14 days.
o Dramatic clinical improvement. rapid defervesence is
characteristic
o Mortality in untreated- 10 to 30 %.
Prevention

 Avoidance of human-mite contact.

 Chemoprophylaxis in endemic areas and high risk
travellers- Doxycycline 200mg OW