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Scrub typhus 

Scrub typhus

Scrub typhus

George Watt



Epidemiology—increasing reports from India.

Clinical—importance of meningoencephalitis, especially in children.

Diagnosis—new immunochromatographic and PCR methods.

Treatment—inadequacy of oral doxycycline in severe disease.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 24 April 2017

Scrub typhus (tsutsugamushi fever) is a zoonosis of rural Asia and the western Pacific islands that is caused by the obligate Gram-negative intracellular bacterium Orientia (formerly Rickettsia) tsutsugamushi, which is transmitted (typically from rats) to humans by the bite of a larval leptotrombidium mite (chigger). More than a billion people are at risk and more than a million cases are transmitted annually, making it the commonest rickettsial disease.

Clinical features—an eschar and regional lymphadenopathy often develop at the site of the chigger bite, and may by followed by a systemic illness ranging in severity from inapparent to fatal. Many cases go undiagnosed, particularly those in which an eschar cannot be found. Diagnosis may be made serologically, but laboratory confirmation of infection is rarely available in rural areas where the disease is most frequently encountered. Aside from supportive care, treatment is with tetracycline, doxycycline, or chloramphenicol. Before antibiotics, mortality rates up to 35% were reported, but were generally much lower. Chemoprophylaxis with doxycycline can prevent infection. There is no vaccine.

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