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Scrub typhus 

Scrub typhus
Chapter:
Scrub typhus
Author(s):

Daniel H. Paris

, and Nicholas P.J. Day

DOI:
10.1093/med/9780198746690.003.0145
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date: 02 March 2021

Orientia spp. are obligate intracellular Gram-negative bacteria that cause scrub typhus, historically known as ‘tsutsugamushi disease’, a febrile illness characterized by early non-specific ‘flu-like’ symptoms, and sometimes a diffuse, macular, or maculopapular rash and/or a necrotic lesion eschar at the inoculation site. Leptotrombidium mites transmit Orientia spp. to humans via the bite of the larval stage, while all mite stages act as bacterial reservoirs through vertical transovarial and transstadial transmission. Scrub typhus is a leading cause of treatable undifferentiated febrile illness in many regions of Asia, and unfortunately remains an underappreciated neglected disease, mainly due to diagnostic difficulties and lack of awareness among medical staff. Complications include meningo-encephalitis, respiratory and renal failure, and severe multiorgan failure. Scrub typhus can be treated effectively with tetracyclines, macrolides, and chloramphenicol. Humans are dead-end hosts and do not participate in the Orientia life cycle, hence treatment does not affect overall disease incidence.

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