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Scrub typhus
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Scrub typhus

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Contributors: Steve Go MD, Edith Lederman MD, Noah Craft MD, PhD
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Synopsis

Scrub typhus is caused by Orientia tsutsugamushi, which is transmitted from rodents to humans by larval mites (Trombiculidae). Scrub typhus is relatively common throughout Asia.

After the bite of the mite, an incubation period of 6-18 days follows and then a small papule develops, rapidly forming a black eschar. The patient usually has regional lymphadenopathy, cough, headache, fever, chills, and myalgias accompanying the initial lesion.

After a week, a second, more generalized rash of erythematous papules and/or a petechial eruption can develop with diffuse lymphadenopathy, splenomegaly, and fever. This diffuse rash can persist for up to 10 days or fade rapidly. It is often accompanied by conjunctival injection, headache, shin pain, and mental status changes.

Complications include multi-organ failure, acute respiratory distress syndrome (ARDS), meningoencephalitis, cranial neuropathies, and/or myocarditis. Infection does not produce long-lived immunity and reinfection is common. Endemic encephalitis, especially in children, is caused by scrub typhus in Uttar Pradesh, India.

Individuals who come in contact with low-lying vegetation are at increased risk of infection. Those who work on palm and rubber plantations, policemen, and soldiers in rural areas are at higher risk.

Reported fatality rates vary from 0%-30%.

There is no vaccine.

Codes

ICD10CM:
A75.3 – Typhus fever due to Rickettsia tsutsugamushi

SNOMEDCT:
271425001 – Scrub typhus

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

A careful travel history will narrow the differential diagnosis for other rickettsial disease (eg, Japanese spotted fever, Australian tick typhus) as many rickettsial illnesses are limited by region.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 10/11/2017
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Scrub typhus
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Scrub typhus (First Phase) : Chills, Cough, Fever, Headache, Asia, Eschar, Regional lymphadenopathy, Myalgia, Splenomegaly
Clinical image of Scrub typhus
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