Scrub typhus

1. A case presentation
Dr Monica Jain
Senior Professor
Department of Pharmacology
SMS Medical College,Jaipur

2. History
• A young male 25 years old was having fever 100
degree F without any chills with bodyache
without rash, he was given paracetamol 500mg
SOS but he continue have fever intermittent
particularly evening rise for another 4to 5 days
• CBC count was advice which WBC -17,000 and
showed lymphocytosis and decrease neutrophil
• ESR NORMAL , Hb normal PBF atypical /reactive
lymphocytes

3. Diagnosis ?
• Malaria
• Typhoid fever
• Leptospirosis
• Tuberculosis
• Scrub typhus
• Infectious mononucleosis

4. More history
• History of trekking few days back and little
itching felt on that day
• on examination no rash or black eschar
• There was mild heaptosplenomegaly
• Raised SGOT AND SGPT

5. Diagnosis
• The Scrub Typhus Detect IgM ELISA test is an
ELISA assay system for the detection
of IgM antibodies in human serum to Orientia
tsutsugamushi (OT; formerly Rickettsia)
derived recombinant antigen (1-10).
This test is to aid in the diagnosis of human
exposure to OT species.

6. Scrub typhus
• Scrub typhus, also known as bush typhus, is a
disease caused by a bacteria called Orientia
tsutsugamushi.
• Tsutsu means small and dangerous and mushi
means insect or mite
• Humans are accidental host in this zoonotic
disease. Scrub typhus was described from Japan
in 1899.
• Scrub typhus is spread to people through bites
of infected chiggers (larval mites).

8. Sign and symptoms
• Symptoms of scrub typhus usually begin within 10 days
of being bitten. Signs and symptoms may include:
• Fever and chills
• Headache
• Body aches and muscle pain
• A dark, scab-like region at the site of the chigger bite
(also known as eschar)
• Mental changes, ranging from confusion to coma
• Enlarged lymph nodes
• Rash develops on the trunk during the 5th to 8th day of
fever, often extending to the arms and legs.

10. Diagnosis
The laboratory-based diagnosis of scrub typhus relies
on serological assays l
The Weil–Felix test
Indirect Immunofluorescence assays
Indirect immunoperoxidase assays
enzyme-linked immunosorbent assay (ELISA) and
immunochromatographic tests (ICT)
Among all serological assays, IgM ELISA-based method
is most reliable for the diagnosis of scrub typhus

11. Treatment
• Doxycycline 200 mg daily or tetracycline 500
mg 6 hrly is treatment of choice.
• The duration of treatment is 7- 14 days.
Treatment of less than a week is initially
curative but may be followed by relapse
• Chloramphenicol 500mg qid is an alternative.
Telithromycin has also been shown to be
effective in the treatment of scrub typhus

12. • Azithromycin has been shown to be effective
in the treatment of scrub typhus in pregnancy
and has shown favorable outcome in
pregnancy.
• 500 mg has been used as single dose or for
three to five days
• Rifampicin than Doxycycline, however it is
only recommended where doxycycline
resistance is suspected.

13. Prevention
• Case detection, public education, rodent control
and habitat modification are aimed at controlling
the infection of scrub typhus in human
population.
• Chemoprophylaxis is recommended under special
circumstances in certain areas where disease is
endemic. Oral chloramphenicol or tetracycline
given once every five days for 35 days, or weekly
dose of doxycycline 200mg have both been
shown to be effective regimens.