How to manage Parkinson's and scrub typhus in the elderly?

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

I am really sorry your grandmother is going through this. Scrub typhus in an elderly person with Parkinson’s disease (PD) is very concerning, especially with her worsening symptoms. This suggests neurological involvement (meningitis or encephalitis) or worsening Parkinsonian symptoms due to infection and fever.

Start tablet Doxycycline 100 mg twice daily for 7 to 14 days (first-line treatment). If she cannot swallow pills, crush the tablet and mix it with honey, applesauce, or thick liquid. If she vomits or her symptoms worsen, she may need intravenous Doxycycline or Azithromycin in the hospital.

Scrub tongue can cause multi-organ failure. You must take her to the hospital immediately if you notice her present symptoms are worsening or she is not getting better within 3 days of starting medicine or any of these symptoms:

1. Severe breathlessness, chest tightness, and chest pain (suggest lung and heart involvement).

2. Jaundice and significantly elevated liver enzymes (mild elevation is normal in infections) suggest liver involvement.

3. Dark color urine, edema (kidney involvement).

4. Confusion, seizures, blurred vision, memory loss (brain involvement).

5. Signs of severe dehydration (sunken eyes no urine output for 6 hours or dark color urine, dizziness, confusion).

Try giving Parkinson's disease medicines crushed in a spoonful of honey or pudding. If she is aspirating, she might need nasogastric tube feeding temporarily. If she misses Parkinson's disease medicines for too long, rigidity may worsen dangerously. If she can not take medicines orally, her doctor may need to switch to a patch (Rotigotine) or injectables.

For fever use the tablet Paracetamol (500mg) every 6 to 8 hours. Use cooling measures like a damp cloth and tepid sponging.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.