How is scrub typhus diagnosed and treated?

Question

Hello doctor,

I am 25 years old, an adventure tour leader, and recently took a hiking expedition across remote areas. About one week after returning home, I developed a fever, a terrible headache, swollen lymph nodes, and considerable weariness. I also observed a little scab-like black lesion on my waist.

I have read that scrub typhus can be rather frequent in some of the regions I was camping in, and I wanted to check with you about it. If we suspect scrub typhus, should we start antibiotics empirically, or is it worthwhile to do a blood test to confirm the diagnosis?

I have another trip planned in a couple of weeks, too, so I would like any direction on the general recuperation period and if there are any precautions I can take in the future to decrease the possibility of this happening again.

Please help.

Thank you for your guidance.

Answer 1

Hi,

Welcome to icliniq.com

Thank you for sharing your concerns.

Symptoms of scrub typhus often present seven to ten days after infection. Common indications and symptoms could include:

Fever and chills.
A headache.
Body pains and muscle pain.
A black, scab-like lesion at the location of the chigger bite (known as an eschar).
Rash.
Enlarged lymph nodes.
Mental status changes, which in severe cases may range from confusion to coma.

If not diagnosed and treated promptly, scrub typhus can become serious and may lead to complications such as organ damage and severe bleeding.

Increased liver enzymes, such as the following, may be detected by blood testing:

ALP stands for alkaline phosphatase.
ALT, or alanine aminotransferase
AST, or aspartate aminotransferase

The following issues could result from scrub typhus:

Acute respiratory distress syndrome, or ARDS.
Acute renal injury (AKI).
Myocarditis (inflammation of the heart muscle).
Acute liver failure (ALF).
Encephalitis (inflammation of the brain).
Pericarditis (inflammation around the heart).
Heart arrhythmias (abnormal heart rhythms).
Acute hearing loss.
Septic shock (infection leading to dangerously low blood pressure and poor blood flow to organs).
Multiple organ dysfunction syndrome (MODS) (organs begin to fail due to severe infection and inflammation).

To confirm the diagnosis, the following laboratory tests may be advised depending on availability:

PCR test: A molecular test that detects the genetic material of the scrub typhus bacteria in the blood, helping identify the infection early.
ELISA test: A blood test that detects antibodies produced by the body against the scrub typhus infection.
Weil-Felix test: An older blood test used to indirectly detect scrub typhus infection by identifying cross-reacting antibodies.

Currently, there is no vaccine available for scrub typhus. Prevention mainly involves reducing exposure to infected chiggers by:

To stay safe from chiggers, you should:

Stay away from thick foliage or bushes.
Using bug sprays as recommended

Use of pre-treated products or treatment of garments and equipment with 0.5 percent permethrin

Being very careful to follow all product directions

Treatment:

Scrub typhus is commonly treated with the antibiotic doxycycline, which is effective in individuals of all age groups. Early treatment usually leads to a faster and complete recovery.

However, it is important to confirm the diagnosis first by getting any of the above-mentioned tests that are available. Once the diagnosis is confirmed, treatment can be started with:

• CapsuleDoxycycline 100 mg twice daily for seven days

Please consult your physician before starting the medication and seek medical attention promptly if symptoms worsen.

I hope this answers your questions.

Please feel free to follow up whenever needed.

Thank you.