How to manage scrub typhus?

Question

Hello doctor,

Initially misdiagnosed as dengue, now with severe scrub typhus. Developing multiorgan failure requiring intensive care unit (ICU) care. Found multiple eschars suggesting repeated mite exposure during archaeological work. On Doxycycline for 48 hours without improvement. When should alternative therapies be considered?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

In severe scrub typhus with multiorgan failure that is not improving after 48 hours of Doxycycline, alternative therapies should be considered immediately.

If Doxycycline was started late, your bacterial load might have increased and it is causing a delayed response or you might be resistant to Doxycycline. Do a blood culture to be sure.

You should switch to intravenous (IV) Doxycycline (Tetracycline antibiotic) or Chloramphenicol (antibacterial) (if you are resistant to Doxycycline). Chloramphenicol causes bone marrow suppression so monitoring complete blood count (CBC) is required.

You can switch to tablet Azithromycin (macrolide antibiotic). Azithromycin is the best alternative for Doxy-resistant cases. It is less effective but the side effects are very mild.

In some severe cases, Rifampicin (antimycobacterial) is used alongside Doxycycline.

It is better to take your treatment in an intensive care unit (ICU) setup because it can provide you with

Hemodynamic support: Fluids, vasopressors if needed.
Ventilation or oxygen if ARDS (acute respiratory distress syndrome) develops.
Dialysis if renal failure progresses.

As you have developed multi-organ failure, you need 24-hour monitoring and that can be done in an intensive care unit (ICU).

Kindly consult a specialist doctor, talk with them, and take medications with their consent.

I hope this helps.

Thank you.