I have scrub typhus – what treatment should I go for now?

Question

Hi doctor,

I am a 35-year-old male and scrub typhus was confirmed yesterday and my bone marrow transplant was only two months ago. I got this black eschar on my neck and it rashes everywhere. ANC (absolute neutrophil count) dropped to 100 and platelets to 15000. Cyclosporine levels are all over the place, and I cannot keep medications down. Donor chimerism was 94 % last week - will this mess it up? Running fever of 102.4 despite broad-spectrum antibiotics.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Given your recent bone marrow transplant and current scrub typhus infection, it is crucial to act quickly. The combination of low ANC (100) and platelets (15,000) puts you at significant risk for infection and bleeding, especially with a high fever. The black eschar and rash are concerning signs of scrub typhus, and it is important to adjust your treatment plan urgently.

Cyclosporine Levels: If you cannot keep medications down, work with your transplant team to adjust cyclosporine levels. Use alternative formulations if needed.
Scrub Typhus Treatment: Continue broad-spectrum antibiotics, but consider adding Doxycycline or Tetracycline for scrub typhus specifically.
Chimerism & Transplant Impact: While infection can affect chimerism, your transplant team should closely monitor this. The immune suppression from cyclosporine might complicate recovery, so balancing infection treatment with immunosuppression is crucial.

Stay in close contact with your transplant and infectious disease specialists. Immediate attention to infection control and possible adjustments to immunosuppressants is essential.

I hope this helps.

Thank you.