My daughter has fever and rash abroad – could it be scrub typhus?

Question

Hello,

I am desperately worried about my 19-year-old daughter, who is in another country. She has been volunteering at a wildlife sanctuary and suddenly developed a raging fever that does not respond to anything. There is a weird black mark on her shoulder. She thinks it came from some bug bite, and now she is covered in these angry red spots. She is having terrible muscle pain and can barely get out of bed. The local clinic mentioned scrub typhus, but the language barrier is making it hard to understand the severity. Her last video call was scary. She seemed to be confused and could not focus. Should we fly her home immediately?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your daughter’s symptoms do sound worrying. Scrub typhus is caused by bacteria transmitted through bites from infected chigger mites and can cause serious complications if not treated properly.

Given the severity of her symptoms, including confusion and muscle pain, flying her home immediately might not be the best option. The stress of travel could worsen her condition.

If the local clinic suspects scrub typhus (based on her symptoms, I also think so), she should start receiving treatment with a capsule or tablet of Doxycycline (Tetracycline) (antibiotic) or capsule of Chloramphenicol (antibiotic), which is the standard antibiotics for scrub typhus.

If she is allergic to any of these, she can start a capsule or tablet of Azithromycin (macrolide antibiotic) (less effective but it is also used to treat scrub typhus).

Usually, patients start feeling better within two to three days of starting Doxycycline and complete recovery may take two to three weeks. In some cases, recovery can take up to three months (in immunocompromised patients or patients with severe infection).

If she does not feel better within three days, she might need intravenous (IV) antibiotics.

If the clinic is not equipped to handle her case, try to have her transferred to a hospital with better resources.

Scrub typhus can cause multi-organ failure. Doctors should monitor her liver, lung, kidney & heart functions.

Another life-threatening complication of scrub typhus is meningoencephalitis and DIC (disseminated intravascular coagulation). Confusion is a sign of meningoencephalitis.

She should do a magnetic resonance imaging (MRI) and lumbar puncture. Also, she should check her platelets, C-reactive protein (CRP), and D-dimer every day.

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

I hope this helps.

Thank you.