What are the tests to diagnose scrub typhus infection?

Question

Hello doctor,

I am a 34-year-old travel blogger who recently returned from a trek. About a week after getting back, I developed a high fever, severe headaches, and muscle aches. My blood tests showed a low platelet count (thrombocytopenia) and elevated liver enzymes. I also found a small black scab on my ankle surrounded by redness, which I think could be an eschar. Could this be scrub typhus? Should I start antibiotics immediately, or do I need specific tests to confirm the diagnosis?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on your symptoms and the possible eschar (the black scab with redness), scrub typhus is a strong possibility. Scrub typhus is caused by the bacterium orientia tsutsugamushi, which is transmitted by infected chigger bites, commonly found in few countries. The typical symptoms of scrub typhus include fever, severe headache, muscle aches, low platelet count, elevated liver enzymes, and an eschar at the site of the bite.

Here is what you should consider:

1. Clinical suspicion: Your symptoms are fever, headache, muscle aches, low platelets, and high liver enzymes, and the eschar strongly suggests scrub typhus.

2. Diagnosis: The diagnosis is usually based on your symptoms, but specific tests can confirm it:

Serologic tests (such as indirect immunofluorescence or ELISA) to detect antibodies to orientia tsutsugamushi.
PCR (polymerase chain reaction) testing can detect the bacteria’s DNA (deoxyribose nucleic acid) for a more definitive diagnosis.
Blood cultures are not helpful because the bacteria are difficult to culture.

3. Treatment: Scrub typhus is treated with antibiotics like Doxycycline or Azithromycin. Given the severity of your symptoms and the risk of complications, it is usually recommended to start treatment right away, even before confirmatory tests, especially if you are in an area where scrub typhus is common. Early treatment reduces the risk of severe complications and death.

Considering your symptoms, you should start antibiotics immediately while waiting for diagnostic confirmation. Contact your healthcare provider or an infectious disease specialist as soon as possible to begin treatment and arrange for the necessary tests.

In the meantime, monitor your symptoms and do not delay starting treatment, as scrub typhus can worsen quickly.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.