What is the treatment for scrub typhus?

Question

Hi doctor,

I am 58 years old, and I have been diagnosed with scrub typhus and cirrhosis. My platelets dropped to 22,000 platelets per microliter, and ammonia is rising.

How do we balance antibiotics with liver damage?
Should I go to the ICU?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

This is a life-threatening emergency, and you need immediate ICU (intensive care unit) care. Bleeding varices and coagulopathy indicate a high risk of shock. You need band ligation or sclerotherapy (a chemical solution to treat abnormal blood vessels) to control bleeding. These are endoscopic procedures. To decrease platelets, you will need:

FFP (fresh frozen plasma) if active bleeding and INR (international normalized ratio) greater than or equal to 2.5.
Platelet transfusion if the platelet count is less than 30000, if no active bleeding, or less than 50000 with active bleeding.
Terlipressin or Octreotide reduces portal pressure and controls bleeding.
IV (intravenous) proton pump inhibitors.

Infected eschar increases the risk of sepsis. You need IV (intravenous) antibiotics.

Doxycycline is the first-line treatment for scrub typhus, but it can contribute to liver damage. Must monitor liver function daily. You can use Azithromycin, which is safe for severe liver diseases. Avoid Chloramphenicol, which may increase bleeding risk.

Elevated levels of ammonia may confuse and indicate hepatic encephalopathy (brain is damaged due to liver disease). You need Lactulose and Rifaximin. Scrub typhus can also cause acute kidney injury (AKI), so one must monitor renal function. IV fluid infusion should be done with care, as there is a chance of overloading. This is a dangerous situation, and delays could be fatal. Go to the ICU (intensive care unit) immediately.

I hope this information will help you.

Thanks.