SCRUB TYPHUS

Tsutsugamushi Disease

ContentsDistributionEpidemiological determinantsMode of TransmissionClinical FeaturesInvestigationsComplicationsManagementPrognosisPrevention

INFECED REGIONS

First in Japan

First in India during world war II

Common among millitants

Epidemiological determinants Agent: Orientia tsutsugamushi.

Reservoir: Trombiculid mite.

Leptotrombidium deliensis- India. Leptotrombidium akamushi- Japan.

Chigger

reservoir

Larval stage

vector

Mode of Transmission

Mite

Rats & Mice

Humans

Mite

No direct person to person transmissionMite Islands

(Accidental host)

Clinical Features Incubation peroid: 1-3 wks(usually6-21 days)

Fever(104-105°F) with chills,malaise,conjunctival Irritation.

Maculopapular rash Lymphadenopathy,Lymphocytosis Headache, Cough, Myalgia Gastrointestinal symptoms Typical “Eschar formation”(5th day of illness)

Punched out lesions with black scab

Investigations• Weil-feilx test positive-proteus strain oxk

• Indirect immunofluorescence.

• PCR for Orientia tsutsugamushi from blood of feverish patients.

• Some studies have used PCR (polymerase chain reaction) on

specimens obtained from eschars.

Complications

Pneumonitis Hepatitis Myocarditis Meningoencephalitis Disseminated intravascular

coagulation Multi organ failure

Management

• Drug of choice: Tetracycline

Doxycycline orally or Chloramphenicol in more severe cases.

Azithromycin has been used in resistant cases and may be better than doxycycline - especially in children and pregnant women.

Prognosis

Fatality of untreated cases is between 5 - 10 % and is even higher in adults.

PreventionVector control:

Application of insecticides eg: lindane or chlordane to ground and vegetation.

Environmental control Personal protection

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