Orientia tsutsugamushi: Difference between revisions
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Orientia tsutsugamushi
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Revision as of 23:59, 14 August 2019
Scrub typhus (Orientia tsutsugamushi)
- Chigger-borne rickettsial infection caused by the intracellular Gram-negative bacterium Orientia tsutsugamushi
Life Cycle
- Transmitted within mites (chiggers) transovarially
Epidemiology
- Most common in rural Asia and western Australia, as well as other parts of eastern Asia, including Russia and India
Presentation
- Fever, headache, myalgia, lymphadenopathy, and an eschar
- Lymphadenopathy sometimes grouped near the eschar
- Should almost always be able to find the eschar if you look hard enough
- Transient pale macular rash
- May have cough
- May have mental status changes and hepatosplenomegaly
- In severe cases, may progress to multiorgan failure and hemorrhage
- After treatment, may relapse
- Infection also decreases HIV viral load and can lead to immune reconstitution
Diagnosis
- Four-fold rise in immunofluorescence serology
- PCR on eschar, blood, or lymph node biopsy
Management
- Doxycycline 100 mg po bid for 7 days
References
- ^ George M. Varghese, Divya Dayanand, Karthik Gunasekaran, Debasree Kundu, Mukta Wyawahare, Navneet Sharma, Dhruva Chaudhry, Sanjay K. Mahajan, Kavitha Saravu, Blessed W. Aruldhas, Binu S. Mathew, Roshini G. Nair, Nalini Newbigging, Aswathy Mathew, Kundavaram P.P. Abhilash, Manisha Biswal, Ann H. Prasad, Anand Zachariah, Ramya Iyadurai, Samuel G. Hansdak, Sowmya Sathyendra, Thambu D. Sudarsanam, John A.J. Prakash, Abi Manesh, Alladi Mohan, Joel Tarning, Stuart D. Blacksell, Pimnara Peerawaranun, Naomi Waithira, Mavuto Mukaka, Phaik Yeong Cheah, John V. Peter, Ooriapadickal C. Abraham, Nicholas P.J. Day. Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus. New England Journal of Medicine. 2023;388(9):792-803. doi:10.1056/nejmoa2208449.
