Orientia tsutsugamushi

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Orientia tsutsugamushi /
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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