Dermatologic Manifestations of Scrub Typhus Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD   more...
 
Updated: May 2, 2011
 

History

Once transmitted to the host, R tsutsugamushi incubates for about 10-12 days (although this can vary from as little as 6 d or as long as 21 d). After incubation, persons may experience headaches, shaking chills, lymphadenopathy, conjunctival infection, fever, anorexia, and general apathy. The fever usually reaches 104-105°F.

Diagnosing this disease early in its course can be difficult because many conditions can present with a high fever; however, the presentation of the rash, a history of exposure to endemic areas, and the presentation of the sore caused by the bite can be diagnostic.

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Physical

The site of infection is marked by a chigger bite. This initial lesion has been said to be most easily discernible in whites. However, the presence or absence of eschar was thoroughly examined among 176 Korean patients with scrub typhus confirmed by immunofluorescent assay[9] ; 162 (92%) cases had eschar, with 128 (79.5%) on the front of the body. Eschars were detected in men within 30 cm below the umbilicus (19 patients, 35.8%). Distribution on the lower extremities and the chest above the umbilicus were 22.6% (12 patients) and 20.8% (11 patients), respectively. In women, the most prevalent area was the chest above the umbilicus, which accounted for 40.7% (44 patients) of all the detected eschars. The incidence of an eschar on head, face or neck is 5%, with one patient having an eschar in the external auditory canal.[10]

The infection begins as a red indurated lesion that eventually enlarges to 8-12 mm in diameter, vesiculates and ruptures, and becomes dark and necrotic in the center. Scarring may occur.

From 5-8 days after infection, a dull red rash may appear all over the body, especially starting on the trunk and extending to the extremities. Additional symptoms at this time include enlargement of the spleen, cough, and delirium. Pneumonitis or encephalitis may develop during the second week.

In severe cases, the patient's pulse rate increases and the blood pressure decreases. The patient may become delirious and lose consciousness. Other complications, such as splenomegaly, muscle twitching, or interstitial myocarditis, may develop.

If the patient does not receive treatment, symptoms may last for more than 2 weeks; with treatment, the patient recovers within 36 hours.

The patient's recovery is usually rapid and without sequelae.

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Causes

Scrub typhus is caused by R tsutsugamushi (O tsutsugamushi). It is a tiny parasite that lives primarily in mites belonging to the species L (Trombicula) akamushi and L deliense.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Cris Jagar, MD  Staff Physician, Department of Psychiatry, Trinitas Regional Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Janet Fairley, MD  Professor and Head, Department of Dermatology, University of Iowa, Roy J and Lucille A Carver College of Medicine

Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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