Dermatologic Manifestations of Scrub Typhus Differential Diagnoses

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

Diagnostic Considerations

Other rickettsial infections

Leptospirosis

Typhoid

Hemorrhagic fever[11]

Scrub typhus may rarely be first seen with fever and a tender neck swelling, mimicking a deep neck infection.[12]

Diagnosing scrub typhus and rickettsial diseases in international travelers can be challenging.[13] Such travelers may become sick before or within a few days of return from an endemic region. An illness that begins more than 18 days after return is unlikely to be rickettsial. If empiric therapy does not result in defervescence within 48 hours, an alternative diagnosis should be strongly considered.

Differential Diagnoses

Proceed to Workup
 
 
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

References
  1. Bavaro MF, Kelly DJ, Dasch GA, Hale BR, Olson P. History of U.S. military contributions to the study of rickettsial diseases. Mil Med. Apr 2005;170(4 Suppl):49-60. [Medline].

  2. Lee IY, Kim HC, Lee YS, et al. Geographical distribution and relative abundance of vectors of scrub typhus in the Republic of Korea. Korean J Parasitol. Dec 2009;47(4):381-6. [Medline]. [Full Text].

  3. Cracco C, Delafosse C, Baril L, et al. Multiple organ failure complicating probable scrub typhus. Clin Infect Dis. Jul 2000;31(1):191-2. [Medline].

  4. Tseng BY, Yang HH, Liou JH, Chen LK, Hsu YH. Immunohistochemical study of scrub typhus: a report of two cases. Kaohsiung J Med Sci. Feb 2008;24(2):92-8. [Medline].

  5. Sonthayanon P, Chierakul W, Wuthiekanun V, et al. Association of high Orientia tsutsugamushi DNA loads with disease of greater severity in adults with scrub typhus. J Clin Microbiol. Feb 2009;47(2):430-4. [Medline].

  6. Kelly DJ, Fuerst PA, Ching WM, Richards AL. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis. Mar 15 2009;48 Suppl 3:S203-30. [Medline].

  7. Blacksell SD, Luksameetanasan R, Kalambaheti T, et al. Genetic typing of the 56-kDa type-specific antigen gene of contemporary Orientia tsutsugamushi isolates causing human scrub typhus at two sites in north-eastern and western Thailand. FEMS Immunol Med Microbiol. Apr 2008;52(3):335-42. [Medline].

  8. Kweon SS, Choi JS, Lim HS, et al. A community-based case-control study of behavioral factors associated with scrub typhus during the autumn epidemic season in South Korea. Am J Trop Med Hyg. Mar 2009;80(3):442-6. [Medline].

  9. Kim DM, Won KJ, Park CY, et al. Distribution of eschars on the body of scrub typhus patients: a prospective study. Am J Trop Med Hyg. May 2007;76(5):806-9. [Medline].

  10. Lee BJ, Chen CY, Hu SY, Tsan YT, Lin TC, Wang LM. Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure. BMC Infect Dis. Mar 30 2011;11(1):79. [Medline].

  11. Liu YX, Feng D, Zhang Q, et al. Key differentiating features between scrub typhus and hemorrhagic fever with renal syndrome in northern China. Am J Trop Med Hyg. May 2007;76(5):801-5. [Medline].

  12. Tsai CC, Chiang DH, Duh RW. Scrub typhus mimicking deep neck infection. Intern Med. 2008;47(22):1997-2000. [Medline].

  13. Hendershot EF, Sexton DJ. Scrub typhus and rickettsial diseases in international travelers: a review. Curr Infect Dis Rep. Jan 2009;11(1):66-72. [Medline].

  14. Sugita Y, Nagatani T, Okuda K, Yoshida Y, Nakajima H. Diagnosis of typhus infection with Rickettsia tsutsugamushi by polymerase chain reaction. J Med Microbiol. Nov 1992;37(5):357-60. [Medline].

  15. Park HS, Lee JH, Jeong EJ, et al. Rapid and simple identification of Orientia tsutsugamushi from other group rickettsiae by duplex PCR assay using groEL gene. Microbiol Immunol. 2005;49(6):545-9. [Medline].

  16. Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD. Diagnosis of scrub typhus. Am J Trop Med Hyg. Mar 2010;82(3):368-70. [Medline]. [Full Text].

  17. Lee SH, Kim DM, Cho YS, Yoon SH, Shim SK. Usefulness of eschar PCR for diagnosis of scrub typhus. J Clin Microbiol. Mar 2006;44(3):1169-71. [Medline].

  18. Cao M, Guo H, Tang T, et al. Preparation of recombinant antigen of O. tsutsugamushi Ptan strain and development of rapid diagnostic reagent for scrub typhus. Am J Trop Med Hyg. Mar 2007;76(3):553-8. [Medline].

  19. Jeong YJ, Kim S, Wook YD, Lee JW, Kim KI, Lee SH. Scrub typhus: clinical, pathologic, and imaging findings. Radiographics. Jan-Feb 2007;27(1):161-72. [Medline].

  20. Rajapakse S, Rodrigo C, Fernando SD. Drug treatment of scrub typhus. Trop Doct. Jan 2011;41(1):1-4. [Medline].

  21. Kim DM, Yu KD, Lee JH, Kim HK, Lee SH. Controlled trial of a 5-day course of telithromycin versus doxycycline for treatment of mild to moderate scrub typhus. Antimicrob Agents Chemother. Jun 2007;51(6):2011-5. [Medline].

  22. Chattopadhyay S, Richards AL. Scrub typhus vaccines: past history and recent developments. Hum Vaccin. May-Jun 2007;3(3):73-80. [Medline].

  23. McGready R, Ashley EA, Wuthiekanun V, et al. Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border. PLoS Negl Trop Dis. Nov 16 2010;4(11):e888. [Medline]. [Full Text].

  24. Kim DM, Kim SW, Choi SH, Yun NR. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis. Apr 30 2010;10(1):108. [Medline].

  25. Ariyoshi K, Whittle H. HIV-1 viral load and scrub typhus. Lancet. Nov 18 2000;356(9243):1766; author reply 1766-7. [Medline].

  26. Chang WH. Current status of tsutsugamushi disease in Korea. J Korean Med Sci. Aug 1995;10(4):227-38. [Medline].

  27. Chanta C, Chanta S. Clinical study of 20 children with scrub typhus at Chiang Rai Regional Hospital. J Med Assoc Thai. Dec 2005;88(12):1867-72. [Medline].

  28. Fan MY, Walker DH, Yu SR, Liu QH. Epidemiology and ecology of rickettsial diseases in the People's Republic of China. Rev Infect Dis. Jul-Aug 1987;9(4):823-40. [Medline].

  29. Johnson S, Wilkinson R, Davidson RN. Tropical respiratory medicine. 4. Acute tropical infections and the lung. Thorax. Jul 1994;49(7):714-8. [Medline].

  30. Kostman JR. Laboratory diagnosis of rickettsial diseases. Clin Dermatol. May-Jun 1996;14(3):301-6. [Medline].

  31. Kovacova E, Kazar J. Rickettsial diseases and their serological diagnosis. Clin Lab. 2000;46(5-6):239-45. [Medline].

  32. McBride WJ, Taylor CT, Pryor JA, Simpson JD. Scrub typhus in north Queensland. Med J Aust. Apr 5 1999;170(7):318-20. [Medline].

  33. Panpanich R, Garner P. Antibiotics for treating scrub typhus. Cochrane Database Syst Rev. 2000;CD002150. [Medline].

  34. Shaked Y. Rickettsial infection of the central nervous system: the role of prompt antimicrobial therapy. Q J Med. Apr 1991;79(288):301-6. [Medline].

  35. Silpapojakul K. Scrub typhus in the Western Pacific region. Ann Acad Med Singapore. Nov 1997;26(6):794-800. [Medline].

  36. Tamura A. Invasion and intracellular growth of Rickettsia tsutsugamushi. Microbiol Sci. Aug 1988;5(8):228-32. [Medline].

  37. Tamura A, Ohashi N, Urakami H, Miyamura S. Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen. nov., as Orientia tsutsugamushi comb. nov. Int J Syst Bacteriol. Jul 1995;45(3):589-91. [Medline].

  38. Tange Y, Kobayashi Y. Transfiguration of rickettsial diseases: tsutsugamushi disease and spotted fever group rickettsiosis in Japan. Intern Med. Dec 1993;32(12):937-9. [Medline].

  39. Tay ST, Kaewanee S, Ho TM, Rohani MY, Devi S. Serological evidence of natural infection of wild rodents (Rattus spp and Tupaia glis) with rickettsiae in Malaysia. Southeast Asian J Trop Med Public Health. Sep 1998;29(3):560-2. [Medline].

  40. Walker DH, Fishbein DB. Epidemiology of rickettsial diseases. Eur J Epidemiol. May 1991;7(3):237-45. [Medline].

  41. Watt G, Kantipong P, Jongsakul K, Watcharapichat P, Phulsuksombati D, Strickman D. Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial. Lancet. Sep 23 2000;356(9235):1057-61. [Medline].

  42. Yun JH, Koh YS, Lee KH, et al. Chemokine and cytokine production in susceptible C3H/HeN mice and resistant BALB/c mice during Orientia tsutsugamushi infection. Microbiol Immunol. 2005;49(6):551-7. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.