eMedicine Specialties > Dermatology > Bacterial Infections

Scrub Typhus: Follow-up

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Cris Jagar, MD, Staff Physician, Department of Psychiatry, Saint Vincent Catholic Medical Centers
Contributor Information and Disclosures

Updated: Aug 31, 2009

Follow-up

Deterrence/Prevention

Advise patients who plan to visit endemic areas to take precautions (eg, wearing protective clothing, using insect repellent). Antibiotic prophylaxis with a single oral dose of chloramphenicol or tetracycline given every 5 days for a total of 35 days, with 5-day nontreatment intervals, produces active immunity to scrub typhus.

Reports of scrub typhus outbreaks in endemic areas and a decreased effectiveness of antibiotic treatment suggest a continued need for a suitable vaccine.18 A scrub typhus vaccine is being developed.

Complications

Scrub typhus patients who are not treated can develop encephalitis, pneumonitis, and circulatory failure, and they can even die.

Prognosis

In patients who are not treated, the mortality rate for scrub typhus varies from 1-60%, depending on the geographic area and the rickettsial strain. With the proper antibiotic treatment, deaths from scrub typhus are rare and the recovery period is short and usually without complications.

Patient Education

Educate travelers to endemic areas about the importance of being aware of bites and seeking treatment immediately if they are affected.

Miscellaneous

Medicolegal Pitfalls

  • Failure to treat scrub typhus patients with the proper antibiotics as soon as possible is a pitfall. Serious complications can develop if treatment is delayed.

Special Concerns

  • When patients who are HIV positive become infected with certain strains of scrub typhus, their viral load can dramatically decrease. This is an important area of research. A proposed hypothesis is that patients infected with HIV who acquire scrub typhus have a powerful immune response raised to the scrub typhus and that is being turned against the HIV.19
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.



More on Scrub Typhus

Overview: Scrub Typhus
Differential Diagnoses & Workup: Scrub Typhus
Treatment & Medication: Scrub Typhus
Follow-up: Scrub Typhus
References
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Further Reading

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Keywords

scrub typhus, typhus, rickettsial infection, tsutsugamushi disease, tsutsugamushi fever, tropical typhus,

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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, UMDNJ-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, Saint Vincent Catholic Medical Centers
Disclosure: Nothing to disclose.

Medical Editor

Janet Fairley, MD, Professor and Head, Department of Dermatology, University of Iowa
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.

Pharmacy Editor

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.

Managing Editor

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: Nothing to disclose.

CME Editor

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

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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