Dermatologic Manifestations of Scrub Typhus 

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

Background

Scrub typhus typically occurs in Southeast Asia and Japan, where the disease was first described in 1899. During World War II, scrub typhus killed or incapacitated thousands of troops who were stationed in rural or jungle areas of the Pacific theatre. The disease is called scrub typhus because it generally occurs after exposure to areas with scrub vegetation because this is where the rodents predominantly live. Scrub typhus can also be prevalent in areas such as sandy beaches, mountain deserts, and equatorial rain forests.

Rickettsial diseases such as scrub typhus have forced the American military to continue work on countermeasures to control the arthropod vectors and participate in the development of rapid, accurate diagnostic tests, vaccines, and improved surveillance methods.[1]

Also see the eMedicine Pediatrics article Scrub Typhus.

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Pathophysiology

Scrub typhus is caused by Rickettsia tsutsugamushi(Orientia tsutsugamushi). It is a tiny intracellular parasite that lives primarily in mites (the primary reservoir) belonging to the species Leptotrombidium(Trombicula) akamushi and Leptotrombidium deliense. The Rickettsia organisms are found throughout the mite's body, but the highest number is present in the salivary glands. When the mite feeds on rodents (eg, rats, moles, and field mice, which are the secondary reservoirs) or humans, the parasites are transmitted to the host. Only larval Leptotrombidium mites (eg, chiggers) transmit the disease. Not surprisingly, in South Korea, a positive correlation is apparent between chigger population abundance and human cases of scrub typhus.[2]

Scrub typhus, a zoonotic disease, may disseminate into multiple organs through endothelial cells and macrophages, resulting in the development of fatal complications.[3, 4] In 2009, an apparent association was reported apparent between high O tsutsugamushi blood polymerase chain reaction (PCR)–determined DNA loads and disease severity.[5]

In 2009, phenotypic and genotypic variants of O tsutsugamushi were reported.[6] DNA analysis together with immunological analysis suggest that the prototype Karp strain and closely related strains are the most common throughout the region of endemicity. About half of isolates are seroreactive to Karp antisera, and approximately one-quarter of isolates are seroreactive to antisera against the prototype Gilliam strain.[7]

In 2009, behavioral factors were shown to be associated with scrub typhus during an autumn epidemic season in South Korea.[8] Taking a rest directly on the grass, working in short sleeves, working with bare hands, and squatting to defecate or urinate posed the highest risks. Wearing a long-sleeved shirt while working, keeping work clothes off the grass, and always using a mat to rest outdoors showed protective associations.

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Epidemiology

Frequency

United States

The United States is not affected by scrub typhus. The only cases of scrub typhus in the United States are in travelers who have recently been to one of the endemic areas.

International

Scrub typhus is limited to eastern and southeastern Asia, India, and northern Australia and the adjacent islands. The seasonal occurrence of scrub typhus varies with the climate in different countries because the mites are able to thrive as conditions change. The mites prefer the rainy season and certain areas (eg, forest clearings, riverbanks, grassy regions). Areas in which the mites thrive pose a greater risk to humans. The prevalence of scrub typhus in Japan has been rising, and much of the current research has been based in Japan.

Mortality/Morbidity

The mortality rate from scrub typhus ranges from 1-60%, depending on the geographic area and the rickettsial strain. Death can occur from the primary infection or from secondary complications (eg, pneumonitis, encephalitis, circulatory failure). Most fatalities occur by the end of the second week of infection.

Race

All races are affected equally by scrub typhus.

Sex

Both men and women are affected equally by scrub typhus.

Age

People of all ages are affected equally by scrub 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, 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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