eMedicine Specialties > Dermatology > Bacterial Infections

Scrub Typhus: Treatment & Medication

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

Treatment

Medical Care

  • The current treatment for scrub typhus is doxycycline. Chloramphenicol is also effective.
  • Relapses may occur if the antibiotics are not taken for a long enough period.
  • Intravenous antibiotics may be administered to patients who are seriously ill and unable to swallow pills.

Consultations

  • Consider consultation with an infectious diseases specialist if the patient does not improve on antibiotics or has atypical symptoms.

Diet

  • Diet is as tolerated.

Activity

  • Activity is as tolerated.

Medication

Antibiotics are necessary to eradicate the rickettsial infection. In a prospective, open-label, randomized trial of Korean patients with mild-to-moderate scrub typhus, the efficacy and safety of a 5-day telithromycin regimen compared favorably with a 5-day doxycycline regimen.17 Telithromycin is a promising new antibacterial agent for patients with scrub typhus.

Antibiotics

Doxycycline or chloramphenicol is effective in treating scrub typhus.


Doxycycline (Bio-Tab, Vibramycin, Doryx)

Synthetic antibiotic derived from tetracycline. Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Effective against a large number of pathogens.

Adult

100 mg PO bid for 7-14 d

Pediatric

<8 years: Not recommended
>8 years: Administer as in adults

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can possibly decrease effects of oral contraceptives by reducing the enterohepatic circulation of estrogens, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines


Chloramphenicol (Chloromycetin)

Binds to 50S bacterial ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria. Very inexpensive.

Adult

500 mg PO qid for 7-14 d

Pediatric

Not established

Administered concurrently with barbiturates, serum levels may decrease while barbiturate levels may increase causing toxicity; manifestations of hypoglycemia may occur with sulfonylureas; rifampin may reduce serum levels, presumably through hepatic enzyme induction; may increase effects of anticoagulants; may increase serum hydantoin levels, possibly resulting in toxicity; hydantoins may either increase or decrease chloramphenicol levels

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Use only for indicated infections or as prophylaxis for bacterial infections; serious and fatal blood dyscrasias (eg, aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia) can occur; evaluate baseline and perform periodic blood studies approximately every 2 d while in therapy; discontinue on appearance of reticulocytopenia, leukopenia, thrombocytopenia, anemia, or findings attributable to chloramphenicol; adjust dose in liver or kidney dysfunction; caution in pregnancy at term or during labor because of potential toxic effects to the fetus (gray syndrome)

More on Scrub Typhus

Overview: Scrub Typhus
Differential Diagnoses & Workup: Scrub Typhus
Treatment & Medication: Scrub Typhus
Follow-up: Scrub Typhus
References
[ CLOSE WINDOW ]

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. 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].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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].

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

  11. 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].

  12. 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].

  13. 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].

  14. 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].

  15. 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].

  16. 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].

  17. 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].

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

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

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

  21. 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].

  22. 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].

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

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

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

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

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

  28. 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].

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

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

  31. 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].

  32. 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].

  33. 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].

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

  35. 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].

  36. 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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.