eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Scrub Typhus: Differential Diagnoses & Workup

Author: Aracelis D Fernandez, MD, FAAP, Attending Physician, Assistant Professor of Pediatrics, Assistant Professor of Immunology an, Department of Pediatrics, Children's Hospital at Albany Medical Center
Coauthor(s): Rosemary Johann-Liang, MD, Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration
Contributor Information and Disclosures

Updated: Jun 29, 2009

Differential Diagnoses

Tularemia

Other Problems to Be Considered

Other Flavivirus infections

Workup

Laboratory Studies

  • Routine laboratory studies in patients with scrub typhus reveal early lymphopenia with late lymphocytosis.
  • Albuminuria is a common laboratory finding.
  • The confirmatory tests are the indirect immunoperoxidase test and the immunofluorescent assay.9 An infection is confirmed by a 4-fold increase in antibody titers between acute and convalescent serum specimens. A single high titer with classic clinical features is considered a probable case.
  • A dot immunoassay has also been used in the serodiagnosis of scrub typhus.
  • The organism has been identified by the polymerase chain reaction (PCR) technique in clinical specimens.10
  • The Weil-Felix OX-K strain agglutination reaction may be the only serologic test available in less developed countries, but it is not a very sensitive assay.

More on Scrub Typhus

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

  1. [Guideline] Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep. Mar 31 2006;55:1-27. [Medline].

  2. Suputtamongkol Y, Suttinont C, Niwatayakul K, et al. Epidemiology and clinical aspects of rickettsioses in Thailand. Ann N Y Acad Sci. May 2009;1166:172-9. [Medline].

  3. 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].

  4. Matsumura Y, Shimizu T. [Case of imported scrub typhus contracted in Myanmar]. Kansenshogaku Zasshi. May 2009;83(3):256-60. [Medline].

  5. Liu Y, Feng D, Suo J, et al. Clinical characteristics of the autumn-winter type scrub typhus cases in south of Shandong province, northern China. BMC Infect Dis. Jun 4 2009;9(1):82. [Medline].

  6. McGready R, Blacksell SD, Luksameetanasan R, Wuthiekanun V, Jedsadapanpong W, Day NP, et al. First Report of an Orientia tsutsugamushi Type TA716-Related Scrub Typhus Infection in Thailand. Vector Borne Zoonotic Dis. Jun 3 2009;[Medline].

  7. Sharma PK, Ramakrishnan R, Hutin YJ, et al. Scrub typhus in Darjeeling, India: opportunities for simple, practical prevention measures. Trans R Soc Trop Med Hyg. Mar 13 2009;[Medline].

  8. Kramme S, An le V, Khoa ND, et al. Orientia tsutsugamushi bacteremia and cytokine levels in Vietnamese scrub typhus patients. J Clin Microbiol. Mar 2009;47(3):586-9. [Medline].

  9. Phetsouvanh R, Blacksell SD, Jenjaroen K, Day NP, Newton PN. Comparison of indirect immunofluorescence assays for diagnosis of scrub typhus and murine typhus using venous blood and finger prick filter paper blood spots. Am J Trop Med Hyg. May 2009;80(5):837-40. [Medline].

  10. Paris DH, Aukkanit N, Jenjaroen K, Blacksell SD, Day NP. A highly sensitive quantitative real-time PCR assay based on the groEL gene of contemporary Thai strains of Orientia tsutsugamushi. Clin Microbiol Infect. May 2009;15(5):488-95. [Medline].

  11. Tsai CC, Lay CJ, Wang CL, Ho YH, Wang LS, Chen LK. Levofloxacin versus tetracycline antibiotics for the treatment of scrub typhus. Int J Infect Dis. Jun 3 2009;[Medline].

  12. Baxter JD. The typhus group. Clin Dermatol. May-Jun 1996;14(3):271-8. [Medline].

  13. Edwards MS, Feigen RD. Rickettsial diseases. In: Textbook of Pediatric Infectious Diseases. Vol 2. 2004:2508-9.

  14. Jensenius M, Fournier PE, Raoult D. Rickettsioses and the international traveler. Clin Infect Dis. Nov 15 2004;39(10):1493-9. [Medline].

  15. Raoult D. Scrub typhus. In: Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. Vol 2. 2005:2309-10.

  16. Seong SY, Choi MS, Kim IS. Orientia tsutsugamushi infection: overview and immune responses. Microbes Infect. Jan 2001;3(1):11-21. [Medline].

  17. Sharma PK, Ramakrishnan R, Hutin YJ, et al. Scrub typhus in Darjeeling, India: opportunities for simple, practical prevention measures. Trans R Soc Trop Med Hyg. Mar 13 2009;[Medline].

  18. Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. Oct 2003;16(5):429-36. [Medline].

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Keywords

scrub typhus, chigger fever, tsutsugamushi fever, tsutsugamushi disease, akamushi disease, flood fever, inundation fever, island disease, island fever, Japanese river fever, kedani fever, mite typhus, shimamushi disease tropical typhus, Rickettsia tsutsugamushi, R tsutsugamushi, Rickettsia orientalis, R orientalis, Oriental tsutsugamushi, O tsutsugamushi, HIV infection, adult respiratory distress syndrome, ARDS, disseminated intravascular coagulation, DIC, treatment, diagnosis

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Contributor Information and Disclosures

Author

Aracelis D Fernandez, MD, FAAP, Attending Physician, Assistant Professor of Pediatrics, Assistant Professor of Immunology an, Department of Pediatrics, Children's Hospital at Albany Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Rosemary Johann-Liang, MD, Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration
Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

José Rafael Romero, MD, Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center
José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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