Scrub Typhus Questions & Answers

1. Olson JG, Bourgeois AL, Fang RC, Coolbaugh JC, Dennis DT. Prevention of scrub typhus. Prophylactic administration of doxycycline in a randomized double blind trial. Am J Trop Med Hyg. 1980 Sep. 29(5):989-97. [QxMD MEDLINE Link].

2. 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. 2009 Mar 13. [QxMD MEDLINE Link].

3. Watt G, Walker DH. Scrub typhus. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases Principles, Pathogens and Practice. 2nd ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2006. Vol 1: Chapter 52.

4. Berman SJ, Kundim WD. Scrub Typhus in South Vietnam: A Study of 87 Cases. Annals Internal Med. July 1973. 79:26-30.

5. Corwin A, Soderquist R, Suwanabun N, Sattabongkot J, Martin L, Kelly D, et al. Scrub typhus and military operations in Indochina. Clin Infect Dis. 1999 Oct. 29(4):940-1. [QxMD MEDLINE Link].

6. Raoult D. Scrub typhus. Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Elsever Churchill Livingstone; 2005. Vol 2: 2309-10.

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

8. Watt G, Chouriyagune C, Ruangweerayud R, Watcharapichat P, Phulsuksombati D, Jongsakul K, et al. Scrub typhus infections poorly responsive to antibiotics in northern Thailand. Lancet. 1996 Jul 13. 348(9020):86-9. [QxMD MEDLINE Link].

9. Watt G, Kantipong P, de Souza M, Chanbancherd P, Jongsakul K, Ruangweerayud R, et al. HIV-1 suppression during acute scrub-typhus infection. Lancet. 2000 Aug 5. 356(9228):475-9. [QxMD MEDLINE Link].

10. Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. 2003 Oct. 16(5):429-36. [QxMD MEDLINE Link].

11. Ogawa M, Hagiwara T, Kishimoto T, Shiga S, Yoshida Y, Furuya Y. Scrub typhus in Japan: epidemiology and clinical features of cases reported in 1998. Am J Trop Med Hyg. 2002 Aug. 67(2):162-5. [QxMD MEDLINE Link].

12. Lee IY, Kim HC, Lee YS, Seo JH, Lim JW, Yong TS, et al. Geographical distribution and relative abundance of vectors of scrub typhus in the Republic of Korea. Korean J Parasitol. 2009 Dec. 47(4):381-6. [QxMD MEDLINE Link]. [Full Text].

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

14. Shirai A, Saunders JP, Dohany AL, et al. Transmission of Scrub Typhus to Human Volunteers by Laboratory Raised Chiggers. Jpn J Med Sci Biol. 1982. 35(9):

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

16. Cracco C, Delafosse C, Baril L, Lefort Y, Morelot C, Derenne JP, et al. Multiple organ failure complicating probable scrub typhus. Clin Infect Dis. 2000 Jul. 31(1):191-2. [QxMD MEDLINE Link].

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

18. Sonthayanon P, Chierakul W, Wuthiekanun V, Phimda K, Pukrittayakamee S, Day NP, et al. Association of high Orientia tsutsugamushi DNA loads with disease of greater severity in adults with scrub typhus. J Clin Microbiol. 2009 Feb. 47(2):430-4. [QxMD MEDLINE Link]. [Full Text].

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

20. Blacksell SD, Luksameetanasan R, Kalambaheti T, Aukkanit N, Paris DH, McGready R, 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. 2008 Apr. 52(3):335-42. [QxMD MEDLINE Link].

21. Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, 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. 2009 Mar. 80(3):442-6. [QxMD MEDLINE Link].

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

23. Chen K, Travanty NV, Garshong R, et al. Detection of Orientia spp. Bacteria in Field-Collected Free-Living Eutrombicula Chigger Mites, United States. Emerg Infect Dis. 2023 Aug. 29 (8):1676-9. [QxMD MEDLINE Link]. [Full Text].

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

25. 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. 2009 Jun 4. 9(1):82. [QxMD MEDLINE Link]. [Full Text].

26. McGready R, Blacksell SD, Luksameetanasan R, et al. First Report of an Orientia tsutsugamushi Type TA716-Related Scrub Typhus Infection in Thailand. Vector Borne Zoonotic Dis. 2009 Jun 3. [QxMD MEDLINE Link].

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

28. Xu G, Walker DH, Jupiter D, Melby PC, Arcari CM. A review of the global epidemiology of scrub typhus. PLoS Negl Trop Dis. 2017 Nov. 11 (11):e0006062. [QxMD MEDLINE Link].

29. Weitzel T, Martínez-Valdebenito C, Acosta-Jamett G, Abarca K. Notes from the Field: Scrub Typhus Outbreak - Los Lagos Region, Chile, January-February 2023. MMWR Morb Mortal Wkly Rep. 2023 Jul 7. 72 (27):753-4. [QxMD MEDLINE Link]. [Full Text].

30. Brown GW, Robinson DM, Huxsoll DL, Ng TS, Lim KJ. Scrub typhus: a common cause of illness in indigenous populations. Trans R Soc Trop Med Hyg. 1976. 70(5-6):444-8. [QxMD MEDLINE Link].

31. Brown GW, Robinson DM, Huxsoll DL. Serological evidence for a high incidence of transmission of Rickettsia tsutsugamushi in two Orang Asli settlements in Peninsular Malaysia. Am J Trop Med Hyg. 1978 Jan. 27(1 Pt 1):121-3. [QxMD MEDLINE Link].

32. Cao M, Guo H, Tang T, Wang C, Li X, Pan X, et al. Spring scrub typhus, People's Republic of China. Emerg Infect Dis. 2006 Sep. 12(9):1463-5. [QxMD MEDLINE Link].

33. Rajapakse S, Rodrigo C, Fernando D. Scrub typhus: pathophysiology, clinical manifestations and prognosis. Asian Pac J Trop Med. 2012 Apr. 5(4):261-4. [QxMD MEDLINE Link].

34. Watt G, Jongsakul K, Chouriyagune C, Paris R. Differentiating dengue virus infection from scrub typhus in Thai adults with fever. Am J Trop Med Hyg. 2003 May. 68(5):536-8. [QxMD MEDLINE Link].

35. Wang CC, Liu SF, Liu JW, Chung YH, Su MC, Lin MC. Acute respiratory distress syndrome in scrub typhus. Am J Trop Med Hyg. 2007 Jun. 76(6):1148-52. [QxMD MEDLINE Link].

36. Kim DM, Kim SW, Choi SH, Yun NR. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis. 2010 Apr 30. 10:108. [QxMD MEDLINE Link]. [Full Text].

37. McGready R, Ashley EA, Wuthiekanun V, Tan SO, Pimanpanarak M, Viladpai-Nguen SJ, et al. Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border. PLoS Negl Trop Dis. 2010 Nov 16. 4(11):e888. [QxMD MEDLINE Link]. [Full Text].

38. McGready R, Prakash JA, Benjamin SJ, Watthanaworawit W, Anantatat T, Tanganuchitcharnchai A, et al. Pregnancy outcome in relation to treatment of murine typhus and scrub typhus infection: a fever cohort and a case series analysis. PLoS Negl Trop Dis. 2014 Nov. 8 (11):e3327. [QxMD MEDLINE Link].

39. Boggs W. Poor Pregnancy Outcomes With Murine Typhus and Scrub Typhus Infection. Reuters Health Information. Available at http://www.medscape.com/viewarticle/835640. December 02, 2014; Accessed: October 2, 2015.

40. Alam AM, Gillespie CS, Goodall J, Damodar T, Turtle L, Vasanthapuram R, et al. Neurological manifestations of scrub typhus infection: A systematic review and meta-analysis of clinical features and case fatality. PLoS Negl Trop Dis. 2022 Nov. 16 (11):e0010952. [QxMD MEDLINE Link]. [Full Text].

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

42. Sirisanthana V, Puthanakit T, Sirisanthana T. Epidemiologic, clinical and laboratory features of scrub typhus in thirty Thai children. Pediatr Infect Dis J. 2003 Apr. 22(4):341-5. [QxMD MEDLINE Link].

43. Kim DM, Won KJ, Park CY, Yu KD, Kim HS, Yang TY. Distribution of eschars on the body of scrub typhus patients: a prospective study. Am J Trop Med Hyg. 2007 May. 76(5):806-9. [QxMD MEDLINE Link].

44. 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. 2011 Mar 30. 11:79. [QxMD MEDLINE Link]. [Full Text].

45. Edwards MS, Feigen RD. Rickettsial and Erlichial Diseases. Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier Saunders; 2009. Vol 2: 2677-2678.

46. Sittiwangkul R, Pongprot Y, Silviliarat S, Oberdorfer P, Jittamala P, Sirisanthana V. Acute fulminant myocarditis in scrub typhus. Ann Trop Paediatr. 2008 Jun. 28(2):149-54. [QxMD MEDLINE Link].

47. Aronoff DM, Watt G. Prevalence of relative bradycardia in Orientia tsutsugamushi infection. Am J Trop Med Hyg. 2003 Apr. 68(4):477-9. [QxMD MEDLINE Link].

48. Tsai CC, Chiang DH, Duh RW. Scrub typhus mimicking deep neck infection. Intern Med. 2008. 47(22):1997-2000. [QxMD MEDLINE Link].

49. Liu YX, Feng D, Zhang Q, Jia N, Zhao ZT, De Vlas SJ, et al. Key differentiating features between scrub typhus and hemorrhagic fever with renal syndrome in northern China. Am J Trop Med Hyg. 2007 May. 76(5):801-5. [QxMD MEDLINE Link].

50. Chanta C, Triratanapa K, Ratanasirichup P, Mahaprom W. Hepatic dysfunction in pediatric scrub typhus: role of liver function test in diagnosis and marker of disease severity. J Med Assoc Thai. 2007 Nov. 90(11):2366-9. [QxMD MEDLINE Link].

51. Phimda K, Hoontrakul S, Suttinont C, Chareonwat S, Losuwanaluk K, Chueasuwanchai S. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother. 2007 Sep. 51(9):3259-63. [QxMD MEDLINE Link].

52. 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. 2009 May. 80(5):837-40. [QxMD MEDLINE Link].

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

54. Silpasakorn S, Srisamut N, Ekpo P, Zhang Z, Chao CC, Ching WM, et al. Development of new, broadly reactive, rapid IgG and IgM lateral flow assays for diagnosis of scrub typhus. Am J Trop Med Hyg. 2012 Jul. 87(1):148-52. [QxMD MEDLINE Link]. [Full Text].

55. Varghese GM, Rajagopal VM, Trowbridge P, Purushothaman D, Martin SJ. Kinetics of IgM and IgG antibodies after scrub typhus infection and the clinical implications. Int J Infect Dis. 2018 Apr 10. [QxMD MEDLINE Link].

56. 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. 2009 May. 15(5):488-95. [QxMD MEDLINE Link].

57. Park HS, Lee JH, Jeong EJ, Kim JE, Hong SJ, Park TK, 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. [QxMD MEDLINE Link].

58. Lee SH, Kim DM, Cho YS, Yoon SH, Shim SK. Usefulness of eschar PCR for diagnosis of scrub typhus. J Clin Microbiol. 2006 Mar. 44(3):1169-71. [QxMD MEDLINE Link]. [Full Text].

59. Cao M, Guo H, Tang T, Wang C, Li X, Pan X, 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. 2007 Mar. 76(3):553-8. [QxMD MEDLINE Link].

60. Chen HC, Chang HC, Chang YC, Liu SF, Su MC, Huang KT, et al. Chest radiographic presentation in patients with scrub typhus. Trans R Soc Trop Med Hyg. 2012 Jan. 106(1):48-53. [QxMD MEDLINE Link].

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

62. Gupta N, Mittal V, Gurung B, Sherpa U. Pediatric Scrub typhus in South Sikkim. Indian Pediatr. 2012 Apr. 49(4):322-4. [QxMD MEDLINE Link].

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

64. 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. 2009 Jun 3. [QxMD MEDLINE Link].

65. Rajapakse S, Rodrigo C, Fernando SD. Drug treatment of scrub typhus. Trop Doct. 2011 Jan. 41(1):1-4. [QxMD MEDLINE Link].

66. Varghese GM, Dayanand D, Gunasekaran K, et al. Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus. N Engl J Med. 2023 Mar 2. 388 (9):792-803. [QxMD MEDLINE Link]. [Full Text].

67. 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. 2000 Sep 23. 356(9235):1057-61. [QxMD MEDLINE Link].

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69. 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. 2007 Jun. 51(6):2011-5. [QxMD MEDLINE Link]. [Full Text].

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72. Chung MH, Lee JS, Baek JH, Kim M, Kang JS. Persistence of Orientia tsutsugamushi in humans. J Korean Med Sci. 2012 Mar. 27(3):231-5. [QxMD MEDLINE Link]. [Full Text].

73. Rodkvamtook W, Prasartvit A, Jatisatienr C, Jatisatienr A, Gaywee J, Eamsobhana P. Efficacy of plant essential oils for the repellents against chiggers (Leptotrombidium imphalum) vector of scrub typhus. J Med Assoc Thai. 2012 May. 95 Suppl 5:S103-6. [QxMD MEDLINE Link].

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

75. Valbuena G, Walker DH. Approaches to vaccines against Orientia tsutsugamushi. Front Cell Infect Microbiol. 2012. 2:170. [QxMD MEDLINE Link]. [Full Text].

76. Walker DH, Mendell NL. A scrub typhus vaccine presents a challenging unmet need. NPJ Vaccines. 2023 Feb 9. 8 (1):11. [QxMD MEDLINE Link]. [Full Text].

77. Kim YS, Kim DM, Yoon NR, Jang MS, Kim CM. Effects of Rifampin and Doxycycline Treatments in Patients with Uncomplicated Scrub Typhus: An Open-label Randomized Controlled Trial. Clin Infect Dis. 2018 Feb 15. [QxMD MEDLINE Link].

David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS Associate Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Rutgers New Jersey Medical School

David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS is a member of the following medical societies: American Academy of HIV Medicine, American Academy of Pediatrics, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Medical Society of New Jersey, Pediatric Infectious Diseases Society

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Arry Dieudonne, MD Associate Professor of Pediatrics, Division of Pulmonology, Allergy, Immunology and Infectious Diseases, Rutgers New Jersey Medical School; Clinical Director, Francois-Xavier Bagnold Center for Children, University Hospital

Arry Dieudonne, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Pediatric Infectious Diseases Society

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Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

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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

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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

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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

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Cris Jagar MD, Staff Physician, Department of Psychiatry, Trinitas Regional Medical Center

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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

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