Dynamics of Clinical Symptoms in Patients with Scrub Typhus

Abstract

SUMMARY:The clinical manifestations and complications of scrub typhus are variable. Few studies have examined the timeline of clinical symptoms after the appropriate antimicrobial agents have been administered. The most prevalent clinical manifestations are fever and cough, followed by headache, myalgia, eschar, skin rash, and nausea. Systemic symptoms are most severe during the early stages of illness (i.e., the first 5 days), but resolve slowly within 2 weeks. The associated skin rash is most severe during the first 8 days of infection, but it resolves slowly within 21 days.Scrub typhus is a potentially fatal infectious disease caused by the organism Orientia tsutsugamushi (1). Typical signs include eschar formation and acute febrile illness with symptoms that include abrupt fever, chills, rash, lymphadenopathy, abdominal pain, and myalgia (2,3). The clinical manifestations and complications of scrub typhus vary; most symptoms are mild but severe complications have been reported, including acute respiratory distress syndrome, encephalitis, interstitial pneumonia, myocarditis and pericarditis, acute renal failure, and acute hepatic failure (4-10). Very few reports describe the clinical course beyond the occurrence of fever after the appropriate antimicrobial agents have been administered (11). An established timeline of the clinical symptoms may help physicians manage patients with scrub typhus more effectively.This study was conducted in 5 university medical centers in Korea between October and December 2010. In the current study, we used several diagnostic criteria for scrub typhus. First, a diagnosis of scrub typhus was made according to the World Health Organization criteria in 4 out of 5 hospitals when specific IgM antibody titers were equal to or greater than 1:10, or IgG titers were either equal to or greater than 1:256, or a 4-fold increase in titer was demonstrated using paired serum samples in an indirect immunofluorescence antibody (IFA) test (11,12). The O. tsutsugamushi strains used in the IFA test included Gilliam, Karp, Kato, and Boryong. Second, in the remaining hospital, O. tsutsugamushi was detected in passive hemagglutination assay (PHA) against O. tsutsugamushi with an antibody titer of 1:80 or greater in a single serum sample or 4-fold increase or greater during follow-up (13,14). The PHA was conducted using the Genedia Tsutsu PHA II test kit (Green Cross Corp., Yongin, Korea), which provides qualitative and quantitative detection of serum antibodies against O. tsutsugamushi. Sheep erythrocytes for the PHA were sensitized with the Karp and Gilliam strains, including the Boryong strain found in Korea (11,12).Respiratory symptoms included cough and dyspnea. Systemic symptoms included subjective fever, chills, headache, weight loss, and myalgia. Gastrointestinal symptoms included nausea, vomiting, diarrhea, and abdominal pain (15). Neurologic symptoms included mental confusion and delirium. Moreover, a skin rash was also observed. Symptom severity was scored using a 4-point scale: no symptoms...

Acute respiratory failure in scrub typhus patients

“…The typical scrub typhus begins insidiously as an acute febrile illness with fever, headache, malaise, rashes, myalgia, sore throat, cough, vomiting, diarrhea, lymphadenopathy, eschar, and abdominal pain. [6] In the respiratory failure group, dyspnea, cough, myalgia, and lymphadenopathy were significantly present, and this finding is consistent with the findings of the previous study. [5] If treated with appropriate antibiotic, symptom resolve rapidly.…”

“…Respiratory manifestations of scrub typhus are usually seen during the 2 nd week of untreated illness,[45] and the presentation ranged from flu-like symptoms, bronchitis, interstitial pneumonitis to ARDS. [67] Respiratory failure can also be seen secondary to pulmonary edema due to cardiogenic shock. The previous report shows that ARDS can complicate scrub typhus in 44% of patients (in preantibiotic era) to 11.1-29% in recent studies[58] and in one recent study, the requirement of ventilator support was 87.9%.…”

“…[5] If treated with appropriate antibiotic, symptom resolve rapidly. [6] Untreated patients entering the 2 nd week of illness develop a serious complication such as severe respiratory distress syndrome,[5] encephalitis,[9] interstitial pneumonia, myocarditis,[7] AKI,[10] acute hepatic failure,[11] pancreatitis, and septic shock. [12] These severe clinical manifestations are due to generalized vasculitis due to the invasion of the endothelial cell by the organism and perivascular infiltrate of leukocyte.…”

Hemophagocytic Lymphohistiocytosis Associated with Scrub Typhus: Systematic Review and Comparison between Pediatric and Adult Cases

“…Symptoms worsen and patients deteriorate within several days or weeks. [ 7 , 8 ]. Diagnosis relies on clinical suspicion, which should lead to appropriate laboratory investigations being performed.…”

Laboratory Diagnosis and Genotype Identification of Scrub Typhus from Pinggu District, Beijing, 2008 and 2010

“…1 The clinical manifestations of this disease range from mild disease with symptoms of fever, rash, eschar, and lymphadenopathy to fatal disease. 2 The disease can be treated effectively with doxycycline, azithromycin, or chloramphenicol.…”