Can scrub typhus cause permanent liver damage?

Question

Hello doctor,

My dad, who is 62 years old, was diagnosed with scrub typhus last week, and we are very anxious about his recovery. He has had a fever of 103°F (39.4°C) for seven days now, and his platelet count has dropped to 80,000 cells/μL in his latest blood report. He also has a dark sore near his shoulder, which the doctor identified as an eschar, but it appears to be getting infected.

He is diabetic, so I am concerned that his immune system may not be strong enough to fight this off effectively. He has been on Doxycycline (100 mg twice daily) for five days, but the fever has not reduced significantly. The doctor mentioned that his liver enzymes are elevated – AST is 82 U/L, and ALT is 95 U/L. Could this infection cause permanent damage to his liver? Should we request additional tests, such as an abdominal ultrasound?

We are feeling helpless seeing him so weak and want to ensure we are doing everything possible for his recovery. Any advice would be greatly appreciated.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concern.

Symptoms of scrub typhus (an infectious disease caused by the bacterium Orientia tsutsugamushi) typically begin within 10 days of infection.

Common signs and symptoms include:

Fever and chills.
Headache.
Body aches and muscle pain.
A dark, scab-like area at the site of the chigger bite (referred to as an eschar).
Mental changes, ranging from confusion to coma.
Enlarged lymph nodes.
Rash.

If not treated promptly and appropriately, scrub typhus can become fatal, leading to organ damage and severe bleeding.

Blood test findings

Patients with scrub typhus often exhibit elevated liver enzymes, including:

Alkaline phosphatase (ALP): Elevated levels are commonly observed.
Alanine aminotransferase (ALT): Elevated levels are typical.
Aspartate aminotransferase (AST): Elevated levels are frequent.

Complications

Scrub typhus can result in severe complications, such as:

Acute respiratory distress syndrome (ARDS): A critical condition requiring immediate attention.
Acute kidney injury (AKI).
Myocarditis: A potentially life-threatening inflammation of the heart.
Acute liver failure (ALF).
Encephalitis: Inflammation of the brain.
Pericarditis: Inflammation of the lining around the heart.
Cardiac arrhythmia: Irregular heartbeats.
Acute hearing loss.
Septic shock: A life-threatening condition caused by infection.
Multiple organ dysfunction syndrome (MODS): Failure of multiple organ systems.

Diagnostic tests

Your physician may recommend additional tests based on the patient’s condition, including:

CT (computerized tomography) scans.
Liver function tests (LFTs).
Kidney function tests (KFTs).
Cardiac enzyme level assessments.

Treatment

Antibiotic therapy: Scrub typhus should be treated with Doxycycline, which can be used in individuals of any age.
Early treatment: Antibiotics are most effective when administered soon after symptoms appear.
Recovery: Patients treated early typically recover quickly.
Extended treatment: Some patients may require prolonged courses of Doxycycline for complete recovery. Multivitamins may be added to the treatment plan to support overall healing. Consult your doctor and take medicines accordingly.

I hope this helps.

Please revert so I can assist you further.

Thank you.