Could scrub typhus be the cause of headache, rash, and fever?

Question

Hello doctor,

I need your help with my cousin's case. He is 26 years old and has been complaining of a severe headache for the past three days. Yesterday, we noticed red, itchy rashes spreading across his back and arms. His fever has been consistently high at 103 degrees Fahrenheit (39 degree Celsius), and Paracetamol barely provides any relief. We live in a rural area, and someone suggested that scrub typhus might be the cause. The local clinic prescribed Doxycycline but did not offer much explanation. Should we seek further testing, such as an ELISA, or any other tests? How long does recovery typically take? Also, is there a risk of organ damage if treatment is delayed?

Please guide.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for posting your query.

If there is a localized scar or bite-like mark on the body, it could indicate scrub typhus. As mentioned, we live in a rural, forested, and hilly area where mites are common. The bacteria Orientia tsutsugamushi, responsible for scrub typhus, is transmitted through larval trombiculid mites.

If detected early, within a week, and treatment is started within one to two weeks, the effects are less severe, and the condition can be completely cured. However, if left untreated for a longer period, it can be fatal and may affect almost all organs of the body, including the brain, lungs, liver, kidneys, and gastrointestinal system.

Scrub typhus is commonly diagnosed through an enzyme-linked immunosorbent assay (ELISA) test, but polymerase chain reaction (PCR) and indirect fluorescent antibody (IFA) tests can also be used. The symptoms you described, such as headache, high fever, and rash, are consistent with scrub typhus.

The treatment is straightforward and highly effective if started early. The recommended treatment includes:

Doxycycline 100 milligrams twice a day.
Paracetamol 500 milligrams two to three times a day as needed for fever.
Levocetirizine 10 milligrams two to three times a day.

It is strongly advised to get an enzyme-linked immunosorbent assay (ELISA) test and keep the patient under medical observation. If left untreated, the condition can lead to seizures, so it is important to get a confirmed diagnosis.

Typically, recovery takes about two to four weeks after starting treatment.

Take care.

Please let me know if you want some help.

Thank you.