How to manage scrub typhus infection?

Question

Hello doctor,

I am a 41-year-old male recently diagnosed with scrub typhus after returning from a hiking trip two weeks ago. My symptoms started with high fever, headache, muscle aches, and a red rash on my abdomen, followed by severe fatigue and confusion. Bloodwork showed elevated liver enzymes (ALT 95 U/L, AST 88 U/L), thrombocytopenia (platelet count 110,000/µL), and an ESR of 65 mm/hr. The scrub typhus IgM test came back positive, and an abdominal ultrasound revealed mild splenomegaly. I have been on Doxycycline 100 mg twice daily for the past five days, and while the fever has reduced, I am still feeling weak, and the rash has not completely subsided. I am concerned about the risk of organ complications or relapse as I have read that scrub typhus can cause long-term issues if not fully treated. Should we consider extending my antibiotic course or doing any follow-up tests to monitor for complications? Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

Scrub typhus infection upon initiation of treatment, usually takes around 15 to 20 days for subsidization and starts recovery. From the infection and symptoms, it is recommended to take treatment for up to 15 days. If completely cured there are very minimal chances of long-term health issues from it. Once the infection subsides, the antibody IgM (immunoglobulin M) test will come back negative for scrub typhus which relieves all the tension. Upon completion of treatment, the affected organs will come to normal. The eschar will take 15 days to one month to go off. In this situation it is advised to continue treatment for up to 15 days or two days of symptomless body and follow-up tests should be done to track record of clearance of infection as a confirmatory measure.

I hope it helps.

Thank you and take care.