Which tests can diagnose scrub typhus?

Question

Hello doctor,

I am 30 years old and recently returned from a hiking trip in a remote area. About a week after I got back, I developed a fever, chills, and a severe headache. At first, I thought it was just exhaustion, but then I noticed a small black scab near my ankle that had not gone away. My joints feel sore, and I have been sleeping much more than usual. A friend mentioned that scrub typhus is common in the area we visited. Should I get tested, or is it okay to wait and see if I improve? Also, if it is scrub typhus, how long does recovery typically take, and are there any potential long-term effects?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your symptoms strongly suggest scrub typhus. A high fever, eschar (black scab near your ankle), and recent travel to an endemic area are usually enough to diagnose the condition. Scrub typhus is primarily diagnosed based on clinical symptoms, but if you want confirmation, you can get a PCR (polymerase chain reaction) test.

Regardless of whether you do a PCR test, you should monitor your condition with the following tests twice a week:

CBC (complete blood count): To check your platelet count and CRP, as DIC (disseminated intravascular coagulation) is a common but potentially life-threatening complication of scrub typhus.
LFT (liver function test): Mild liver inflammation is common in scrub typhus, but if your levels are significantly elevated, medical intervention may be needed.

Treatment includes:

Doxycycline (100 mg): Take one tablet twice daily for seven to 10 days. Symptoms usually start improving within 24 to 48 hours after starting the medication.
Paracetamol (1 gm): Take three times a day after meals if your fever is above 100°Farheneit.
Esomeprazole (20 mg): Take twice daily 30 minutes before meals to protect your stomach. Consult your specialist doctor, discuss with him or her, and take the medicines with their consent.
Stay hydrated and get plenty of rest.
For fatigue, consider taking a multivitamin, omega-3 fatty acids, and magnesium supplements.

Full recovery typically takes one to two weeks, but fatigue and muscle weakness may persist for several weeks, sometimes up to three months. If you do not start feeling at least a little better within three days of starting Doxycycline, go to a hospital. Your infection could be severe, requiring IV Doxycycline or an alternative antibiotic like Azithromycin. In severe or untreated cases, scrub typhus can cause organ damage, pneumonia, myocarditis, or meningoencephalitis. Seek emergency care if you experience breathlessness, chest heaviness or pain, dizziness or confusion, and any other unusual or worsening symptoms.

I hope I have addressed your concerns. Feel free to reach out if you have further questions or need additional guidance.

Wishing you good health.

Thank you.