Orientia tsutsugamushi infection transmitted by chigger bite, endemic across the Asia-Pacific 'tsutsugamushi triangle'.
Clinical features
- • Acute undifferentiated fever
- • Eschar at bite site (look in skin folds)
- • Lymphadenopathy, rash
- • ARDS, AKI, meningoencephalitis in severe disease
Investigations
- • IgM ELISA, PCR from eschar or blood
- • FBC (thrombocytopenia), LFTs, CXR
- • Exclude dengue, malaria, leptospirosis
Management
- • Doxycycline 100 mg BD × 7 days (rapid defervescence within 48 h)
- • Azithromycin 500 mg OD in pregnancy or children
- • Supportive care for ARDS/shock
Clinical pearls
- • Always undress and search for the eschar — it clinches the diagnosis
- • Failure to defervesce in 48 h should prompt review of the diagnosis
Related in WardRound
Educational — verify locally.
