SCRUB THYPUSSCRUB THYPUS

risnarisna

Rickettsia tsutsugamushiRickettsia tsutsugamushi (R. orientalis) (R. orientalis)

ETIOLOGIETIOLOGI

From mild to severe/fatalFrom mild to severe/fatal ACute illnessACute illness

Incubation periodeIncubation periode HeadacheHeadache Ocular painOcular pain Conjuctival injectionConjuctival injection CoughCough MalaiseMalaise AnorexiaAnorexia WeaknessWeakness ApathyApathy

Clinical manifestations & Clinical manifestations & course (1)course (1)

From mild to severe/fatalFrom mild to severe/fatal ACute illnessACute illness

Fever rise progressively during the first few daysFever rise progressively during the first few days Chills Chills A small, painless papuleA small, painless papule Central necrosisCentral necrosis Crust to form escharCrust to form eschar The regional lymphnode are enlarged & tenderThe regional lymphnode are enlarged & tender Interstitial pneumonitisInterstitial pneumonitis

The second week The second week

Clinical manifestations & course (2)Clinical manifestations & course (2)

The second week …The second week … A macular rash first on the trunk A macular rash first on the trunk

and then on the extremitis and then on the extremitis Generelized lymphadenopathyGenerelized lymphadenopathy Soft splenic enlargementSoft splenic enlargement HepatomegalyHepatomegaly

Clinical manifestations & Clinical manifestations & course (3)course (3)

ConvalesceneConvalescene During the second week, the During the second week, the

temperature remains elevated temperature remains elevated

Signs of complex multiple organs Signs of complex multiple organs system appearsystem appear

……

Clinical manifestations & Clinical manifestations & course (4)course (4)

MeningoencephalitisMeningoencephalitis Cranial nervesCranial nerves MyocarditisMyocarditis

Signs of complex multiple Signs of complex multiple organs system appearorgans system appear

Meningoencephalitis:Meningoencephalitis: ApathyApathy DeliriumDelirium RestlessnessRestlessness StuporStupor Coma Coma Convulsions Convulsions Muscular weaknessMuscular weakness HyperesthesiasHyperesthesias Tremors Tremors

Signs of complex multiple organs Signs of complex multiple organs system appearsystem appear

Cranial nervesCranial nerves DeafnessDeafness Papilledema Papilledema DysarthriaDysarthria Dysphagia Dysphagia

MyocarditisMyocarditis

The Weil-Felix testThe Weil-Felix test The indirect fluorescent The indirect fluorescent

antibody test antibody test Culture Culture

Diagnosis

TetracylineTetracyline drugs. A single drugs. A single

200-mg dose of 200-mg dose of docycyclinedocycycline for for

several daysseveral days

Treatment Treatment

In untreated scrub typhus, the In untreated scrub typhus, the

mortality rate: mortality rate: 0-30%0-30% Prompt antibiotic therapy reduces Prompt antibiotic therapy reduces

mortality to zeromortality to zero

Prognosis Prognosis