Scrub typhus: Clinical features and diagnosis

Scrub typhus: Clinical features and diagnosis

Author
Daniel J Sexton, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Elinor L Baron, MD, DTMH
Disclosures
All topics are updated as new evidence becomes available and our peer review process is
complete.
Literature review current through: Nov 2012. | This topic last updated: May 11, 2012.
INTRODUCTION Scrub typhus is a mite-borne infectious disease caused by Orientia
tsutsugamushi (previously called Rickettsia tsutsugamushi). This disease was first described by
the Chinese in the third century, but the first description of its classic features did not appear in
the western literature until the end of the nineteenth century. Knowledge about scrub typhus
increased dramatically during World War II due to its common occurrence in soldiers fighting on
both sides in the Pacific theater.
The epidemiology, clinical features, and diagnosis of scrub typhus will be reviewed here.
Treatment of this disorder is discussed separately. (See "Scrub typhus: Treatment and
prevention".)
MICROBIOLOGY O. tsutsugamushi is a gram-negative coccobacillus that is antigenically
distinct from the typhus group rickettsiae. This organism has features that are common to and
distinct from other rickettsiae.

Like all rickettsiae, it cannot be propagated in cell-free media. (See "Biology of

Rickettsia rickettsii infection".)
Similar to typhus group rickettsiae, O. tsutsugamushi has a slime layer that may play a
role in both pathogenicity and virulence.
Unlike other rickettsiae, the trilaminar outer membrane of O. tsutsugamushi is unique in
its morphology.
O. tsutsugamushi is unique in that it is released from infected cells by budding from the
plasma membrane of host cells. It may then be phagocytosed by adjacent cells while still
coated with its original host cell membranes. Rickettsial phospholipase A2 appears to be
involved as a mediator of entry into host cells with subsequent release from phagosomes
and injury to the host cell [1].
Organisms disseminate widely after initial inoculation into the skin. One study showed
that O. tsutsugamushi could be detected by staining mononuclear cells in the peripheral
blood of three of seven patients studied with acute scrub typhus [2].

There are three variants or strains of O. tsutsugamushi (Karp, Gilliam, and Kato). Infection with
one strain does not preclude reinfection with a different strain.