Tsutsugamushi fever

Kedami fever, Japanese river fever, river fever, scrub typhus.

Rickettsiosis, which is caused by R. tsutsugamushi.

Specialy found in Asia, Pacific Islands and Australia.

• Pathogen
  • Rickettsia tsutsugamushi.
• R. tsutsugamuschi is transmitted by mites.

• Localisations
• Axillae, trunk, Leisen, thigh.
• The primary lesion (eschar) is characterised by an erythematous papulovesicle, which may ulcerate.
• Locoregional lymph node adenopathy.
• Maculopapular exanthema (from day 6-10 of illness), enanthema.

• Travel history.
• Clinical.
• Lice infestation.
• BB (leukopenia, eosinophilia, thrombocytopenia, ESR ↑), liver and kidney values (transaminases↑).
• Electrolytes.
• From the 2nd week of illness. Weil-Felix reaction (agglutination test).
• From the 3rd week of illness complement fixation reaction.
• From the 3rd week of illness indirect immunofluorescence test.

• Atypical pneumonias.
• Disseminated intravascular coagulation.
• Myocarditis.

• If necessary, intensive medical measures and transfer to the intensive care unit.
• Control of vital signs, fluid balance, electrolytes and protein replacement.

   

  Topical therapy

• Jacutin® gel (lindane) 0.3%. Use not recommended due to neurotoxicological side effects. In Switzerland, Jacuin® is no longer on the market.
• Loxazole Lot. 1% (reapply after 1 and 2 weeks).
• Permethrin 5% in e.g.: Excipial U Lipolotio.
• Prioderm® shampoo (reapply after 1 and 2 weeks).
• Paranix® Sprax (dimeticone), exposure time: 15 min., repeat after 7 days if necessary
• Lausweg® foam solution, exposure time: 15 min. , repeat after 7 and 14 days.
• Rausch Laus stop® cream, exposure time: 20 min., repeat after 7 and 14 days.

   

  Systemic therapy

• Doxycycline p.o. 100 mg 2x tgl. for 8-10 days.
• Alternatively: Ciprofloxacin p.o 500 mg 2x tgl.
• In severe cases, if necessary, i.v. glucocorticoids 100 mg/d for 2-3 days.

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