Scrub typhus

Last Updated: 2019-08-26

Author(s): -

Kedami-Fieber, japanisches Flussfieber, river fever, Scrub typhus.

Rickettsiosis caused by R. tsutsugamushi.

Especially in Asia, Pacific Islands and Australia.

  • Causative organism 
    • Rickettsia tsutsugamushi.
  • R. tsutsugamuschi is transmitted by mites.
  • Localizations
  • Axils, trunk, groins, thighs.
  • The primary lesion (eschar) is characterized by an erythematous papulovesicle, which can ulcerate.
  • Locoregional lymph node adenopathy.
  • Maculopapular exanthema (from the 6th-10th day of illness), enanthema.
  • Travel history.
  • Clinic.
  • Lice infestation.
  • Blood count (leukopenia, eosinophilia, thrombopenia, ESR ↑), liver and kidney values (Transaminasen↑).
  • Electrolytes.
  • From the 2nd week of disease Weil-Felix reaction (agglutination test).
  • Complement fixation reaction from the 3rd week of the disease.
  • Indirect immunofluorescence test after the 3rd week of the disease.
  • Atypical pneumonia.
  • Disseminated intravascular coagulation.
  • Myocarditis.
  • If necessary, intensive care measures and transfer to the intensive care unit.
  • Control of vital parameters, fluid balance, electrolytes and protein replacement.

    Topical Therapy
  • Loxazole solder. 1% (reapply after 1 and 2 weeks).
  • Permethrin 5% in e.g.: Excipial U Lipolotio.
  • Prioderm® Shampoo (use again after 1 and 2 weeks).
  • Paranix® Sprax (Dimeticon), application time: 15 min., possibly repeated after 7 days
  • Lausweg® foam solution, reaction time: 15 min. Repeat after 7 and 14 days.
  • Rausch Laus stop® cream, application time: 20 min., repeated after 7 and 14 days.


    Systemic Therapy

  • Doxycycline p.o. 100 mg 2x daily for 8-10 days.
  • Alternative: Ciprofloxacin p.o 500 mg 2x daily.
  • In pronounced cases, intravenously glucocorticoids 100 mg/d for 2-3 days.
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