Re: Undiagnosed illness, 19 fatalities since April 2011 - Viet Nam: Quang Ngai, ProMED RFI- spread to Thailand discarded- rickettsia identified
Orientia tsutsugamushi
Scrub typhus is typically a nonspecific febrile illness;
its severity may be influenced by the strain of O. tsutsugamushi,
a person’s immune status, and other factors
Diagnosis may be complicated in areas where the disease
has not been documented recently or in regions lacking the
capacity for laboratory confirmation. Illness develops after
an incubation period of 6 to 21 days and usually begins
with an eschar at the site of a chigger bite. Fever,
headache, and myalgias are common, and a maculopapular
rash may also be present. Nausea, vomiting, diarrhea, or
lower respiratory symptoms can also occur. Manifestations
such as pneumonitis, meningoencephalitis, jaundice, renal
failure, and myocarditis can develop during the prolonged
clinical course of untreated illness (6). Establishing the
diagnosis and initiating prompt antimicrobial drug therapy
are important because death rates for untreated scrub
typhus patients are 1%–30% (5). Scrub typhus is effectively
treated with doxycycline, and treatment should begin
immediately upon suspicion of illness without awaiting
laboratory confirmation.
From October 2001 to October 2003, an outbreak of
scrub typhus was confirmed among residents of the
Republic of Palau, a Pacific island nation 900 km east of
the Philippines (Figure 1). The outbreak occurred among
residents of several remote southwest islands (7). These
islands, ≈300 km from the capital of Koror, are difficult to
reach, and affected persons required emergency evacuation
by boat to Koror for treatment. This outbreak affected
primarily children, and illness was characterized by fever
and severe abdominal distress (7).
Orientia tsutsugamushi
Scrub typhus is typically a nonspecific febrile illness;
its severity may be influenced by the strain of O. tsutsugamushi,
a person’s immune status, and other factors
Diagnosis may be complicated in areas where the disease
has not been documented recently or in regions lacking the
capacity for laboratory confirmation. Illness develops after
an incubation period of 6 to 21 days and usually begins
with an eschar at the site of a chigger bite. Fever,
headache, and myalgias are common, and a maculopapular
rash may also be present. Nausea, vomiting, diarrhea, or
lower respiratory symptoms can also occur. Manifestations
such as pneumonitis, meningoencephalitis, jaundice, renal
failure, and myocarditis can develop during the prolonged
clinical course of untreated illness (6). Establishing the
diagnosis and initiating prompt antimicrobial drug therapy
are important because death rates for untreated scrub
typhus patients are 1%–30% (5). Scrub typhus is effectively
treated with doxycycline, and treatment should begin
immediately upon suspicion of illness without awaiting
laboratory confirmation.
From October 2001 to October 2003, an outbreak of
scrub typhus was confirmed among residents of the
Republic of Palau, a Pacific island nation 900 km east of
the Philippines (Figure 1). The outbreak occurred among
residents of several remote southwest islands (7). These
islands, ≈300 km from the capital of Koror, are difficult to
reach, and affected persons required emergency evacuation
by boat to Koror for treatment. This outbreak affected
primarily children, and illness was characterized by fever
and severe abdominal distress (7).
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