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Scrub typhus & rickettsial infections

Rickettsioses (typhus tsutsugamushi, febres maculosae) · Křovinný tyfus a rickettsiózy

What it is

Intracellular bacteria spread by mites (scrub typhus, Asia-Pacific), ticks (spotted fevers such as Rocky Mountain and Mediterranean), lice (epidemic typhus) and fleas (murine typhus); they inflame small blood vessels and can kill within days, yet respond quickly to doxycycline.

Symptoms & signs

  • Fever, severe headache and muscle aches
  • a black scab (eschar) at the bite
  • rash, spotted in spotted fevers
  • swollen nodes
  • cough, confusion
  • in severe cases: lung, kidney and brain failure

🚩 Get help if…

  • call 112 / 911 now Fever with confusion, drowsiness or breathlessness
  • call 112 / 911 now Rash with bruise-like spots and fever
  • see a doctor soon Fever and headache within 2 weeks of a tick bite or rural travel
  • see a doctor soon Black scab at a bite with fever

Where it strikes

Medical treatment

  • Diagnosis is clinical first; antibody and PCR tests confirm later
  • Doxycycline started on suspicion, children included — short courses do not stain teeth trials support
  • azithromycin in pregnancy (scrub typhus)
  • Intravenous doxycycline plus azithromycin for severe scrub typhus — better than either alone (INTREST trial, 2023) trials support
  • chloramphenicol as a fallback

Natural & lifestyle

  • Long clothing and repellent in scrub, grass and forest
  • check for ticks and remove them early
  • delousing in crowded shelters

Emerging & experimental

  • Scrub typhus vaccines
  • rapid point-of-care tests

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Plant-based repellents (oil of lemon eucalyptus) — protect, but for a shorter time than DEET mixed evidence
  • Herbal fever remedies — delay doxycycline in a disease that can kill within days anecdotal / traditional

ICD codes