Scrub Typhus

Bush Fever

Step 1: View clinicals

A 23 year old man presents with a productive cough with mucoid sputum for 2 days, in a background of high-grade fever, nausea and vomiting for 6 days. Furthermore, he experienced a mild generalized headache, myalgia and a widespread itchy rash for the last 10 days. He returned from a military training course in India 3 days ago. He has not obtained any treatment so far, except acetaminophen for fever. His medical history is otherwise unremarkable.


Step 2: Order all relevant investigations

Full Blood Count

WBC: 13,000/mm3 (4000-11,000) N: 50% (50-70) L: 45% (20-40) Hb: 14.5g/dL (13.5-17.5) Platelets: 190,000/mm3 (150,000-400,000)

Chest Radiograph

B/L non-homogenous infiltrates in lower zones of both lungs, R>L

Indirect FAT

The indirect Fluorescence Antibody Test (FAT) is reactive for Orientia tsutsugamushi

Blood Cultures

Culture results will be available in 3 days.


Step 3: Select appropriate management

Doxycycline
Isolate Patient
Admit to Hospital
Notification


Score: ★★☆