Clinical Manifestations

Scrub typhus incubates in human hosts for about 10 to 12 days, after which it manifests itself suddenly, with chills and fever, headache, and other typical typhuslike symptoms. In most Caucasians and, less frequently, in Asians, an eschar or initial lesion from the mite bite occurs and causes lymph-gland swelling. During the first week of the disease, the fever increases to 104° or 105°F. Between the fifth and the eighth day, a red macular rash appears on the trunk of the body, and it may extend to the arms and the legs. During the second week, the pulse rate may increase to 120 or 140, blood pressure falls, and neurological symptoms such as deafness, stupor, delirium, and muscle twitching may appear in untreated patients. Pneumonia and signs of circulatory failure may also occur, but by the beginning of the third week, those untreated individuals who recover begin to experience a reduction in fever and other symptoms. Those who die usually do so by the end of the second week from circulatory failure or from secondary pneumonia or encephalitis. Even in recovered patients, however, neurological effects may continue, and convalescence is usually long. Fortunately, the broad-spectrum antibiotics have reduced the mortality in treated patients to nearly zero.

Unfortunately, the immunity conferred by this infection is specific to the scrub typhus strain only. Current infections may occur when the individual is infected by other strains.

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