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Scrub typhus and tropical rickettsioses.

George Watt1, Philippe Parola

  • 1Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand. wattgh@thai.amedd.mil

Current Opinion in Infectious Diseases
|September 23, 2003
PubMed
Summary

Recent advances in rickettsial disease classification highlight the re-emergence of scrub typhus and the global spread of new pathogens. Early doxycycline treatment is effective for rickettsial infections in travelers.

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Area of Science:

  • Microbiology and Infectious Diseases
  • Molecular Taxonomy
  • Epidemiology

Background:

  • Molecular taxonomic advancements have led to significant reclassification of rickettsial diseases.
  • Orientia tsutsugamushi, the agent of scrub typhus, is no longer classified under the genus Rickettsia.
  • Numerous new rickettsial pathogens have been identified, necessitating updated clinical guidance.

Purpose of the Study:

  • To provide a timely update on recent research findings concerning rickettsial diseases for non-specialist physicians.
  • To summarize the epidemiology and clinical features of emerging and re-emerging rickettsial infections.
  • To highlight advancements in diagnostics and treatment strategies.

Main Methods:

  • Review of recent scientific literature on rickettsial diseases.

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  • Analysis of epidemiological data on scrub typhus and other rickettsioses.
  • Summary of findings on pathogen mechanisms, clinical presentations, and treatment outcomes.

    • Main Results:

    • Scrub typhus affects an estimated one billion people, with one million cases annually, and is re-emerging in Japan.
    • Orientia tsutsugamushi employs mechanisms like calcium modulation and chemokine induction to survive intracellularly.
    • Pulmonary complications are common in scrub typhus, while African tick-bite fever and flea-borne spotted fever (Rickettsia felis) are significant concerns for travelers.

    Conclusions:

    • Rickettsial infections, characterized by rash and fever, are crucial considerations for returning travelers, with doxycycline as a potential curative treatment.
    • Recent findings underscore the complexity of rickettsial diseases and the need for further research.
    • Standardized diagnostic tests and improved treatment protocols, especially for vulnerable populations, are under development.