Clinical Characteristics and Evolution of Ocular Manifestations in Scrub Typhus

Scrub typhus, caused by Orientia tsutsugamushi infection, manifests with fever, rash, eschar, pneumonia, hepatosplenomegaly, and lymphadenopathy. We conducted a review of the ocular manifestations post-infection and found a high incidence (67%) during the recovery phase (2-4 weeks), particularly prevalent in the tropical Tsutsugamushi triangle. Despite China, only three cases of optic neuritis had been reported, suggesting its rarity due to early antibiotic administration, we present the first documented case of binocular optic neuroretinitis due to Orientia tsutsugamushi infection in China. Ophthalmologic screenings should be conducted for patients with systemic scrub typhus infection to rule out ocular involvement. Based on previous literature and our case findings, whether scrub typhus affects the anterior or posterior segment of the eye may be determined by different strains of the pathogen, and this in turn influences the visual prognosis. Early initiation of antibiotics effectively eradicated the pathogens. Studies have indicated that delayed immune inflammation, rather than direct infection, may be the underlying pathogenesis of ocular manifestations. Early and comprehensive corticosteroid therapy during secondary ocular inflammation has shown to effectively curb disease progression and preserve visual function.