All about scrub typhus

Rickettsia is Gram-negative, non-motile, obligate intracellular proteobacteria. They stay in various forms such as coccus, bacillus, and threads. At times, they are regarded as coccobacilli. No human-to-human transmission is there. They always need a vector such as fleas, lice, mite, and ticks for transmission. Rickettsiae species were classically divided into spotted fever and typhus groups. Scrub typhus also known as bush typhus is an important cause of acute febrile illness in South and East Asia and Pacific. It is caused by the intracellular parasite Orientia tsutsugamushi, a gram negative alpha proteobacterium of family Rickettsiaceae which was first isolated and identified in 1930 in Japan. It is distinct from other Rickettsiae in that it lacks both peptidoglycan and lipopolysaccharide in its cell wall. Like other vasculotropic rickettsiae, it affects vascular endothelial cells causing vasculitis. It also affects macrophages and cardiac myocytes. This review will give a way forward regarding all information about scrub typhus in detail. Various clinical profile especially clinical features, presence or absence of ESCHAR, organ invovement, investigations, treatment and final outcome was studied in detail. Clinical results, investigations were analysed to stamp the diagnosis. Different modalities of management has interpreted well. Among all rickettsial infections, scrub typhus being most common is seen all over Indian states and UTs. A child presenting to ER with fever of unknown origin, nephropathy, acute encephalitic syndrome, hepatosplenomegaly, lymphadenopathy, and also hypotension pointing toward possibility of scrub, hence, a detailed search for ESCHAR being essential in clinical examination.