What is the prognosis for scrub typhus?

Updated: Apr 19, 2018
  • Author: David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS; Chief Editor: Russell W Steele, MD  more...
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Prognosis varies and depends on the severity of illness, which relates to the different strains of O tsutsugamushi, as well as to host factors. Severe disease is uncommon with antimicrobial treatment. Prognostic indicators for severe disease have not been established. [31] Incomplete immunity and strain heterogeneity open the door to frequent reinfections. Immunity to the same strain is believed to last 3 years, whereas immunity to other strains may last as little as 1 month; however, repeat infections may be attenuated. [3]

In patients who are not treated, mortality ranges from 1% to 60%, depending on the patient’s age, the geographic area, and the particular strain responsible for the infection. In the preantibiotic era, mortality in Japan averaged 30%: 15% in patients aged 11-20 years, 20% in those aged 21-30 years, and 59% in those older than 60 years. In Taiwan, overall mortality was estimated at 11% but was only 5% in children and 45% in the elderly.

With appropriate antibiotic treatment, mortality from scrub typhus is quite rare, and the recovery period is short and usually without complications. [3, 30] However, mortality is still approximately 15% in some areas as a consequence of missed or delayed diagnosis. [32] If severe complications such as acute respiratory distress syndrome (ARDS) arise, mortality may still be high. [33]

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