ABSTRACT

Introduction: Scrub typhus is one of the most underdiagnosed and under-reported febrile illnesses requiring hospitalization, mainly occurring in Southeast and East Asia and the Pacific Islands, in an area referred to as the ‘Tsutsugamushi Triangle.’ Scrub typhus is a zoonotic rickettsial disease that is transmitted to humans by trombiculid mites.

Areas covered: A MEDLINE/PubMed search of the available literature was performed to describe the role of antibiotic-resistant scrub typhus in therapy failure.

Expert opinion: Scrub typhus is characterized by an eschar that may appear 2–3 days before sudden-onset fever with chills, headache, backache, myalgia, profuse sweating, vomiting, and enlarged lymph nodes. A macular or maculopapular skin rash can develop within 3–8 days after the onset of fever. Various antibiotics, such as chloramphenicol, tetracycline, doxycycline, macrolides, quinolones, and rifampicin, have been used to treat scrub typhus. Resistance to tetracycline has been proposed to underlie delayed clinical improvement since 1996, but recent reports have questioned the existence of doxycycline resistance. Nevertheless, the existence and importance of antibiotic-resistant scrub typhus remain uncertain and require further study.

摘要

简介： 恙虫病是需要住院治疗的最容易被漏诊和被漏报的发热性疾病之一，主要发生在被称为“Tsutsugamushi 三角”的东南亚、东亚和太平洋岛屿地区。恙虫病是一种人畜共患立克次体病，由恙螨传播给人类。

涵盖的领域：对现有文献进行了 MEDLINE/PubMed 搜索，以描述耐抗生素恙虫病在治疗失败中的作用。

专家意见：恙虫病的特点是焦痂，可在突发发热前2-3天出现，伴有寒战、头痛、背痛、肌痛、大量出汗、呕吐和淋巴结肿大。发热后 3-8 天内可出现黄斑或斑丘疹。各种抗生素，如氯霉素、四环素、强力霉素、大环内酯类、喹诺酮类和利福平，已被用于治疗恙虫病。自 1996 年以来，已提出对四环素的耐药性是延迟临床改善的基础，但最近的报道质疑多西环素耐药性的存在。然而，耐抗生素恙虫病的存在及其重要性仍不确定，需要进一步研究。