A Gulf Keralite’s impulsive decision to return home to treat a persistent fever turned out to be life-saving after he was diagnosed with scrub typhus — a potentially fatal infection that requires early treatment.

About Scrub Typhus
Scrub typhusis a bacterial infection caused by the bacterium Orientia tsutsugamushi, transmitted to humans through the bite of infected chiggers (larval mites). It is a significant cause of fever in rural parts of the Asia-Pacific region and Northern Australia. 

Symptoms
Symptoms usually begin suddenly, about 6 to 21 days after the chigger bite, and can range from mild to life-threatening. Common symptoms include: 

• High fever and chills
• Severe headache
• Body aches and muscle pain
• A dark, scab-like lesion (eschar) at the site of the bite, which is a key diagnostic sign, though not always present
• Rash that appears a few days after the fever, typically on the trunk and spreading to the limbs
• Swollen lymph nodes
• Gastrointestinal issues such as nausea, vomiting, and abdominal pain
• Cough and respiratory problems, which can develop into severe pneumonia or acute respiratory distress syndrome (ARDS)
• Mental changes, ranging from confusion to coma, in severe cases 

Causes and Transmission
The disease is maintained in a cycle involving chiggers and small mammals, particularly rodents. Humans are accidental hosts who get infected when an infected chigger bites them. The mites are found in areas with dense vegetation, such as forests, grasslands, and rural areas. The disease is not contagious and cannot spread from person to person. 

Diagnosis
Diagnosing scrub typhus can be challenging as early symptoms are similar to other diseases like malaria or dengue. Diagnosis is typically based on clinical symptoms, a history of exposure to endemic areas, and confirmed by laboratory tests, such as serological tests (like indirect immunofluorescence assay (IFA) or ELISA) or molecular methods like PCR. 

Treatment and Prevention
Treatment

• Scrub typhus is a curable disease if caught early. Treatment involves the use of antibiotics: 
• Doxycycline is the primary antibiotic of choice for adults and children of all ages.
• Azithromycin is an effective alternative, often used for pregnant women or those who cannot tolerate doxycycline.
• Prompt treatment with antibiotics leads to rapid recovery, usually within a few days. 

Prevention
There is currently no vaccine available for scrub typhus, so prevention focuses on avoiding chigger bites. Key preventive measures include: 

• Avoiding dense vegetation and brush in endemic areas.
• Wearing protective clothing (long sleeves, long pants tucked into socks or boots) when outdoors in risky areas.
• Using insect repellents containing DEET on exposed skin and clothing.
• Treating clothing and gear with permethrin, which kills mites.
• Maintaining a clean environment around living spaces by trimming overgrown grass. 

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