Scrub Typhus With Multi-Organ Dysfunction in an Adolescent: A Narrative Review

Abstract

Scrub typhus, caused by Orientia tsutsugamushi and transmitted by the larvae of trombiculid mites, is a common but frequently unrecognised cause of fever across the Asia-Pacific region, and in a minority of patients it progresses to dysfunction of several organs at once. Adolescents sit awkwardly between paediatric and adult series. This narrative review brings together published work on the organism, on the vascular and inflammatory biology of severe disease, on the organ systems most often involved, and on diagnosis and treatment. It reports no patient data. The evidence suggests that endothelial injury and a strong cytokine response, rather than uncontrolled bacterial growth alone, underlie multi-organ dysfunction, that lung, kidney, liver, brain and circulation are the systems most often affected, and that delay in considering the diagnosis is a recurring theme. Doxycycline is the standard agent, yet the trials that support it enrolled mild illness, and no randomised evidence addresses severe disease. Case definitions and organ-dysfunction scores are not standardised for this infection.