Antibiotics Combination Proves Effective for Severe Scrub Typhus

Combination therapy with antibiotics doxycycline and azithromycin is a better treatment option for treating severe scrub typhus than monotherapies of either drug, say Indian researchers.

What is Scrub Typhus?

The Scrub Typhus typically presents as a fever that may be associated with headaches, coughs, shortness of breath, and brain symptoms, like confusion and disorientation.

About six percent of the patients infected with scrub typhus could die despite diagnosis and treatment.

Scrub Typhus - Causes, Symptoms, Diagnosis, Treatment, Complications, Risk Factors
Scrub typhus is a bacterial disease caused by Orientia tsutsugamushi. It is spread to humans by the bites of larvae called chiggers.

‘Severe Scrub Typhus caused by the bacteria Orientia tsutsugamushi leads to a life-threatening infection, which primarily affects rodents, and is transmitted to humans (zoonoses) by the larvae of trombiculid mites’

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One-third of the patients develop severe disease that affects multiple organs in the body and leads to lethally low blood pressure. Death rates in severe disease can reach up to 70 percent without treatment and 24 percent with treatment.

The team of researchers including from Christian Medical College in Vellore, Tamil Nadu, and PGIMER Chandigarh in a study of 800 adult patients demonstrated that treatment with intravenous doxycycline and azithromycin is more effective than using either drug on its own.

Scrub Typhus: Treatment

The findings, published in The New England Journal of Medicine, showed that antibiotic combo therapy led to an early discharge of patients -- by day seven -- from hospital. The patients also had fewer persisting complications, such as respiratory distress syndrome (ARDS), hepatitis, hypotension/shock, meningoencephalitis, and kidney failure. The overall mortality rate in this study was 12 per cent.

"This new evidence will change treatment guidelines and save the lives of thousands of people with scrub typhus in the future," Prof George M Varghese, from CMC's Department of Infectious Diseases, said in a statement.

Child Tests Positive for Scrub Typhus
In Delhi, one kid has tested positive for scrub typhus, most commonly known as mysterious fever . Like COVID, it is also a viral infection so all Covid protocols should be followed.

Scrub typhus is a major public health threat in India and other South Asian countries. It is estimated that in endemic regions, about a billion people are at risk of contracting the infection, while a million people get infected and 1.5 lakh people die from it every year.

As Orientia tsutsugamushi is a bacterium which multiplies and survives inside host cells, it is important that the antibiotic reaches high concentrations within host cells as well.

New Mystery Infection Scrub Typhus Cases Reported in India
The medical teams took samples from people in several districts of India after reports of infection from the area. These samples were later found to be infected with scrub typhus.

This study found that when both azithromycin and doxycycline were administered together to patients with severe scrub typhus, the bacteria were cleared away quicker and patients improved faster.

This could be because doxycycline and azithromycin stop the bacteria from producing proteins through different, but complementary, mechanisms.

The combination of the two drugs may have resulted in a more complete blockade of protein synthesis and consequently reduced bacterial growth and multiplication.

As combination therapy quickly controlled bacterial growth within the first week of infection, severe disease may have been prevented and resolution of symptoms might have quickened, the researchers said.

Source-IANS