Infectious Diseases Unit, "Maggiore Della Carità" University Hospital, Novara, Italy.
Department of Infectious and Tropical Diseases, Azienda Ospedaliera di Padova, Padova, Italy.
Travel Med Infect Dis. 2021 Jul-Aug;42:102062. doi: 10.1016/j.tmaid.2021.102062. Epub 2021 Apr 17.
Scrub typhus is a vector-borne rickettsial infection, which can cause relevant morbidity and mortality. While the number of cases is around a million per year globally, the infection is seldom diagnosed in travellers from Europe.
We herein report three cases diagnosed in Italian travellers and review the literature about imported cases in Europe in the last 60 years.
Three participants to the same hiking trip to the forest of northern Laos presented fever and other symptoms, including eschars (2 individuals) and skin rash (2 individuals). Overall, they didn't report complications, and recovered soon after doxycycline treatment. Diagnosis was retrospectively confirmed with PCR in one of them. The review collected data from 40 patients. Almost all of them (95%) presented fever, more than a half had headache, skin rash, eschars, arthromyalgias. 73% of them were hospitalized, and 16.2% needed intensive care. Diagnosis was confirmed by serology in almost all cases (94.6%). Most patients (88%) were treated with doxycycline. All patients survived, although one case resulted in incomplete tetraparesis.
Scrub typhus should be considered in all travellers coming back from endemic areas and presenting with acute febrile illness. Laboratory diagnosis can be challenging, as specific tests are not widely available. In case of clinical suspicion, a prompt treatment with oral doxycycline could avoid severe complications.
恙虫病是一种由媒介传播的立克次体感染，可导致相关发病率和死亡率。虽然每年全球有大约 100 万人感染，但在来自欧洲的旅行者中，这种感染很少被诊断出来。
我们在此报告了三例在意大利旅行者中诊断出的病例，并回顾了过去 60 年在欧洲输入性病例的文献。
参加同一次徒步旅行到老挝北部森林的三名参与者出现发热和其他症状，包括焦痂（2 人）和皮疹（2 人）。总的来说，他们没有报告并发症，并在服用强力霉素治疗后很快康复。其中 1 人通过 PCR 进行了回顾性诊断。该综述从 40 名患者中收集了数据。几乎所有患者（95%）都有发热，超过一半的患者有头痛、皮疹、焦痂、关节痛。73%的患者住院治疗，16.2%的患者需要重症监护。几乎所有病例（94.6%）均通过血清学确诊。大多数患者（88%）接受强力霉素治疗。所有患者均存活，尽管有 1 例导致不完全性四肢瘫痪。
所有从流行地区返回并出现急性发热性疾病的旅行者都应考虑恙虫病。实验室诊断可能具有挑战性，因为并非广泛提供特定的检测方法。如果临床怀疑，及时使用口服强力霉素治疗可以避免严重并发症。
