SCRUB TYPHUS AS MISSED DIAGNOSIS FOR ACUTE FEBRILE ILLNESS IN MALAYSIA, SOUTHEAST ASIA

Scrub typhus (Tsutsugamushi fever) is caused by Orientia tsutsugamushi (previous Rickettsia)and is transmitted to man by a mite vector of the Trombiculidae family (Leptotrombidiumdeliense and L. akamushi). Scrub typhus was confined geographically to the Asia Pacific region,but now distributed in the tsutsugamushi triangle.The patient usually presents with Eschar, a vesicular lesion at mite feeding site. Other complicationsare fever, maculopapular rash on trunk, and spreading to limbs. Serious one in the formof myocarditis, pneumonia, meningoencephalitis, jaundice acute renal failure, gastrointestinalbleeding, and even acute respiratory distress syndrome may develop.The fever and eschar supported the diagnosis, which was confirmed serological by Scrub TypusIgM antibodies. The patient was improved by doxycycline injections. Doctors must be aware ofzoonotic bacterial infections, which are easily treatable on early diagnosing.