Tsutsugamushi Fever

By | June 10, 2022

Tsutsugamushi fever is an infectious disease also known as Japanese spotted fever. The disease caused by bacteria is particularly common in Asia, Oceania and parts of Australia. The Tsutsugamushi fever or its pathogen is caused by animals such. B. ticks, mites and fleas.

What is Tsutsugamushi fever?

Tsutsugamushi fever is colloquially referred to as bush fever or mite spotted fever, since so-called arthropods (mites, lice, fleas, etc.) are the carriers of the disease. Tsutsugamushi fever is an infectious disease and belongs to the group of rickettsioses. Rickettsioses are diseases that are caused by bacteria of the genus Rickettsia. For introduction to kleine-levin syndrome, please visit sciencedict.com.

The first symptoms appear after about 7 to 30 days. The bite site is usually red and feels hot. At the beginning, flu-like symptoms such as fever, headache and body aches appear. Only later does a rash form, which spreads over the entire body. Without proper treatment, infection can spread throughout the body and tsutsugamushi fever can be fatal.

Studies show that after suffering from Tsutsugamushi fever, you have immunity for about 1 to 2 years, so that even if you are infected again with the pathogen, the disease does not break out.


Tsutsugamushi fever is caused by bacteria of the genus Rickettsia tsutsugamushi, also known as Rickettsia orientalis. The preferred hosts of the bacteria include mites, ticks, lice and fleas. A distinction is currently made between four Rickettsia genera, with each genus having several subgroups.

The bacteria are transmitted through a bite. The arthropods (ticks, etc.) secrete saliva before and during the bite to numb the bite site. The bacteria are transferred into the wound and can thus infect humans (and animals) with Tsutsugamushi fever.

The incubation period for Tsutsugamushi fever is between 7 and 30 days. The incubation period is the time that elapses between infection and the onset of the disease.

Symptoms, Ailments & Signs

One of the first symptoms to appear with Tsutsugamushi fever is a skin lump (papule) that forms in about half of people and appears where the mite has bitten. The nodule can also subsequently develop into a painful ulcer and form black scabs. The disease also causes headaches and body aches, swollen lymph nodes, high fever and an enlarged spleen.

Those affected suffer from a severe feeling of illness and may also be confused. A skin rash then develops within a few days with pale reddish patches that then darken in color and spread over the entire body. Severe fever can also lead to encephalitis or heart muscle inflammation.

Patients then suffer from hallucinations, severe nausea and seizures, and some also lose consciousness. As a result of the heart muscle inflammation, severe circulatory problems, heart palpitations and drop in blood pressure can occur. If Tstusugamushi fever occurs in children, the symptoms are usually milder. Without treatment, the fever leads to severe mental and physical disabilities and, in the worst case, even to death.

Diagnosis & History

Tsutsugamushi fever is diagnosed by the general practitioner. With the help of a detailed anamnesis (collecting the medical history), it is determined whether the person concerned has stayed in risk areas, whether there are insect bites and what symptoms have set in.

Blood tests are used to determine if an infection is present. Furthermore, if necessary, a tropical medicine specialist can also be called in if the diagnosis cannot be clearly assigned.

With early diagnosis and treatment, Tsutsugamushi fever usually heals without consequences. If no treatment is given, the infection will continue to spread as the disease progresses. As a result, pneumonia and myocarditis can occur, which, if left untreated, can lead to death. In addition, encephalitis often occurs over the course of the disease, which, if left untreated or treated too late, can lead to physical and mental disabilities.

After a single infection with Tsutsugamushi fever, the patient usually has an immunity of about 1 to 2 years. This means that even with a repeated infection with the Reckettsia, the disease does not break out. A so-called titer determination (blood analysis) can be used to determine whether antibodies have been formed by the immune system and whether they are still present in sufficient quantities.


Tsutsugamushi fever is associated with various ailments and complications. Those affected usually suffer from a very high fever. The patient is also extremely tired and exhausted, so that most of those affected can no longer easily participate in everyday life. Papules or ulcers form on the skin.

Likewise, patients often suffer from a rash on the skin. This also leads to inferiority complexes or a significantly reduced self-esteem, since the aesthetics are reduced by the symptoms of Tsutsugamushi fever. The disease can also lead to body aches or severe headaches. Patients’ lymph nodes are severely swollen, and impaired consciousness and acumen occur.

If Tsutsugamushi fever is not treated, it can also lead to inflammation in the lungs or heart muscle. In the worst case, the person concerned dies from the symptoms of the fever. Treatment is relatively simple with antibiotics. There are no particular complications. With an early diagnosis, a positive course of the disease is usually achieved. The life expectancy of the patient remains unchanged with successful treatment of this disease.

When should you go to the doctor?

In the case of Tsutsugamushi fever, a doctor should be consulted immediately. This disease cannot heal itself, so without treatment it can lead to serious complications and further worsening of the symptoms. For this reason, with this disease, a doctor should be contacted as soon as the first symptoms and signs appear. In most cases, a high fever and swelling and enlargement of the spleen indicate this disease. There is also severe pain in the limbs and a severe rash on the skin.

The rash often spreads over the entire body of the affected person and significantly reduces the aesthetics. Left untreated, it can also lead to inflammation in the brain. In some cases, hallucinations or severe nausea can also indicate Tsutsugamushi fever and should also be examined by a doctor. In severe cases, depression also occurs. Tsutsugamushi fever can be diagnosed and treated by a general practitioner. The further course depends heavily on the time of diagnosis, so that no general prediction can be made.

Treatment & Therapy

Tsutsugamushi fever is usually treated with antibiotics. Tetracyclines and choramphenicol are preferably used here. Treatment should be in hospital as an inpatient, as Tsutsugamushi fever is sometimes difficult to treat. As with all infectious diseases, the earlier Tsutsugamushi fever is diagnosed and treated, the better the chances of recovery.

Further treatment for Tsutsugamushi fever includes treating the accompanying symptoms. Since the rash can sometimes be very itchy, mild creams or gels containing cortisone can be used. Antipyretics can be prescribed for fever and analgesics for pain. Since the infection can spread quickly and cause further inflammation in the body, anti-inflammatory drugs are also given.

When treating antibiotics, it is important that they are taken in sufficient doses over an adequately long period of time. If the treatment is too short, there is a risk that bacteria will survive and develop resistance to the antibiotic.


The primary preventive measure against Tsutsugamushi fever is avoidance of mite, tick and flea bites. Before traveling to a risk area, you should find out in detail whether Tsutsugamushi fever is widespread there.

It is advisable to wear long-sleeved clothing and a hat at all times. After being outdoors, the entire body should be checked for arthropods as well as bite wounds. In particular, the hairy parts of the body (head, armpits and genital area) must be searched particularly well.

Insect repellents do not provide adequate protection. There is currently no vaccine that could prevent infection with Tsutsugamushi fever. If you find lice, fleas, etc. on your body or clothing, or if you have a bite wound, you should see a doctor immediately, even if there are no symptoms yet. Tsutsugamushi fever can only be treated successfully and without consequences if it is treated early.


Follow-up care for Tsutsugamushi fever depends on the course of the disease. If the course is positive, the fever should subside quickly. The doctor usually prescribes the drug doxycycline, which is tapered off as part of the aftercare. In addition, typical side effects of the preparation must be clarified, such as inflammation of the oral and pharyngeal mucosa and other gastrointestinal complaints.

If the treatment causes a hypersensitivity reaction in the patient, the drug must subside immediately. The physical examination during follow-up includes various tests, such as checking body temperature and blood pressure. Any accompanying symptoms of Tsutsugamushi fever such as nausea and malaise should be clarified as part of the anamnesis.

The doctor can detect a swelling of the lymph nodes, which mainly occurs in severe cases, based on visible signs of inflammation. Depending on how the aftercare goes, the patient is then discharged or undergoes further treatment. The aftercare for Tsutsugamushi fever, for example, is carried out by the internist or general practitioner.

A stay in the hospital is usually necessary, especially in severe cases with necrosis or coma. If the course is severe, other specialists are involved in the treatment. Care for family members and the patient themselves may also be necessary.

You can do that yourself

Tsutsugamushi fever is an extremely rare disease that mainly occurs in Asia, India, Australia and Oceania. The self-help measures are limited to protecting the body and taking prescribed drugs such as the antibiotic doxycycline as prescribed. Since it is an extremely rare infectious disease with few scientific studies, close medical monitoring is all the more important. Patients should be hospitalized or see their doctor regularly.

Should the typical symptoms of scrub typhus occur during a trip to Asia, Australia, Oceania or India, the trip must be canceled immediately and a doctor consulted. If possible, Tsutsugamushi fever in Germany is treated by a specialist in internal medicine. If the initial treatment takes place abroad, a doctor must be consulted without delay after returning to Germany.

In addition to medical treatment, general measures such as rest breaks, light food and regular fluid intake apply. Most important is bed rest, as Tsutsugamushi fever puts a great strain on the body and especially the immune system. It is best for those affected to consult a specialist and get more detailed advice from him on suitable self-help measures.

Tsutsugamushi Fever