Abstract
Rickettsiosis is an important cause of febrile illness among travellers visiting Southeast Asia (SEA). The true incidence of rickettsiosis is underestimated; however, murine typhus and scrub typhus are widely distributed across SEA. Among travellers visiting SEA, scrub typhus was mostly reported from Thailand, whereas murine typhus was frequently found in Indonesia. Although most cases are self-limited or present with mild symptoms, a few cases with severe clinical manifestations have been reported. Doxycycline remains the key treatment of rickettsiosis. Some travellers, such as backpackers, trekkers, or cave explorers, are at a higher risk for rickettsiosis than others. Therefore, in resource-limited conditions, empirical treatment should be considered in these travellers. The coronavirus disease 2019 (COVID-19) pandemic has contributed to difficulty in the diagnosis of rickettsiosis because of the clinical similarities between these diseases. In addition, physical distancing mandated by COVID-19 management guidelines limits accurate physical examination, resulting in misdiagnosis and delayed treatment of rickettsiosis. This review summarises the characteristics of murine typhus and scrub typhus, describes travel-associated rickettsiosis, and discusses the impact of the COVID-19 pandemic on rickettsiosis.
Highlights
Rickettsiosis ranks fourth among the identifiable aetiologies for febrile immigrants and returning travellers (mean 1.7% of febrile cases (0–7%)) from Africa, followed by those from the continent of Asia [1]
Scrub typhus cases were mostly reported from Thailand and Laos, whereas most murine typhus cases were reported from Indonesia
Sporadic cases were frequently documented. This was unlike African tick bite fever, which is caused by Rickettsia africae and usually occurs in clusters or outbreaks among travellers who engaged in risky activities while on safari
Summary
Rickettsiosis ranks fourth among the identifiable aetiologies for febrile immigrants and returning travellers (mean 1.7% of febrile cases (0–7%)) from Africa, followed by those from the continent of Asia [1]. R. africae, the causal agent of African tick bite fever, is a common rickettsiosis found in travellers [6]. R. typhi, O. tsutsugamushi, and some SFGRs, including R. honei, are important rickettsial species in SEA Both R. typhi and O. tsutsugamushi play a major role in rickettsiosis among SEA residents and travellers returning from SEA [8,9]. Prompt diagnosis and appropriate antibiotic use are the main factors that contribute to survival This narrative review aims to enhance the recognition and understanding of rickettsiosis, SFGR, murine typhus, and scrub typhus, which are widely reported in SEA. Symptoms are usually mild and an eschar might be seen It was used as a reference species in serologic diagnosis tests in SEA [14]. The symptoms are mild and the rash is absent [16]
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