Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives

Abstract

Scrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without early diagnosis and treatment, the disease can develop fatal complications. We retrospectively reviewed de-identified data from a 23-year-old woman who presented to an emergency department with complaints of worsening abdominal pain. On presentation, she appeared jaundiced and toxic-looking. Other positive findings on abdominal examination were a positive Murphey’s sign, abdominal guarding and hepatosplenomegaly. Magnetic resonance cholangiopancreatography demonstrated acalculous cholecystitis. Additional findings included eschar on the medial aspect of the left thigh with inguinal regional lymphadenopathy. Further, positive results were obtained for immunoglobulins M and G, confirming scrub typhus. The workup for other infectious causes of acute acalculous cholecystitis (AAC) detected antibodies against human herpesvirus 4 (Epstein–Barr virus), suggesting an alternative cause of AAC. Whether that represented re-activation of the Epstein–Barr virus could not be determined. As other reports have described acute acalculous cholecystitis in adult scrub typhus patients, we recommend doxycycline to treat acute acalculous cholecystitis in endemic regions while awaiting serological confirmation.

Concurrent Infection with SARS-CoV-2 and Orientia tsutsugamushi during the COVID-19 Pandemic in the Maldives

“…Several tropical diseases are endemic in the Maldives, including scrub typhus [ 16 , 24 , 25 , 26 , 27 , 28 ]. We previously reported on the epidemiology of scrub typhus in the Maldives and identified certain atolls considered as hotspots for scrub typhus within the archipelago [ 15 ]. Additionally, sporadic cases have been previously reported from the Lhaviyani Atoll where our patient resides.…”

“…The clinical manifestations of scrub typhus begin with a fever with chills and myalgia [ 15 ]. Although headache is a predominant feature, scrub typhus’s cardinal feature is an eschar at the inoculation site accompanied by regional lymphadenopathy [ 12 ].…”

A Fatal Case of Native Valve Endocarditis with Multiple Embolic Phenomena and Invasive Methicillin-Resistant Staphylococcus aureus Bacteremia: A Case Report from the Maldives

“…The Maldives is a small-island developing state located in the Indian Ocean, where tropical diseases such as dengue, chikungunya, Zika, and scrub typhus are endemic [ 28 , 29 , 30 , 31 , 32 ]. It is the smallest country in Asia, with a population of 557,426 people and with a median age of 28 years and an overall life expectancy of 79.61 years.…”

Epidemiological and clinical characteristics of scrub typhus in northern Fujian, China, from 2015 to 2019

“…Diagnosing and treating this disease is not timely; severe complications may occur, and even life-threatening, so primary doctors should improve their understanding of this disease [ 23 ]. The primary pathological changes in scrub typhus are systemic minor vessel inflammation and perivascular inflammation, which cause congestion, edema, cell degeneration, and necrosis of solid organs [ 24 ].…”