Acute Fulminant Myocarditis Recovered from Electro-Mechanical Dissociation in Scrub Typhus

Jung, Young Hak; Lee, Minjoo Larry; Lee, Kyoung Hwa; Lee, Jihoon; Kim, Seok-hyung; Lee, Byoung Kwon

doi:10.12771/emj.2016.39.1.1

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…At last, in the case of fulminant progression which does not respond to medical management, successful and rapid implantation of VA ECMO on time was critical to saving the patient. Experience of ECMO in fulminant myocarditis caused by scrub typhus seems limited and only a few reports are available ( 16 ). Clinicians, however, should be alert to the possibility of rapid progression of scrub typhus myocarditis and be prepared for temporary mechanical support (MCS) based on the evidence provided by some studies ( 17 , 18 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Fulminant Myocarditis Successfully Treated With Extracorporeal Membrane Oxygenation in Ikeda Strain Orientia tsutsugamushi Infection

Park

Lim

Kim

et al. 2021

Front. Cardiovasc. Med.

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Scrub typhus is an acute zoonotic febrile illness caused by Orientia tsutsugamushi having a specific geographic endemic area. This infection could be complicated with multi-organ involvement including myocarditis with variable severity. Here, we report a rare case of scrub typhus with biopsy-proven acute fulminant myocarditis which progressed very rapidly to cardiac arrest and was treated successfully with extracorporeal cardiopulmonary resuscitation. Clinicians should be alert to possible rapid progression of scrub typhus myocarditis to fulminant form and be prepared for close monitoring and temporary mechanical support if indicated.

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Section: Discussionmentioning

confidence: 99%

Case Report: Fulminant Myocarditis Successfully Treated With Extracorporeal Membrane Oxygenation in Ikeda Strain Orientia tsutsugamushi Infection

Park

Lim

Kim

et al. 2021

Front. Cardiovasc. Med.

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A case report of scrub typhus complicated with myocarditis and rhabdomyolysis

Kim

Yoon

et al. 2018

BMC Infect Dis

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BackgroundScrub typhus is a zoonotic disease caused by Orientia tsutsugamushi, a gram-negative intracellular bacterium. Myocarditis and rhabdomyolysis are rare complications of scrub typhus.Case presentationWe report a case of scrub typhus, which was simultaneously complicated with myocarditis and rhabdomyolysis. A 54-year-old woman presented to our hospital with myalgia in the upper and lower limbs, oedema and a fever of 7 days’ duration. We confirmed the diagnosis of scrub typhus complicated with myocarditis by pericardial fluid analysis and cardiac magnetic resonance imaging results. The pericardial fluid showed characteristics of an exudate, an elevated immunofluorescence assay (IFA) IgG titer of 1:2048 and a positive 16S rRNA qPCR result. We also diagnosed rhabdomyolysis by the patient’s presenting symptoms, elevated muscle enzyme levels and bone scan results.ConclusionWe report for the first time a case of scrub typhus complicated with both myocarditis and rhabdomyolysis, the causative agent of which was the Boryong genotype of O. tsutsugamushi.

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Comprehensive review on cardiac manifestation of scrub typhus

Sivasubramanian,

Abdul Khader,

Ravikumar

et al. 2024

Front. Trop. Dis

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Scrub typhus, a zoonotic disease caused by Orientia tsutsugamushi and transmitted by chiggers, predominantly affects the Asia-Pacific region. Complications of Scrub Typhus involve multiple systems, including cardiovascular (pericarditis, arrhythmia, myocarditis), respiratory (acute respiratory distress syndrome), hepatic (hepatitis), and renal (azotemia). In this review, we comprehensively focused on the cardiac manifestations caused due to scrub typhus. Scrub typhus-induced pericarditis should be suspected in patients residing in endemic regions presenting with fever, thrombocytopenia, and pericardial effusion. If undetected, it frequently leads to cardiomegaly, pericardial effusion, and congestive heart failure. Heart failure with scrub typhus commonly occurs following myocardial inflammation, particularly in patients with pre-existing cardiac disorders. Scrub typhus myocarditis is a relatively rare, but serious cardiac complication with a high mortality rate of up to 24.0%. Arrhythmias arise due to the involvement of the interventricular septum, coronary artery, or cardiac valves causing variable ECG findings including sinus arrhythmia, T wave changes, and QTc interval prolongation. Atrial fibrillation due to scrub typhus is associated with a 1.3 fold increase in 3-month mortality. These cardiac complications are mainly assessed using electrocardiography (ECG) and echocardiography. Serology is the primary diagnostic tool for O. tsutsugamushi. While the Scrub Typhus Detect IFA test offers 100% sensitivity, the Weil Felix test is specific and cost-effective. Nested PCR and ELISA are effective for early detection but are limited to resource-rich settings. Diagnostic difficulties arise from nonspecific symptoms and current testing limitations. Vaccine development using extracellular vesicles, nanoparticles, and subunit vaccines shows promise. Combined therapy with doxycycline and azithromycin is recommended for cardiac complications, alongside guideline-directed therapy. The review underscores the need for heightened clinical awareness and prompt management of scrub typhus, especially in endemic regions. It also highlights the necessity for further research into the pathogenesis of cardiac involvement and the development of more effective diagnostic tools and treatments.

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Acute Fulminant Myocarditis Recovered from Electro-Mechanical Dissociation in Scrub Typhus

Cited by 3 publications

References 11 publications

Case Report: Fulminant Myocarditis Successfully Treated With Extracorporeal Membrane Oxygenation in Ikeda Strain Orientia tsutsugamushi Infection

Case Report: Fulminant Myocarditis Successfully Treated With Extracorporeal Membrane Oxygenation in Ikeda Strain Orientia tsutsugamushi Infection

A case report of scrub typhus complicated with myocarditis and rhabdomyolysis

Comprehensive review on cardiac manifestation of scrub typhus

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