An Unusual Clinical Presentation of Scrub Typhus

Abstract

Scrub typhus is still underdiagnosed despite a resurgence in incidence as the clinical presentation is often atypical leading to low index of suspicion among clinicians. We report a case of a young girl presenting as lobar pneumonia and diagnosed as scrub typhus. Despite such a classical picture of community-acquired pneumonia on clinical presentation and radiological findings the patient was found to have scrub typhus serologically thereby posing a diagnostic dilemma. Upon serological confirmation, doxycycline therapy was initiated followed by a rapid and complete resolution of pneumonia, both clinically and radiographically. This case report highlights the importance of recognizing an uncommon clinical presentation of this common tropical disease and its prompt diagnosis and treatment.

Beta-Lactam Plus Macrolide for Patients Hospitalized With Community-Acquired Pneumonia: Difference Between Autumn and Spring

“… 35 According to the literature, clinical presentation of scrub typhus varies and eschar can be absent. 36 37 Respiratory complications of scrub typhus can be presented in the form of interstitial pneumonia frequently and the incidence of chest radiographic abnormalities in patients with scrub typhus varies from 59% to 72%. 38 39 Therefore, there is a possibility that the clinicians misdiagnose atypical pathogens including scrub typhus and treat it with ordinary CAP empiric antibiotics which can effect on the clinical outcome of CAP.…”

Typhus pneumonitis – A rare and life-threatening complication of scrub typhus

“…Eschar, a painless lesion with a black crust, is characteristic of scrub typhus but could be easily missed [4]. Prevalence of an eschar in typhus patients is highly variable (7-97%) [5]. Eschars are rare among patients in countries of South-East Asia and, indigenous persons in typhus-endemic areas are likely to have less severe illness, often without rash or eschar [6].…”

“…Pulmonary involvement in scrub typhus is significantly associated with morbidity and disease severity [11]. According to studies, around 58% of patients with scrub typhus show symptoms of pulmonary involvement [5] and around 78% have chest radiographic abnormalities [11] but the exact incidence of clinically significant typhus pneumonitis is not clear. The pathogenesis of scrub typhus pneumonitis is explained as an immunological reaction due to vasculitis secondary to direct endothelial injury or direct injury by the organism itself.…”