Autopsy case of acute liver failure due to scrub typhus

Shioi, Yoshihiro; Murakami, Akihiko; Takikawa, Yasuhiro; Miyate, Yoshiharu; Tomichi, Nobukazu; Takayama, Kazuo; Uesugi, Noriyuki; Sugai, Tamotsu

doi:10.1007/s12328-009-0087-7

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…In a retrospective short report by Hu et al [5], from Taiwan, 90% of the patients had a significant surge in SGOT, SGPT, and gamma-glutamyl transferase although alkaline phosphatase was found to be raised in 35-40% of the participants. In agreement with our diagnosis, Shioi et al [8] reported an autopsy of a scrub typhus patient who drowned in virtue of acute liver failure. Not surprisingly, findings were of submassive hepatic necrosis, infiltrates in the Glisson's capsule, and sporadic fibrin thrombi in the sinusoids backing disseminated intravascular coagulation.…”

Section: Discussionsupporting

confidence: 90%

Scrub typhus, a rare of cause of fulminant hepatic failure: A common disease with uncommon presentation

Jagadeesan¹,

Patel²,

Jain³

2022

Indian J Case Reports

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Scrub typhus (bush typhus) is a potentially lethal mite-borne, acute febrile infectious illness caused by Orientia tsutsugamushi, reported precipitating frequent outbreaks in the Asia-pacific belt. Usual presentation after a median incubation period of 10–14 days, stretches from pathognomonic eschar, high-grade fever, centrifugal skin rash, jaundice, regional lymphadenopathy to frontal headache, nevertheless complicated at times with myocarditis, acute respiratory distress syndrome, acute kidney injury, encephalitis, and shock. Although patients with scrub typhus invariably do display mild liver injury, fulminant hepatic failure (FHF) is rarely reported. We describe herein, a case of FHF in an elderly male that responded well to antibiotics. Early diagnosis and sensitive antibiotic administration aids in mortality prevention of the former.

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Section: Discussionsupporting

confidence: 90%

Scrub typhus, a rare of cause of fulminant hepatic failure: A common disease with uncommon presentation

Jagadeesan¹,

Patel²,

Jain³

2022

Indian J Case Reports

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“…Scrub typhus has been reported to be an important infectious cause of acute liver failure in India, along with dengue, viral hepatitis, malaria and amoebic liver abscess [16]. Pathologic examination of the liver of a 73-year-old woman with acute liver failure in Japan displayed necrosis and fatty degeneration of hepatocytes, inflammatory infiltrate of lymphocytes, macrophages and plasma cells in the Glisson's capsule, and presence of fibrin thrombi in the hepatic sinusoids, suggesting microvascular injury due to DIC as the mechanism of fulminant liver failure [17].…”

Section: Discussionmentioning

confidence: 99%

Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India

Gaba

Gupta

et al. 2020

Cureus

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Introduction Scrub typhus is a resurging zoonotic infection prevalent in South Asia with many recent outbreaks in India. It can mimic other tropical infections and the disease spectrum ranges from subclinical illness to life-threatening disease with multiorgan dysfunction. This study was conducted to study the pattern of hepatic and renal injury. Methods A retrospective study was done on 176 patients diagnosed by detecting IgM antibodies using an enzyme-linked immunosorbent assay (ELISA) over a period of three years at a tertiary center in Chandigarh, India. They were treated with doxycycline (azithromycin if pregnant) and supportive therapies. The patterns of hepatic and renal functions, along with the need of renal replacement therapy, were recorded and evaluated. The values were expressed as mean ± SD, and p values were calculated to establish statistical significance. Results Most of the cases were from the state of Haryana (37.5%), followed by Punjab (33.5%), Himachal Pradesh (13.6%), Uttar Pradesh (10.2%) and Chandigarh (5%). 30% of the study population was engaged in agriculture. The mean age was 32.3 ± 13.5 years with range of 13-65 years. A peak in the incidence was observed during monsoon months. Approximately 13% of the patients died. Urea, creatinine, bilirubin and aspartate transaminase were found to be higher in mortality group with statistical significance (p < 0.05). Alanine transaminase was higher and albumin was lower in the mortality group but without statistical significance. 27.8% had acute kidney injury, 90.9% had liver dysfunction and one patient had acute liver failure. All the pregnant patients had fetal loss. Conclusion Renal and liver dysfunctions are common in scrub typhus, and their occurrence adversely affects the outcome.

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“…It has also been reported in neonates with scrub typhus [11]. Histopathologic examination of the liver on autopsy of a patient with acute liver failure secondary to scrub typhus revealed necrosis of hepatocytes, inflammatory infiltrate in hepatic capsule and fibrin thrombi in the sinusoids [12]. These findings were suggestive of DIC as the possible mechanism.…”

Section: Discussionmentioning

confidence: 65%

Scrub Typhus Leading to Acute Liver Failure in a Pregnant Patient

Gaba

Sharma

Gaba

et al. 2020

Cureus

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Scrub typhus is a mite-borne rickettsial infection that presents with fever and a diverse array of complications. Lately, many epidemics have been reported from the Indian subcontinent. Data from these outbreaks suggest that liver injury in scrub typhus is common and reversible. We are reporting the case of a 27-year-old pregnant female who presented with fever, encephalopathy, jaundice and seizure. She had acute liver failure and dead fetus on admission. Despite appropriate antibiotics and supportive treatment, she continued to deteriorate and developed multiorgan dysfunction, leading to her demise.

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Autopsy case of acute liver failure due to scrub typhus

Cited by 8 publications

References 11 publications

Scrub typhus, a rare of cause of fulminant hepatic failure: A common disease with uncommon presentation

Scrub typhus, a rare of cause of fulminant hepatic failure: A common disease with uncommon presentation

Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India

Scrub Typhus Leading to Acute Liver Failure in a Pregnant Patient

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