Imported scrub typhus: first case in South America and review of the literature

Abstract

BackgroundScrub typhus is a neglected vector-borne zoonosis causing life-threatening illnesses, endemic in the Asian-Pacific region and, as recently discovered, in southern Chile. Scrub typhus is rarely reported in travelers, most probably due to the lack of clinical experience and diagnostic tests in non-endemic countries. We report the first case of imported scrub typhus in South America.Case presentationA 62-year-old tourist from South Korea presented severely ill with fever, rash, and eschar in Santiago, Chile. Laboratory exams showed thrombocytopenia and elevated inflammation parameters, hepatic enzymes, and LDH. With the clinical suspicion of scrub typhus, empirical treatment with doxycycline was initiated and the patient recovered rapidly and without complications. The diagnosis was confirmed by IgM serology and by real-time PCR, which demonstrated infection with Orientia tsutsugamushi (Kawasaki clade).ConclusionsOnly due to the emerging clinical experience with endemic South American scrub typhus and the recent implementation of appropriate diagnostic techniques in Chile, were we able to firstly identify and adequately manage a severe case of imported scrub typhus in South America. Physicians attending febrile travelers need to be aware of this rickettsiosis, since it requires prompt treatment with doxycycline to avoid complications.

Diagnosis of severe scrub typhus infection by next-generation sequencing:a case report

“…Scrub typhus is a natural epidemic caused by Orientia tsutsugamushi, spread globally, mainly in the Asia-Pacific region [1,3,5] and is considered as the world's leading rickettsial infection, threatening the health of one billion people every year and causing more than one million deaths [10]. The hosts of Orientia tsutsugamushi are larvae and rats, while it could also infect humans and spread through the sputum in grass or soil on the floor [2].…”

Molecular Description of a Novel Orientia Species Causing Scrub Typhus in Chile

“…Although this disease has been known since at least 313 ce and currently threatens over 1 billion people in Asia and Australasia, it is widely underdiagnosed and underreported ( 3 , 4 ). Disinterest has been influenced by the perception that scrub typhus is a geographically limited disease, threatening rural populations within a certain region, known as the “tsutsugamushi triangle,” and rarely affecting travelers ( 5 , 6 ).…”

Complex Cytokine Responses in Imported Scrub Typhus Cases, Germany, 2010–2018

“…7 The overall majority of published data describe imported infections from the traditional area of the tsutsugamushi triangle. [7][8][9][10][11] In line with these reports, all infections with O. tsutsugamushi in our study were acquired in countries located in Southeast Asia and in Nepal. In contrast to the few reported cases in travelers, at least one million cases of scrub typhus occur in the Asian-Pacific region annually.…”

“…These results are in line with previous reports about imported scrub typhus cases. 7,8 According to studies in endemic areas, laboratory changes are not as frequent as in imported cases, but more studies with larger numbers of imported O. tsutsugamushi infections are needed to draw further conclusions. 20,21 Detection of antibodies against O. tsutsugamushi by IFAT is the gold standard in diagnosing scrub typhus.…”