Multiple eschars in scrub typhus: a case report

Koralur, Munegowda; Nandigam, Manideep; Bairy, Indira; Vidyasagar, Sudha; Varma, Muralidhar

doi:10.1177/0049475516658400

Cited by 4 publications

(6 citation statements)

References 8 publications

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“…Our patient presented with an acute febrile illness and a rash, so the differential diagnosis had to include various diseases. 5,6 Characteristic skin eschar in an acute febrile patient from the Tsutsugamushi Triangle is a valuable sign in scrub typhus diagnosis. The frequency of eschars in patients with scrub typhus is highly variable and can be seen in 11–44% of patients.…”

Section: Discussionmentioning

confidence: 99%

Scrub Typhus Complicated by ARDS, Myocarditis, and Encephalitis Imported to Oman from Nepal

Mahdi

Al-Khalili

Chung

et al. 2019

OMJ

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Scrub typhus is a potentially fatal rickettsial infection caused by Orientia tsutsugamushi . It is an obligate intracellular Gram-negative bacterium transmitted by the bite of infected chigger larva. The disease is distributed from Asia to the Pacific islands, and this region is known as the Tsutsugamushi Triangle. A 28-year-old man was admitted to the Royal Hospital with a four-day history of fever, headache, rigors, anorexia, and a nonspecific macular rash. Clinical presentation, laboratory results as well as epidemiological data indicated that this might be a case of scrub typhus. Additional serology tests confirmed the presumed diagnosis, and the patient was successfully treated with empirical therapy. Untreated scrub typhus has high mortality and early diagnosis and adequate treatment can prevent the potentially fatal outcome of the disease.

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Section: Discussionmentioning

confidence: 99%

Scrub Typhus Complicated by ARDS, Myocarditis, and Encephalitis Imported to Oman from Nepal

Mahdi

Al-Khalili

Chung

et al. 2019

OMJ

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“… 37 Eschars are often found in covered areas of the body, such as the groin, axilla, chest, and lower back, including the buttocks. 9 , 10 , 38 – 40 Recently, there have been reports of multiple eschars 41 , 42 and atypical eschars, 43 which were punched-out ulcers with slough. This could also be due to the original eschar scab being removed by scratching 44 or falling away, especially during bathing.…”

Section: Clinical Clues Favoring a Diagnosis Of Scrub Typhusmentioning

confidence: 99%

Scrub typhus: risks, diagnostic issues, and management challenges

Prakash¹

2017

RRTM

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Scrub typhus is an acute febrile illness in the “tsutsugamushi triangle”, transmitted by chiggers that can be treated effectively if detected early. Laboratory testing, including molecular and serological assays, is needed for confirming the diagnosis, especially in the absence of the pathognomonic eschar. In this review, factors that play a role in disease occurrence and clinical clues for diagnosis, in addition to risk factors contributing to disease severity, including mortality, are discussed in detail. Moreover, issues related to diagnostic assays, treatment, and mixed infections are also enumerated and described.

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“…Also, the lack of the pathognomonic eschars, characteristic of ST, adds to the misdiagnosis ( Kundavaram et al, 2013 ; Prakash, 2017 ). Although a well-timed treatment with doxycycline helps in the speedy recovery of the patient in initial phases of infection, lack of medical attention or delay in treatment may lead to severe complications such as multiple organ failure that may be lethal ( Rapsang and Bhattacharyya, 2013 ; Koraluru et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Genotypic Characterization of Orientia tsutsugamushi Isolated From Acute Encephalitis Syndrome and Acute Febrile Illness Cases in the Gorakhpur Area, Uttar Pradesh, India

Nanaware

Desai²,

Banerjee³

et al. 2022

Front. Microbiol.

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Scrub typhus infections caused by Orientiatsutsugamushi (OT), continue to remain underdiagnosed globally, due to the lack of distinctive symptoms. The elusive nature of the Acute Encephalitis Syndrome (AES) outbreak in Gorakhpur, Uttar Pradesh that claimed numerous pediatric lives was the driving force of this study which involved serological diagnosis (IgM–ELISA), isolation of OT in cell culture, confirmation by PCR, and characterization by Sanger sequencing. In total, 12 out of 36 patients were seropositive, of which 4 were positive by PCR. Upon enrichment in cell culture, additional 3 patients (including two seronegative) were detected positive by PCR. In total, three of these 7 patients were found to be infected with two strains of OT. Taken together, this study for the first time reports the occurrence of dual infections in addition to three circulating OT genotypes (Gilliam, Kato, and Karp-like) and highlights the significance of enriching OT in cell culture systems for efficient molecular detection.

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Multiple eschars in scrub typhus: a case report

Cited by 4 publications

References 8 publications

Scrub Typhus Complicated by ARDS, Myocarditis, and Encephalitis Imported to Oman from Nepal

Scrub Typhus Complicated by ARDS, Myocarditis, and Encephalitis Imported to Oman from Nepal

Scrub typhus: risks, diagnostic issues, and management challenges

Genotypic Characterization of Orientia tsutsugamushi Isolated From Acute Encephalitis Syndrome and Acute Febrile Illness Cases in the Gorakhpur Area, Uttar Pradesh, India

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