Pathologic study of thirty-one cases of scrub typhus fever with especial reference to the cardiovascular system

Identification of the Target Cells of Orientia tsutsugamushi in Human Cases of Scrub Typhus

“…Although the pathogenesis of scrub typhus may be very complex and involve immune and inflammatory mediators such as cytokines, prostaglandins, leukotrienes, and kinins, the key factor of disseminated endothelial infection has now been established for tsutsugamushi disease as well as the rick- ettsioses. Indeed, Case 3 was apparently associated with generalized edema, and pleural, pericardial, and peritoneal effusions were reported in a substantial portion of fatal cases necropsied during World War II (15,18). The histopathology of scrub typhus was investigated carefully in reports of 27, 31, 55, and 78 cases (14,15,18,19).…”

“…Indeed, Case 3 was apparently associated with generalized edema, and pleural, pericardial, and peritoneal effusions were reported in a substantial portion of fatal cases necropsied during World War II (15,18). The histopathology of scrub typhus was investigated carefully in reports of 27, 31, 55, and 78 cases (14,15,18,19). The consensus in 1945 was that disseminated vasculitis with perivasculitis was the paramount lesion, with involvement of the brain and lungs being the most important factors in a fatal outcome.…”

“…The identification of O. tsutsugamushi in cardiac myocytes reopens this question. In Levine's study, which focused on microscopic examination of the heart in 31 cases, six were perfectly normal, and 13 with inflammatory infiltrates showed intact heart muscle fibers (18). Twelve cases showed injury to cardiac myocytes, including several with frank focal necrosis that was rarely severe.…”

A rare clinical case of subdural hemorrhage in a patient with scrub typhus

“…8 Endothelial cell dysfunction and disseminated intravascular coagulation may occur in response to endothelial cell injury by O. tsutsugamushi in scrub typhus patients. [9][10][11] It has been shown that haemostatic and fibrinolytic changes occur as late manifestations of illness, rather than as initial clinical features. In our case an interesting point is that the patient had improved significantly and was about to be discharged when he suffered from subdural hemorrhage.…”

Pulmonary Manifestations of Scrub Typhus: Wisdom May Prevail Obstacles

“…Subsequently, hematogenously disseminated infection is postulated due to key involvement of endothelial cells and macrophages, both of which release soluble cell-specific adhesion molecules [22]. Although, the exact mechanism of vascular damage caused by O. tsutsugamushi infection remains poorly understood, the primary event might be the destruction of endothelial cells lining small blood vessels and the accompanying inflammatory responses [23,24].…”