Revisiting scrub typhus: A neglected tropical disease

Bhandari, Mini; Singh, Rahul; Лаишевцев, А. И.; Mohapatra, Tribhuban Mohan; Nigam, Manisha; Mori, Edna; Lacerda, Bruna Caroline Gonçalves Vasconcelos de; Coutinho, Henrique Douglas Melo; Mishra, Abhay Prakash

doi:10.1016/j.cimid.2022.101888

Cited by 6 publications

(6 citation statements)

References 79 publications

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“…[ 9 , 13 , 14 ] Unless there is a high level of suspicion, diagnosis can be missed as its clinical features are nonspecific. [ 15 ] In this case, the patient had no clinical symptoms such as fever, headache, or myalgia at admission. However, multiple eschars were found at admission to our hospital.…”

Section: Discussionmentioning

confidence: 91%

A CARE-compliant article: A case report of unusual eschar and extensive soft tissue necrosis in Tsutsugamushi disease

Byeon,

Kim,

Lee

et al. 2023

Medicine

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Rationale: Tsutsugamushi disease is a common infectious disease in the Northern Hemisphere. A patient infected with tsutsugamushi disease will show a characteristic clinical course with eschar formation, which is mostly small and self-limited in nature without causing major problems. We report a rare case of unusually extensive necrosis started from a small eschar. Patient concerns: In this report, a 65-year-old female patient with a history of diabetes mellitus present an 8 × 6 cm-sized huge eschar and extensive soft tissue necrosis aggravated from a small eschar. Also, there were 3 other small eschars in the scalp and left flank area. In early July, she was farming in a field in Hongseong-gun, South Korea. She had been treated at another hospital for 2 weeks. However, the eschar became bigger and worse. Diagnoses: After admission, escharectomy was performed and extensive soft tissue necrosis was identified. Orientia tsutsugamushi antibody tests were positive from blood test. Providencia rettgeri and Enterococcus faecalis were detected in a tissue bacterial culture test. Intervention: While using oral azithromycin and intravenous imipenem/cilastatin, the necrosis of the thigh was excised and covered by lateral femoral circumflex artery based myocutaneous Keystone flap. Outcomes: The remaining small eschars recovered spontaneously, the large eschars that had caused necrosis were successfully treated, and all other clinical symptoms improved without complications. Lessons: For unusual eschar of an unknown cause, especially in patients with uncontrolled diabetes or immunocompromised, the possibility of Tsutsugamushi should be considered. Careful physical examination and proper management should be performed as soon as possible.

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Section: Discussionmentioning

confidence: 91%

A CARE-compliant article: A case report of unusual eschar and extensive soft tissue necrosis in Tsutsugamushi disease

Byeon,

Kim,

Lee

et al. 2023

Medicine

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“…A high index of suspicion can detect this infection, and timely management can be started. Scrub typhus is frequently characterized by fever, myalgia, a maculopapular rash, and eschar from a vector bite [ 2 ]. As a safe peripartum medicine, azithromycin was given to this woman as a drug of choice [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Though rare, it can lead to multiorgan failure and catastrophic feto-maternal outcomes [ 1 ]. Scrub typhus is commonly found in Asia and is caused by the intracellular bacteria Orientia tsutsugamushi via a flea vector [ 2 ]. Most of the cases reported in India belong to the hilly Himalayan area [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Onset Postpartum Pleural Effusion: A Near-Miss Maternal Case Due to Scrub Typhus Infection

Acharya¹,

Acharya²,

Shukla³

et al. 2023

Cureus

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A 32-year-old puerperal patient developed acute onset breathlessness and fever on the third postoperative day. On evaluation, the patient was diagnosed to have scrub typhus pneumonia without any characteristic eschar. The condition was associated with pleural effusion, and it was drained. Azithromycin was used as the drug of choice due to the peripartum status of this patient. The patient improved due to early detection and multidisciplinary timely care. The safe outcome of this near-miss case suggests that fever profile workup, especially in scrub typhus endemic areas, should include scrub typhus testing even if classical signs are absent in the peripartum period.

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“… 2 If the patient initially has respiratory symptoms, such as cough and difficulty breathing, it usually indicates some degree of inflammation or damage to the lungs. 3 , 4 The infection can escalate to severe pneumonia, acute respiratory distress syndrome (ARDS), potentially advancing to sepsis without timely untreated. 4 During sepsis, gut microbiome composition is severely affected, promoting disease‐causing microorganisms, immune dysregulation, and reduced production of beneficial short‐chain fatty acids.…”

Section: Introductionmentioning

confidence: 99%

The role of gut microbiota and the gut–lung axis in sepsis: A case study of a pregnant woman with severe rickettsial pneumonia and septic shock complicated by MODS

Qin,

Fu,

Deng

et al. 2024

Clinical Case Reports

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Key Clinical MessageIn this case report, we describe the successful management of severe scrub typhus with pneumonia, sepsis, and multiple organ dysfunction in a pregnant woman. Despite initial challenges, the patient responded favorably to fecal microbiota transplantation and oral fecal microbiota capsule therapy.AbstractScrub typhus, caused by Orientia tsutsugamushi, can lead to severe multiorgan dysfunction and carries a mortality rate of up to 70% if not treated properly. In this report, we present the case of a 27‐year‐old pregnant woman at 18 + 6 weeks gestation whose symptoms worsened 15 days after onset and progressed to severe pneumonia with sepsis and multiple organ dysfunction syndrome. After the pathogen was confirmed by next‐generation sequencing analysis of bronchoalveolar‐lavage fluid and blood samples, the patient's treatment was switched to antiinfective chloramphenicol. The patient also underwent uterine evacuation due to a miscarriage. Extracorporeal membrane oxygenation was discontinued once the pulmonary infection significantly improved. Subsequently, the patient had recurrent diarrhea, abdominal distension, and difficulty eating. The antibiotic regimen was adjusted according to the drug sensitivity, but the diarrhea and abdominal distension still did not improve. Following a comprehensive multidisciplinary risk assessment, we initiated fecal microbiota transplantation and oral fecal microbiota capsule therapy. As a result, the patient's condition was effectively managed, and they were gradually discharged. Fecal microbiota transplantation may be a safe and effective treatment for severe pneumonia and shock in pregnant women. This has significant implications for maternal health. However, further clinical cases are required to observe its long‐term effectiveness.

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Revisiting scrub typhus: A neglected tropical disease

Cited by 6 publications

References 79 publications

A CARE-compliant article: A case report of unusual eschar and extensive soft tissue necrosis in Tsutsugamushi disease

A CARE-compliant article: A case report of unusual eschar and extensive soft tissue necrosis in Tsutsugamushi disease

Acute Onset Postpartum Pleural Effusion: A Near-Miss Maternal Case Due to Scrub Typhus Infection

The role of gut microbiota and the gut–lung axis in sepsis: A case study of a pregnant woman with severe rickettsial pneumonia and septic shock complicated by MODS

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