Tsutsugamushi Myocarditis With Congestive Heart Failure and Persistent Atrial Standstill

Abstract

Acute infectious myocarditis is primarily by viruses and bacteria, but sometimes by rickettsia. Tsutsugamushi disease is a febrile illness caused by Rickettsia tsutsugamushi, and has been prevalent in Korea since 1985. Characteristics of tsutsugamushi disease are fever, rash and eschar. Tsutsugamushi myocarditis is rare. Cardiac involvement may include ST-T changes, PR prolongation, mild mitral regurgitation, and perivascular inflammation with myocardial necrosis. We describe here a 50-year-old woman who complained of fever, orthopnea and chest pain. Work-up of the patient revealed abdominal scar, positive tsutsugamushi antibody, congestive heart failure with severe mitral and tricuspid regurgitation, persistent atrial standstill on electrophysiologic study, junctional rhythm and ST-T changes mimicking anterior myocardial infarction and myocardial inflammation with perivasculitis on endomyocardial biopsy. The patient's condition improved with doxycycline and inotropics. Persistent atrial standstill during was found at the one-year follow-up.

Application of Monoclonal Antibody, Specific for Intracellular Orientia tsutsugamushi, to Immunofluorescent Antibody Test for Determining Antibiotic Susceptibility

“…The measured MIC value was 0.05 µg/ml and close to the MIC values of 0.0625 µg/ml and 0.02-0.09 µg/ml reported by Strickman et al and Urakami et al, respectively (14,15). Previous clinical studies showed that tetracycline antibiotics are effective in the treatment of scrub typhus occurring in Korea (1,5,13). When taken together, the Korean strains of O. tsutsugamushi may be sensitive to tetracycline as are most strains of other countries.…”

Scrub Typhus: Clinical, Pathologic, and Imaging Findings

“…Vasculitis and perivasculitis in the myocardium induce cellular infiltration along with hemorrhage and edema of interstitial tissues. Cardiomegaly, which may be due to myocardial or pericardial involvement in the infection (22)(23)(24), is usually reversible (9) (Fig 11).…”

Scrub typhus in Southern India: are we doing enough?

“…10 There are also studies which show the involvement of respiratory, cardiac and renal systems. 12–15 Headache is a common symptom in rickettsioses and suggests CNS involvement. CNS involvement with the presentations of meningitis and meningoencephalitis has been reported in association with scrub typhus.…”