Afebrile Scrub Typhus (Tsutsugamushi disease) with Acute Respiratory Distress Syndrome.

Abstract

A 74-year-old Japanese man with scrub typhus presented without the typical symptomof high fever and subsequently developed the complication of acute respiratory distress syndrome. It was suspected that exposure occurred at the river side of Kinugawa, Tochigi Prefecture, Japan. His body temperature was below 38.0°C. After intensive supportive care and minocycline therapy, he dramatically recovered. With the increase in popularity of outdoor recreation, scrub typhus can be found in clinics all over Japan. Physicians should therefore be aware of the manifestations of the disease and the necessity of early treatment in suspected cases. (Internal Medicine 41: 667-670, 2002)

Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission

“…Previous studies have reported an incidence of 11-29%. [791217] for acute respiratory distress syndrome (ARDS) in patients admitted for scrub typhus. In our study, 85 patients (73.3%) fulfilled criteria for the diagnosis of ARDS, the higher incidence probably a reflection of the inclusion of only the sicker ICU patients in the cohort.…”

“…[123456789101112131415] Once a dreaded disease in the pre-antibiotic era, reports suggest that scrub typhus continues to be a public health problem in South Asian and Western Pacific regions. [14161718192021] More recent publications have highlighted that scrub typhus is an important cause of acute undifferentiated febrile illness in India[18] leading to organ dysfunction and death in some patients.…”

Delay in Tetracycline Treatment Increases the Risk of Complications in Tsutsugamushi Disease: Data from the Japanese Diagnosis Procedure Combination Database

“…The early diagnosis of Tsutsugamushi disease is considered difficult because of lack of specific clinical findings (1,11). Wide-spectrum β-lactam antibiotics may be tried in vain, for a 'fever of unknown origin'.…”

“…Serologic assays (including an indirect immunoperoxidase test and an immunofluorescence assay) are the mainstays of a laboratory diagnosis (1,10). However, the clinical findings are non-specific (1,11), and the manifestations of the disease range widely from mild and self-limiting to fatal (10). Several severe complications may occur, such as respiratory complications (1, 11) acute renal failure (12,13) and coagulation disorders (2).…”

“…Sporadic case reports and anecdotal evidence have demonstrated the clinical course of patients with this disease (1,11,15), and have described a delay in the diagnosis leading to severe complications in some cases (1). However, data on the actual incidence of various complications or mortality associated with Tsutsugamushi disease are scarce (2).…”