Case Report: Acute pyelonephritis and hearing loss in scrub typhus

Abstract

Acute pyelonephritis is a common renal manifestation in patients with diabetes. A 52-year-old diabetic lady presented with loin pain, dysuria, and fever and urinary incontinence that had begun seven and three days prior to presentation respectively. She was treated with escalating spectra of intravenous antibiotics without improvement. Urine and blood cultures were sterile, while radiological investigations were suggestive of pyelonephritis. Mild hepatic dysfunction prompted consideration of scrub typhus and she improved with empirical doxycycline. Scrub IgM was later confirmed to be positive. In conclusion, local prevalence of systemic infections such as rickettsioses should always be considered in diabetics with fever, even if symptoms and signs otherwise suggest typical diabetes-related infections. We, therefore report a case of acute pyelonephritis caused by scrub typhus which has not been previously described in English medical literature.

Neurological Facets of Scrub Typhus

“…Approximately 20%–25% of patients with scrub typhus suffer from neurological complications, making this an important part of the clinical constellation. [ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 ...…”

Epidemiological and clinical characteristics of scrub typhus in northern Fujian, China, from 2015 to 2019

“…Diagnosing and treating this disease is not timely; severe complications may occur, and even life-threatening, so primary doctors should improve their understanding of this disease [ 23 ]. The primary pathological changes in scrub typhus are systemic minor vessel inflammation and perivascular inflammation, which cause congestion, edema, cell degeneration, and necrosis of solid organs [ 24 ]. It can involve multiple systems and organs, and its diverse clinical manifestations make it easy to misdiagnose [ 25 ].…”