Case Report: Concurrent Sympatric Scrub Typhus and Japanese Spotted Fever in Japan

Abstract

Scrub typhus and Japanese spotted fever-both rickettsial diseases-are endemic and notifiable in Japan and may cause a fatal outcome without prompt treatment. Here we present the first case of a concurrent sympatric infection of both diseases with grade II evidence. A 67-year-old woman, after a single event of potential exposure to the pathogens, presented with a 12-day history of fever, pharyngeal pain, papulo-erythematous rash, and pronounced fatigue. Her erythematous rash was distributed on her trunk and extremities, palms, and soles and eventually progressed to purpura. Fever persisted until doxycycline was administered on day 12. A significant > 4-fold increase in immunoglobulin G and immunoglobulin M titers against multiple serotypes of Orientia tsutsugamushi and Rickettsia japonica were revealed by indirect immunoperoxidase assays. These clinical and serological data, even in the absence of molecular or isolation evidence, provided grade II evidence that this was a concurrent infection of sympatric scrub typhus and Japanese spotted fever.

Case Report: A Fatal Case of Scrub Typhus Complicated by Heatstroke

“…3,8 In the period from 1999 to 2016, 34 fatal cases were found over total 7,888 reported cases, and the fatality rate was 0.4% in Japan. 9 Generally, serotype Hirano/Kuroki transmitted by L. scutellare has a relatively mild clinical course. 10 From a previous report, it was shown that the virulence of strains is classified into three types: a highly virulent strain, such as Kato and Karp, which are capable of killing mice with only a few organisms; a low virulent strain, such as Irie/Kawasaki and Hirano/ Kuroki, which are not capable of infecting mice even with relatively large doses of organisms; and a intermediately virulent strain, such as Gilliam, which readily kills susceptible mice.…”

Clinical Significance of C-Reactive Protein in Patients with Trauma on Arrival

“…Concerning the minor etiology underlying the increased CRP levels on arrival among patients with trauma in our study, one patient died of rickettsia due to a delay in their diagnosis; this patient might have survived if the diagnosis had been made earlier and they had received appropriate antibiotics. 15) Two patients were incidentally diagnosed with a neoplasm that required other treatments. 16) Trauma also triggers an inflammatory response, so delaying visiting a medical facility can inadvertently cause an increase in the CRP level.…”