Pericarditis due to Tsutsugamushi Disease

Chang, Jung Hyun; Ju, Mi Soon; Chang, Jong San; Park, Young Sik; Han, Woon Sup; Kim, Ik-Sang; Chang, William

doi:10.1080/00365540050164344

Cited by 24 publications

(6 citation statements)

References 3 publications

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“…Subsequently, infection with O. tsutsugamushi results in vasculitis in multiple organs, leading to various complications. Among these complications, cardiac manifestations such as myocarditis, pericarditis and infective endocarditis have been reported [ 1 , 2 , 4 – 6 ].…”

Section: Discussionmentioning

confidence: 99%

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A case report of scrub typhus complicated with myocarditis and rhabdomyolysis

Kim

Yoon

et al. 2018

BMC Infect Dis

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BackgroundScrub typhus is a zoonotic disease caused by Orientia tsutsugamushi, a gram-negative intracellular bacterium. Myocarditis and rhabdomyolysis are rare complications of scrub typhus.Case presentationWe report a case of scrub typhus, which was simultaneously complicated with myocarditis and rhabdomyolysis. A 54-year-old woman presented to our hospital with myalgia in the upper and lower limbs, oedema and a fever of 7 days’ duration. We confirmed the diagnosis of scrub typhus complicated with myocarditis by pericardial fluid analysis and cardiac magnetic resonance imaging results. The pericardial fluid showed characteristics of an exudate, an elevated immunofluorescence assay (IFA) IgG titer of 1:2048 and a positive 16S rRNA qPCR result. We also diagnosed rhabdomyolysis by the patient’s presenting symptoms, elevated muscle enzyme levels and bone scan results.ConclusionWe report for the first time a case of scrub typhus complicated with both myocarditis and rhabdomyolysis, the causative agent of which was the Boryong genotype of O. tsutsugamushi.

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Section: Discussionmentioning

confidence: 99%

“…To date, cardiac involvement (e.g., myocarditis, pericarditis, and infective endocarditis) or rhabdomyolysis in scrub typhus has been intermittently reported [ 1 – 6 ]. Furthermore, the simultaneous complication of scrub typhus with both myocarditis and rhabdomyolysis has not been reported.…”

Section: Introductionmentioning

confidence: 99%

A case report of scrub typhus complicated with myocarditis and rhabdomyolysis

Kim

Yoon

et al. 2018

BMC Infect Dis

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“…Echocardiogram is a key non-invasive tool in detecting impaired LV function in suspected myocarditis, even when subclinical[ 7 , 18 ]. Depressed LVEF was observed in 25 (30.9%) patients.…”

Section: Discussionmentioning

confidence: 99%

“…Eighteen patients had evidence of diastolic dysfunction; however, only two had E/e’ > 15. Pericardial involvement has been reported in autopsy studies, case reports[ 7 , 20 ], and case series[ 21 ]. We observed mild to moderate pericardial effusion in 41 (51%) patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although the overall case fatality rate of patients admitted with scrub typhus infection is reported to be 9%[ 2 ], in those presenting with severe illness and requiring intensive care unit (ICU) admission, mortality may be as high as 24%[ 3 ]. There are reports that scrub typhus can cause myocarditis and myocardial dysfunction[ 4 - 7 ]. However, the magnitude of this problem and its impact on outcome are unclear.…”

Section: Introductionmentioning

confidence: 99%

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Spectrum of cardiac manifestations and its relationship to outcomes in patients admitted with scrub typhus infection

Gunasekaran

Sudarsan

Peter

et al. 2018

WJCCM

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AIMTo study the spectrum of cardiac manifestations in scrub typhus infection and assess its relationship to outcomes.METHODSDemographic data, electrocardiographic (ECG) changes, left ventricular (LV) systolic and diastolic function, myocardial injury (defined as troponin T > 14 pg/mL), and pericardial effusion were documented. Myocarditis was diagnosed when myocardial injury was associated with global LV systolic dysfunction. The relationship between myocarditis and outcomes was assessed using logistic regression analysis and expressed as odds ratio (OR) with 95%CI.RESULTSThe cohort (n = 81; 35 males) aged 49.4 ± 16.1 years (mean, SD) presented 8.1 ± 3.1 d after symptom onset. The APACHE-II score was 15.7 ± 7.0. Forty-eight (59%) patients were ventilated, and 46 (56%) required vasoactive agents. Mortality was 9.9%. ECG changes were non-specific; sinus tachycardia was the most common finding. Myocardial injury was evident in 61.7% of patients and LV systolic dysfunction in 30.9%. A diagnosis of myocarditis was made in 12.3%. In addition, seven patients with regional wall motion abnormalities had LV systolic dysfunction and elevated cardiac enzymes. Mild diastolic dysfunction was observed in 18 (22%) patients. Mild to moderate pericardial effusion was seen in 51%. On multivariate logistic regression analysis, patients with myocarditis tended to be older (OR = 1.04, 95%CI: 0.99-1.09), had shorter symptom duration (OR = 0.69, 95%CI: 0.49-0.98), and tended to stay longer in hospital (OR = 1.17, 95%CI: 0.98-1.40). Myocarditis was not associated with increased mortality.CONCLUSIONIn scrub typhus infection, cardiac manifestations are frequent and associated with increased morbidity but not mortality.

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