Scrub typhus: the clinical significance of the eschar

Akaike, Takashi; Ishizuka, Kosuke; Tominaga, Naoto; Motohashi, Iori

doi:10.1136/bcr-2023-255404

BMJ Case Rep

2023

DOI: 10.1136/bcr-2023-255404

|View full text |Cite

Scrub typhus: the clinical significance of the eschar

Takashi Akaike

Kosuke Ishizuka

Naoto Tominaga

et al.

Abstract: Provenance and peer review Not commissioned; externally peer reviewed.Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2024

Publication Types

Select...

Article4

Relationship

Self Cite0

Independent4

Authors

Journals

Cited by 4 publications

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Clinical and laboratory findings in scrub typhus associated Guillain‐Barré syndrome in South Korea

Yoon,

Kim,

Kim

et al. 2024

J Peripheral Nervous Sys

View full text Add to dashboard Cite

Background and AimsScrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain‐Barré syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus.MethodsPatients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS‐associated clinical and electrophysiological characteristics, outcomes, and scrub typhus‐associated features were collected.ResultsOf the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2–14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1–4) points.InterpretationPatients with scrub typhus‐associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS.

show abstract

Clinical and laboratory findings in scrub typhus associated Guillain‐Barré syndrome in South Korea

Yoon,

Kim,

Kim

et al. 2024

J Peripheral Nervous Sys

View full text Add to dashboard Cite

show abstract

Cerebral Venous Sinus Thrombosis Following Scrub Typhus Meningoencephalitis in a Pregnant Woman

Biswas,

León-Ruiz,

Ghosh

et al. 2024

The Neurohospitalist

View full text Add to dashboard Cite

Background Scrub typhus, a mite-borne zoonosis caused by Orientia tsutsugamushi, is prevalent in the Asia Pacific region and presents with various neurological manifestations, including meningoencephalitis, polyneuropathy, and, rarely, cerebral venous sinus thrombosis (CVST). Case Report We report a unique case of CVST following scrub typhus meningoencephalitis in an 18-year-old pregnant woman from West Bengal, India. Her condition was complicated by fever, headache, neck stiffness, and altered sensorium. Laboratory tests revealed leukopenia and thrombocytopenia, while serologies for other infectious diseases were negative. Cerebrospinal fluid analysis was significant for lymphocytic pleocytosis and elevated protein, with a positive O tsutsugamushi-IgM assay. Treatment with azithromycin resulted in initial improvement; however, persistent headaches led to the discovery of CVST. The patient responded well to anticoagulation therapy with low molecular weight heparin and was discharged asymptomatic, with subsequent uneventful pregnancy and delivery. Discussion Cerebral venous sinus thrombosis should be ruled out in pregnant women with refractory scrub typhus meningoencephalitis despite antibiotic therapy. Because scrub typhus is treatable with intravenous doxycycline and azithromycin, it should be considered in the workup of febrile patients with acute onset neurological disorders in the tropics or subtropics or travelers coming back from endemic areas, despite the absence of eschar and unremarkable neuroimaging findings.

show abstract

Omadacycline in the treatment of scrub typhus: Three case reports

Lang,

Qiu,

Jia

et al. 2024

World J Clin Cases

View full text Add to dashboard Cite

BACKGROUND Scrub typhus is a naturally occurring acute infectious disease that is primarily transmitted through the bites of chiggers or larval mites infected by Orientia tsutsugamushi (O. tsutsugamushi) . Omadacycline, a novel tetracycline, exhibits potent antibacterial efficacy against both typical bacteria and atypical pathogens. However, omadacycline application in the treatment of scrub typhus remains limited. CASE SUMMARY In the present work, we report several cases of scrub typhus, with the main clinical symptoms being fever, the formation of eschars or ulcers, local or systemic lymphadenopathy, headache, myalgia and rash. Blood samples were collected before omadacycline was administered, and O. tsutsugamushi infection was confirmed through targeted next-generation sequencing (tNGS). After two days of treatment, the patients’ symptoms, including fever, were alleviated, with no adverse drug reactions. CONCLUSION tNGS is an effective method for diagnosing scrub typhus. Omadacycline can be considered an alternative option for antiinfective therapy in patients with O. tsutsugamushi infections.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Scrub typhus: the clinical significance of the eschar

Cited by 4 publications

References 5 publications

Clinical and laboratory findings in scrub typhus associated Guillain‐Barré syndrome in South Korea

Clinical and laboratory findings in scrub typhus associated Guillain‐Barré syndrome in South Korea

Cerebral Venous Sinus Thrombosis Following Scrub Typhus Meningoencephalitis in a Pregnant Woman

Omadacycline in the treatment of scrub typhus: Three case reports

Contact Info

Product

Resources

About