Successful diagnosis and treatment of scrub typhus associated with haemophagocytic lymphohistiocytosis and multiple organ dysfunction syndrome: A case report and literature review

Wu, Hongxia; Xiong, Xiaofeng; Zhu, Meifang; Zhuo, Kaiquan; Deng, Yiyun; Cheng, Donghui

doi:10.1016/j.heliyon.2022.e11356

Cited by 6 publications

(3 citation statements)

References 45 publications

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“…In comparison, the mortality rate in HLH cases linked to EBV has been documented at 14.1% ( 23 ), and approximately 50% in tuberculosis ( 24 ). Although the prognosis of scrub typhus illness is generally favorable, severe or fatal complications may arise in cases where misdiagnosis occurs due to the oversight or absence of eschars ( 25 ). Many reports have emphasized the significance of early diagnosis and timely treatment in facilitating rapid recovery and reducing mortality rates.…”

Section: Discussionmentioning

confidence: 99%

mNGS helped diagnose scrub typhus-associated HLH in children: a report of two cases

Jian,

Yang,

Duan

et al. 2024

Front. Public Health

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BackgroundScrub typhus, caused by the Orientia tsutsugamushi (Ot), is a widespread vector-borne disease transmitted by chigger mites. Hemophagocytic lymphohistiocytosis (HLH) is considered to be one of the potentially severe complications. The diagnosis of scrub typhus-associated HLH may be overlooked due to the non-specific clinical characteristics and the absence of pathognomonic eschar.Case presentationWe obtained clinical data from two patients in the South of Sichuan, China. The first case involved a 6-year-old girl who exhibited an unexplained fever and was initially diagnosed with sepsis, HLH, and pulmonary infection. The other patient presented a more severe condition characterized by multiple organ dysfunction and was initially diagnosed with septic shock, sepsis, HLH, acute kidney injury (AKI), and pulmonary infection. At first, a specific examination for scrub typhus was not performed due to the absence of a characteristic eschar. Conventional peripheral blood cultures yielded negative results in both patients, and neither of them responded to routine antibiotics. Fortunately, the causative pathogen Orientia tsutsugamushi (Ot) was detected in the plasma samples of both patients using metagenomics next-generation sequencing (mNGS) and further confirmed by polymerase chain reaction. Subsequently, they both were treated with doxycycline and recovered quickly.ConclusionThe unbiased mNGS provided a clinically actionable diagnosis for an uncommon pathogen-associated infectious disease that had previously evaded conventional diagnostic approaches.

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Section: Discussionmentioning

confidence: 99%

mNGS helped diagnose scrub typhus-associated HLH in children: a report of two cases

Jian,

Yang,

Duan

et al. 2024

Front. Public Health

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show abstract

“…Of those, the Weil-Felix test is a commonly used serological test. However, its specificity and sensitivity are often unsatisfying [ 4 ]. In the current study, the Weil-Felix test still showed a negative result on the 9th of August, 8 days after the disease onset.…”

mentioning

confidence: 99%

“…Compared to the tests above, NGS provides a fast (in 48 hours) and unbiased method which simultaneously detects a wide range of pathogens. In recent years, it has been reported that NGS be successfully applied to the diagnosis of scrub typhus [ 4 , 5 ]. In this study, an atypical patient who has no history of fieldwork, no eschars, and was negative for the Weil-Felix test, was diagnosed by NGS.…”

mentioning

confidence: 99%

Next-generation sequencing helped diagnosis and successful treatment of an atypical severe scrub typhus patient

Liu

Wang

et al. 2023

New Microbes and New Infections

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Utility of next-generation sequencing for the etiological diagnosis of Orientia tsutsugamushi infection

Xu,

Sai,

Wang

et al. 2024

Infectious Medicine

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Successful diagnosis and treatment of scrub typhus associated with haemophagocytic lymphohistiocytosis and multiple organ dysfunction syndrome: A case report and literature review

Cited by 6 publications

References 45 publications

mNGS helped diagnose scrub typhus-associated HLH in children: a report of two cases

mNGS helped diagnose scrub typhus-associated HLH in children: a report of two cases

Next-generation sequencing helped diagnosis and successful treatment of an atypical severe scrub typhus patient

Utility of next-generation sequencing for the etiological diagnosis of Orientia tsutsugamushi infection

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