Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi (O. tsutsugamushi) in which humans are accidental hosts. Acute arrest of
hemopoiesis (AAH) always
manifests in pancytopenia and with supportive treatment or inducement removal,
the AAH patients would show significant improvement in blood routine for about a week. As a rapidly progressive and
potentially life-threatening organ function disorder syndrome, multiple organ
dysfunction syndrome (MODS) is often induced by many factors including infection, illness and injury. We received a
rare case of scrub typhus rapidly presenting with AAH and MODS 2 weeks ago. The
clinical data of a 32-year-old female with O. tsutsugamushi-induced AAH
and MODS was summarized retrospectively and analyzed with a literature review.
In this case, we selected tigecycline and moxifloxacin as treatment regimensfor scrub typhus. When the potential infection was controlled, her pancytopenia and hepatic function rapidly improved in a few days.
References
[1]
Salje, J. (2017) Orientia tsutsugamushi: A Neglected but Fascinating Obligate Intracellular Bacterial Pathogen. PLOS Pathogens, 13, Article ID: e1006657. https://doi.org/10.1371/journal.ppat.1006657
[2]
Rajapakse, S., Rodrigo, C. and Fernando, D. (2012) Scrub Typhus: Pathophysiology, Clinical Manifestations and Prognosis. Asian Pacific Journal of Tropical Medicine, 5, 261-264. https://doi.org/10.1016/S1995-7645(12)60036-4
[3]
Lu, C.-T., Wang, L.-S. and Hsueh, P.-R. (2021) Scrub Typhus and Antibiotic-Resistant Orientia tsutsugamushi. Expert Review of Anti-Infective Therapy, 19, 1519-1527. https://doi.org/10.1080/14787210.2021.1941869
[4]
Rossaint, J. and Zarbock, A. (2015) Pathogenesis of Multiple Organ Failure in Sepsis. Critical ReviewsTM in Immunology, 35, 277-291. https://doi.org/10.1615/CritRevImmunol.2015015461
[5]
Seong, S.-Y., Choi, M.-S. and Kim, I.-S. (2001) Orientia tsutsugamushi Infection: Overview and Immune Responses. Microbes and Infection, 3, 11-21. https://doi.org/10.1016/S1286-4579(00)01352-6
[6]
Xu, G., Walker, D.H., Jupiter, D., Melby, P.C. and Arcari, C.M. (2017) A Review of the Global Epidemiology of Scrub Typhus. PLOS Neglected Tropical Diseases, 11, Article ID: e0006062. https://doi.org/10.1371/journal.pntd.0006062
[7]
Moron, C.G., Popov, V.L., Feng, H.-M., Wear, D. and Walker, D.H. (2001) Identification of the Target Cells of Orientia tsutsugamushi in Human Cases of Scrub Typhus. Modern Pathology, 14, 752-759. https://doi.org/10.1038/modpathol.3880385
[8]
Tseng, B.-Y., Yang, H.-H., Liou, J.-H., Chen, L.-K. and Hsu, Y.-H. (2008) Immunohistochemical Study of Scrub Typhus: A Report of Two Cases. The Kaohsiung Journal of Medical Sciences, 24, 92-98. https://doi.org/10.1016/S1607-551X(08)70103-7
[9]
Rajapakse, S., Weeratunga, P., Sivayoganathan, S. and Fernando, S.D. (2017) Clinical Manifestations of Scrub Typhus. Transactions of the Royal Society of Tropical Medicine and Hygiene, 111, 43-54. https://doi.org/10.1093/trstmh/trx017
[10]
Jeong, Y.J., Kim, S., Wook, Y.D., Lee, J.W., Kim, K.-I. and Lee, S.H. (2007) Scrub Typhus: Clinical, Pathologic, and Imaging Findings. RadioGraphics, 27, 161-172. https://doi.org/10.1148/rg.271065074
[11]
Izumo, T., Yamaguchi, M., Onizawa, S., Kiguchi, T. and Nagai, A. (2008) Severe Case of Tsutsugamushi Disease with Disseminated Intravascular Coagulation and Acute Respiratory Distress Syndrome. Nihon Kokyuki Gakkai Zasshi, 46, 385-389.
[12]
Ono, Y., Ikegami, Y., Tasaki, K., Abe, M. and Tase, C. (2012) Case of Scrub Typhus Complicated by Severe Disseminated Intravascular Coagulation and Death: Scrub Typhus with Disseminated Intravascular Coagulation. Emergency Medicine Australasia, 24, 577-580. https://doi.org/10.1111/j.1742-6723.2012.01600.x
[13]
Jin, Y., Huang, L., Fan, H., Lu, G., Xu, Y. and Wu, Z. (2016) Scrub Typhus Associated with Hemophagocytic Lymphohistiocytosis: A Report of Six Pediatric Patients. Experimental and Therapeutic Medicine, 12, 2729-2734. https://doi.org/10.3892/etm.2016.3668
[14]
Pazhaniyandi, S., Lenin, R. and Sivathanu, S. (2015) Hemophagocytic Lymphohistiocytosis with a Leukemoid reaction In an Infant with Scrub Typhus. Journal of Infection and Public Health, 8, 626-629. https://doi.org/10.1016/j.jiph.2015.05.012
[15]
Kumar, K.J. and Manjunath, V.G. (2011) Persistent Thrombocytopenia Due to Scrub Typhus. Indian Pediatrics, 48, 991.
[16]
Cho, J.H. and Park, D.S. (2009) Incidence and Type of Monoclonal or Biclonal Gammopathies in Scrub Typhus. Korean Journal of Laboratory Medicine, 29, 116-121. https://doi.org/10.3343/kjlm.2009.29.2.116
[17]
Jena, S., Mathew, A., Sanjith, A., Ajith, S., Nair, B. and Prakash, J. (2014) Cerebral Venous Sinus Thrombosis Presentation in Severe Scrub Typhus Infection: A Rare Entity. Neurology India, 62, 301.
