Acute respiratory distress syndrome in scrub typhus.

Abstract

Sir, Scrub typhus, caused by Orientia tsutsugamushi , is transmitted to humans by the bite of the larval stage of thromboculid mites or chiggers. It is distributed widely in the Asia‐Pacific region and is common in some parts of Taiwan. It is an acute febrile illness characterized by a typical primary lesion (eschar), generalized lymphadenopathy, rash, and non‐specific symptoms such as fever, chills, cough, abdominal pain and myalgia. Clinically, the manifestations and complications of scrub typhus are protean. Serious complications are not uncommon and may be fatal if diagnosis is delayed. Complications include myocarditis, meningitis, acute renal failure and interstitial pneumonia.1,3–,5 Acute respiratory distress syndrome (ARDS) is a rarely reported but serious complication of scrub typhus. It is important to know that ARDS may develop in scrub typhus and the possible risk factors, because it is treatable if considered and diagnosed early. From June 1993 to July 1997, among 33 hospitalized patients with scrub typhus, five fulfilled the criteria of ARDS. Scrub typhus was confirmed by either a four‐fold or greater rise of IgG+IgA+IgM titre, for Karp , Kato and Gilliam strains of O. tsutsugamushi , to at least …