Abstract
BackgroundScrub typhus is an acute infectious zoonotic disease caused by Orientia tsutsugamushi. Multi-organ dysfunction secondary to scrub typhus is hard to diagnose and has a high mortality rate. Only one case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia has been reported thus far. In this study, we report a second case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia, and we summarize its diagnosis and treatment.Case presentationA 43-year-old Han Chinese woman, a sanitation worker, was admitted to our hospital after 7 days of a skin infection and 5 days of a sore throat with fever and dizziness. A physical examination revealed the presence of an eschar on the right side of her neck. She had a history of insect bites during her sanitation work. A diagnostic evaluation identified scrub typhus as the primary illness, which was associated with multi-organ dysfunction syndrome and immune thrombocytopenia. She recovered completely after 15 days of treatment and extensive symptomatic supportive care.ConclusionWe report a second case of tsutsugamushi disease with multi-organ dysfunction syndrome and immune thrombocytopenia, which resolved after treatment and extensive care.
Highlights
We report a second case of tsutsugamushi disease with multi-organ dysfunction syndrome and immune thrombocytopenia, which resolved after treatment and extensive care
Scrub typhus is a rickettsial zoonotic disease transmitted by mites and caused by Orientia tsutsugamushi [1]
The original name of scrub typhus, which was given by Hashimoto in 1810, is “tsutsugamushi disease.”
Summary
Scrub typhus is a rickettsial zoonotic disease transmitted by mites and caused by Orientia tsutsugamushi [1]. Laboratory examinations upon admission revealed that hemoglobin was 113 g/L, her platelet count was 21 × 109 platelets/L, and her white cell count was 10.09 × 109 cells/L (8.88 × 109 neutrophils/L, 0.74 × 109 lymphocytes/L, and 0.46 × 109 monocytes/L) Her coagulation function was significantly abnormal, where the prothrombin time was 24.80 (11.00–15.00 seconds), international normalized ratio was 2.25 (0.80–1.20), D-dimer was 12.64 (0–0.50 mg/L), and fibrin degradation products were 52.13 (0–5.00 mg/L), in addition to positive plasma protamine sulfate sub-coagulation results. Imipenem/cilastatin sodium (1 g every 8 hours) was used to treat the infection, and doxycycline (100 mg twice a day) was used to treat scrub typhus She received symptomatic treatment, such as platelet supplementation, liver protection, and acid inhibition. She did not experience any of the initial symptoms again, and all the indicators remained normal during the 3 months
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