1/11. Acute respiratory distress syndrome associated with scrub typhus: diffuse alveolar damage without pulmonary vasculitis.Pathologic findings of scrub typhus have been characterized by vasculitis of the microvasculature of the involved organ resulting from a direct invasion by orientia tsutsugamushi. We experienced a case of acute respiratory distress syndrome (ARDS) associated with scrub typhus. The case was proven by eschar and high titer of serum IgM antibody (positive at 1:1280). Open lung biopsy showed diffuse alveolar damage (DAD) in the organizing stage without evidence of vasculitis. Immunofluorescent antibody staining and polymerase chain reaction for O. tsutsugamushi failed to demonstrate the organism in the lung tissue. The patient expired due to progressive respiratory failure despite doxycycline therapy. Immunologic mechanism, without direct invasion of the organism, may participate in the pathogenesis of ARDS associated with scrub typhus.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/11. multiple organ failure complicating probable scrub typhus.This report describes a case of life-threatening acute respiratory distress syndrome with multiple organ failure complicating probable scrub typhus. Favorable outcome was associated with fluoroquinolone therapy. scrub typhus should be suspected in travelers returning from Southeast asia presenting with unexplained respiratory manifestations.- - - - - - - - - - ranking = 1.25keywords = organ (Clic here for more details about this article) |
3/11. scrub typhus encephalomyelitis with prominent focal neurologic signs.BACKGROUND: encephalomyelitis with prominent focal neurologic signs and associated neuroradiologic abnormalities has not been previously described in scrub typhus. CASE DESCRIPTION: A 22-year-old woman was admitted because of fever and an altered mental state. neurologic examination revealed bilateral sixth and seventh nerve palsies, bilateral gaze evoked nystagmus, anarthria, dysphagia, quadriparesis, and sensory level at T1. serum and cerebrospinal fluid samples were positive for tsutsugamushi antibody. The patient's magnetic resonance images demonstrated the lesions responsible for the neurologic dysfunctions: in the lower brainstem, cerebellar peduncles, and spinal cord. It was interesting that the gray matter of the spinal cord was predominantly involved. CONCLUSIONS: The recognition of unusual manifestations and the clinical suspicion of this treatment-responsive disease may be important, particularly in the face of increasing international and intranational travel.- - - - - - - - - - ranking = 0.036480070565531keywords = nerve (Clic here for more details about this article) |
4/11. Identification of the target cells of orientia tsutsugamushi in human cases of scrub typhus.orientia tsutsugamushi is the etiologic agent of scrub typhus, a chigger-borne zoonosis that is a highly prevalent, life-threatening illness of greatest public health importance in tropical asia and the islands of the western pacific ocean. The target cell of this bacterium is poorly defined in humans. In this study, O. tsutsugamushi were identified by immunohistochemistry using a rabbit polyclonal antibody raised against O. tsutsugamushi Karp strain in paraffin-embedded archived autopsy tissues of three patients with clinical suspicion of scrub typhus who died during world war ii and the vietnam War. Rickettsiae were located in endothelial cells in all of the organs evaluated, namely heart, lung, brain, kidney, pancreas, and skin, and within cardiac muscle cells and in macrophages located in liver and spleen. Electron microscopy confirmed the location of rickettsiae in endothelium and cardiac myocytes.- - - - - - - - - - ranking = 0.25keywords = organ (Clic here for more details about this article) |
5/11. scrub typhus: a frequently overlooked cause of acute renal failure.Acute renal failure associated with scrub typhus infection is not rare as previously thought. The possibility of scrub typhus should be borne in mind when patients present with fever and varying degrees of acute renal failure, particularly if an eschar exists, along with a history of environmental exposure in an area like taiwan, where scrub typhus is endemic. Prompt diagnosis and the use of appropriate antibiotics can rapidly alter the clinical course of the disease and prevent the development of serious or fatal complications. To illustrate the above point, this study reports 3 cases of scrub typhus associated with acute renal failure. They were seen at Chang Gung Memorial Hospital in a 2-year interval. Case 1 was referred from district hospital with clinical features of multiple organ dysfunctions, including shock, fever, acute respiratory failure, acute renal failure, and acute hepatitis. Case 2 was admitted with the chief problems of shock, fever, acute renal failure, and DIC. Case 3 visited our outpatient clinic due to fever, maculopapular rash and acute renal failure. In all these patients, the diagnosis was confirmed using immunofluorescence techniques, which showed that orientia tsutsugamushi had an IgM titer of 1:80 or greater. Notably, despite having varying degrees of acute renal deterioration, the patients responded very well to doxycycline therapy and recovered completely. Additionally, a total of 4 similar cases of scrub typhus associated with acute renal failure were reviewed from the past literature.- - - - - - - - - - ranking = 0.25keywords = organ (Clic here for more details about this article) |
6/11. Rickettsial meningitis and encephalitis.Nine of 72 patients with scrub typhus and three of 137 with murine typhus presented with meningitis and/or encephalitis syndromes. Focal neurologic signs were rare, and cerebrospinal fluid profiles were similar to those of leptospirosis and viral and tuberculous meningitis. One patient had papilledema, and another had cerebellitis. Other major organ involvement (renal, liver, or lungs) occurred in five patients. One patient died and four spontaneously recovered, while the conditions of the rest responded well to either chloramphenicol or doxycycline. Scrub and murine typhus should be included in the differential diagnoses of aseptic meningitis and encephalitis in patients exposed to endemic areas, especially when accompanied by renal insufficiency and/or jaundice. They are treatable forms of virallike meningoencephalitis.- - - - - - - - - - ranking = 0.25keywords = organ (Clic here for more details about this article) |
7/11. life-threatening scrub typhus in a traveler returning from thailand.scrub typhus is not one of the more commonly encountered diseases in travelers returning from asia, but it deserves more consideration in view of its severity and the availability of specific chemotherapy and chemoprophylaxis. We describe a case of scrub typhus that was associated with coma and multiorgan failure in a traveler returning to the united states from thailand. The diagnosis was made only retrospectively despite a travel history and clinical signs that suggested infection with rickettsia tsutsugamushi. No specific therapy was given, and marked neurological impairment persisted 6 months after the beginning of the illness. An increased awareness of scrub typhus is a prerequisite for recommending prophylaxis and instituting prompt therapy.- - - - - - - - - - ranking = 0.25keywords = organ (Clic here for more details about this article) |
8/11. scrub typhus complicating acute respiratory distress syndrome: a report of two cases.scrub typhus is a zoonotic disease, caused by rickettsia tsutsugamushi, in which humans are accidental hosts. Although it is an acute febrile illness, severe complications of this disease are very rare since the introduction of specific antibiotic therapy. The authors report two cases of scrub typhus complicating acute respiratory distress syndrome. The first case progressed to multiple organ failure, and the patient expired. In the second case, the patient recovered and was discharged. These two cases were proved to be scrub typhus by their travel history or their having lived in endemic area, clinical manifestations, an eschar and indirect immunofluorescent antibody test. For a good prognosis, early diagnosis and early treatment of this disease are important.- - - - - - - - - - ranking = 0.25keywords = organ (Clic here for more details about this article) |
9/11. Isolation of a new orientia tsutsugamushi serotype.orientia tsutsugamushi, the etiological agent of scrub typhus, is an antigenically diverse organism and many serologically distinct strains have been identified. The 56 kDa protein of O. tsutsugamushi, a major protein in the outer membrane, has been thought to be responsible for this antigenic variability. A strain of O. tsutsugamushi isolated in korea cross-reacted with both Gilliam strain-specific and Karp strain-specific monoclonal antibodies. When its 56 kDa protein gene was cloned and analyzed, its sequence showed variation especially between 1,200 and 1,250 bp, showing that this isolate is a new O. tsutsugamushi strain.- - - - - - - - - - ranking = 0.25keywords = organ (Clic here for more details about this article) |
10/11. scrub typhus associated with multiorgan failure: a case report.The spectrum of clinical severity for scrub typhus ranges from inapparent, mild, to severe or fatal. The pathologic changes are focal or disseminated multiorgan vasculitis of the small blood vessels, a fact that helps explain the great diversity of clinical manifestations that can be encountered. We reported a case of scrub typhus with unusual and serious multiorgan involvement, including tubulointerstitial nephritis (tin) with acute renal failure (ARF), interstitial pneumonitis with adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), liver function impairment, upper gastrointestinal bleeding, prolonged hyperamylasaemia and hyperlipasaemia. chloramphenicol administration rapidly altered the clinical course, but with sequelae of renal impairment and prolonged hyperamylasaemia and hyperlipasaemia for 10 months.- - - - - - - - - - ranking = 1.5keywords = organ (Clic here for more details about this article) |
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