pISSN 2093-2340   eISSN 2092-6448
Indexed in ESCI, PubMed, Scopus, DOAJ and more
Open Access, Peer-reviewed
    Infect Chemother. 2012 Dec;44(6):469-472. Korean.
    Published online Dec 31, 2012.
    https://doi.org/10.3947/ic.2012.44.6.469
    Copyright © 2012 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
    Case Report

    Severe Scrub Typhus with Enterocolitis by the Ikeda Strain of Orientia tsutsugamushi

    Kyung Han Kim,1 Dong Sik Jung,1 Su Young Kim,1 Bosung Kim,1 Seung-Hee Han,1 Eui Han Jung,1 Dong-Min Kim,2 and Hyuck Lee1
      • 1Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
      • 2Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea.
    • Correspondence to Dong Sik Jung. Department of Internal Medicine, Dong-A University College of Medicine, 1 3-ga dongdaeshin-dong, Busan 602-715, Korea. Tel: +82-51-240-5047, Fax: +82-51-242-5852, Email: dsjung@dau.ac.kr
    Received March 22, 2012; Revised November 16, 2012; Accepted December 03, 2012.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Scrub typhus is a mite-borne bacterial infection of humans that is caused by Orientia tsutsugamushi, which causes generalized vasculitis. The disease may involve the tissues of any organ system but no case with involvement of the lower gastrointestinal tract has been reported. We report a case of a 39-year old Korean male with enterocolitis of severe scrub typhus, of which the serotype was Ikeda strain. The patient was admitted to hospital with fever, abdominal pain and shock. He developed multi organ failure and frequent watery diarrhea. Abdominal computed tomography revealed diffuse edematous thickening of the entire small and colon with inflammation. Three days after admission, the antibody to O. tsutsugamushi was reported to be 1:320. He improved with doxycycline and azithromycin, and the persistent watery diarrhea stopped at 24 hours. This study shows that scrub typhus should be considered when the small and large intestine are affected. For the genotype of O. tsutsugamushi in Korea, additional studies of the impact of changes in the vector distribution on the genotype distribution will be needed.

    Keywords
    Orientia tsutsugamushi; Scrub typhus; Enterocolitis; Genotype

    Figures

    Figure 1
    Abdominal CT scan showed diffuse edematous thickening of whole small bowel (white arrow) and colon with infammation (black arrow).

    Figure 2
    1×0.5 cm sized dark brown-colored eschar is shown in the right axillary area.

    Figure 3
    Gel electrophoresis of amplified DNAs by nested polymerase chain reaction of white cell buffy coat, which purified whole blood taken on day 4 showed band of 483 bp.

    M, 100bp DNA ladder; N, negative control; P, positive control; S, sample(pt)

    References

      1. Ogawa M, Hagiwara T, Kishimoto T, Shiga S, Yoshida Y, Furuya Y, Kaiho I, Ito T, Nemoto H, Yamamoto N, Masukawa K. Scrub typhus in Japan: epidemiology and clinical features of cases reported in 1998. Am J Trop Med Hyg 2002;67:162–165.
      1. Kim DM, Kim SW, Choi SH, Yun NR. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis 2010;10:108.
      1. Kim SJ, Chung IK, Chung IS, Song DH, Park SH, Kim HS, Lee MH. The clinical significance of upper gastrointestinal endoscopy in gastrointestinal vasculitis related to scrub typhus. Endoscopy 2000;32:950–955.
      1. Hwang JH, Lee CS. Risk Factors Leading to Fatal Outcome in Scrub Typhus. JK Sci 2010;12:67–69.
      1. Lee YM, Kim DM, Lee SH, Jang MS, Neupane GP. Phylogenetic analysis of the 56 kDa protein genes of Orientia tsutsugamushi in southwest area of Korea. Am J Trop Med Hyg 2011;84:250–254.
      1. Kim DM. Clinical features and diagnosis of scrub typhus. Infect Chemother 2009;41:315–322.
      1. Lee N, Ip M, Wong B, Lui G, Tsang OT, Lai JY, Choi KW, Lam R, Ng TK, Ho J, Chan YY, Cockram CS, Lai ST. Risk factors associated with life-threatening rickettsial infections. Am J Trop Med Hyg 2008;78:973–978.
      1. Balthazar EJ. CT of the gastrointestinal tract: principles and interpretation. AJR Am J Roentgenol 1991;156:23–32.
      1. Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 2001;176:1105–1116.
      1. Nakayama K, Kurokawa K, Fukuhara M, Urakami H, Yamamoto S, Yamazaki K, Ogura Y, Ooka T, Hayashi T. Genome comparison and phylogenetic analysis of Orientia tsutsugamushi strains. DNA Res 2010;17:281–291.
      1. Kim ES, Kim MK, Lee HM, Kil SH, Chung MH, Lee JS, Kang JS. Doxycycline resistance in Orientia tsutsugamushi isolated from Korean patients. Infect Chemother 2008;40:259–265.
      1. Joo K, Kim MK, Kil SH, Chung MH, Kim JM, Kang JS. Cholestatic hepatitis caused by Tongyeong strain of Orientia tsutsugamushi. Infect Chemother 2009;41:99–104.
      1. Park SW, Lee CK, Kwak YG, Moon C, Kim BN, Kim ES, Kang JM, Lee CS. Antigenic drift of Orientia tsutsugamushi in South Korea as identified by the sequence analysis of a 56-kDa protein-encoding gene. Am J Trop Med Hyg 2010;83:930–935.
      1. Nakayama K, Yamashita A, Kurokawa K, Morimoto T, Ogawa M, Fukuhara M, Urakami H, Ohnishi M, Uchiyama I, Ogura Y, Ooka T, Oshima K, Tamura A, Hattori M, Hayashi T. The Whole-genome sequencing of the obligate intracellular bacterium Orientia tsutsugamushi revealed massive gene amplification during reductive genome evolution. DNA Res 2008;15:185–199.
      1. Kelly DJ, Fuerst PA, Ching WM, Richards AL. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis 2009;48 Suppl 3:S203–S230.
    Cited by
    Crossref 1
    Google Scholar 
    MeSH Terms
    Abdominal Pain
    Azithromycin
    Bacterial Infections
    Colon
    Diarrhea
    Doxycycline
    Enterocolitis
    Fever
    Genotype
    Humans
    Inflammation
    Intestine, Large
    Korea
    Lower Gastrointestinal Tract
    Male
    Orientia tsutsugamushi
    Scrub Typhus
    Shock
    Sprains and Strains
    Vasculitis
    Metrics
    Share
    Figures
    slide
    slide
    slide

    1 / 3

    PERMALINK