Infect Chemother.  2012 Dec;44(6):469-472. 10.3947/ic.2012.44.6.469.

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

• Kim KH
• Jung DS
• Kim SY
• Kim B
• Han SH
• Jung EH
• Kim DM
• Lee H

• KMID: 1806935
• DOI: http://doi.org/10.3947/ic.2012.44.6.469

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.

Keyword

Orientia tsutsugamushi; Scrub typhus; Enterocolitis; Genotype

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
Azithromycin
Doxycycline

Figure

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

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

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  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)

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