Kosin Med J.  2023 Sep;38(3):224-228. 10.7180/kmj.23.114.

Scrub typhus infection in a kidney transplant recipient: a case report

• Lee D
• Jeon J
• Ahn JS
• Baek CH

• KMID: 2546159
• DOI: http://doi.org/10.7180/kmj.23.114

Abstract

Scrub typhus is a febrile disease that is endemic to Asia and the Pacific region. Its clinical manifestations include fever, myalgia, lymphadenopathy, and a characteristic eschar. The main manifestations of this disease are difficult to differentiate from those of other febrile illnesses; thus, a careful clinical examination and a high index of suspicion are crucial for an early diagnosis. Our case involved a 55-year-old female renal transplant recipient who presented with fever and sore throat in November. Her clinical symptoms did not improve after oral amoxicillin/clavulanate administration for 7 days, after which proteinuria and acute kidney injury were identified. After hospitalization, an eschar was found and immunoglobulin M antibodies against Orientia tsutsugamushi were detected by indirect immunofluorescence. She received oral doxycycline for 7 days and showed improvement in renal function and proteinuria. This is the first case report of scrub typhus infection in a kidney transplant patient in Korea. It is meaningful to report that the renal abnormalities associated with scrub typhus improved in a renal transplant patient through treatment of the disease. This case highlights the importance of examining the social history and symptoms of patients suspected of having scrub typhus in endemic areas. Early diagnosis and treatment are crucial in kidney transplant patients to preserve graft function and prevent fatal complications.

Keyword

Acute kidney injury; Case reports; Kidney transplantation; Proteinuria; Scrub typhus

Figure

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  Fig. 1. Clinical photograph showing an eschar on the patient’s anterior chest.

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  Fig. 2. Change in serum creatinine levels and proteinuria. ER, emergency room.

Reference

References

1. Luce-Fedrow A, Lehman ML, Kelly DJ, Mullins K, Maina AN, Stewart RL, et al. A review of scrub typhus (Orientia tsutsugamushi and related organisms): then, now, and tomorrow. Trop Med Infect Dis. 2018; 3:8.

2. Kim DM. Clinical features and diagnosis of scrub typhus. Infect Chemother. 2019; 41:315–22.

3. Peter JV, Sudarsan TI, Prakash JA, Varghese GM. Severe scrub typhus infection: clinical features, diagnostic challenges and management. World J Crit Care Med. 2015; 4:244–50.

4. Hwang K, Jang HN, Lee TW, Cho HS, Bae E, Chang SH, et al. Incidence, risk factors and clinical outcomes of acute kidney injury associated with scrub typhus: a retrospective study of 510 consecutive patients in South Korea (2001-2013). BMJ Open. 2017; 7:e013882.

5. Yoo JS, Kim D, Choi HY, Yoo S, Hwang JH, Hwang JH, et al. Prevalence rate and distribution of eschar in patients with scrub typhus. Am J Trop Med Hyg. 2022; 106:1358–62.

6. Korea Disease Control and Prevention Agency (KDCA). Clinical practice guidelines for tick and rodent-borne diseases [Internet]. KDCA;c2021. [cited 2023 Jan 14]. https://kdca.go.kr/board/board.es?mid=a20507020000&bid=0019&act=view&list_no=713673.

7. Kim YJ, Park S, Premaratna R, Selvaraj S, Park SJ, Kim S, et al. Clinical evaluation of rapid diagnostic test kit for scrub typhus with improved performance. J Korean Med Sci. 2016; 31:1190–6.

8. Attur RP, Kuppasamy S, Bairy M, Nagaraju SP, Pammidi NR, Kamath V, et al. Acute kidney injury in scrub typhus. Clin Exp Nephrol. 2013; 17:725–9.

9. Basu G, Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, et al. Acute kidney injury in tropical acute febrile illness in a tertiary care centre: RIFLE criteria validation. Nephrol Dial Transplant. 2011; 26:524–31.

10. Yen TH, Chang CT, Lin JL, Jiang JR, Lee KF. Scrub typhus: a frequently overlooked cause of acute renal failure. Ren Fail. 2003; 25:397–410.

11. Kim DY, Park HS, Han DJ, Kang HC, Lee JH, Jang WJ, et al. A case of scrub typhus requiring maintenance hemodialysis. Kidney Res Clin Pract. 2013; 32:190–3.

12. Dhanapriya J, Dineshkumar T, Sakthirajan R, Murugan S, Jayaprakash V, Balasubramaniyan T, et al. Scrub typhus meningitis in a renal transplant recipient. Indian J Nephrol. 2017; 27:151–3.

13. Thakur CK, Batra P, Vinayaraj EV, Sreenath K, Rathor N, Singh UB, et al. Scrub typhus in two COVID-19 patients: a diagnostic dilemma. Future Microbiol. 2022; 17:161–7.