Successful diagnosis and treatment of scrub typhus associated with haemophagocytic lymphohistiocytosis and multiple organ dysfunction syndrome: A case report and literature review

Abstract

Scrub typhus is a natural foci disease caused by the bacteria Orientia tsutsugamushi. Symptoms of the disease range from fever to severe multiple organ dysfunction. The diagnosis is based on clinical signs and antibody serological tests, which has poor sensitivity and specificity. Scrub typhus is rarely associated with multiple organ dysfunction syndrome (MODS) and haemophagocytic lymphohistiocytosis (HLH). In this paper, we report a 17-year-old Asian male who was characterized with a persistent fever without eschar. He was diagnosed with scrub typhus using metagenomic next-generation sequencing (mNGS) of the blood after negative of routine examinations. The patient was progressed to HLH and MODS but had a good recovery following anti-rickettsial therapy, dexamethasone, and advanced life support. Besides, we present a brief overview of the literature about scrub typhus and associated complications.

Keywords

• Orientia tsutsugamushi
• Haemophagocytic lymphohistiocytosis
• Tsutsugamushi disease
• Scrub typhus
• Next-generation sequencing (NGS)
• Multiple organ dysfunction syndrome