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Lee, Shin, Lee, Kwak, Kim, Kim, Sohn, Yoon, Shin, and Park: A Case of Concomitant Scrub Typhus and Leptospirosis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 63(4): 378-381.

Published online: 31 October 2007

DOI: https://doi.org/10.4046/trd.2007.63.4.378

A Case of Concomitant Scrub Typhus and Leptospirosis

Sang-Pyo Lee, M.D., Hyun Jong Shin, M.D., Hee-Kyung Lee, M.D., Hyun Jung Kwak, M.D., Sang-Heon Kim, M.D., Tae-Hyung Kim, M.D., Jang-Wong Sohn, M.D., Ho-Joo Yoon, M.D., Dong-Ho Shin, M.D., Sung-Soo Park, M.D.

Division of Pulmonology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Address for correspondence: Tae-Hyung Kim, M.D. Division of Pulmonology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, 249-1, Kyomun-dong, Guri-city, Gyunggi-do, Korea. Phone: 82-31-560-2240, Fax: 82-31-553-7369, drterry@hanyang.ac.kr

Received 13 September 2007       Accepted 28 September 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Tsutsugamushi disease (Scrub typhus) is an acute, febrile illness caused by Orientia tsutsugamushi, which is transmitted to humans through chigger bites. Leptospirosis, a febrile disease caused by various pathogenic Leptospira, and is acquired by exposure to contaminated water and soil. Both diseases have been the most common acute febrile diseases in the autumn in Korea for many years.
Concomitant leptospirosis and scrub typhus is quite rare. We report a case of a coinfection with leptospirosis and scrub typhus in a 51-year-old male who presented with fever, abdominal pain and acute dyspnea. The patient was diagnosed with as acalculous cholecystitis, acute respiratory distress syndrome, and septic shock caused by the infection. This is the first case report of a coinfection with leptospirosis and scrub typhus in Korea.

Keywords: Leptospirosis, Scrub typhus

Figures and Tables

Figure 1
Chest X-ray on admission reveals diffuse consolidation in the both lung fields and increased interstitial markings in the peripheral lung zones.
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Figure 2
Abdominal ultrasonography shows suspicious parenchymal liver disease(A) and acalculous cholecystitis(B).
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Figure 3
Chest CT shows diffuse ground-glass opacities and compact consolidations in the both lung fields(A & B).
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Figure 4
Diffuse haziness in both lung fields has much improved on the follow-up chest X-ray(taken on the 14th day after treatment).
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References

1. McBride AJ, Athanazio DA, Reis MG, Ko AI. Leptospirosis. Curr Opin Infect Dis. 2005. 18:376–386.
2. Tachibana N, Okayama A. [Tsutsugamushi disease (scrub typhus)]. Nippon Rinsho. 2007. 65:208–211.
3. Jeong YJ, Kim S, Wook YD, Lee JW, Kim KI, Lee SH. Scrub typhus: clinical, pathologic, and imaging findings. Radiographics. 2007. 27:161–172.
4. Wang NC, Ni YH, Peng MY, Chang FY. Acute acalculous cholecystitis and pancreatitis in a patient with concomitant leptospirosis and scrub typhus. J Microbiol Immunol Infect. 2003. 36:285–287.
5. Watt G, Jongsakul K, Suttinont C. Possible scrub typhus coinfections in Thai agricultural workers hospitalized with leptospirosis. Am J Trop Med Hyg. 2003. 68:89–91.
6. Lu PL, Tseng SH. Fatal septicemic melioidosis in a young military person possibly co-infected with Leptospira interrogans and Orientia tsutsugamushi. Kaohsiung J Med Sci. 2005. 21:173–178.
7. Guarner J, Shieh WJ, Morgan J, Bragg SL, Bajani MD, Tappero JW, et al. Leptospirosis mimicking acute cholecystitis among athletes participating in a triathlon. Hum Pathol. 2001. 32:750–752.
8. Monno S, Mizushima Y. Leptospirosis with acute acalculous cholecystitis and pancreatitis. J Clin Gastroenterol. 1993. 16:52–54.
9. Vilaichone RK, Mahachai V, Wilde H. Acute acalculous cholecystitis in leptospirosis. J Clin Gastroenterol. 1999. 29:280–283.
10. Barton LL, Escobedo MB, Keating JP, Ternberg JL. Leptospirosis with acalculous cholecystitis. Am J Dis Child. 1973. 126:350–351.
11. Inaba H, Sugawara Y, Oouchi K, Tomichi N, Sato S, Takikawa Y, et al. [A case of Tsutsugamushi disease complicated with cholecystitis]. Nippon Shokakibyo Gakkai Zasshi. 2004. 101:52–56.
12. Zaltzman M, Kallenbach JM, Goss GD, Lewis M, Zwi S, Gear JH. Adult respiratory distress syndrome in Leptospira canicola infection. Br Med J (Clin Res Ed). 1981. 283:519–520.
13. Ichimura K, Uchida Y, Arai K, Nakazawa K, Sasaki J, Kobayashi K, et al. Afebrile scrub typhus (Tsutsugamushi disease) with acute respiratory distress syndrome. Intern Med. 2002. 41:667–670.
14. Phimda K, Hoontrakul S, Suttinont C, Chareonwat S, Losuwanaluk K, Chueasuwanchai S, et al. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother. 2007. 51:3259–3263.
15. Kim YS, Yun HJ, Shim SK, Koo SH, Kim SY, Kim S. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin Infect Dis. 2004. 39:1329–1335.
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