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

Kyung Han Kim; Dong Sik Jung; Su Young Kim; Bosung Kim; Seung-Hee Han; Eui Han Jung; Dong-Min Kim; Hyuck Lee

doi:10.3947/ic.2012.44.6.469

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Kim, Jung, Kim, Kim, Han, Jung, Kim, and Lee: Severe Scrub Typhus with Enterocolitis by the Ikeda Strain of Orientia tsutsugamushi

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2012; 44(6): 469-472.

Published online: 31 December 2012

DOI: https://doi.org/10.3947/ic.2012.44.6.469

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

Kyung Han Kim¹, Dong Sik Jung¹, Su Young Kim¹, Bosung Kim¹, Seung-Hee Han¹, Eui Han Jung¹, Dong-Min Kim², 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, dsjung@dau.ac.kr

Received 22 March 2012 Revised 16 November 2012 Accepted 3 December 2012

(open-access):

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 and Tables

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)

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