{"title":"从感染到诊断:一名返程旅客感染恙虫病致多器官功能衰竭1例报告。","authors":"Patrick Eaton, Ahmed Ahmed, Emyr Huws","doi":"10.1016/j.clinme.2025.100307","DOIUrl":null,"url":null,"abstract":"<p><p>Scrub typhus, caused by Orientia tsutsugamushi, is a rickettsial infection transmitted by mite bites, often underdiagnosed in travellers from endemic regions. This case report describes a 65-year-old female with hypertension who developed severe scrub typhus after a trip to Sri Lanka. She presented with fever, myalgia, headache, fatigue and a scabbed lesion. Initial tests showed neutrophilia, lymphocytopenia and elevated liver enzymes. Malaria was ruled out, and empiric treatment with intravenous Tazocin was initiated. On day 5, she developed Clostridium difficile infection, requiring a switch to oral vancomycin. By day 5, her condition worsened with hypoxia, hypotension, oliguria and renal failure. Chest X-ray revealed bilateral infiltrates and subsequently, she was transferred to critical care. Tests showed positive IgM test for O. tsutsugamushi. Oral doxycycline was started, resulting in rapid improvement. PCR confirmed scrub typhus. This case underscores the importance of early diagnosis and treatment with doxycycline in travellers from endemic areas presenting with febrile illness.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100307"},"PeriodicalIF":3.6000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083904/pdf/","citationCount":"0","resultStr":"{\"title\":\"From eschar to diagnosis: A case report on scrub typhus causing multi-organ failure in a returning traveller.\",\"authors\":\"Patrick Eaton, Ahmed Ahmed, Emyr Huws\",\"doi\":\"10.1016/j.clinme.2025.100307\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Scrub typhus, caused by Orientia tsutsugamushi, is a rickettsial infection transmitted by mite bites, often underdiagnosed in travellers from endemic regions. This case report describes a 65-year-old female with hypertension who developed severe scrub typhus after a trip to Sri Lanka. She presented with fever, myalgia, headache, fatigue and a scabbed lesion. Initial tests showed neutrophilia, lymphocytopenia and elevated liver enzymes. Malaria was ruled out, and empiric treatment with intravenous Tazocin was initiated. On day 5, she developed Clostridium difficile infection, requiring a switch to oral vancomycin. By day 5, her condition worsened with hypoxia, hypotension, oliguria and renal failure. Chest X-ray revealed bilateral infiltrates and subsequently, she was transferred to critical care. Tests showed positive IgM test for O. tsutsugamushi. Oral doxycycline was started, resulting in rapid improvement. PCR confirmed scrub typhus. This case underscores the importance of early diagnosis and treatment with doxycycline in travellers from endemic areas presenting with febrile illness.</p>\",\"PeriodicalId\":10492,\"journal\":{\"name\":\"Clinical Medicine\",\"volume\":\" \",\"pages\":\"100307\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083904/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.clinme.2025.100307\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.clinme.2025.100307","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
From eschar to diagnosis: A case report on scrub typhus causing multi-organ failure in a returning traveller.
Scrub typhus, caused by Orientia tsutsugamushi, is a rickettsial infection transmitted by mite bites, often underdiagnosed in travellers from endemic regions. This case report describes a 65-year-old female with hypertension who developed severe scrub typhus after a trip to Sri Lanka. She presented with fever, myalgia, headache, fatigue and a scabbed lesion. Initial tests showed neutrophilia, lymphocytopenia and elevated liver enzymes. Malaria was ruled out, and empiric treatment with intravenous Tazocin was initiated. On day 5, she developed Clostridium difficile infection, requiring a switch to oral vancomycin. By day 5, her condition worsened with hypoxia, hypotension, oliguria and renal failure. Chest X-ray revealed bilateral infiltrates and subsequently, she was transferred to critical care. Tests showed positive IgM test for O. tsutsugamushi. Oral doxycycline was started, resulting in rapid improvement. PCR confirmed scrub typhus. This case underscores the importance of early diagnosis and treatment with doxycycline in travellers from endemic areas presenting with febrile illness.
期刊介绍:
Clinical Medicine is aimed at practising physicians in the UK and overseas and has relevance to all those managing or working within the healthcare sector.
Available in print and online, the journal seeks to encourage high standards of medical care by promoting good clinical practice through original research, review and comment. The journal also includes a dedicated continuing medical education (CME) section in each issue. This presents the latest advances in a chosen specialty, with self-assessment questions at the end of each topic enabling CPD accreditation to be acquired.
ISSN: 1470-2118 E-ISSN: 1473-4893 Frequency: 6 issues per year