Life-threatening scrub typhus with meningoencephalitis and acute respiratory distress syndrome
Journal
Journal of the Formosan Medical Association
Journal Volume
96
Journal Issue
3
Pages
213-216
Date Issued
1997
Author(s)
Ferng W.-F.
Wang M.-H.
Hsieh W.-C.
Abstract
A 21-year-old man presented with fever, rash, seizure, stiff neck and rapidly progressive bilateral pulmonary infiltrates. Cerebrospinal fluid (CSF) study revealed pleocytosis with predominant polymorphonuclear cells, and hypo-glycorrhachia. Status epilepticus occurred, followed by acute respiratory distress syndrome with respiratory failure. Blood and CSF cultures for bacteria were negative, but an indirect immunofluorescence assay revealed a fourfold rise in antibody to Rickettsia tsutsugamushi in paried serum and a 1:2560 (+) IgM antibody titer. Severe scrub typhus with meningoencephalitis and extensive pneumonitis was diagnosed. The patient survived after intravenous minocycline therapy and intensive care, including aggressive seizure control, supportive mechanical ventilation and avoidance of fluid overloading. He had a nearly complete recovery. Practicing physicians in Taiwan should be aware of this reportable disease and its potentially serious complications if not promptly diagnosed and treated.
SDGs
Other Subjects
ceftriaxone; minocycline; phenobarbital; adult; adult respiratory distress syndrome; article; artificial ventilation; case report; fever; human; intensive care; intravenous drug administration; male; meningoencephalitis; Orientia tsutsugamushi; pneumonia; rash; scrub typhus; seizure; serodiagnosis; Taiwan; Adult; Humans; Male; Meningoencephalitis; Respiratory Distress Syndrome, Adult; Scrub Typhus
Type
journal article