Case Report: Coinfection with Rickettsia monacensis and Orientia tsutsugamushi

Seok Won Kim Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Republic of Korea;

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Choon-Mee Kim Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea;

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Dong-Min Kim Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Na Ra Yun Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Rickettsia monacensis and Orientia tsutsugamushi are bacteria of the family Rickettsiaceae, which causes fever, rash, and eschar formation; outdoor activities are a risk factor for Rickettsiaceae infection. A 75-year-old woman presented with fever, rash, and eschar and was confirmed as being scrub typhus based on a nested-polymerase chain reaction (N-PCR) test for a 56-kDa gene of O. tsutsugamushi; the genome was identified as the Boryong genotype. In addition, a pan-Rickettsia real-time PCR test was positive and a N-PCR test using a Rickettsia-specific partial outer membrane protein A (rOmpA) confirmed R. monacensis. This is the first case wherein a patient suspected of having scrub typhus owing to the presence of rash and eschar was also found to be coinfected with O. tsutsugamushi and R. monacensis based on molecular testing.

Author Notes

Address correspondence to Dong-Min Kim, Department of Internal Medicine, School of Medicine, Chosun University, 588 Seosuk-dong, Dong-gu, Gwangju 501-717, Republic of Korea. E-mail: drongkim@chosun.ac.kr

Financial support: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2016R1D1A1B03930956).

Disclosure: The authors do not have any commercial interests or other associations that might pose a conflict of interest.

Authors’ addresses: Seok Won Kim, Chosun University College of Medicine, Departments of Neurosurgery Chosun University College of Medicine, Gwangju, Republic of Korea, E-mail: chosunns@chosun.ac.kr. Choon-Mee Kim, College of Medicine, Premedical Science, Gwangju, Republic of Korea, E-mail: choonmee@chosun.ac.kr. Dong-Min Kim and Na Ra Yun, Chosun University College of Medicine, Departments of Internal Medicine Chosun University College of Medicine, Gwang-Ju, Republic of Korea, E-mails: drongkim@chosun.ac.kr and shine@chosun.ac.kr.

These authors contributed equally to this work.

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