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    An eschar in a 22-year-old man.

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    Generalized lymphadenopathy and hypermetabolism in the spleen of a 22-year-old man with scrub typhus. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) image before (A and C) and after (B and D) treatment. Fluorodeoxyglucose PET/CT image shows a FDG uptake on the eschar lesion (arrow).

  • 1.

    Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, Yoo HS, Park O, 2009. Rapid increase of scrub typhus, South Korea, 2001–2006. Emerg Infect Dis 15: 11271129.

    • Search Google Scholar
    • Export Citation
  • 2.

    Paris DH 2012. Orientia tsutsugamushi in human scrub typhus eschars shows tropism for dendritic cells and monocytes rather than endothelium. PLoS Negl Trop Dis 6: e1466.

    • Search Google Scholar
    • Export Citation
  • 3.

    Choi JH 2013. Orientia tsutsugamushi subverts dendritic cell functions by escaping from autophagy and impairing their migration. PLoS Negl Trop Dis 7: e1981.

    • Search Google Scholar
    • Export Citation
  • 4.

    Sunyakumthorn P 2013. An intradermal inoculation model of scrub typhus in Swiss CD-1 mice demonstrates more rapid dissemination of virulent strains of Orientia tsutsugamushi. PLoS One 8: e54570.

    • Search Google Scholar
    • Export Citation

 

 

 

 

Dissemination of Orientia tsutsugamushi in a Case of Scrub Typhus

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  • 1 Department of Nuclear Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea;
  • 2 Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea;
  • 3 Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea;
  • 4 Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea

A 22-year-old man presented to the emergency room with fever, chills, headache, and skin rash that developed 7 days before. On physical examination, an eschar was observed on the left upper buttock (Figure 1). On F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), FDG uptake was increased in the left upper buttock at the eschar site. Lymphadenopathy was observed in cervical, supraclavicular, axillary, mediastinum, intraperitoneal, retroperitoneal, iliac chain, and inguinal areas. Hepatosplenomegaly and hypermetabolism in the spleen were also observed (Figure 2A and C). Follow-up F-18 FDG PET/CT was taken around 3 weeks after antibiotic treatment. Fluorodeoxyglucose uptake was dramatically decreased in the eschar, lymph nodes, and spleen after treatment (Figure 2B and D).

Figure 1.
Figure 1.

An eschar in a 22-year-old man.

Citation: The American Journal of Tropical Medicine and Hygiene 100, 2; 10.4269/ajtmh.18-0689

Figure 2.
Figure 2.

Generalized lymphadenopathy and hypermetabolism in the spleen of a 22-year-old man with scrub typhus. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) image before (A and C) and after (B and D) treatment. Fluorodeoxyglucose PET/CT image shows a FDG uptake on the eschar lesion (arrow).

Citation: The American Journal of Tropical Medicine and Hygiene 100, 2; 10.4269/ajtmh.18-0689

A diagnosis of scrub typhus was confirmed by an increase in the indirect immunofluorescent antibody titer of 1:640. Nucleotide sequencing of a 56-kDa protein-encoding gene obtained from peripheral blood mononuclear cells was performed, and revealed the Orientia tsutsugamushi Boryong strain. Oral doxycycline 100 mg twice daily was administered for 7 days. The clinical course improved and the patient was stable 2 months after discharge.

Scrub typhus is the most common rickettsial disease in Korea and it occurs mainly in October and November.1 Orientia tsutsugamushi is the causative agent of scrub typhus and has tropism for dendritic cells and monocytes rather than endothelial cells.2 The infected dendritic cells and macrophages migrate from peripheral tissues via afferent lymphatic vessels into draining lymph nodes where they prime antigen-specific naive T cells.3,4 F-18 FDG PET/CT imaging showed the specific findings of scrub typhus as hypermetabolic eschar, lymphadenopathy, and splenomegaly. These findings could provide useful information for early diagnosis, and clinical response after treatments.

REFERENCES

  • 1.

    Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, Yoo HS, Park O, 2009. Rapid increase of scrub typhus, South Korea, 2001–2006. Emerg Infect Dis 15: 11271129.

    • Search Google Scholar
    • Export Citation
  • 2.

    Paris DH 2012. Orientia tsutsugamushi in human scrub typhus eschars shows tropism for dendritic cells and monocytes rather than endothelium. PLoS Negl Trop Dis 6: e1466.

    • Search Google Scholar
    • Export Citation
  • 3.

    Choi JH 2013. Orientia tsutsugamushi subverts dendritic cell functions by escaping from autophagy and impairing their migration. PLoS Negl Trop Dis 7: e1981.

    • Search Google Scholar
    • Export Citation
  • 4.

    Sunyakumthorn P 2013. An intradermal inoculation model of scrub typhus in Swiss CD-1 mice demonstrates more rapid dissemination of virulent strains of Orientia tsutsugamushi. PLoS One 8: e54570.

    • Search Google Scholar
    • Export Citation

Author Notes

Address correspondence to Chang-Seop Lee, Department of Internal Medicine, Chonbuk National University Medical School, 567 Baekje-daero, Deokjin-gu, Jeonju 54907, Republic of Korea. E-mail: lcsmd@jbnu.ac.kr

Financial support: This research was supported with research funds from Chonbuk National University in 2018, and by Biomedical Research Institute, Chonbuk National University Hospital, and by the Basic Science Research Programs (NRF-2015R1D1A1A01060251 and 2018R1D1A3B07049557) of the National Research Foundation of Korea, which are funded by the Ministry of Education.

Authors’ addresses: Yeon-Hee Han, Department of Nuclear Medicine, Chonbuk National University, Jeonju, Jeollabuk-do, Republic of Korea, E-mail: yani0878@hanmail.net. Joo-Hee Hwang, Department of Internal Medicine, Chonbuk National University, Jeonju, Jeollabuk-do, Republic of Korea, E-mail: zany78@naver.com. Chang-Seop Lee, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea, E-mail: lcsmd@jbnu.ac.kr.

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