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Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure.
BMC Infect Dis. 2011 Mar 30; 11:79.BI

Abstract

BACKGROUND

Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed.

CASE PRESENTATIONS

We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days.

CONCLUSION

Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.

Authors+Show Affiliations

Intensive Care Unit, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, 00407, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

21450057

Citation

Lee, Bor-Jen, et al. "Otalgia and Eschar in the External Auditory Canal in Scrub Typhus Complicated By Acute Respiratory Distress Syndrome and Multiple Organ Failure." BMC Infectious Diseases, vol. 11, 2011, p. 79.
Lee BJ, Chen CY, Hu SY, et al. Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure. BMC Infect Dis. 2011;11:79.
Lee, B. J., Chen, C. Y., Hu, S. Y., Tsan, Y. T., Lin, T. C., & Wang, L. M. (2011). Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure. BMC Infectious Diseases, 11, 79. https://doi.org/10.1186/1471-2334-11-79
Lee BJ, et al. Otalgia and Eschar in the External Auditory Canal in Scrub Typhus Complicated By Acute Respiratory Distress Syndrome and Multiple Organ Failure. BMC Infect Dis. 2011 Mar 30;11:79. PubMed PMID: 21450057.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure. AU - Lee,Bor-Jen, AU - Chen,Chia-Yi, AU - Hu,Sung-Yuan, AU - Tsan,Yu-Tse, AU - Lin,Tzu-Chieh, AU - Wang,Lee-Min, Y1 - 2011/03/30/ PY - 2010/01/09/received PY - 2011/03/30/accepted PY - 2011/4/1/entrez PY - 2011/4/1/pubmed PY - 2011/8/11/medline SP - 79 EP - 79 JF - BMC infectious diseases JO - BMC Infect Dis VL - 11 N2 - BACKGROUND: Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed. CASE PRESENTATIONS: We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days. CONCLUSION: Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/21450057/Otalgia_and_eschar_in_the_external_auditory_canal_in_scrub_typhus_complicated_by_acute_respiratory_distress_syndrome_and_multiple_organ_failure_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-11-79 DB - PRIME DP - Unbound Medicine ER -