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mNGS helped diagnose scrub typhus presenting as a urinary tract infection with high D-dimer levels: a case report.
BMC Infect Dis. 2021 Dec 07; 21(1):1219.BI

Abstract

BACKGROUND

Scrub typhus is caused by O. tsutsugamushi and spreads through mite larvae biting the skin. Classic symptoms of the disease are eschar and lymphadenopathy. Previous reports have revealed clinical manifestations of scrub typhus, including gastrointestinal symptoms, meningoencephalitis, ocular flutter, pneumonitis, acute respiratory distress syndrome, and acute kidney injury. However, cases of scrub typhus presenting as a urinary tract infection (UTI) with high D-dimer levels could be easily misdiagnosed when clinical attention is insufficient, resulting in difficulty in making a timely diagnosis of the infection. Metagenomics next-generation sequencing (mNGS) is a revolutionary and highly sensitive method that may help in diagnosing atypical cases, even when trace amounts of pathogens are present.

CASE PRESENTATION

A 52-year-old female presented with a 10-day history of fever, chills, headache and myalgia. She was initially diagnosed with influenza at a local clinic. Various antibacterials were used on the 2nd-12th day onwards; however, her symptoms persisted and were followed by increased urination duration, frequency, urgency and dysuria for 2 days. Orientia tsutsugamushi was confirmed as the pathogen responsible for the infection through mNGS analysis of her blood samples from Day 13 onwards. The patient's temperature changed remarkably 24 h after the initiation of doxycycline. Over the next 48 h (i.e., Day 15 onwards), the patient showed clinical improvement. She recovered and was discharged from the hospital.

CONCLUSIONS

Scrub typhus can present atypical clinical symptoms, such as UTIs, in a febrile patient. mNGS may be a useful method for identifying O. tsutsugamushi infection in patients with atypical clinical manifestations.

Authors+Show Affiliations

Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China.Department of Emergency, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China.Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China.Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China. WLGME196412@126.com.Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China. zhaoruisc@163.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

34876034

Citation

Liu, Mei-Fang, et al. "MNGS Helped Diagnose Scrub Typhus Presenting as a Urinary Tract Infection With High D-dimer Levels: a Case Report." BMC Infectious Diseases, vol. 21, no. 1, 2021, p. 1219.
Liu MF, Liu Y, Xu DR, et al. MNGS helped diagnose scrub typhus presenting as a urinary tract infection with high D-dimer levels: a case report. BMC Infect Dis. 2021;21(1):1219.
Liu, M. F., Liu, Y., Xu, D. R., Wan, L. G., & Zhao, R. (2021). MNGS helped diagnose scrub typhus presenting as a urinary tract infection with high D-dimer levels: a case report. BMC Infectious Diseases, 21(1), 1219. https://doi.org/10.1186/s12879-021-06889-9
Liu MF, et al. MNGS Helped Diagnose Scrub Typhus Presenting as a Urinary Tract Infection With High D-dimer Levels: a Case Report. BMC Infect Dis. 2021 Dec 7;21(1):1219. PubMed PMID: 34876034.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - mNGS helped diagnose scrub typhus presenting as a urinary tract infection with high D-dimer levels: a case report. AU - Liu,Mei-Fang, AU - Liu,Yong, AU - Xu,De-Rong, AU - Wan,La-Gen, AU - Zhao,Rui, Y1 - 2021/12/07/ PY - 2021/05/05/received PY - 2021/11/22/accepted PY - 2021/12/8/entrez PY - 2021/12/9/pubmed PY - 2021/12/15/medline KW - Metagenomics next-generation sequencing KW - O. tsutsugamushi KW - Scrub typhus KW - Urinary tract infection SP - 1219 EP - 1219 JF - BMC infectious diseases JO - BMC Infect Dis VL - 21 IS - 1 N2 - BACKGROUND: Scrub typhus is caused by O. tsutsugamushi and spreads through mite larvae biting the skin. Classic symptoms of the disease are eschar and lymphadenopathy. Previous reports have revealed clinical manifestations of scrub typhus, including gastrointestinal symptoms, meningoencephalitis, ocular flutter, pneumonitis, acute respiratory distress syndrome, and acute kidney injury. However, cases of scrub typhus presenting as a urinary tract infection (UTI) with high D-dimer levels could be easily misdiagnosed when clinical attention is insufficient, resulting in difficulty in making a timely diagnosis of the infection. Metagenomics next-generation sequencing (mNGS) is a revolutionary and highly sensitive method that may help in diagnosing atypical cases, even when trace amounts of pathogens are present. CASE PRESENTATION: A 52-year-old female presented with a 10-day history of fever, chills, headache and myalgia. She was initially diagnosed with influenza at a local clinic. Various antibacterials were used on the 2nd-12th day onwards; however, her symptoms persisted and were followed by increased urination duration, frequency, urgency and dysuria for 2 days. Orientia tsutsugamushi was confirmed as the pathogen responsible for the infection through mNGS analysis of her blood samples from Day 13 onwards. The patient's temperature changed remarkably 24 h after the initiation of doxycycline. Over the next 48 h (i.e., Day 15 onwards), the patient showed clinical improvement. She recovered and was discharged from the hospital. CONCLUSIONS: Scrub typhus can present atypical clinical symptoms, such as UTIs, in a febrile patient. mNGS may be a useful method for identifying O. tsutsugamushi infection in patients with atypical clinical manifestations. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/34876034/mNGS_helped_diagnose_scrub_typhus_presenting_as_a_urinary_tract_infection_with_high_D_dimer_levels:_a_case_report_ DB - PRIME DP - Unbound Medicine ER -