Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 6 ( June, 2022 ) > List of Articles

CASE REPORT

Rare and Unusual Presentation as Immune Thrombocytopenic Purpura in Scrub Typhus Complicated by Meningitis and Acute Kidney Injury

Prawash Kumar Chowdhary, Rakesh Kumar Agrawal, Sanjeev Anant Kale, Vishal Kumar

Keywords : Immune thrombocytopenic purpura, Meningoencephalitis, Scrub typhus

Citation Information : Chowdhary PK, Agrawal RK, Kale SA, Kumar V. Rare and Unusual Presentation as Immune Thrombocytopenic Purpura in Scrub Typhus Complicated by Meningitis and Acute Kidney Injury. Indian J Crit Care Med 2022; 26 (6):748-751.

DOI: 10.5005/jp-journals-10071-24256

License: CC BY-NC 4.0

Published Online: 20-06-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Scrub typhus is a known etiology of acute febrile illness in tropical regions such as Asia–Pacific. Several such reports are from the Indian subcontinent with manifestations such as non-specific febrile illness or multiorgan dysfunction [Acute respiratory distress syndrome (ARDS), myocarditis, hepatitis, acute kidney injury, or meningoencephalitis]. We came across a case with a presentation as immune thrombocytopenic purpura complicated by meningitis and acute kidney injury secondary to scrub typhus. This combination of presentation is rare and demands meticulous clinical examination and targeted management toward scrub typhus.


HTML PDF Share
  1. Tamura A, Ohashi N, Urakami H, Miyamura S. Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen. nov., as Orientia tsutsugamushi comb. nov. Int J Syst Bacteriol 1995;45(3):589–591. DOI: 10.1099/00207713-45-3-589.
  2. Mahajan SK, Rolain JM, Kashyap R, Bakshi D, Sharma V, Prasher BS, et al. Scrub typhus in Himalayas. Emerg Infect Dis 2006;12(10): 1590–1592. DOI: 10.3201/eid1210.051697.
  3. Blewitt B. Fevers of the typhus group in the Bhim Tal area, Kumaun Hills, UP, India. BMJ Military Health 1938;70:379–387. DOI: 10.1136/jramc-70-06-03.
  4. Sayen JJ, Pond HS, Forrester JS, Wood FC. Scrub typhus in Assam and Burma; a clinical study of 616 cases. Medicine (Baltimore) 1946;25:155–214. DOI: 10.1097/00005792-194605000-00003.
  5. Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, et al. Scrub typhus among hospitalised patients with febrile illness in South India: magnitude and clinical predictors. J Infect 2006;52(1): 56–60. DOI: 10.1016/j.jinf.2005.02.001.
  6. Kawamura A, Jr. Tsutsugamushi disease: an overview, In: A Kawamura, Jr., H. Tanaka, and A. Tamura (ed.), Tsutsugamushi disease. University of Tokyo Press: Tokyo, Japan, 1995, p. 1–34.
  7. Abhilash KP, Jeevan JA, Mitra S, Paul N, Murugan TP, Rangaraj A, et al. Acute undifferentiated febrile illness in patients presenting to a tertiary care hospital in South India: clinical spectrum and outcome. J Glob Infect Dis 2016;8(4):147–154. DOI: 10.4103/0974-777X.192966.
  8. Kim HA, Lee JY, Hyun M, Ryu SY. A case of immune thrombocytopenic purpura associated with scrub typhus. Korean J Med 2014;86(3): 362–366. DOI: 10.3904/kjm.2014.86.3.362.
  9. Vallejo–Maroto I, García–Morillo S, Wittel MB, Stiefela P, Mirandaa M, Pamiesa E, et al. Aseptic meningitis as a delayed neurologic complication of murine typhus. Clin Microbiol Infect 2002;8(12): 826–827. DOI: 10.1046/j.1469-0691.2002.00502.x.
  10. Pai H, Sohn S, Seong Y, Kee S, Chang WH, Choe KW. Central nervous system involvement in patients with scrub typhus. Clin Infect Dis 1997;24(3):436–440. DOI: 10.1093/clinids/24.3.436.
  11. Strickman D, Sheer T, Salata K, Hershey J, Dasch G, Kelly D, et al. In vitro effectiveness of Azithromycin against doxycycline-resistant and -susceptible strains of Rickettsia tsutsugamushi, etiologic agent of scrub typhus. Antimicrob Agents Chemother 1995;39(11):2406–2410. DOI: 10.1128/aac.39.11.2406.
  12. Sedhain A, Bhattarai GR. Renal manifestation in scrub typhus during a major outbreak in Central Nepal. Indian J Nephrol 2017;27(6):440–445. DOI: 10.4103/ijn.IJN_133_17.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.