Basukala Sunil, Sharma Shriya, Tamang Ayush, Bhusal Ujwal
Department of Surgery, Shree Birendra Hospital (SBH), Kathmandu, Nepal.
College of Medicine, Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal.
Ann Med Surg (Lond). 2022 Jan 29;74:103329. doi: 10.1016/j.amsu.2022.103329. eCollection 2022 Feb.
Scrub typhus presents with diverse clinical manifestations which range from sub-clinical disease to organ failure and fatal disease.
The patient presented with fever followed by acute abdominal pain and later developed septic shock with multi-organ failure. Radiological evaluations were normal, however, on thorough physical examination, an eschar was found in her right inguinal region.
Aside from classical clinical symptoms, it can also involve various organs, most commonly of respiratory, cardiovascular and hepatic systems. Additionally, suspected patients should be thoroughly examined for the presence of an eschar, especially over the covered areas such as the groin, genitalia, infra-mammary area and axilla.
Scrub typhus should be considered in all patients from an endemic area presenting as acute undifferentiated febrile illness associated with organ involvement. Positive finding of an eschar and high index of suspicion for the various presentations of scrub typhus can avoid unnecessary surgical exploration and aid in prompt diagnosis and treatment.
恙虫病临床表现多样，从亚临床疾病到器官衰竭及致命性疾病不等。
患者起初发热，随后出现急性腹痛，继而发展为感染性休克并伴有多器官功能衰竭。影像学检查结果正常，但经全面体格检查发现，其右腹股沟区有一焦痂。
除典型临床症状外，恙虫病还可累及多个器官，最常见的是呼吸系统、心血管系统和肝脏系统。此外，对于疑似患者，应仔细检查是否存在焦痂，尤其是在腹股沟、生殖器、乳房下区域和腋窝等隐蔽部位。
对于来自疫区且表现为伴有器官受累的急性未分化发热性疾病的所有患者，均应考虑恙虫病。焦痂的阳性发现以及对恙虫病各种表现的高度怀疑指数，可避免不必要的手术探查，并有助于及时诊断和治疗。
