Han Song, Yang Suge, Wang Yun, Xu Yingying
The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People's Republic of China.
Department of Neurology Medicine, The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People's Republic of China.
Infect Drug Resist. 2024 Feb 26;17:749-760. doi: 10.2147/IDR.S450693. eCollection 2024.
Scrub typhus, caused by Orientia tsutsugamushi, is characterized by fever, eschars, lymphadenopathy, and rash. The absence of eschars in some cases makes it difficult to distinguish it from other diseases, complicating the diagnosis process. Atypical Scrub typhus is difficult to diagnose and often leads to delayed treatment. Therefore, early diagnosis and treatment through effective detection methods have high clinical value. Here, a case of scrub typhus with encephalitis symptoms is reported.
A 64-year-old man and mNGS testing.
A 64-year-old man developed cough, headache, and fever, dismissing it as a respiratory tract infection. Initial treatment with cephalosporin antibiotics had minimal effect. Admission to the respiratory department showed inflammation in blood tests. Subsequent CT and further treatment provided no improvement. Multidisciplinary discussions and neurology department guidance were conducted to consider the suspected diagnosis of encephalitis in the patient. After improving the mNGS detection, the patient was diagnosed with "Orientia tsutsugamushi encephalitis". After treatment with doxycycline, the patient's symptoms were alleviated. He remained afebrile in follow-up and adhered well to medical advice.
Our case demonstrates that it is difficult to distinguish Orientia tsutsugamushi encephalitis from central nervous system infectious diseases such as meningitis and encephalitis using conventional diagnostic methods, which may affect the treatment plan for the disease. mNGS is a useful and valuable method for early diagnosis of scrub typhus.
恙虫病由恙虫病东方体引起，其特征为发热、焦痂、淋巴结病和皮疹。部分病例无焦痂，难以与其他疾病区分，使诊断过程复杂化。非典型恙虫病难以诊断，常导致治疗延迟。因此，通过有效的检测方法进行早期诊断和治疗具有很高的临床价值。在此，报告一例有脑炎症状的恙虫病病例。
一名64岁男性及宏基因组测序检测。
一名64岁男性出现咳嗽、头痛和发热，起初将其当作呼吸道感染而未重视。最初使用头孢菌素抗生素治疗效果甚微。入住呼吸科时血液检查显示有炎症。随后的CT检查及进一步治疗均无改善。进行了多学科讨论并在神经内科指导下考虑患者疑似脑炎的诊断。改进宏基因组测序检测后，患者被诊断为“恙虫病东方体脑炎”。使用强力霉素治疗后，患者症状缓解。随访期间体温正常，且严格遵医嘱。
我们的病例表明，使用传统诊断方法难以将恙虫病东方体脑炎与脑膜炎和脑炎等中枢神经系统传染病区分开来，这可能会影响该病的治疗方案。宏基因组测序是早期诊断恙虫病的一种有用且有价值的方法。
