Yamamoto Chie, Maruyama Ayano, Munakata Jun, Matsuyama Tasuku, Furukawa Keitaro, Hamashima Ryosuke, Ogawa Motohiko, Hashimoto Yuki, Fukuda Akiko, Inaba Tohru, Nukui Yoko
Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Pathogens. 2025 Jan 13;14(1):64. doi: 10.3390/pathogens14010064.
Scrub typhus, caused by , is a neglected and reemerging disease that causes considerable morbidity and mortality. It now extends beyond the Tsutsugamushi Triangle, the region wherein it has traditionally been endemic. Influenza has also resurged since the infection control measures against COVID-19 were relaxed. A few cases of scrub typhus and influenza co-infection have been reported. Herein, we report the case of a 74-year-old woman with fever and upper respiratory symptoms diagnosed with influenza A and treated with oseltamivir; however, her fever persisted, and she developed respiratory failure, liver dysfunction, headache, diarrhea, and an erythematous skin rash. She lived in a forested area where scrub typhus was endemic and worked on a farm. Physical examination revealed an eschar on her posterior neck, and she was diagnosed with scrub typhus and influenza A co-infection. After minocycline treatment, her symptoms improved within a few days. This is the first reported case of scrub typhus and influenza A co-infection in Japan. This case illustrates that co-infection should be suspected in patients with fever persisting after their initial infection has been treated and that in patients living in endemic areas, scrub typhus can occur concurrently with influenza. The symptoms of scrub typhus are flu-like and nonspecific, which may delay diagnosis and treatment.
恙虫病由恙虫病东方体引起，是一种被忽视且再度出现的疾病，会导致相当高的发病率和死亡率。它现在已超出了恙虫病的传统流行区域——恙虫病三角区。自针对新冠疫情的感染控制措施放松以来，流感也再次出现。已有数例恙虫病与流感合并感染的病例报告。在此，我们报告一例74岁女性病例，该患者有发热及上呼吸道症状，被诊断为甲型流感并接受了奥司他韦治疗；然而，她的发热持续不退，并出现了呼吸衰竭、肝功能障碍、头痛、腹泻及皮肤红斑疹。她居住在恙虫病流行的林区，在农场工作。体格检查发现她后颈部有焦痂，最终被诊断为恙虫病与甲型流感合并感染。经米诺环素治疗后，她的症状在数天内有所改善。这是日本首例报告的恙虫病与甲型流感合并感染病例。该病例表明，对于初始感染治疗后仍持续发热的患者应怀疑合并感染，并且在流行地区的患者中，恙虫病可能与流感同时发生。恙虫病的症状类似流感且无特异性，这可能会延迟诊断和治疗。
