The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Severe Scrub Typhus Complicated by Myofascitis Due to the Taguchi Strain of Orientia tsutsugamushi

근육근막염을 동반한 Taguchi 항원형 중증 쯔쯔가무시병 1예

  • Beom, Jong Wook (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Heo, Sang Teak (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Park, Ji Kang (Department of Radiology, Jeju National University School of Medicine) ;
  • Koh, Young-Sang (Department of Microbiology, Jeju National University School of Medicine) ;
  • Kim, Sohyun (Department of Microbiology, Jeju National University School of Medicine)
  • 범종욱 (제주대학교 의학전문대학원 내과학교실) ;
  • 허상택 (제주대학교 의학전문대학원 내과학교실) ;
  • 박지강 (제주대학교 의학전문대학원 영상의학과교실) ;
  • 고영상 (제주대학교 의학전문대학원 미생물학교실) ;
  • 김소현 (제주대학교 의학전문대학원 미생물학교실)
  • Received : 2013.02.12
  • Accepted : 2013.07.18
  • Published : 2014.02.01
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Abstract

Scrub typhus is an acute febrile illness with focal or general vasculitis that is caused by Orientia tsutsugamushi. The spectrum of clinical severity ranges from mild to severe with potentially fatal complications including acute renal failure, gastrointestinal bleeding, meningitis, myocarditis, and pneumonia. However, myofascitis with scrub typhus has not been reported to date. We report a case of pneumonia, meningitis, and myofascitis in a 56-year-old male patient with scrub typhus due to the Taguchi strain of O. tsutsugamushi.

쯔쯔가무시병은 O. tsutsugamushi에 의한 내피세포 파괴로 전신적인 혈관염이 발생하여 고열, 두통, 근육통, 가피 형성, 림프절 종대가 발생하는 급성 열성 질환으로 다양한 임상증상을 보일 수 있으며 중증 합병증을 야기하여 사망에 이를 수 있는 병이다. 조기에 적절한 치료는 완치 가능하며 빠른 진단이 중요하다. 현재까지 폐렴이나 뇌수막염의 동반은 보고가 되어 왔으나 근육근막염까지 복합적으로 동반된 중증의 쯔쯔가무시병은 보고된 적이 없다. 이에 저자들은 폐렴, 뇌수막염과 함께 근육근막염이 동반된 중증의 Taguchi 항원형 쯔쯔가무시병을 적절히 진단하고 치료하여 완치한 경험을 보고하는 바이다.

Keywords

References

  1. Berman SJ, Kundin WD. Scrub typhus in South Vietnam: a study of 87 cases. Ann Intern Med 1973;79:26-30. https://doi.org/10.7326/0003-4819-79-1-26
  2. Jeong YJ, Kim S, Wood YD, Lee JW, Kim KI, Lee SH. Scrub typhus: clinical, pathologic, and imaging findings. Radiographics 2007;27:161-172. https://doi.org/10.1148/rg.271065074
  3. Park SW, Lee CK, Kwak YG, et al. Antigenic drift of Orientia tsutsugamushi in South Korea as identified by the sequence analysis of a 56-kDa protein-encoding gene. Am J Trop Med Hyg 2010;83:930-935. https://doi.org/10.4269/ajtmh.2010.09-0791
  4. Kim KH, Jung DS, Kim SY, et al. Severe scrub typhus with enterocolitis by the Ikeda strain of Orientia tsutsugamushi. Infect Chemother 2012;44:469-472. https://doi.org/10.3947/ic.2012.44.6.469
  5. Silpapojakul K, Ukkachoke C, Krisanapan S, Silpapojakul K. Rickettsial meningitis and encephalitis. Arch Intern Med 1991;151:1753-1757. https://doi.org/10.1001/archinte.1991.00400090051010
  6. Suputtamongkol Y, Suttinont C, Niwatayakul K, et al. Epidemiology and clinical aspects of rickettsioses in Thailand. Ann N Y Acad Sci 2009;1166:172-179. https://doi.org/10.1111/j.1749-6632.2009.04514.x
  7. Chung MH, Han SW, Choi MG, et al. Comparison of a 3-day course of azithromycin with doxycycline for the treatment of scrub typhus. Korean J Infect Dis 2000;32:433-438.
  8. Kim YS, Yun HJ, Shim SK, Koo SH, Kim SY, Kim S. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin Infect Dis 2004;39:1329-1335. https://doi.org/10.1086/425008
  9. Park SW, Lee CS, Lee CK, et al. Severity predictors in eschar-positive scrub typhus and role of serum osteopontin. Am J Trop Med Hyg 2011;85:924-930. https://doi.org/10.4269/ajtmh.2011.11-0134