A Case of Acute Renal Failure Associated with Tsutsugamushi Disease

Tsutsugamushi disease is acute febrile illness, transmitted by Rickettsia tsutsugamushi. R. tsutusgamushi invade and proliferate in the endothelial cells of small blood vessels. Destruction of endothelial cells occurs from the proliferation of the organism and eventual disruption, and thus vascular rich organs must be carefully examined such as the kidney, lung, heart, liver. Recently we experienced a case of acute renal failure associated with R. tsutsugamushi infection in a child. Renal biopsy showed diffuse interstitial edema and mononuclear cell infiltration in the deep cortex. R. tsutusgamushi should be included as one of the causes of acute interstitial nephritis causing ARF in children, especially when the children have a acute febrile illness with rash in the fall and winter.

Pathologic study of mice infected with Rickettsia tsutsugamushi R19 strain

Scrub typhus, an acute febrile infectious disease caused by R. tsutsugamushi, has been reported from various parts of the far east and pacific rim of Asia including Korea. It is well known that all human pathogenic rickettsia share an affinity to endothelial cells of the small blood vessels and evoke vascular inflammation variably associated with a rash, microthrombi, and hemorrhage. We infected the ICR mice by inoculating sublethal doses of R. tsutsugamushi R19 strain intraperitoneally and observed the pathologic changes by time sequence. The histopathologic features of experimentally induced scrub typhus in the mice were generally nonspecific interstitial inflammations characterized by interstitial pneumonitis, periportal inflammation, multifocal hepatic necrosis, interstitial nephritis, sinusoidal engorgement, and lymphohistiocytic cell infiltration in lymph nodes and spleen. Contrary to the general features of other rickettsial diseases, the pathologic process of scrub typhus experimentally induced by R. tsutsugamushi R19 strain mainly involved the interstitial connective tissue but not the blood vessels.