Three Cases of Scrub Typhus with Acute Epiglottitis / 감염과화학요법

Scrub typhus is an endemic rickettsial disease with annual seasonal outbreak in Korea and its incidence is increasing. Recently, cases of scrub typhus with severe complications, such as septic shock, acute respiratory distress syndrome, acute renal failure, myocarditis, disseminated intravascular coagulation and meningitis have been increasingly reported. Acute epiglottitis is the one of potentially life- threatening scrub typhus related complications. Its initial clinical manifestations are sore throat, dysphagia or dyspnea. Although 22-62% of scrub typhus patients complain of sore throat, the etiology and optimal therapy are not yet known. We experienced 3 cases of scrub typhus-associated acute epiglottitis which rapidly responded to short-term corticosteroid administration.

Three Cases of Scrub Typhus with Acute Epiglottitis / 감염과화학요법

Scrub typhus is an endemic rickettsial disease with annual seasonal outbreak in Korea and its incidence is increasing. Recently, cases of scrub typhus with severe complications, such as septic shock, acute respiratory distress syndrome, acute renal failure, myocarditis, disseminated intravascular coagulation and meningitis have been increasingly reported. Acute epiglottitis is the one of potentially life- threatening scrub typhus related complications. Its initial clinical manifestations are sore throat, dysphagia or dyspnea. Although 22-62% of scrub typhus patients complain of sore throat, the etiology and optimal therapy are not yet known. We experienced 3 cases of scrub typhus-associated acute epiglottitis which rapidly responded to short-term corticosteroid administration.

A clinical research of tsutsugamushi disease occurred in and around Jeoung-up in the autumn of 2000

BACKGROUND: In korea, tsutsugamushi disease is one of the common diseases which occurs in more than 40% among acute febrile diseases during Autumn. The diagnosis is confirmed with Rickettsia tsutsugamushi antibody, and is characterised by fever, chill, headache, myalgia, skin rash, escha and lymphadenopathy. METHODS: We have conducted a survey on 16 clinically and serologically confirmed cases of Tsutsugamushi disease occurring during the period of October -November, 2000. RESULTS: Of 16 cases,7 were males and 9 were females with an average age of 67.76. Most patients had fever, chill, headache, myalgia, sore throat, cojunctival injection, cough, abdominal, pain, nausea, vomiting, hematuria in order of frequency. The physical findings were eachar (81.257) and skin rash (62.77) . Serologically 7 cases (43.75%) of 16 cases were confirmed positively R.tsutsugamushi antibody. General hematologic findings were decreased platelet count (37.57) , increased or decreased WBC (31.25% and 25% each other) , and anemia (25%) , Test for liver function included elevated AST, ALT (68.76%) , alkaline phosphatase (62.6%) , hypoalbuminemia (12.6%) , and hyperbilirubinemia(6.25) . Urinalysis showed hematuria (50%) , proteinuria (50%) , and pyuria (12.67) . Doxyrcycline therapy decreased fever in 2.85 days and after 5-6 days patients were discharged with improvement of almost all symptoms. CONCLUSION: Primary care physician in a community should always consider tsutsugamushi disease when he encounters patients with acute febrile disease in late Autumn and early winter and expect good prognosis with early diagnosis and treatment.