Am J Trop Med Hyg 86(6): 1046-1048

Peritonitis in Patients with Scrub Typhus

Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Jeonju, Republic of Korea; Department of Internal Medicine, Department of Pathology, Wonkwang University College of Medicine, Iksan, Republic of Korea

*Address correspondence to Chang-Seop Lee, Department of Internal Medicine, Chonbuk National University Medical School, San 2-20, Geumam-Dong, Deokjin-Gu, Jeonju, Jeonbuk, Republic of Korea. E-mail: rk.ca.unbj@dmscl

†These authors contributed equally to this work.

Received 2011 Sep 18; Accepted 2011 Dec 23.

Abstract

Various complications have been reported in scrub typhus cases including acute respiratory distress syndrome, encephalitis, pneumonia, pericarditis, acute renal failure, and acute hepatic failure. Few studies have reported on the gastrointestinal manifestations of scrub typhus. Typical gastrointestinal manifestations in patients with scrub typhus include abdominal pain, nausea, vomiting, hematemesis, melena, and diarrhea. The two cases presented in this study are the first reported cases of peritonitis associated with scrub typhus. This study shows that scrub typhus should also be included in the differential diagnosis of peritonitis in areas where Orientia tsutsugamushi is endemic.

Abstract

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, which is transmitted to humans through the bite of the larva of trombiculid mites. The major pathology of scrub typhus is focal or disseminated vasculitis caused by destruction of endothelial cells and organ-system dysfunction.¹2Orientia tsutsugamushi may affect the lung, heart, liver, skin, central nervous system, and gastrointestinal tract. Over one-third of patients with scrub typhus present with gastrointestinal symptoms.³4

Primary intra-abdominal processes leading to secondary peritonitis are numerous, including diseases or injuries of the gastrointestinal or genitourinary tracts.⁵ Peritonitis in patients with scrub typhus has never been reported. Herein, we report on two cases of peritonitis that were discovered while the patients were undergoing treatment of scrub typhus.

Notes

Disclaimer: The authors certify there is no conflict of interest in this work.

Notes

Footnotes

Financial support: This paper was supported by research funds of Chonbuk National University in 2011.

Authors' addresses: Chang-Hun Lee, Jeong-Hwan Hwang, and Chang-Seop Lee, Department of Internal Medicine, Chonbuk National University Medical School, Jeonbuk, Republic of Korea, E-mails: ten.liamnah@suraci4, ten.liamnah@77gnawhelims, and rk.ca.unbj@dmscl. Jae-Hoon Lee, Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea, E-mails: ten.liamnah@6207nhoj. Ki Jung Yoon, Department of Pathology, Wonkwang University College of Medicine, Iksan, Republic of Korea, E-mail: rk.ca.ukw@nuyjk.

Footnotes

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