Main Article Content
Abstract
Melioidosis and scrub typhus are endemic diseases in Malaysia. However, unlike melioidosis, scrub typhus is more difficult to be diagnosed and in Malaysia its true disease burden is unknown. We report a case of severe melioidosis and scrub typhus co-infection in a patient living in a small village in Peninsular Malaysia whom presented with fever and headache. This case highlights the importance of considering scrub typhus as a diagnostic possibility in cases of acute undifferentiated febrile illness in rural areas such as that of in Peninsular Malaysia.
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Muhammad Yazli Yuhana, Infectious Diseases Unit, Department of Internal Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Selangor, Malaysia
References
- Nathan S, Chieng S, Kingsley PV, Mohan A, Podin Y, Ooi MH, et al. Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis. Trop Med Infect Dis. 2018;3(1).
- Lee SH, Kim DM, Cho YS, Yoon SH, Shim SK. Usefulness of eschar PCR for diagnosis of scrub typhus. J Clin Microbiol. 2006;44(3):1169-71.
- Kingston HW, Hossain M, Leopold S, Anantatat T, Tanganuchitcharnchai A, Sinha I, et al. Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerg Infect Dis. 2018;24(4).
- Theunissen C, Cnops L, Van Esbroeck M, Huits R, Bottieau E. Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report. BMC Infect Dis. 2017;17(1):273.
- Malheiro L, Ceia F, Alves J, Carvalho AC, Sobrinho-Simoes J, Sousa R, et al. Severe interstitial pneumonia due to murine typhus in a patient returning from Bali. IDCases. 2017;9:17-20.
- Wulff J, Margolin J, Coleman NE, Demmler-Harrison G, Lam F, Shah MD. A Severe Case of Murine Typhus Presenting With Anemia and Severe Thrombocytopenia. J Pediatr Hematol Oncol. 2018;40(3):e185-e90.
- Sakamoto N, Nakamura-Uchiyama F, Kobayashi K, Takasaki T, Ogasawara Y, Ando S, et al. Severe murine typhus with shock and acute respiratory failure in a Japanese traveler after returning from Thailand. J Travel Med. 2013;20(1):50-3.
- Dittrich S, Rattanavong S, Lee SJ, Panyanivong P, Craig SB, Tulsiani SM, et al. Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study. Lancet Glob Health. 2015;3(2):e104-12.
- Stephens BE, Thi M, Alkhateb R, Agarwal A, Sharkey FE, Dayton C, et al. Case Report: Fulminant Murine Typhus Presenting with Status Epilepticus and Multi-Organ Failure: an Autopsy Case and a Review of the Neurologic Presentations of Murine Typhus. Am J Trop Med Hyg. 2018;99(2):306-9.
- Zueter A, Yean CY, Abumarzouq M, Rahman ZA, Deris ZZ, Harun A. The epidemiology and clinical spectrum of melioidosis in a teaching hospital in a North-Eastern state of Malaysia: a fifteen-year review. BMC Infect Dis. 2016;16:333.
- Paris DH, Dumler JS. State of the art of diagnosis of rickettsial diseases: the use of blood specimens for diagnosis of scrub typhus, spotted fever group rickettsiosis, and murine typhus. Curr Opin Infect Dis. 2016;29(5):433-9.
- Paris DH, Shelite TR, Day NP, Walker DH. Unresolved problems related to scrub typhus: a seriously neglected life-threatening disease. Am J Trop Med Hyg. 2013;89(2):301-7.
- Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
- Jiang J, Chan TC, Temenak JJ, Dasch GA, Ching WM, Richards AL. Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi. Am J Trop Med Hyg. 2004;70(4):351-6.
- Afzal Z, Kallumadanda S, Wang F, Hemmige V, Musher D. Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1,2. Emerg Infect Dis. 2017;23(8):1268-73.
- Mayxay M, Castonguay-Vanier J, Chansamouth V, Dubot-Peres A, Paris DH, Phetsouvanh R, et al. Causes of non-malarial fever in Laos: a prospective study. Lancet Glob Health. 2013;1(1):e46-54.
- Paris DH, Chattopadhyay S, Jiang J, Nawtaisong P, Lee JS, Tan E, et al. A nonhuman primate scrub typhus model: protective immune responses induced by pKarp47 DNA vaccination in cynomolgus macaques. J Immunol. 2015;194(4):1702-16.
- Wangrangsimakul T, Althaus T, Mukaka M, Kantipong P, Wuthiekanun V, Chierakul W, et al. Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand. PLoS Negl Trop Dis. 2018;12(5):e0006477.
- Newton PN, Keolouangkhot V, Lee SJ, Choumlivong K, Sisouphone S, Choumlivong K, et al. A prospective, open-label, randomized trial of doxycycline versus azithromycin for the treatment of uncomplicated murine typhus. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2018.
- Phimda K, Hoontrakul S, Suttinont C, Chareonwat S, Losuwanaluk K, Chueasuwanchai S, et al. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother. 2007;51(9):3259-63.
References
Nathan S, Chieng S, Kingsley PV, Mohan A, Podin Y, Ooi MH, et al. Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis. Trop Med Infect Dis. 2018;3(1).
Lee SH, Kim DM, Cho YS, Yoon SH, Shim SK. Usefulness of eschar PCR for diagnosis of scrub typhus. J Clin Microbiol. 2006;44(3):1169-71.
Kingston HW, Hossain M, Leopold S, Anantatat T, Tanganuchitcharnchai A, Sinha I, et al. Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerg Infect Dis. 2018;24(4).
Theunissen C, Cnops L, Van Esbroeck M, Huits R, Bottieau E. Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report. BMC Infect Dis. 2017;17(1):273.
Malheiro L, Ceia F, Alves J, Carvalho AC, Sobrinho-Simoes J, Sousa R, et al. Severe interstitial pneumonia due to murine typhus in a patient returning from Bali. IDCases. 2017;9:17-20.
Wulff J, Margolin J, Coleman NE, Demmler-Harrison G, Lam F, Shah MD. A Severe Case of Murine Typhus Presenting With Anemia and Severe Thrombocytopenia. J Pediatr Hematol Oncol. 2018;40(3):e185-e90.
Sakamoto N, Nakamura-Uchiyama F, Kobayashi K, Takasaki T, Ogasawara Y, Ando S, et al. Severe murine typhus with shock and acute respiratory failure in a Japanese traveler after returning from Thailand. J Travel Med. 2013;20(1):50-3.
Dittrich S, Rattanavong S, Lee SJ, Panyanivong P, Craig SB, Tulsiani SM, et al. Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study. Lancet Glob Health. 2015;3(2):e104-12.
Stephens BE, Thi M, Alkhateb R, Agarwal A, Sharkey FE, Dayton C, et al. Case Report: Fulminant Murine Typhus Presenting with Status Epilepticus and Multi-Organ Failure: an Autopsy Case and a Review of the Neurologic Presentations of Murine Typhus. Am J Trop Med Hyg. 2018;99(2):306-9.
Zueter A, Yean CY, Abumarzouq M, Rahman ZA, Deris ZZ, Harun A. The epidemiology and clinical spectrum of melioidosis in a teaching hospital in a North-Eastern state of Malaysia: a fifteen-year review. BMC Infect Dis. 2016;16:333.
Paris DH, Dumler JS. State of the art of diagnosis of rickettsial diseases: the use of blood specimens for diagnosis of scrub typhus, spotted fever group rickettsiosis, and murine typhus. Curr Opin Infect Dis. 2016;29(5):433-9.
Paris DH, Shelite TR, Day NP, Walker DH. Unresolved problems related to scrub typhus: a seriously neglected life-threatening disease. Am J Trop Med Hyg. 2013;89(2):301-7.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
Jiang J, Chan TC, Temenak JJ, Dasch GA, Ching WM, Richards AL. Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi. Am J Trop Med Hyg. 2004;70(4):351-6.
Afzal Z, Kallumadanda S, Wang F, Hemmige V, Musher D. Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1,2. Emerg Infect Dis. 2017;23(8):1268-73.
Mayxay M, Castonguay-Vanier J, Chansamouth V, Dubot-Peres A, Paris DH, Phetsouvanh R, et al. Causes of non-malarial fever in Laos: a prospective study. Lancet Glob Health. 2013;1(1):e46-54.
Paris DH, Chattopadhyay S, Jiang J, Nawtaisong P, Lee JS, Tan E, et al. A nonhuman primate scrub typhus model: protective immune responses induced by pKarp47 DNA vaccination in cynomolgus macaques. J Immunol. 2015;194(4):1702-16.
Wangrangsimakul T, Althaus T, Mukaka M, Kantipong P, Wuthiekanun V, Chierakul W, et al. Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand. PLoS Negl Trop Dis. 2018;12(5):e0006477.
Newton PN, Keolouangkhot V, Lee SJ, Choumlivong K, Sisouphone S, Choumlivong K, et al. A prospective, open-label, randomized trial of doxycycline versus azithromycin for the treatment of uncomplicated murine typhus. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2018.
Phimda K, Hoontrakul S, Suttinont C, Chareonwat S, Losuwanaluk K, Chueasuwanchai S, et al. Doxycycline versus azithromycin for treatment of leptospirosis and scrub typhus. Antimicrob Agents Chemother. 2007;51(9):3259-63.