Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives
Scrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without earl...
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2021-12-01
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| Series: | Tropical Medicine and Infectious Disease |
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| Online Access: | https://www.mdpi.com/2414-6366/6/4/208 |
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| author | Hisham Ahmed Imad Aishath Azna Ali Mariyam Nahuza Rajan Gurung Abdulla Ubaid Aishath Maeesha Sariu Ali Didi Rajib Kumar Dey Abdullah Isneen Hilmy Aishath Hareera Ibrahim Afzal Wasin Matsee Wang Nguitragool Emi. E. Nakayama Tatsuo Shioda |
| author_facet | Hisham Ahmed Imad Aishath Azna Ali Mariyam Nahuza Rajan Gurung Abdulla Ubaid Aishath Maeesha Sariu Ali Didi Rajib Kumar Dey Abdullah Isneen Hilmy Aishath Hareera Ibrahim Afzal Wasin Matsee Wang Nguitragool Emi. E. Nakayama Tatsuo Shioda |
| author_sort | Hisham Ahmed Imad |
| collection | DOAJ |
| description | Scrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without early diagnosis and treatment, the disease can develop fatal complications. We retrospectively reviewed de-identified data from a 23-year-old woman who presented to an emergency department with complaints of worsening abdominal pain. On presentation, she appeared jaundiced and toxic-looking. Other positive findings on abdominal examination were a positive Murphey’s sign, abdominal guarding and hepatosplenomegaly. Magnetic resonance cholangiopancreatography demonstrated acalculous cholecystitis. Additional findings included eschar on the medial aspect of the left thigh with inguinal regional lymphadenopathy. Further, positive results were obtained for immunoglobulins M and G, confirming scrub typhus. The workup for other infectious causes of acute acalculous cholecystitis (AAC) detected antibodies against human herpesvirus 4 (Epstein–Barr virus), suggesting an alternative cause of AAC. Whether that represented re-activation of the Epstein–Barr virus could not be determined. As other reports have described acute acalculous cholecystitis in adult scrub typhus patients, we recommend doxycycline to treat acute acalculous cholecystitis in endemic regions while awaiting serological confirmation. |
| first_indexed | 2024-03-10T03:57:09Z |
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| language | English |
| last_indexed | 2024-03-10T03:57:09Z |
| publishDate | 2021-12-01 |
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| series | Tropical Medicine and Infectious Disease |
| spelling | doaj.art-7f61d7b837474b65b6b01bfa73dca9952023-11-23T10:52:08ZengMDPI AGTropical Medicine and Infectious Disease2414-63662021-12-016420810.3390/tropicalmed6040208Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the MaldivesHisham Ahmed Imad0Aishath Azna Ali1Mariyam Nahuza2Rajan Gurung3Abdulla Ubaid4Aishath Maeesha5Sariu Ali Didi6Rajib Kumar Dey7Abdullah Isneen Hilmy8Aishath Hareera9Ibrahim Afzal10Wasin Matsee11Wang Nguitragool12Emi. E. Nakayama13Tatsuo Shioda14Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, ThailandDepartment of Surgery, Indira Gandhi Memorial Hospital, Malé 20002, MaldivesDepartment of Surgery, Indira Gandhi Memorial Hospital, Malé 20002, MaldivesDepartment of Surgery, Indira Gandhi Memorial Hospital, Malé 20002, MaldivesDepartment of Surgery, Indira Gandhi Memorial Hospital, Malé 20002, MaldivesDepartment of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, MaldivesDepartment of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, MaldivesDepartment of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, MaldivesDepartment of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, MaldivesHealth Protection Agency, Ministry of Public Health, Malé 20002, MaldivesHealth Protection Agency, Ministry of Public Health, Malé 20002, MaldivesDepartment of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, ThailandMahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, ThailandDepartment of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, JapanDepartment of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, JapanScrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without early diagnosis and treatment, the disease can develop fatal complications. We retrospectively reviewed de-identified data from a 23-year-old woman who presented to an emergency department with complaints of worsening abdominal pain. On presentation, she appeared jaundiced and toxic-looking. Other positive findings on abdominal examination were a positive Murphey’s sign, abdominal guarding and hepatosplenomegaly. Magnetic resonance cholangiopancreatography demonstrated acalculous cholecystitis. Additional findings included eschar on the medial aspect of the left thigh with inguinal regional lymphadenopathy. Further, positive results were obtained for immunoglobulins M and G, confirming scrub typhus. The workup for other infectious causes of acute acalculous cholecystitis (AAC) detected antibodies against human herpesvirus 4 (Epstein–Barr virus), suggesting an alternative cause of AAC. Whether that represented re-activation of the Epstein–Barr virus could not be determined. As other reports have described acute acalculous cholecystitis in adult scrub typhus patients, we recommend doxycycline to treat acute acalculous cholecystitis in endemic regions while awaiting serological confirmation.https://www.mdpi.com/2414-6366/6/4/208acute acalculous cholecystitis<i>Orientia tsutsgugamushi</i>scrub typhusescharEpstein–Barr virusre-activation |
| spellingShingle | Hisham Ahmed Imad Aishath Azna Ali Mariyam Nahuza Rajan Gurung Abdulla Ubaid Aishath Maeesha Sariu Ali Didi Rajib Kumar Dey Abdullah Isneen Hilmy Aishath Hareera Ibrahim Afzal Wasin Matsee Wang Nguitragool Emi. E. Nakayama Tatsuo Shioda Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives Tropical Medicine and Infectious Disease acute acalculous cholecystitis <i>Orientia tsutsgugamushi</i> scrub typhus eschar Epstein–Barr virus re-activation |
| title | Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives |
| title_full | Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives |
| title_fullStr | Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives |
| title_full_unstemmed | Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives |
| title_short | Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives |
| title_sort | acalculous cholecystitis in a young adult with scrub typhus a case report and epidemiology of scrub typhus in the maldives |
| topic | acute acalculous cholecystitis <i>Orientia tsutsgugamushi</i> scrub typhus eschar Epstein–Barr virus re-activation |
| url | https://www.mdpi.com/2414-6366/6/4/208 |
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