Key result
Next-generation sequencing identifies Orientia tsutsugamushi in eschar-free severe scrub typhus to enable targeted therapy.
Why the study?
The diagnosis of scrub typhus can be missed due to the absence of the pathognomonic eschar.
Case Report (n=1)
No
Next-generation sequencing can accurately and rapidly identify scrub typhus in patients lacking the pathognomonic eschar.
May aid targeted therapy in eschar-negative scrub typhus; hypothesis-generating and should not yet change diagnostic practice.
BACKGROUND: Scrub typhus is an acute febrile illness, which was caused by Orientia tsutsugamushi and transmitted through the bite of chiggers. The diagnosis of scrub typhus could be missed diagnosis due to the absence of the pathognomonic eschar. CASE PRESENTATION: A 76-year-old man was hospitalized with fever and kidney injury and was diagnosed of hemorrhagic fever with renal syndrome first. However, the situation of the illness deteriorated into refractory septic shock and multiple organ dysfunction rapidly,although the treatment of anti-sepsis was used in 3rd-5th day. Orientia tsutsugamushi was determined to be the causative pathogen by Next-generation sequencing of his plasma sample in 6th day. Then, the patient was treated with doxycycline and azithromycin and recovered quickly. CONCLUSIONS: Next-generation sequencing was a new diagnostic technology and could identify scrub typhus in accurately and fast without the pathognomonic eschar.
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Chen et al. (2020) conducted a case report in Severe scrub typhus infection (n=1). Next-generation sequencing (NGS) was evaluated on Pathogen identification and clinical recovery. Next-generation sequencing successfully identified Orientia tsutsugamushi in a patient with severe scrub typhus lacking a pathognomonic eschar, enabling targeted therapy and full recovery.
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