title: Successful treatment of septic shock and respiratory failure due to leptospirosis and scrub typhus coinfection with penicillin, levofloxacin, and activated protein C.
abstract: Leptospirosis and scrub typhus are common zoonoses and coinfection with both diseases has been reported sporadically, particularly in tropical and subtropical areas. A 53-year-old male presented with acute hypoxemic respiratory failure and septic shock due to leptospirosis and scrub typhus coinfection confirmed by serological assessments. Antibiotics, including intravenous penicillin and levofloxacin, were administered and human recombinant activated protein C was added because of a high risk of death due to septic shock with multiple organ failure. The patient's hemodynamics and hypoxemia substantially improved 4 days later and he had a complete recovery from the disease after 10 days of hospitalization. Coinfection of leptospirosis and scrub typhus may easily go unrecognized by physicians in febrile travelers or patients in the region where both diseases are endemic. In severe and critical cases of leptospirosis, scrub typhus, or coinfection with both, the use of APC in addition to appropriate antibiotic treatment and standard critical care might provide a greater chance for survival and a favorable outcome.
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan.
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Wei
authors.forename: Chien-Tung
authors.initials: CT
authors.lastname: Chiu
authors.forename: Yung-Fa
authors.initials: YF
authors.lastname: Lai
authors.forename: Chung-Hsu
authors.initials: CH
authors.lastname: Lai
authors.forename: Hsi-Hsun
authors.initials: HH
authors.lastname: Lin
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D006801:Humans; D007919:Leptospira / Q000302:isolation & purification; D007922:Leptospirosis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D012285:Orientia tsutsugamushi / Q000302:isolation & purification; D010406:Penicillins / Q000627:therapeutic use*; D011486:Protein C / Q000627:therapeutic use*; D012131:Respiratory Insufficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D012612:Scrub Typhus / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000890:Anti-Infective Agents; D000907:Antibodies, Bacterial; D010406:Penicillins; D011486:Protein C; D064704:Levofloxacin; D015242:Ofloxacin