title: Scrub typhus with sepsis and acute respiratory distress syndrome.
abstract: Scrub typhus is a major infectious threat in the Asia-Pacific region. We report an unusual case of scrub typhus in a patient in Singapore who presented with sepsis and acute respiratory distress syndrome but lacked the pathognomonic eschar. The patient recovered after appropriate diagnosis and doxycycline treatment. Rickettsial diseases should be included in the differential diagnosis of febrile illnesses in regions where the diseases are endemic, and absence of eschar should not be the criterion used to rule out scrub typhus.
authors.affiliation: Mount Elizabeth Hospital, Singapore.
authors.forename: Asok
authors.initials: A
authors.lastname: Kurup
authors.forename: Aneesh
authors.initials: A
authors.lastname: Issac
authors.forename: Jin Phang
authors.initials: JP
authors.lastname: Loh
authors.forename: Too Bou
authors.initials: TB
authors.lastname: Lee
authors.forename: Robert
authors.initials: R
authors.lastname: Chua
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bist
authors.forename: Chien-Chung
authors.initials: CC
authors.lastname: Chao
authors.forename: Michael
authors.initials: M
authors.lastname: Lewis
authors.forename: Duane J
authors.initials: DJ
authors.lastname: Gubler
authors.forename: Wei Mei
authors.initials: WM
authors.lastname: Ching
authors.forename: Eng Eong
authors.initials: EE
authors.lastname: Ooi
authors.forename: Bindu
authors.initials: B
authors.lastname: Sukumaran
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D001208:Asia; D015153:Blotting, Western; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D012612:Scrub Typhus / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D018805:Sepsis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D012846:Singapore; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007075:Immunoglobulin M; D004318:Doxycycline