It's not a cold, it's just a flu! Beware of the "grass killer" scrub typhus

Grandma Zhong, a 76-year-old woman from Jiangxi Province, developed unexplained recurrent high fever, chills, abdominal pain, general fatigue, and loss of appetite half a month ago. The local hospital diagnosed her with "sepsis, liver and kidney failure, and thrombocytopenia", but no cause of the disease was found. After 5 days of anti-infection treatment, her symptoms gradually worsened and she was finally admitted to the intensive care unit of the Department of Respiratory and Critical Care Medicine of Hunan Provincial Second People's Hospital .

Through blood etiology metagenomic testing, "Oriental tsutsugamushi Rickettsia" was detected and she was diagnosed with "tsutsugamushi disease". After treatment, Grandma Zhong's body temperature has returned to normal, her spirit and appetite have improved significantly, and various test indicators have gradually recovered.

Initially misdiagnosed as a cold

Grandma Zhong's family said that Grandma Zhong suddenly developed a fever half a month ago, with the highest body temperature reaching 39.7 degrees Celsius, accompanied by body pain, very poor spirits, and refusing to eat or drink. At first, they thought it was a cold caused by catching a cold. After a week of intravenous treatment at a local clinic, there was no improvement, so she was hospitalized in a local tertiary hospital. Examination revealed liver and kidney failure and a significant decrease in platelets. After 5 days of treatment with strong antibiotics, the fever and chills did not improve, and she also developed obvious breathing difficulties, her spirits became worse and worse, and she was bedridden. The family hurriedly sent Grandma Zhong to the Respiratory and Critical Care Medicine Department of Hunan Provincial Second People's Hospital for treatment.

The patient suffered multiple organ damage and was in critical condition. Doctors unraveled the case and found the real culprit.

The doctor found that the patient was in poor spirits, drowsy, short of breath, multiple ecchymoses and petechiae on the skin, abdominal tenderness, and significant increase in serious indicators. The patient's liver and kidney functions were severely damaged, platelets continued to decrease, and blood gas analysis showed severe metabolic acidosis. The other hospital had given a combination of antibiotics but it was ineffective.

Zeng Xiangbo, director of the Department of Respiratory and Critical Care Medicine, immediately led the team to conduct a ward round. Director Zeng carefully analyzed the patient's condition and found mild enlargement of the left axillary lymph nodes and a black eschar in the axilla. The patient was suspected of being infected with a special pathogen. The antimicrobial drug regimen was adjusted, and doxycycline was added for oral administration. At the same time, blood was drawn for pathogenic microorganism metagenomic testing to confirm the etiological diagnosis.

Sure enough, that night the patient's temperature dropped to normal, his spirits improved, and he began to ask for food. The next day, the results of the pathogenic microorganism metagenomic test were reported: Orientia tsutsugamushi, sequence number 1358. At this point, the truth was revealed! The patient was diagnosed with oriental tsutsugamushi. The patient recalled carefully that it was the season when edamame was ripe, and the patient became ill after harvesting beans in the field.

Combined with the patient's clinical manifestations, specific skin lesions in the left axilla, and a clear etiological diagnosis, it is speculated that the patient was infected with Rickettsia by a tick bite. At present, Grandma Zhong's symptoms have improved significantly, and she has been transferred out of the intensive care unit and will be discharged soon.

Why do people get hospitalized in the ICU after being bitten by insects? How terrible is scrub typhus?

Director Zeng Xiangbo said that in fact, the typical scrub typhus disease is not difficult to treat, but because its first symptoms are high fever and abdominal symptoms, most people will not immediately realize that they have been bitten by ticks, thinking that they just have a cold and ignore or delay treatment. In addition, the bite site of the scrub larvae is relatively hidden, and the eschar (or ulcer) is difficult to find. When the tick bites, there is usually no obvious pain due to the anesthetic analgesic components in the saliva. It is often difficult for the patient to explain the medical history clearly, which is easy to be misdiagnosed.

How to prevent scrub typhus?

Director Zeng Xiangbo said that there is no protective vaccine for scrub typhus at present, and personal protection is an effective way to prevent the disease . June to November each year is the peak period for scrub typhus. Ticks mainly live in grass or shrubs. People who are engaged in field work, field workers (loggers, road builders, geological prospectors, etc.), people who are exposed to jungle weeds, camping outdoors, etc., are more likely to be attacked by ticks and are prone to infection. You should avoid sitting, lying down, resting, or drying clothes and quilts in such environments.

If you need to enter such areas, especially areas where patients have been found, you should pay attention to personal protection, tie up your cuffs and trouser legs, and tuck your shirt into your trouser waist to reduce the attachment or bites of chiggers. You can also spray repellents containing dimethyl phthalate or DEET on exposed skin and trouser legs, collars or cuffs for protection, such as mosquito repellent and mosquito-free. After working in the field, pat your clothes in time to shake off the attached chiggers; change clothes and take a bath, focusing on scrubbing the soft skin areas such as the armpits, waist, and perineum to reduce the chance of being bitten by chiggers.

If you find a tick bite, do not pull it hard to prevent the mouthparts from breaking inside the skin. You can spray or apply alcohol to anesthetize the insect and let it fall off on its own, and seek medical attention immediately.

Hunan Medical Chat Special Author: Gong Lijuan, Department of Respiratory and Critical Care Medicine, Hunan Second People's Hospital

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(Edited by YH)