A man with high fever and fatigue self-treated at home for 4 days without improvement before being diagnosed with septic shock and multiple organ failure at the provincial hospital. He required dialysis, a ventilator, and intravenous broad-spectrum antibiotics but his condition did not improve. In critical condition, he was transferred to the 108 Central Military Hospital with circulatory collapse, myocarditis, progressive acute respiratory failure, acute liver and kidney damage, and thrombocytopenia.
Doctors at the 108 Military Central Hospital identified an ulcer on the patient’s right chest as typical of scrub typhus on July 2. Test results confirmed the patient was infected with Orientia tsutsugamushi, the pathogen that causes scrub typhus. Following diagnosis, the patient was treated with specific antibiotics and supportive measures for organ failure. Currently, his fever has subsided, his breathing has improved, and his organ failure is showing signs of recovery.
Scrub typhus is an acute infectious disease transmitted through the bite of mite larvae that is caused by Orientia tsutsugamushi. Its diverse manifestations include prolonged high fever, severe headache, skin and mucous membrane congestion, and rash. Skin ulcers, round or oval in shape with light or dark brown scales, can form at the site of the larval bite, typically in soft, moist skin areas.
Tick bite ulcers initially present as blisters before progressing into oval shapes that become 0.5-2 cm nodules with black scabs. They are usually painless and not itchy, making them difficult for patients to notice. Most scrub typhus cases will have ulcers, usually just one, sometimes two or three. As a disease that can be dangerous but also prevented, it’s important for individuals in endemic areas to take precautions when staying or working in environments favored by scrub typhus larvae. Prompt medical attention is recommended for fevers of unknown origin accompanied by potential risk factors for scrub typhus.