Pulmonary pathology in patients associated with scrub typhus

Pathology
Yung-Hsiang Hsu, Hsing I Chen

Abstract

Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi. Severe cases resulting in mortality from this disease have rarely been reported. We present two scrub typhus cases (a man and a girl) who died of acute respiratory distress syndrome (ARDS). Autopsies were performed. Histopathological and immunohistochemical stains were employed using specific antibody for O. tsutsugamushi and inducible nitric oxide synthase (iNOS). These subjects developed respiratory distress shortly after admission, and expired following respiratory failure. At autopsy, generalised lymphadenopathy was observed. The lung weight was about two-fold the normal value. Gross inspection revealed oedematous and haemorrhagic lungs. Microscopic examination revealed diffuse alveolar damage with hyaline membrane formation and interstitial pneumonitis with infiltration of inflammatory cells. Immunohistochemical stain showed O. tsutsugamushi antigen depositions in the endothelial cells. We also demonstrated iNOS in the alveolar macrophages and lung tissue debris in both cases. Scrub typhus is usually a mild infectious disease. Our cases present the most dramatic example of sudden death due to ARDS in a short period of time. The clinical investigation and ...Continue Reading

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Citations

Mar 22, 2014·Japanese Journal of Infectious Diseases·Jae-Hyoung ImJae-Seung Kang
Jul 17, 2015·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Shakti Bedanta Mishra, Afzal Azim
Apr 14, 2015·Future Microbiology·Alison Luce-FedrowAllen L Richards
Jun 12, 2016·BMC Infectious Diseases·Hyung Ho KimMi Ah Han
Mar 11, 2017·PLoS Neglected Tropical Diseases·Nicole L MendellDavid H Walker
Jun 28, 2017·International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases·Hongliu ChenYing Shen
Apr 4, 2012·World Journal of Critical Care Medicine·Chain-Fa SuHsing I Chen
Jul 11, 2014·PLoS Neglected Tropical Diseases·Thomas R SheliteDavid H Walker
Feb 13, 2018·The Journal of Immunology : Official Journal of the American Association of Immunologists·Lynn Soong

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