Xerostomia in a patient with scrub typhus

Area of Science:

• Infectious Diseases
• Medical Imaging
• Otolaryngology

Background:

• Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, typically presenting with multi-organ vasculitis.
• While pneumonia and meningoencephalitis are known complications, sialoadenitis has not been previously reported.
• Dry mouth (xerostomia) is a significant symptom that can impact patient quality of life.

Observation:

• A 79-year-old male with scrub typhus presented with severe dry mouth.
• Tc-99m pertechnetate salivary scintigraphy showed normal radiopharmaceutical uptake but markedly decreased salivary excretion.
• Post-antibiotic treatment, salivary excretion and ejection fraction improved significantly.

Findings:

• This is the first report detailing salivary scintigraphy findings in a scrub typhus patient.
• Scrub typhus-associated sialoadenitis demonstrates preserved salivary gland uptake but impaired excretory function.
• Salivary scintigraphy objectively quantifies salivary gland function, differentiating it from Sjögren's syndrome or radiation-induced xerostomia.

Implications:

• Tc-99m salivary scintigraphy offers an objective method for assessing sialoadenitis in scrub typhus.
• This imaging technique can evaluate the effectiveness of antibiotic treatment for salivary gland dysfunction.
• Understanding the pathophysiology of scrub typhus-induced sialoadenitis may lead to improved patient management.