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Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster
Siti Roszilawati Ramli1, Nuridayu Arifin2, Mohd Fahmi Ismail2
1Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Shah Alam 40170, Selangor, Malaysia.
Abstract:
Background: Scrub typhus (ST) is caused by Orientia tsutsugamushi (OT) infection, which is transmitted to humans through the bites of infected chiggers. The clinical presentations range from mild to life-threatening multi-organ dysfunction. This report describes a cluster of ST cases involving five oil palm estate workers in Pekan district, Pahang, Malaysia. Methods: The clinical history, laboratory, and entomological investigation were conducted on the patients, including the index case and four suspected cases in the cluster. Polymerase chain reaction (PCR) tests for OT and genotyping were performed on the patients' blood and urine samples. Serological testing by indirect immunoperoxidase (IIP) test against Rickettsial diseases was also conducted. Principal Findings: Patients presented with fever, myalgia, headache, rash, cough, and eschar. The index case developed severe ST complicated by acute kidney injury (AKI) and respiratory distress, requiring intubation and ventilation at the intensive care unit of a tertiary hospital. ST was confirmed through PCR analysis of a urine sample, showcasing a novel diagnostic approach. The other four cases were confirmed by a four-fold rise in immunoglobulin G (IgG) antibody titers. Conclusions: Oil palm estate workers are at high risk for chigger exposure in Malaysia. Awareness among clinicians and the public of ST is crucial for effective prevention, accurate diagnosis, and optimal management.
Insights
Scrub typhus (ST) outbreaks can occur in Malaysian oil palm estates. Early diagnosis and awareness are vital for preventing severe illness, as demonstrated in a cluster of five workers.
Area of Science:
- Infectious Diseases
- Medical Entomology
- Public Health
Background:
- Scrub typhus (ST) is an infectious disease caused by Orientia tsutsugamushi (OT).
- Transmission occurs via infected chigger bites, with symptoms ranging from mild to severe multi-organ dysfunction.
- A cluster of five ST cases was identified among oil palm estate workers in Pahang, Malaysia.
Purpose of the Study:
- To report and analyze a cluster of scrub typhus cases in oil palm estate workers.
- To highlight the diagnostic methods and clinical outcomes.
- To emphasize the importance of awareness and prevention in high-risk occupational settings.
Main Methods:
- Clinical, laboratory, and entomological investigations were performed on five patients.
- Polymerase chain reaction (PCR) for OT and genotyping were used on blood and urine samples.
- Serological testing (indirect immunoperoxidase) and analysis of immunoglobulin G (IgG) titers confirmed diagnoses.
Main Results:
- Patients exhibited typical ST symptoms including fever, myalgia, headache, rash, cough, and eschar.
- The index case experienced severe ST with acute kidney injury and respiratory distress, requiring intensive care.
- ST was confirmed via PCR in a urine sample, and four other cases by serological antibody rise.
Conclusions:
- Oil palm estate workers in Malaysia face a significant risk of chigger bites and subsequent ST infection.
- Increased clinical and public awareness of ST is essential for timely diagnosis and effective management.
- Prompt recognition and treatment are crucial for preventing severe complications and improving patient outcomes.
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