Infect Chemother.  2009 Apr;41(2):99-104. 10.3947/ic.2009.41.2.99.

Cholestatic Hepatitis Caused by Tongyeong Strain of Orientia tsutsugamushi

• Joo K
• Kim MK
• Kil SH
• Chung MH
• Kim JM
• Kang JS

• KMID: 2170258
• DOI: http://doi.org/10.3947/ic.2009.41.2.99

Abstract

In Korea, the clinical manifestation of scrub typhus in humans appears to be severe in the northern regions of the country and mild in the southern areas. Studies on the geographic distribution of the serotype of Orientia tsutsugamushi revealed that the Boryong serotype is predominant in the southern Korean peninsula, whereas the Gilliam, Karp, and Gilliam-Karp serotypes prevail in the northern or central peninsula. We report a case of severe scrub typhus caused by the Japanese Gilliam type of Orientia tsutsugamushi in a 66-year-old woman from Tongyeong, a city located in the southern part of Korean peninsula. The patient was admitted to the hospital with fever on August 29th, 2001. Scrub typhus complicated by shock, pneumonitis, and encephalitis was diagnosed. Additionally, markedly elevated alkaline phosphatase levels was observed, which necessitated an ultrasonographic examination, which showed an ill-defined hyperechogenic mass on the right hepatic lobe. Liver biopsy showed cholestatic hepatitis and blood culture showed growth of O. tsutsugamushi. Gene sequencing of the amplicons of a polymerase chain reaction using primers for the amplification of the gene encoding the 56-kDa protein of O. tsutsugamushi revealed a nucleotide sequence that matched Yonchon strain of O. tsutsugamushi.

Keyword

Orientia tsutsugamushi; Scrub typhus; Cholestatic hepatitis; Genotype

MeSH Terms

Aged
Alkaline Phosphatase
Asian Continental Ancestry Group
Base Sequence
Biopsy
Encephalitis
Female
Fever
Genotype
Hepatitis
Humans
Korea
Liver
Orientia tsutsugamushi
Pneumonia
Polymerase Chain Reaction
Scrub Typhus
Shock
Sprains and Strains
Alkaline Phosphatase