Kosin Med J.  2023 Sep;38(3):210-214. 10.7180/kmj.23.111.

Scrub typhus with complications of acute myocarditis and cardiac tamponade in metropolitan areas: two case reports

• Kang KW
• Kim W

• KMID: 2546156
• DOI: http://doi.org/10.7180/kmj.23.111

Abstract

Scrub typhus is known as one of the most common seasonal infections in endemic rural areas, but life-threatening cardiac complications in cases of scrub typhus are very infrequent. In addition, scrub typhus infection has been rarely reported among workers assembling pallets using manufactured wood in metropolitan areas. Herein, we present two cases involving myocarditis and cardiac tamponade as complications of scrub typhus. One patient died and the other patient survived. These cases indicate that scrub typhus infection could be an environmental hazard in metropolitan areas, especially in locations with poor hygiene, and highlight the need for timely diagnosis and proper management of severe scrub typhus infections. Therefore, we present these two informative fatal cases of scrub typhus infection presenting with myocarditis and cardiac tamponade as an environmental hazard in metropolitan areas.

Keyword

Cardiac tamponade; Case reports; Environmental hazard; Metropolitan; Scrub typhus

Figure

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  Fig. 1. The photo of public workplace in the infection. (A) The pallet manufacturing plant in a metropolitan area. Piles of logs in a neighboring carpentry workplace. (B) Pictures of the plant and surroundings show poor hygiene.

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  Fig. 2. The change of QRS voltage in the serial electrocardiogram (ECG) during the cardiac complication. (A) Initial ECG shows a low voltage of QRS amplitude in the intensive care unit. (B) Post-pericardiocentesis ECG shows improvement in the low voltage of QRS amplitude at discharge.

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  Fig. 3. The image of cardiac complications. (A) Chest computed tomography shows pericardial effusion with pericardial enhancement (filled arrows). (B) Echocardiography shows marked pericardial effusion (hollow arrows).

Reference

References

1. Bonell A, Lubell Y, Newton PN, Crump JA, Paris DH. Estimating the burden of scrub typhus: a systematic review. PLoS Negl Trop Dis. 2017; 11:e0005838.

2. Kim DM, Chung JH, Yun NR, Kim SW, Lee JY, Han MA, et al. Scrub typhus meningitis or meningoencephalitis. Am J Trop Med Hyg. 2013; 89:1206–11.

3. Bharathi SL, Jayachandran S, Senthil N, Sujatha S. Scrub typhus causing myocarditis and ARDS: a case report. Heart India. 2013; 1:85–6.

4. Kurup A, Issac A, Loh JP, Lee TB, Chua R, Bist P, et al. Scrub typhus with sepsis and acute respiratory distress syndrome. J Clin Microbiol. 2013; 51:2787–90.

5. Han DJ, Park HS, Kim DY, Kang HC, Rhee HS, Lee SW, et al. Acute fulminant myocarditis following scrub typhus infection. Korean J Med. 2013; 85:623–8.

6. Chin JY, Kang KW, Moon KM, Kim J, Choi YJ. Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea. Korean J Intern Med. 2018; 33:323–30.

7. Kim S, Kim JS, Lee H. Epidemiological characteristics of scrub typhus in Korea, 2009. Osong Public Health Res Perspect. 2010; 1:55–60.

8. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013; 34:2636–48.

9. Li T, Yang Z, Dong Z, Wang M. Meteorological factors and risk of scrub typhus in Guangzhou, southern China, 2006-2012. BMC Infect Dis. 2014; 14:139.

10. Lee HW, Cho PY, Moon SU, Na BK, Kang YJ, Sohn Y, et al. Current situation of scrub typhus in South Korea from 2001-2013. Parasit Vectors. 2015; 8:238.

11. Jang SY, Kang KW, Kim JH, Kim B, Chin JY, Park SH, et al. New-onset atrial fibrillation predicting for complicating cardiac adverse outcome in scrub typhus infection. Clin Cardiol. 2019; 42:1210–21.

12. Myong JP, Ahn YS, Kim HR, Kim YJ, Park CY, Koo JW. Work-related infectious diseases among Korean workers compensated under the Industrial Accident Compensation Insurance Law, 2006-2011. Int J Occup Environ Health. 2013; 19:344–51.