Summary:
Scrub typhus is an acute, febrile, infectious illness that is
caused by Orientia tsutsugamushi. Scrub and murine
endemic typhus infections are under-diagnosed causes of
febrile illness across the tropics, and it is not known how
common they are in Bangladesh. Here reporting a case
who presented with high grade fever for 7 days associated
with headache, abdominal discomfort, cough and receiving
inj ceftriaxone for 2 days considering as a case of enteric
fever. Forty-eight hours after admission, the presence of
continued high grade fever, conjunctival congestion,
headache, loose motion, cough, low platelet, elevated
transaminase raised the possibility of a different aetiology.
The two most likely differentials being dengue and malaria.
Finally, typhus was discovered due to history of field visit,
presence of eschar and raised titre of WF OXK antigen.
All other causes of fever were ruled out by history, clinical
examination and relevant investigations. Patient was treated
with capsule doxycycline and other supportive therapy and
become afebrile within 48 hours. This uncommon clinical
scenario should be taken into account in the management
of patients with high fever on admission.
(J Bangladesh Coll Phys Surg 2018; 36: 123-127)
DOI: http://dx.doi.org/10.3329/jbcps.v36i2.36081