Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2026 Sep;38(9):866-870. doi: 10.3760/cma.j.cn121430-20260219-00096.
ABSTRACT
Tsutsugamushi disease (TD) is a zoonotic and naturally focal infectious disease caused by Orientia tsutsugamushi (Ot), transmitted between humans and rodents through the bite of chigger mites. On August 17, 2025, a patient with TD complicated by acute left sided heart failure and multiple organ dysfunction was admitted to Wuhan Jinyintan Hospital. The patient presented to the emergency department with a 10 day history of fever, palpitations, dyspnea, and cough, and had a history of outdoor exposure. Physical examination revealed a temperature of 39.2 centigrade, a heart rate of 79 beats/min (showing relative bradycardia), an eschar of 0.5 cm×0.6 cm at the intersection of the right mid axillary line and the umbilical horizontal line, and a truncal rash. Laboratory findings showed an eosinophil count of 0, troponin T 1.31 μg/L, N terminal pro B type natriuretic peptide 2 912.60 ng/L, and elevated procalcitonin. Electrocardiography revealed prolonged Q T and Q Tc intervals, and chest CT demonstrated bilateral interstitial pulmonary edema and bilateral pleural effusion. Next generation sequencing of blood detected Ot nucleic acid fragments, and serum Ot immunoglobulin M (IgM) antibody was positive, confirming the diagnosis of TD complicated by myocarditis, acute left sided heart failure, and multiple organ dysfunction. The patient was treated with doxycycline combined with rifampicin for anti infection, along with symptomatic and supportive care, as well as local interventions including thoracentesis drainage and bronchoalveolar lavage. Subsequently, the patient's body temperature normalized, cardiac function improved, pulmonary edema and pleural effusion resolved, and myocardial enzymes returned to normal levels; the patient was discharged with clinical cure. This case indicates that TD can affect the cardiovascular system, presenting as acute left sided heart failure and myocarditis. For patients with fever, relative bradycardia, and multiple organ dysfunction, TD should be considered in the differential diagnosis, and early recognition of the eschar together with prompt initiation of etiological therapy are crucial for improving prognosis.
PMID:42875247 | DOI:10.3760/cma.j.cn121430-20260219-00096