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A case series of possibly recrudescent Orientia tsutsugamushi infection presenting as pneumonia.
[scrub typhus]
Orientia
tsutsugamushi
remains
latent
in
humans
after
scrub
typhus
.
Pneumonia
occurs
as
a
complication
of
scrub
typhus
in
the
late
-phase
disease
.
However
,
pneumonia
may
also
occur
as
a
presenting
manifestation
of
O
.
tsutsugamushi
infection
.
We
reviewed
the
cases
of
3
patients
with
atypical
pneumonia
who
presented
at
our
hospital
and
were
later
confirmed
to
have
O
.
tsutsugamushi
infection
by
serology
,
nested
polymerase
chain
reaction
(
PCR
)
,
and
cell
culture
.
All
patients
were
young
adults
with
no
history
of
scrub
typhus
,
and
none
claimed
to
have
recently
been
exposed
to
areas
where
scrub
typhus
is
endemic
.
Two
cases
occurred
in
non-outbreak
seasons
.
Furthermore
,
eschar
was
not
observed
.
Pneumonia
was
documented
within
4
days
after
fever
onset
.
The
immunoglobulin
(
Ig
)
G
antibody
titers
against
O
.
tsutsugamushi
were
higher
than
the
IgM
titers
,
although
the
serologic
test
results
were
less
helpful
in
the
diagnosis
.
Nested
PCR
and
cell
culture
of
blood
specimens
confirmed
the
diagnosis
of
O
.
tsutsugamushi
infection
.
These
findings
suggest
that
pneumonia
can
occur
as
a
result
of
recrudescence
of
latent
O
.
tsutsugamushi
infection
.
