A Rare Presentation of Scrub Typhus: Multi-Organ Dysfunction [Acute Kidney Injury, Hepatitis] and Acute Respiratory Distress Syndrome

Bhaumil Shah *

Department of Medicine, Dhiraj Hospital, SBKS MIRC, Vadodara, Gujarat, India.

Sunil Kumar

Department of Medicine, Dhiraj Hospital, SBKS MIRC, Vadodara, Gujarat, India.

Shaily Shah

Department of Medicine, Dhiraj Hospital, SBKS MIRC, Vadodara, Gujarat, India.

*Author to whom correspondence should be addressed.


Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi- a gram negative intracellular bacilli. It typically manifests as eschar formation, fever, rash, myalgia and diffuse lymphadenopathy. The clinical severity of scrub typhus ranges from mild fever to a lethal outcome. Complications like sepsis, acute respiratory distress syndrome (ARDS) and multi organ dysfunction syndrome (MODS)--hepatitis, acute kidney injury contribute to the higher mortality rates, which range from 7-30% in untreated cases. Here, we report a case of 35 years old male who presented with complaints of fever, headache, generalised abdominal pain and dry cough for 7 days. The patient was tested positive for Scrub Typhus IgM antibody; and was complicated with MODS- AKI, Hepatitis and ARDS. After extensive intensive care, monitoring and treatment of 15-20 days, the patient recovered. Hence, early diagnosis and prompt treatment aids in decreasing the mortality in such cases.

Keywords: Orientia tsutsugamushi, scrub typhus, ARDS, MODS

How to Cite

Shah, B., Kumar, S., & Shah, S. (2023). A Rare Presentation of Scrub Typhus: Multi-Organ Dysfunction [Acute Kidney Injury, Hepatitis] and Acute Respiratory Distress Syndrome. Asian Journal of Research in Infectious Diseases, 12(1), 1–7. https://doi.org/10.9734/ajrid/2023/v12i1232


Sapkota, et al. Acute pancreatitis, shock, and multiple organ dysfunction syndrome in scrub typhus. Cureus. 2022;14(8):e28233.

DOI: 10.7759/cureus.28233

Sivarajan S, Shivalli S, Bhuyan D, Mawlong M, Barman R. Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India. Infect Dis Poverty. 2016;5:91.

Walker DH, Dumler S, Marrie T. 211: Rickettsial Diseases. In: Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J, et al., (eds.). Harrison’s principles of internal medicine. 19th ed. New York:McGraw Hill. 2015:1154-1162.

Bhargava A, Kaushik R, Kaushik RM, Sharma A, Ahmad S, Dhar M, et al. Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality. Indian J Med Res. 2016;144:901–909.

Li, et al. Scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia : A case report and review of the literature. Journal of Medical Case Reports. 2019;13:358.


Singh, et al. Clinical profile of scrub typhus patients during COVID pandemic: A sub-Himalayan single center experience. medRxiv preprint; 2022.


Kumar V, Kumar V, Yadav AK, et al. Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India. PLoS Negl Trop Dis. 2014;8: e2605.

Basu G, Chrispal A, Boorugu H, et al. Acute kidney injury in tropical acute febrile illness in a tertiary care centre – RIFLE criteria validation. Nephrol Dial Transplant. 2011;26:524- 31.

Varghese GM, Trowbridge P, Janardhanan J, et al. Clinical profile and improving mortality trend of scrub typhus in South India. Int J Infect Dis. 2014;23:39-43.

Sedhain A, Bhattarai GR. Renal manifestation in scrub typhus during a major outbreak in central Nepal. Indian J Nephrol. 2017;27:440-5.

Song, et al. A case report of scrub typhus: Secondary acute arrest of hemopoiesis with multiple organ dysfunction syndromes. Open Journal of Blood Diseases. 2022;12:53-59.


Mahajan, et al. Spectrum of multiorgan dysfunction in scrub typhus infection. Journal of Tropical Pediatrics. 2021;67(4): 1-9.

DOI: 10.1093/tropej/jmab074

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.

Raoult D. Scrub typhus. In: Mandell GL, Douglas RG, Bennett JE, Dolin R. editors. Mandell Douglas. Bennett’s principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Elsevier/Churchill Livingstone. 2005:2309-10.

Sayen J, Pond H, Forrester J. Scrub typhus in Assam and Burma: A clinical study of 616 cases. Medicine. 1946;25: 155–214.

Chogle AR. Diagnosis and treatment of scrub typhus—The Indian scenario. J Assoc Physicians India. 2010;58:11–2.

Wang CC, Liu SF, Liu JW, Chung YH, Su MC, Lin MC. Acute respiratory distress syndrome (ARDS) in scrub typhus. Am J Trop Med Hyg. 2007;76:1148–52.

Lee S, Kang KP, Kim W, Kang SK, Lee HB, Park SK. A case of acute renal failure, rhabdo- myolysis and disseminated intravascular coa-gulation associated with scrub typhus. Clin Nephrol. 2003;60: 59-61.

Kim DM, Kang DW, Kim JO, et al. Acute renal failure due to acute tubular necrosis caused by direct invasion of Orientia tsutsugamushi. J Clin Microbiol. 2008;46: 1548-50.

Lee WS, Wang FD, Wang LS, Wong WW, Young D, Fung CP, et al. Scrub typhus complicating acute respiratory distress syndrome: A report of two cases. Zhonghua Yi Xue Za Zhi. 1995;56:205–10.