{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T03:38:37Z","timestamp":1772077117994,"version":"3.50.1"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Haemophagocytic lymphohistiocytosis (HLH) is a rare complication of rickettsial infections. We report a 50-y-old man from northern India who presented with fever, respiratory distress, altered sensorium and an eschar. Despite treatment with doxycycline, his condition deteriorated with multi-organ dysfunction. PCR and sequencing from the eschar confirmed Rickettsia conorii. Bone marrow examination, elevated ferritin and triglycerides, as well as an H-score of 224 confirmed HLH. The patient was treated with corticosteroids but succumbed to refractory ventricular arrhythmias. A high index of suspicion is essential in rickettsial infections that present with multi-organ dysfunction, as early recognition of HLH enables the prompt initiation of treatment of the underlying disease and adjunctive immunosuppressive therapy. [GenBank accession nos. U59728.1 and MZ779037.]<\/jats:p>","DOI":"10.1093\/trstmh\/traf074","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T12:04:39Z","timestamp":1753185879000},"page":"1309-1311","source":"Crossref","is-referenced-by-count":1,"title":["Haemophagocytic lymphohistiocytosis triggered by\n                    <i>Rickettsia conorii<\/i>"],"prefix":"10.1093","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8333-9445","authenticated-orcid":false,"given":"Divyashree","family":"Krishna","sequence":"first","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research Department of Internal Medicine, , Chandigarh 160012 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4426-9610","authenticated-orcid":false,"given":"Mohan Kumar","family":"Hanumanthappa","sequence":"additional","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research Department of Internal Medicine, , Chandigarh 160012 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1168-6661","authenticated-orcid":false,"given":"Shriya","family":"Goel","sequence":"additional","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research Department of Medical Microbiology, , Chandigarh 160012 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6255-2685","authenticated-orcid":false,"given":"Kamlesh","family":"Bisht","sequence":"additional","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research Department of Medical Microbiology, , Chandigarh 160012 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4476-3478","authenticated-orcid":false,"given":"Ashok Kumar","family":"Pannu","sequence":"additional","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research Department of Internal Medicine, , Chandigarh 160012 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Praveen","family":"Sharma","sequence":"additional","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research Department of Hematology, , Chandigarh 160012 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manisha","family":"Biswal","sequence":"additional","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research Department of Medical Microbiology, , Chandigarh 160012 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5707-9686","authenticated-orcid":false,"given":"Navneet","family":"Sharma","sequence":"additional","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research Department of Internal Medicine, , Chandigarh 160012 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"issue":"1","key":"2025110305581809300_bib1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1179\/2047773212Y.0000000001","article-title":"Molecular detection and analysis of spotted fever group Rickettsia in patients with fever and rash at a tertiary care centre in Tamil Nadu","volume":"106","author":"Prakash","year":"2012","journal-title":"India Pathog Glob Health"},{"issue":"4","key":"2025110305581809300_bib2","doi-asserted-by":"crossref","first-page":"351","DOI":"10.4269\/ajtmh.2004.70.351","article-title":"Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi","volume":"70","author":"Jiang","year":"2004","journal-title":"Am J Trop Med Hyg"},{"issue":"6","key":"2025110305581809300_bib3","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1007\/s004310050859","article-title":"Clinical and laboratory findings of boutonneuse fever in Sicilian children","volume":"157","author":"Cascio","year":"1998","journal-title":"Eur J Pediatr"},{"issue":"1","key":"2025110305581809300_bib4","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1186\/s13054-020-02941-3","article-title":"Hemophagocytic lymphohistiocytosis in critically ill patients: diagnostic reliability of HLH-2004 criteria and HScore","volume":"24","author":"Knaak","year":"2020","journal-title":"Crit Care"},{"issue":"4","key":"2025110305581809300_bib5","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1099\/jmm.0.025833-0","article-title":"Haemophagocytic syndrome and rickettsial diseases","volume":"60","author":"Cascio","year":"2011","journal-title":"J Med Microbiol"},{"issue":"12","key":"2025110305581809300_bib6","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/S1473-3099(07)70290-6","article-title":"Infections associated with haemophagocytic syndrome","volume":"7","author":"Rouphael","year":"2007","journal-title":"Lancet Infect Dis"},{"issue":"8-9","key":"2025110305581809300_bib7","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.annder.2017.10.017","article-title":"Haemophagocytic syndrome secondary to Mediterranean spotted fever","volume":"145","author":"Bertrand","year":"2018","journal-title":"Ann Dermatol Venereol"},{"issue":"10","key":"2025110305581809300_bib8","doi-asserted-by":"crossref","first-page":"ofaa355","DOI":"10.1093\/ofid\/ofaa355","article-title":"A case of hemophagocytic lymphohistiocytosis associated with Mediterranean spotted fever in a healthy 29-year-old female","volume":"7","author":"Karra","year":"2020","journal-title":"Open Forum Infect Dis"}],"container-title":["Transactions of the Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/119\/11\/1309\/63817626\/traf074.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/119\/11\/1309\/63817626\/traf074.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T10:58:26Z","timestamp":1762167506000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/119\/11\/1309\/8210264"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,22]]},"references-count":8,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,7,22]]},"published-print":{"date-parts":[[2025,11,3]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/traf074","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,7,22]]}}}