{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T10:52:06Z","timestamp":1740135126622,"version":"3.37.3"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T00:00:00Z","timestamp":1588723200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T00:00:00Z","timestamp":1588723200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Scrub typhus can present with atypical signs and symptoms such as those of acute kidney injury, gastroenteritis, pneumonitis, and acute respiratory distress syndrome. Meningitis, encephalitis, and hepatic dysfunction have also been reported, particularly in severe cases with multisystem involvement. Scrub typhus has never been reported in the literature to cause urinary tract infections (UTIs) which includes cystitis and pyelonephritis.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>A 45-year old male presenting to the outpatient unit with fever, right flank pain, and burning micturition for three days was initially treated for UTI. However, he returned to the hospital on the fourth day of illness with persistent symptoms. He was hospitalized, with intravenous (IV) ceftriaxone. Computerized tomography scan of his abdomen-pelvis showed features of acute pyelonephritis, so his antibiotics were upgraded to meropenem and teicoplanin. Despite this, the patient\u2019s condition deteriorated. Laboratory investigations showed multisystem involvement: decreasing platelets, raised creatinine, and deranged liver panel. As Kathmandu was hit by dengue epidemic during the patient\u2019s hospitalization, on the seventh day of his illness, blood samples were sent for tropical fever investigation. All tests came out negative except for scrub typhus\u2014IgM antibodies positive on rapid diagnostic test. The patient\u2019s symptoms subsided after 48\u2009h of starting doxycycline and he became fully asymptomatic four days later. Fever did not recur even after discontinuing other IV antibiotics, favoring scrub typhus disease rather than systemic bacterial sepsis.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Scrub typhus is an emerging infectious disease of Nepal. Therefore, every unexplained fever cases (irrespective of clinical presentation) should be evaluated for potential Rickettsiosis. Moreover, for cases with acute pyelonephritis, atypical causative agents should be investigated, for example scrub typhus in this case.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12879-020-05050-2","type":"journal-article","created":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T07:03:26Z","timestamp":1588748606000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Scrub typhus as a rare cause of acute pyelonephritis: case report"],"prefix":"10.1186","volume":"20","author":[{"given":"Tulsi","family":"Bhattarai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sujan Chandra","family":"Poudel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nishma","family":"Pokharel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6843-6677","authenticated-orcid":false,"given":"Suraj","family":"Bhattarai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,5,6]]},"reference":[{"key":"5050_CR1","doi-asserted-by":"crossref","unstructured":"Taylor AJ, Paris DH, Newton PN. A systematic review of mortality from untreated scrub typhus (orientia tsutsugamushi). PLoS Negl Trop Dis. 2015;9(8):e0003971.","DOI":"10.1371\/journal.pntd.0003971"},{"key":"5050_CR2","doi-asserted-by":"crossref","unstructured":"Basnyat B. Typhoid versus typhus fever in post-earthquake Nepal. Lancet Glob Health. 2016;4(8):516\u201317.","DOI":"10.1016\/S2214-109X(16)30094-8"},{"key":"5050_CR3","doi-asserted-by":"crossref","unstructured":"Rajapakse S, Weeratunga P, Sivayoganathan S, Fernando SD. Clinical manifestations of scrub typhus. Trans R Soc Trop Med Hyg. 2017;111(2):43\u201354.","DOI":"10.1093\/trstmh\/trx017"},{"key":"5050_CR4","doi-asserted-by":"crossref","unstructured":"BonellBonell A, Lubell Y, Newton PN, Crump JA, Paris DH. Estimating the burden of scrub typhus: A systematic review. PLoS Negl Trop Dis. 2017;11(9)e0005838.","DOI":"10.1371\/journal.pntd.0005838"},{"key":"5050_CR5","doi-asserted-by":"crossref","unstructured":"Lim C, Paris DH, Blacksell SD, Laongnualpanich A, Kantipong P, Chierakul W, et al. How to determine the accuracy of an alternative diagnostic test when it is actually better than the reference tests: A re-evaluation of diagnostic tests for scrub typhus using Bayesian LCMs. PLoS One. 2015;10(5):e0114930.","DOI":"10.1371\/journal.pone.0114930"},{"key":"5050_CR6","doi-asserted-by":"crossref","unstructured":"Ronald A. The etiology of urinary tract infection: Traditional and emerging pathogens. Disease-a-Month. 2003;49(2):71\u201382.","DOI":"10.1067\/mda.2003.8"},{"key":"5050_CR7","doi-asserted-by":"crossref","unstructured":"Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012;366(11):1028\u201337.","DOI":"10.1056\/NEJMcp1104429"},{"key":"5050_CR8","doi-asserted-by":"crossref","unstructured":"Hwang K, Jang HN, Lee TW, Cho HS, Bae E, Chang SH, et al. Incidence, risk factors and clinical outcomes of acute kidney injury associated with scrub typhus: A retrospective study of 510 consecutive patients in South Korea (2001-2013). BMJ Open. 2017;7(3):e013882.","DOI":"10.1136\/bmjopen-2016-013882"},{"key":"5050_CR9","unstructured":"Shu LH, Xu Y. [One case of scrub typhus patient with clinical manifestation of acute pyelonephritis]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2013;31(4):Inside back cover."}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05050-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-020-05050-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05050-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T23:29:11Z","timestamp":1620257351000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-020-05050-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,6]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["5050"],"URL":"https:\/\/doi.org\/10.1186\/s12879-020-05050-2","relation":{},"ISSN":["1471-2334"],"issn-type":[{"type":"electronic","value":"1471-2334"}],"subject":[],"published":{"date-parts":[[2020,5,6]]},"assertion":[{"value":"23 January 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Institutional ethical approval is generally not required for case reports in our setting. The patient provided informed consent in written form to participate in this study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The patient authorized the main author, in written form, to publish this case report and the accompanying image (CT KUB). A copy of the consent is available for review by the journal editor","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"322"}}