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Classic symptoms of the disease are eschar and lymphadenopathy. Previous reports have revealed clinical manifestations of scrub typhus, including gastrointestinal symptoms, meningoencephalitis, ocular flutter, pneumonitis, acute respiratory distress syndrome, and acute kidney injury. However, cases of scrub typhus presenting as a urinary tract infection (UTI) with high D-dimer levels could be easily misdiagnosed when clinical attention is insufficient, resulting in difficulty in making a timely diagnosis of the infection. Metagenomics next-generation sequencing (mNGS) is a revolutionary and highly sensitive method that may help in diagnosing atypical\u00a0cases, even when trace amounts of pathogens are present.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 52-year-old female presented with a 10-day history of fever, chills, headache and myalgia. She was initially diagnosed with influenza at a local clinic. Various antibacterials were used on the 2nd\u201312th day onwards; however, her symptoms persisted and were followed by increased urination duration, frequency, urgency and dysuria for 2\u00a0days.\n                      <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                      was confirmed as the pathogen responsible for the infection through mNGS analysis of her blood samples from Day 13 onwards. The patient\u2019s temperature changed remarkably 24\u00a0h after the initiation of doxycycline. Over the next 48\u00a0h (i.e., Day 15 onwards), the patient showed clinical improvement. She recovered and was discharged from the hospital.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Scrub typhus can present atypical clinical symptoms, such as UTIs, in a febrile patient. mNGS may be a useful method for identifying\n                      <jats:italic>O. tsutsugamushi<\/jats:italic>\n                      infection in patients with atypical clinical manifestations.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-021-06889-9","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T03:02:52Z","timestamp":1638846172000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["mNGS helped diagnose scrub typhus presenting as a urinary tract infection with high D-dimer levels: a case report"],"prefix":"10.1186","volume":"21","author":[{"given":"Mei-fang","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"De-rong","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"La-gen","family":"Wan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,7]]},"reference":[{"issue":"10","key":"6889_CR1","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1056\/NEJMp1608499","volume":"375","author":"D Walker","year":"2016","unstructured":"Walker D. 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