{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T05:26:01Z","timestamp":1764739561517,"version":"3.46.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82460015"],"award-info":[{"award-number":["82460015"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Guizhou Provincial Clinical Research Center for Respiratory Diseases","award":["([2016]Support2097"],"award-info":[{"award-number":["([2016]Support2097"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Coinfection of pulmonary tuberculosis and scrub typhus caused by\n                      <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                      is exceptionally rare. Overlapping clinical and radiologic features, together with the frequent absence of clear epidemiologic clues, complicate timely diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 57-year-old man residing in a non-endemic region presented with a left-sided cavitary lung lesion on imaging. Computed tomography (CT)-guided percutaneous lung biopsy, acid-fast bacillus staining, and\n                      <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                      DNA PCR established the diagnosis of active cavitary pulmonary tuberculosis. Despite initiation of a standard first-line anti-tuberculosis regimen, high-grade fever persisted. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) detected\n                      <jats:italic>O. tsutsugamushi<\/jats:italic>\n                      , which was subsequently confirmed by a positive IgM indirect immunofluorescence assay (IFA). Doxycycline was added, leading to defervescence within 48\u202fh and marked symptomatic improvement. On follow-up, chest CT demonstrated lesion absorption and cavity shrinkage, while new fibrotic changes emerged. The patient was started on maintenance pirfenidone and prescribed home oxygen therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with pulmonary tuberculosis who exhibit persistent fever or suboptimal response despite appropriate therapy\u2014and after excluding drug resistance\u2014scrub typhus should be included in the differential diagnosis, even in non-endemic settings without a typical exposure history. Longitudinal imaging in this case also shows that irreversible structural remodeling may occur despite microbiologic control, underscoring the need to pair prompt pathogen-directed therapy with ongoing monitoring and early strategies to preserve lung function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1692918","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T05:20:54Z","timestamp":1764739254000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cavitary pulmonary tuberculosis with Orientia tsutsugamushi coinfection in a non-endemic region: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Yuanjiang","family":"Zheng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiangyan","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youjun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shanyu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianglin","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianwei","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e0006062","DOI":"10.1371\/journal.pntd.0006062","article-title":"A 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