{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T17:34:25Z","timestamp":1785000865574,"version":"3.55.0"},"reference-count":76,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T00:00:00Z","timestamp":1638921600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP19m0108003"],"award-info":[{"award-number":["JP19m0108003"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["21wm0225010h0102"],"award-info":[{"award-number":["21wm0225010h0102"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Scrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without early diagnosis and treatment, the disease can develop fatal complications. We retrospectively reviewed de-identified data from a 23-year-old woman who presented to an emergency department with complaints of worsening abdominal pain. On presentation, she appeared jaundiced and toxic-looking. Other positive findings on abdominal examination were a positive Murphey\u2019s sign, abdominal guarding and hepatosplenomegaly. Magnetic resonance cholangiopancreatography demonstrated acalculous cholecystitis. Additional findings included eschar on the medial aspect of the left thigh with inguinal regional lymphadenopathy. Further, positive results were obtained for immunoglobulins M and G, confirming scrub typhus. The workup for other infectious causes of acute acalculous cholecystitis (AAC) detected antibodies against human herpesvirus 4 (Epstein\u2013Barr virus), suggesting an alternative cause of AAC. Whether that represented re-activation of the Epstein\u2013Barr virus could not be determined. As other reports have described acute acalculous cholecystitis in adult scrub typhus patients, we recommend doxycycline to treat acute acalculous cholecystitis in endemic regions while awaiting serological confirmation.<\/jats:p>","DOI":"10.3390\/tropicalmed6040208","type":"journal-article","created":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T23:30:00Z","timestamp":1639006200000},"page":"208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4812-6334","authenticated-orcid":false,"given":"Hisham Ahmed","family":"Imad","sequence":"first","affiliation":[{"name":"Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishath Azna","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Surgery, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariyam","family":"Nahuza","sequence":"additional","affiliation":[{"name":"Department of Surgery, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajan","family":"Gurung","sequence":"additional","affiliation":[{"name":"Department of Surgery, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulla","family":"Ubaid","sequence":"additional","affiliation":[{"name":"Department of Surgery, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishath","family":"Maeesha","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sariu Ali","family":"Didi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajib Kumar","family":"Dey","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Isneen","family":"Hilmy","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indira Gandhi Memorial Hospital, Mal\u00e9 20002, Maldives"},{"name":"Gastrointestinal Unit, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town 7935, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishath","family":"Hareera","sequence":"additional","affiliation":[{"name":"Health Protection Agency, Ministry of Public Health, Mal\u00e9 20002, Maldives"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Afzal","sequence":"additional","affiliation":[{"name":"Health Protection Agency, Ministry of Public Health, Mal\u00e9 20002, Maldives"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7165-2765","authenticated-orcid":false,"given":"Wasin","family":"Matsee","sequence":"additional","affiliation":[{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wang","family":"Nguitragool","sequence":"additional","affiliation":[{"name":"Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0477-0980","authenticated-orcid":false,"given":"Emi. E.","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3439-8331","authenticated-orcid":false,"given":"Tatsuo","family":"Shioda","sequence":"additional","affiliation":[{"name":"Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Paris, D.H. (2020). Special Issue \u201cThe Past and Present Threat of Rickettsial Diseases\u201d. Trop. Med. Infect. Dis., 5.","DOI":"10.3390\/tropicalmed5040187"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kelly, D.J., Fuerst, P.A., and Richards, A.L. (2019). 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