{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T16:16:39Z","timestamp":1767802599863,"version":"3.49.0"},"reference-count":40,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,7]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Scrub typhus, caused by\n                    <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                    , is a common endemic vector-borne disease in Asia that can lead to a range of systemic complications, including the rare but potentially life-threatening manifestation of acute pancreatitis. We conducted a systematic review of all reported cases of scrub typhus\u2013associated acute pancreatitis from 1943 to 2024 using PubMed, including English, Japanese, and Chinese literature, and analyzed a total of 14 cases, including one newly identified case at our institution. Diagnostic criteria were based on compatible clinical features, elevated pancreatic enzymes, and characteristic imaging findings. The median age of patients was 47 years (range 22\u201375), with 69.2% of patients being male. The most frequent clinical manifestations were fever (100%), abdominal pain (92.3%), and thrombocytopenia (30.8%). Over one-third of the patients developed multiple organ dysfunction syndrome (MODS) or shock, and the mortality rate was 23.1%, with all fatalities occurring in patients with MODS. Most patients received doxycycline or azithromycin along with supportive care. The newly reported case presented with rapidly progressive pancreatitis requiring intensive care and multiple organ support, but the patient eventually recovered. These findings highlight that acute pancreatitis is an underrecognized yet severe complication of scrub typhus, often associated with poor outcomes when MODS is present. Clinicians in endemic regions should consider pancreatitis in the differential diagnoses when evaluating scrub typhus patients with abdominal symptoms or systemic inflammation. Prompt recognition and timely, aggressive management may improve survival and reduce complications in affected patients.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0300","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T17:44:33Z","timestamp":1762278273000},"page":"27-30","source":"Crossref","is-referenced-by-count":0,"title":["Scrub Typhus\u2013Associated Acute Pancreatitis: A Comprehensive Review and New Case Series"],"prefix":"10.4269","volume":"114","author":[{"given":"Chang-Seop","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea;"},{"name":"Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Int J Syst Bacteriol","first-page":"589","article-title":"Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen. nov., as Orientia tsutsugamushi comb. nov","volume":"45","author":"Tamura","year":"1995"},{"key":"b2","series-title":"Clin Infect Dis","first-page":"S203","article-title":"Scrub typhus: The geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi.","volume":"48","author":"Kelly","year":"2009"},{"key":"b3","series-title":"N Engl J Med","first-page":"954","article-title":"Endemic scrub typhus in South America","volume":"375","author":"Weitzel","year":"2016"},{"key":"b4","series-title":"Sci Rep","first-page":"20737","article-title":"Determination of scrub typhus suggests a new epidemic focus in the Anhui Province of China","volume":"6","author":"Cao","year":"2016"},{"key":"b5","series-title":"PLoS Negl Trop Dis","first-page":"e0004467","article-title":"IL-33-dependent endothelial activation contributes to apoptosis and renal injury in Orientia tsutsugamushi-infected mice","volume":"10","author":"Shelite","year":"2016"},{"key":"b6","series-title":"PLoS Negl Trop Dis","first-page":"e3191","article-title":"Strong type 1, but impaired type 2, immune responses contribute to Orientia tsutsugamushi-induced pathology in mice","volume":"8","author":"Soong","year":"2014"},{"key":"b7","series-title":"Clin Gastroenterol Hepatol","first-page":"A19","article-title":"A cutaneous clue to a tropical cause of acute pancreatitis: Scrub typhus","volume":"19","author":"James","year":"2021"},{"key":"b8","series-title":"J Microbiol Immunol Infect","first-page":"285","article-title":"Acute acalculous cholecystitis and pancreatitis in a patient with concomitant leptospirosis and scrub typhus (abstract)","volume":"36","author":"Wang","year":"2003"},{"key":"b9","series-title":"J Glob Infect Dis","first-page":"28","article-title":"Pancreatitis in scrub typhus","volume":"6","author":"Bhatt","year":"2014"},{"key":"b10","series-title":"Trop Doct","first-page":"65","article-title":"Acute pancreatitis associated with scrub typhus","volume":"47","author":"Devi","year":"2017"},{"key":"b11","series-title":"Ann Medicus","first-page":"260","article-title":"Scrub typhus presenting as acute pancreatitis with multiorgan dysfunction: a rare case report","volume":"2","author":"Katyal","year":"2015"},{"key":"b12","series-title":"World J Gastroenterol","first-page":"3523","article-title":"Pancreatic abscess following scrub typhus associated with multiorgan failure","volume":"13","author":"Yi","year":"2007"},{"key":"b13","series-title":"Trop Med Health","first-page":"19","article-title":"Pancreatitis and MODS due to scrub typhus and dengue co-infection","volume":"40","author":"Iqbal","year":"2012"},{"key":"b14","series-title":"BMJ Case Rep","first-page":"bcr2013201849","article-title":"Pancreatitis in scrub typhus: A rare complication","volume":"2014","author":"Dhakal","year":"2014"},{"key":"b15","series-title":"J Glob Infect Dis","first-page":"31","article-title":"Acute pancreatitis due to scrub typhus","volume":"6","author":"Ahmed","year":"2014"},{"key":"b16","series-title":"Cureus","first-page":"e28233","article-title":"Acute pancreatitis, shock, and multiple organ dysfunction syndrome in scrub typhus","volume":"14","author":"Sapkota","year":"2022"},{"key":"b17","series-title":"Cureus","first-page":"e42358","article-title":"Acute pancreatitis as a rare complication of scrub typhus: A case report","volume":"15","author":"Rana","year":"2023"},{"key":"b18","series-title":"Mod Pathol","first-page":"752","article-title":"Identification of the target cells of Orientia tsutsugamushi in human cases of scrub typhus","volume":"14","author":"Moron","year":"2001"},{"key":"b19","series-title":"Am J Pathol","first-page":"603","article-title":"A comparative study of the pathology of scrub typhus (tsutsugamushi disease) and other rickettsial diseases","volume":"21","author":"Allen","year":"1945"},{"key":"b20","series-title":"Am J Clin Pathol","first-page":"139","article-title":"The pathology of scrub typhus","volume":"16","author":"Park","year":"1946"},{"key":"b1","series-title":"Int J Syst Bacteriol","first-page":"589","article-title":"Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen. nov., as Orientia tsutsugamushi comb. nov","volume":"45","author":"Tamura","year":"1995"},{"key":"b2","series-title":"Clin Infect Dis","first-page":"S203","article-title":"Scrub typhus: The geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi.","volume":"48","author":"Kelly","year":"2009"},{"key":"b3","series-title":"N Engl J Med","first-page":"954","article-title":"Endemic scrub typhus in South America","volume":"375","author":"Weitzel","year":"2016"},{"key":"b4","series-title":"Sci Rep","first-page":"20737","article-title":"Determination of scrub typhus suggests a new epidemic focus in the Anhui Province of China","volume":"6","author":"Cao","year":"2016"},{"key":"b5","series-title":"PLoS Negl Trop Dis","first-page":"e0004467","article-title":"IL-33-dependent endothelial activation contributes to apoptosis and renal injury in Orientia tsutsugamushi-infected mice","volume":"10","author":"Shelite","year":"2016"},{"key":"b6","series-title":"PLoS Negl Trop Dis","first-page":"e3191","article-title":"Strong type 1, but impaired type 2, immune responses contribute to Orientia tsutsugamushi-induced pathology in mice","volume":"8","author":"Soong","year":"2014"},{"key":"b7","series-title":"Clin Gastroenterol Hepatol","first-page":"A19","article-title":"A cutaneous clue to a tropical cause of acute pancreatitis: Scrub typhus","volume":"19","author":"James","year":"2021"},{"key":"b8","series-title":"J Microbiol Immunol Infect","first-page":"285","article-title":"Acute acalculous cholecystitis and pancreatitis in a patient with concomitant leptospirosis and scrub typhus (abstract)","volume":"36","author":"Wang","year":"2003"},{"key":"b9","series-title":"J Glob Infect Dis","first-page":"28","article-title":"Pancreatitis in scrub typhus","volume":"6","author":"Bhatt","year":"2014"},{"key":"b10","series-title":"Trop Doct","first-page":"65","article-title":"Acute pancreatitis associated with scrub typhus","volume":"47","author":"Devi","year":"2017"},{"key":"b11","series-title":"Ann Medicus","first-page":"260","article-title":"Scrub typhus presenting as acute pancreatitis with multiorgan dysfunction: a rare case report","volume":"2","author":"Katyal","year":"2015"},{"key":"b12","series-title":"World J Gastroenterol","first-page":"3523","article-title":"Pancreatic abscess following scrub typhus associated with multiorgan failure","volume":"13","author":"Yi","year":"2007"},{"key":"b13","series-title":"Trop Med Health","first-page":"19","article-title":"Pancreatitis and MODS due to scrub typhus and dengue co-infection","volume":"40","author":"Iqbal","year":"2012"},{"key":"b14","series-title":"BMJ Case Rep","first-page":"bcr2013201849","article-title":"Pancreatitis in scrub typhus: A rare complication","volume":"2014","author":"Dhakal","year":"2014"},{"key":"b15","series-title":"J Glob Infect Dis","first-page":"31","article-title":"Acute pancreatitis due to scrub typhus","volume":"6","author":"Ahmed","year":"2014"},{"key":"b16","series-title":"Cureus","first-page":"e28233","article-title":"Acute pancreatitis, shock, and multiple organ dysfunction syndrome in scrub typhus","volume":"14","author":"Sapkota","year":"2022"},{"key":"b17","series-title":"Cureus","first-page":"e42358","article-title":"Acute pancreatitis as a rare complication of scrub typhus: A case report","volume":"15","author":"Rana","year":"2023"},{"key":"b18","series-title":"Mod Pathol","first-page":"752","article-title":"Identification of the target cells of Orientia tsutsugamushi in human cases of scrub typhus","volume":"14","author":"Moron","year":"2001"},{"key":"b19","series-title":"Am J Pathol","first-page":"603","article-title":"A comparative study of the pathology of scrub typhus (tsutsugamushi disease) and other rickettsial diseases","volume":"21","author":"Allen","year":"1945"},{"key":"b20","series-title":"Am J Clin Pathol","first-page":"139","article-title":"The pathology of scrub typhus","volume":"16","author":"Park","year":"1946"}],"container-title":["The American Journal of Tropical Medicine and 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