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A Case of Tsutsugamushi Disease after Traveling to the Philippines
Kye-Hyung Kim, M.D.1, Nak-Hyun Kim, M.D.1, Moonsuk Kim, M.D.1, Chung Jong Kim, M.D.1,Jae Hyun Jeon, M.D.1, Wan Beom Park, M.D.1, Won-Jong Jang, Ph.D.3, Sang-Won Park, M.D.1,Ik-Sang Kim, M.D.2, Myoung-don Oh, M.D.1 and Kang Won Choe, M.D.1
1Departments of Internal Medicine and 2Microbiology, Seoul National University, College of Medicine, 3Department of Microbiology, Konkuk University, School of Medicine, Seoul, Korea
Vol.40 Num.6 (p333~336)
Infectious diseases imported from other countries have increased as more and more Koreans are going abroad for various purposes. Tsutsugamushi disease from other endemic area such as Southeast Asia is important, because it can occur in any season and eschar may be absent. We report a case of imported tsutsugamushi disease acquired in the Philippines. A patient presented with fever, headache, and maculopapular skin rash. However, eschar was absent. Polymerase chain reaction (PCR) for 56-kDa gene of Orientia tsutsugamushi using buffy coat was positive. Serum indirect immunofluorescent antibody assay was initially negative but became positive with a titer of 1:320 at follow-up. Sequencing analysis revealed the strain to be 100% identical to the TW73R strain identified in Taiwan. After the patient received doxycycline, body temperature normalized in 12 hours. Tsutsugamushi disease is one of the differential diagnoses that should be included for patients with fever who have recently returned from Southeast Asian countries. PCR for O. tsutsugamushi using patient's buffy coat was useful for early diagnosis.
Keywords : Tsutsugamushi disease, Scrub typhus, Travel, Philippines