Could my wife’s splenectomy worsen her scrub typhus?

Question

Hello doctor,

My wife (39 years old, marine biologist) was studying coral reefs. She developed a high fever and severe joint pain six days ago. The initial symptoms resembled dengue, but now she has developed black scabs on her thighs and back. The local hospital confirmed scrub typhus, but they are seeing an unusual presentation she is developing acute pancreatitis (lipase levels greater than 1000) and severe acute respiratory distress syndrome (ARDS). Her oxygen saturation drops to 70% with minimal movement. She has been started on Doxycycline and Azithromycin but is showing signs of a drug allergy (severe rash and angioedema (sudden swelling of deeper layers of the skin, often around the eyes, lips, or throat, typically caused by allergic reactions or other triggers). Her liver function is deteriorating rapidly (bilirubin level 8.5). The hospital has not encountered scrub typhus with pancreatitis before. Three other research team members are also showing early symptoms. Should we arrange an airlift? What alternative antibiotics can we try? I am also concerned because she had a splenectomy after a diving accident could this make things worse?

Please guide.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for posting your query.

Acute respiratory distress syndrome (ARDS)(severe lung condition characterized by widespread inflammation, low oxygen levels, and difficulty breathing, often resulting from trauma, infection, or other underlying health issues), hepatitis(the inflammation of the liver, commonly caused by viral infections (hepatitis A, B, C, D, E), alcohol use, or autoimmune conditions, leading to symptoms like jaundice, fatigue, and abdominal pain), pre-renal azotemia(a condition characterized by an increase in blood urea nitrogen (BUN) and creatinine levels due to reduced blood flow to the kidneys, often caused by dehydration, heart failure, or blood loss), and multi-organ dysfunction syndrome are possible complications of scrub typhus.

Pancreatitis in scrub typhus is an extremely rare complication and, when present, is associated with increased mortality rates (42.8%). As this is not a well-known complication of scrub typhus, clinicians may not consider this possibility, leading to underdiagnosis.

Both antibiotics, Doxycycline, and Azithromycin, are equally effective in preventing fatal outcomes in scrub typhus patients. No interaction has been reported between Azithromycin and Doxycycline.

Rifampicin appears to be more effective than Doxycycline in areas where scrub typhus responds poorly to standard drugs.

A splenectomy will not worsen her condition.

Yes, you should arrange for an airlift as early as possible.

Probable causes: Complications in scrub typhus.

Investigations to be done: Immediate hospitalization.

Probable diagnosis: A case of complicating scrub typhus poorly responding to treatment.

Please let me know if you want some help.

Thank you.