A case of scrub typhus presenting as ARDS

Abstract

Acute respiratory distress syndrome (ARDS) is a rapidly progressive disease, mainly occurring in critically ill patients. The systemic spread of infections mainly causes ARDS due to the seepage of fluid in the interstial spaces of the lung parenchyma. Scrub typhus is a rickettsial infection caused by Orientia tsutsugamuchi.  The bite of trombiculid mite transmits it. Scrub typhus is frequently underdiagnosed due to its non-specific clinical presentation and relatively low level of suspicion in treating physicians. The clinical presentation of scrub typhus is varied from fever, myalgia, rashes, headache, lymphadenopathy to pneumonia, acute respiratory distress syndrome, sepsis, central nervous system involvement. The disease is usually indistinguishable from other febrile illness like enteric fever, weils disease, malaria and certain viral hemorrhagic fevers. Identification of an eschar points to the diagnosis without which the diagnosis is based on a high index of clinical suspicion. We report an interesting case of scrub typhus presenting as acute respiratory distress syndrome.