Cholestatic Hepatitis Caused by Tongyeong Strain of Orientia tsutsugamushi

다국어 초록 (Multilingual Abstract)

In Korea, the clinical manifestation of scrub typhus in humans appears to be severe in the northern regions of the country and mild in the southern areas. Studies on the geographic distribution of the serotype of Orientia tsutsugamushi revealed that the Boryong serotype is predominant in the southern Korean peninsula, whereas the Gilliam, Karp, and Gilliam-Karp serotypes prevail in the northern or central peninsula. We report a case of severe scrub typhus caused by the Japanese Gilliam type of Orientia tsutsugamushi in a 66-year-old woman from Tongyeong, a city located in the southern part of Korean peninsula. The patient was admitted to the hospital with fever on August 29th, 2001. Scrub typhus complicated by shock, pneumonitis, and encephalitis was diagnosed. Additionally, markedly elevated alkaline phosphatase levels was observed, which necessitated an ultrasonographic examination, which showed an ill-defined hyperechogenic mass on the right hepatic lobe. Liver biopsy showed cholestatic hepatitis and blood culture showed growth of O. tsutsugamushi. Gene sequencing of the amplicons of a polymerase chain reaction using primers for the amplification of the gene encoding the 56-kDa protein of O. tsutsugamushi revealed a nucleotide sequence that matched Yonchon strain of O. tsutsugamushi.

참고문헌 (Reference)

1 박상돈, "여름에 비정형 폐렴으로 발현한 쯔쯔가무시병 1예" 대한감염학회 40 (40): 241-245, 2008

2 김은실, "국내 환자에서 분리된 Orientia tsutsugamushi에서 doxycycline 내성" 대한감염학회 40 (40): 259-265, 2008

3 Kang JS, "Serotype of Rickettsia tsutsugamushi isolated in Ulsan area" 24 : 179-182, 1992

4 Chang WH, "Serological classification by monoclonal antibodies of Rickettsia tsutsugamushi isolated in Korea" 28 : 685-688, 1990

5 Kanno A, "Liver involvement in tsutsugamushi disease" 179 : 213-217, 1996

6 Chung MH, "Japanese spotted fever, South Korea" 12 : 1122-1124, 2006

7 Seong SY, "Isolation of a new Orientia tsutsugamushi serotype" 41 : 437-443, 1997

8 Chong YS, "Isolation of Rickettsia tsutsugamushi from patients in Chinhae area in 1987" 24 : 81-87, 1989

9 Chang WH, "Infection rate and serotype distribution of Orientia tsutsugamushi among field rodents in Chollanamdo using nested polymerase chain reaction" 32 : 301-306, 1997

10 Mi Jeong Kim, "Improved Antibiotic Susceptibility Test of Orientia tsutsugamushi by Flow Cytometry Using Monoclonal Antibody" 대한의학회 22 (22): 1-6, 2007

11 Roh JY, "Identification of serotypes of Orientia tsutsugamushi using nested PCR" 29 : 183-189, 1997

12 Chien RN, "Granulomatous hepatitis associated with scrub typhus" 10 : 484-487, 1995

13 Ree HI, "Geographical distribution of vectors and sero-strains of tsutsugamushi disease at mid-south inland of Korea" 35 : 171-179, 1997

14 Tamura A, "Epidemiological survey of Orientia tsutsugamushi distribution in field rodents in Saitama Prefecture, Japan, and discovery of a new type" 45 : 439-446, 2001

15 Pongponratn E, "Electron-microscopic examination of Rickettsia tsutsugamushi-infected human liver" 3 : 242-248, 1998

16 Ree HI, "Determination and geographical distribution of Orientia tsutsugamushi serotypes in Korea by nested polymerase chain reaction" 65 : 528-534, 2001

17 Kim JK, "Comparison of clinical manifestations of tsutsugamushi disease by serotype" 63 : S152-, 2002

18 Allen AC, "A comparative study of the pathology of scrub typhus (tsutsugamushi disease) and other rickettsial diseases" 21 : 603-681, 1945

19 Satoh T, "A case of hepatitis with granulomatous lesions by Rickettsia tsutsugamushi" 88 : 2827-2830, 1991

20 박재일, "2000년대 초에 유행한 Orientia tsutsugamushi에 의한 간염" 대한간학회 9 (9): 198-204, 2003