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Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives.

ABSTRACT: Scrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without early diagnosis and treatment, the disease can develop fatal complications. We retrospectively reviewed de-identified data from a 23-year-old woman who presented to an emergency department with complaints of worsening abdominal pain. On presentation, she appeared jaundiced and toxic-looking. Other positive findings on abdominal examination were a positive Murphey's sign, abdominal guarding and hepatosplenomegaly. Magnetic resonance cholangiopancreatography demonstrated acalculous cholecystitis. Additional findings included eschar on the medial aspect of the left thigh with inguinal regional lymphadenopathy. Further, positive results were obtained for immunoglobulins M and G, confirming scrub typhus. The workup for other infectious causes of acute acalculous cholecystitis (AAC) detected antibodies against human herpesvirus 4 (Epstein-Barr virus), suggesting an alternative cause of AAC. Whether that represented re-activation of the Epstein-Barr virus could not be determined. As other reports have described acute acalculous cholecystitis in adult scrub typhus patients, we recommend doxycycline to treat acute acalculous cholecystitis in endemic regions while awaiting serological confirmation.

SUBMITTER: Imad HA

PROVIDER: S-EPMC8707333 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Acute HIV infection with presentations mimicking acalculous cholecystitis: A case report.

Project description:RationaleAcute retroviral syndrome is the symptomatic presentation of acute human immunodeficiency virus (HIV) infection, which often manifests as a self-limited infectious mononucleosis-like syndrome and occurs 2 to 6 weeks after exposure to HIV. Atypical manifestations including hepatitis, meningitis, or hemophagocytic lymphohistiocytosis have been reported. However, manifestations of acute acalculous cholecystitis during acute HIV infection are rarely reported.Patient concernsA 30-year-old man with nausea and loose stools, followed by fever and abdominal pain at the right upper quadrant for 10 days.DiagnosisAcute retroviral syndrome, complicated with acute acalculous cholecystitis.InterventionsPercutaneous transhepatic gallbladder drainage was performed and treatment with co-formulated bictegravir/emtricitabine/tenofovir alafenamide was initiated upon HIV diagnosis.OutcomesThe patient's symptoms improved after the drainage. The levels of liver enzyme including aspartate transaminase alanine aminotransferase decreased to a level within normal limits 1 month after initiation of antiretroviral therapy.ConclusionAcalculous cholecystitis in combination with acute hepatitis could be manifestations of acute HIV infection. For individuals at risk of acquiring HIV infection who present with manifestations of acute acalculous cholecystitis, HIV testing should be considered.

| S-EPMC8284728 | biostudies-literature

Acute acalculous cholecystitis on a COVID-19 patient: a case report.

Project description:IntroductionWe report an extremely rare case of acute acalculous cholecystitis on a COVID-19 patient. In our knowledge, this is the first report of laparoscopic cholecystectomy performed on a COVID-19 patient.Presentation of caseA COVID-19 patient was diagnosed with acute acalculous cholecystitis and a multidisciplinary team decided to perform a percutaneous transhepatic biliary drainage (PTBD) as the first treatment. SARS-CoV-2 RNA was not found in the bile fluid. Because of deterioration of the patient's clinical conditions, laparoscopic cholecystectomy had to be performed and since the gallbladder was gangrenous, the severe inflammation made surgery difficult to perform.DiscussionAcalculous cholecystitis was related with mechanical ventilation and prolonged total parenteral nutrition, in this case the gangrenous histopathology pattern and the gallbladder wall ischemia was probably caused by vascular insufficiency secondary to severe acute respiratory distress syndrome of COVID-19 pneumonia. The percutaneous transhepatic gallbladder drainage (PTBD) was performed according to Tokyo Guidelines because of high surgical risk. Laparoscopic cholecystectomy was next performed due to no clinical improvement. The absence of viral RNA in the bile highlights that SARS-CoV-2 is not eliminated with the bile while it probably infects small intestinal enterocytes which is responsible of gastrointestinal symptoms such as anorexia, nausea, vomiting, and diarrhoea.ConclusionsAlthough the lack of evidence and guidelines about the management of patient with acute cholecystitis during COVID-19 pandemic, laparoscopic cholecystectomy, at most preceded by PTGBD on high surgical risk patients, remains the gold standard for the treatment of acute cholecystitis on COVID-19 patients.

| S-EPMC7456800 | biostudies-literature

A case report of acalculous cholecystitis due to Salmonella paratyphi B.

Project description:Acute acalculous cholecystitis (AAC) is a rare condition occurring in only 5%-10 % of patients with acute cholecystitis. Systemic illness caused, for example, by E coli, Klebsiella pneumoniae, Vibrio cholera, and Salmonella species can result acute inflammation of gallbladder wall. It is a surgical emergency and if left untreated can lead to high mortality due to gangrene or perforation of gallbladder. We managed a 60-year-old female with clinical presentation of acute cholecystitis caused by Salmonella-induced gastroenteritis. Prompt use of radiological modalities such as computer tomography (CT scan) and ultrasound played an important role in pathologic diagnosis, overall follow up, and management of the patient.

| S-EPMC6138858 | biostudies-other

A suspected surgical case of acute abdomen: A case report of scrub typhus.

Project description:IntroductionScrub typhus presents with diverse clinical manifestations which range from sub-clinical disease to organ failure and fatal disease.Case presentationThe patient presented with fever followed by acute abdominal pain and later developed septic shock with multi-organ failure. Radiological evaluations were normal, however, on thorough physical examination, an eschar was found in her right inguinal region.Clinical discussionAside from classical clinical symptoms, it can also involve various organs, most commonly of respiratory, cardiovascular and hepatic systems. Additionally, suspected patients should be thoroughly examined for the presence of an eschar, especially over the covered areas such as the groin, genitalia, infra-mammary area and axilla.ConclusionScrub typhus should be considered in all patients from an endemic area presenting as acute undifferentiated febrile illness associated with organ involvement. Positive finding of an eschar and high index of suspicion for the various presentations of scrub typhus can avoid unnecessary surgical exploration and aid in prompt diagnosis and treatment.

| S-EPMC8818520 | biostudies-literature

Scrub typhus vectors

Project description:Identification of Scrub typhus and its vectors

| PRJEB42597 | ENA

Diagnosis of severe scrub typhus infection by next-generation sequencing:a case report.

Project description:BACKGROUND:Scrub typhus is an acute febrile illness, which was caused by Orientia tsutsugamushi and transmitted through the bite of chiggers. The diagnosis of scrub typhus could be missed diagnosis due to the absence of the pathognomonic eschar. CASE PRESENTATION:A 76-year-old man was hospitalized with fever and kidney injury and was diagnosed of hemorrhagic fever with renal syndrome first. However, the situation of the illness deteriorated into refractory septic shock and multiple organ dysfunction rapidly,although the treatment of anti-sepsis was used in 3rd-5th day. Orientia tsutsugamushi was determined to be the causative pathogen by Next-generation sequencing of his plasma sample in 6th day. Then, the patient was treated with doxycycline and azithromycin and recovered quickly. CONCLUSIONS:Next-generation sequencing was a new diagnostic technology and could identify scrub typhus in accurately and fast without the pathognomonic eschar.

| S-EPMC7137524 | biostudies-literature

A review of the global epidemiology of scrub typhus.

Project description:Scrub typhus is a serious public health problem in the Asia-Pacific area. It threatens one billion people globally, and causes illness in one million people each year. Caused by Orientia tsutsugamushi, scrub typhus can result in severe multiorgan failure with a case fatality rate up to 70% without appropriate treatment. The antigenic heterogeneity of O. tsutsugamushi precludes generic immunity and allows reinfection. As a neglected disease, there is still a large gap in our knowledge of the disease, as evidenced by the sporadic epidemiologic data and other related public health information regarding scrub typhus in its endemic areas. Our objective is to provide a systematic analysis of current epidemiology, prevention and control of scrub typhus in its long-standing endemic areas and recently recognized foci of infection.

| S-EPMC5687757 | biostudies-literature

Post COVID 19 acute acalculous cholecystitis raising the possibility of underlying dysregulated immune response, a case report.

Project description:IntroductionNovel Coronavirus disease 2019 or COVID-19 has rapidly spread throughout the world and has become an unprecedented pandemic. It has a vast spectrum of clinical presentations and can affect various organs. Rarely, it has been reported to cause acalculous cholecystitis in a non ICU setting patient.Case presentationHere we report a rare association of COVID 19 with acalculous cholecystitis in a 40 years old healthy woman. She developed fever, malaise, generalized body weakness, and right hypochondrial pain after fourteen days of COVID 19 infection, raising the possibility of Post COVID dysregulated immune response resulting in acalculous cholecystitis. She was managed conservatively with broad spectrum antibiotics.DiscussionAcalculous cholecystitis primarily occurs due to the gall bladder's hypomotility and most commonly seen in critically ill patients such as severe burns, mechanically ventilated patients, and prolonged parenteral nutrition. The management depends upon treating the underlying pathology and, in some severe cases, may need surgical intervention as well. Up to our knowledge, COVID 19, causing acalculous cholecystitis, is a rare association described only in a few critically ill patients but not in young, healthy patients. It can be attributed to the body's dysregulated immunological response against the virus resulting in systemic inflammation.ConclusionCurrently, there is are no clear guidelines for managing acute cholecystitis in COVID-19 patients. It depends on the patient's clinical state and disease severity. We aim to highlight the importance of early diagnosis and management in such clinical scenarios to avoid fatal complications.

| S-EPMC7664478 | biostudies-literature

COVID-19 patients presenting with gangrenous acalculous cholecystitis: Report of two cases.

Project description:Introduction and importanceCOVID-19 virus is thought to complicate underlying conditions, including acalculous cholecystitis. Two COVID-19 patients with gangrenous gallbladder are reported who were not involved with severe pneumonia.Case presentationWe present two non-critically ill patients with COVID-19 presenting with acalculous cholecystitis. Both patients had gangrenous gallbladder and had to undergo cholecystectomy. Upon surgery, one of the patients showed patchy gangrene on gallbladder and the other, a fully gangrenous gallbladder.ConclusionThere may be a possibility for COVID-19 patients with cholecystitis to develop ischemic gallbladder.

| S-EPMC8960289 | biostudies-literature

Acute Acalculous Cholecystitis due to primary acute Epstein-Barr virus infection treated with laparoscopic cholecystectomy; a case report.

Project description:IntroductionEpstein Barr virus (EBV) is a human herpes virus 4, transmitted through intimate contact between susceptible persons and asymptomatic EBV shedders. It usually presents with fever, pharyngitis and lymphadenopathy. Majority of individuals with primary EBV infection recover uneventfully. Acute Acalculous Cholecystitis (AAC) is usually seen in hospitalized and critically ill patients with major trauma, shock, severe sepsis, total parenteral nutrition and mechanical ventilation.Case presentationWe report a 25-year- old woman presented with acute Epstein-Barr Virus (EBV)infection and hepatobiliary iminodiacetic acid (HIDA) scan confirmed presence of Acute Acalculous Cholecystitis (AAC). Conservative management was advised initially, but she had a laparoscopic cholecystectomy due to intolerable abdominal pain.ConclusionAAC is a rare complication of acute EBV infection and it is usually managed conservatively, although our patient had laparoscopic cholecystectomy due to intolerable abdominal pain.

| S-EPMC6197716 | biostudies-literature

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