Scrub typhus associated with hemophagocytic lymphohistiocytosis: A report of six pediatric patients

Jin,Yingkang; Huang,Li; Fan,Huifeng; Lu,Gen; Xu,Yi; Wu,Zhiyuan

doi:10.3892/etm.2016.3668

October-2016 Volume 12 Issue 4

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October-2016 Volume 12 Issue 4

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Article

Scrub typhus associated with hemophagocytic lymphohistiocytosis: A report of six pediatric patients

Authors:
- Yingkang Jin
- Li Huang
- Huifeng Fan
- Gen Lu
- Yi Xu
- Zhiyuan Wu
View Affiliations / Copyright

Affiliations: Department of Respiratory Infection, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China, Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China, Department of Infectious Diseases, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
Pages: 2729-2734
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Published online on: September 6, 2016

https://doi.org/10.3892/etm.2016.3668
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Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening immune disorder that may be inherited or secondary to infection, malignancy or rheumatological disease. The aim of the present study was to highlight the clinical features of scrub typhus-associated HLH in children. A retrospective study was performed on 6 pediatric patients with scrub typhus‑associated HLH. For each patient, medical records were reviewed and analyzed, and demographic, clinical and laboratory data and outcomes were collected. The duration of fever prior to admission ranged between 4 and 12 days. All patients exhibited persistent or intermittent fever, eschar, hepatosplenomegaly and lymphadenopathy at the time of diagnosis. Five patients experienced acute respiratory distress syndrome and disseminated intravascular coagulation (DIC) during hospitalization. Thrombocytopenia was detected in all patients with cytopenia involving two or three cell types, simultaneously. Coagulopathy with prolonged prothrombin time and/or activated partial thromboplastin time were noted in all patients. Markedly elevated serum ferritin levels (>1,500 µg/ml) were identified in all patients. Elevated lactate dehydrogenase (>1,000 U/l) was detected in 4 (66.7%) patients and elevated alanine aminotransferase was exhibited by 5 (83/3%) patients. Lung infiltrates and consolidation were the most common imaging findings. Only 1 patient succumbed, with DIC and multi‑organ failure. Of the survivors, 1 patient was lost to follow‑up, and the remaining patients are in remission with excellent general health, to date. In conclusion, HLH should be considered in severe pediatric cases of scrub typhus. Upon the early recognition of this syndrome, prompt and supportive treatment in the pediatric intensive care unit are vital.

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1	Verbsky JW and Grossman WJ: Hemophagocytic lymphohistiocytosis: Diagnosis, pathophysiology, treatment and future perspectives. Ann Med. 38:20–31. 2006. View Article : Google Scholar : PubMed/NCBI
2	Domachowske JB: Infectious triggers of hemophagocytic syndrome in children. Pediatr Infect Dis J. 25:1067–1068. 2006. View Article : Google Scholar : PubMed/NCBI
3	Janka GE: Familial and acquired hemophagocytic lymphohistiocytosis. Annu Rev Med. 63:233–246. 2012. View Article : Google Scholar : PubMed/NCBI
4	Henter JI, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S, Ladisch S, McClain K, Webb D, Winiarski J and Janka G: HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 48:124–131. 2007. View Article : Google Scholar : PubMed/NCBI
5	Han DK, Baek HJ, Shin MG, Kim JW, Kook H and Hwang TJ: Scrub typhus-associated severe hemophagocytic lymphohistiocytosis with encephalomyelitis leading to permanent sequelae: a case report and review of the literature. J Pediatr Hematol Oncol. 34:531–533. 2012. View Article : Google Scholar : PubMed/NCBI
6	Kwon HJ, Yoo IH, Lee JW, Chung NG, Cho B, Kim HK and Kang JH: Life-threatening scrub typhus with hemophagocytosis and acute respiratory distress syndrome in an infant. J Trop Pediatr. 59:67–69. 2013. View Article : Google Scholar : PubMed/NCBI
7	Koraluru M, Bairy I, Varma M and Vidyasagar S: Diagnostic validation of selected serological tests for detecting scrub typhus. Microbiol Immunol. 59:371–374. 2015. View Article : Google Scholar : PubMed/NCBI
8	Jeong YJ, Kim S, Wook YD, Lee JW, Kim KI and Lee SH: Scrub typhus: Clinical, pathologic and imaging findings. Radiographics. 27:161–172. 2007. View Article : Google Scholar : PubMed/NCBI
9	Kamarasu K, Malathi M, Rajagopal V, Subramani K, Jagadeeshramasamy D and Mathai E: Serological evidence for wide distribution of spotted fevers & typhus fever in Tamil Nadu. Indian J Med Res. 126:128–130. 2007.PubMed/NCBI
10	Kim DM, Kim SW, Choi SH and Yun NR: Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis. 10:1082010. View Article : Google Scholar : PubMed/NCBI
11	Lee CS, Hwang JH, Lee HB and Kwon KS: Risk factors leading to fatal outcome in scrub typhus patients. Am J Trop Med Hyg. 81:484–488. 2009.PubMed/NCBI
12	Cascio A, Pernice LM, Barberi G, Delfino D, Biondo C, Beninati C, Mancuso G, Rodriguez-Morales AJ and Iaria C: Secondary hemophagocytic lymphohistiocytosis in zoonoses. A systematic review. Eur Rev Med Pharmacol Sci. 16:1324–1337. 2012.
13	Valsalan R, Kosaraju K, Sohanlal T and Kumar PS: Hemophagocytosis in scrub typhus. J Postgrad Med. 56:301–302. 2010. View Article : Google Scholar : PubMed/NCBI
14	Chen YC, Chao TY and Chin JC: Scrub typhus-associated hemophagocytic syndrome. Infection. 28:178–179. 2000. View Article : Google Scholar : PubMed/NCBI
15	Nahum E, Ben-Ari J, Stain J and Schonfeld T: Hemophagocytic lymphohistiocytic syndrome: Unrecognized cause of multiple organ failure. Pediatr Crit Care Med. 1:51–54. 2000. View Article : Google Scholar : PubMed/NCBI
16	Imashuku S: Clinical features and treatment strategies of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis. Crit Rev Oncol Hematol. 44:259–272. 2002. View Article : Google Scholar : PubMed/NCBI
17	Freeman HR and Ramanan AV: Review of haemophagocytic lymphohistiocytosis. Arch Dis Child. 96:688–693. 2011. View Article : Google Scholar : PubMed/NCBI
18	Emmenegger U, Frey U, Reimers A, Fux C, Semela D, Cottagnoud P, Spaeth PJ and Neftel KA: Hyperferritinemia as indicator for intravenous immunoglobulin treatment in reactive macrophage activation syndromes. Am J Hematol. 68:4–10. 2001. View Article : Google Scholar : PubMed/NCBI
19	Jin YK, Xie ZD, Yang S, Lu G and Shen KL: Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: A retrospective study of 78 pediatric cases in mainland of China. Chin Med J (Engl). 123:1426–1430. 2010.PubMed/NCBI
20	Yasunaga H, Horiguchi H, Kuwabara K, Hashimoto H and Matsuda S: Delay in tetracycline treatment increases the risk of complications in Tsutsugamushi disease: Data from the Japanese diagnosis procedure combination database. Intern Med. 50:37–42. 2011. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Scrub typhus associated with hemophagocytic lymphohistiocytosis: A report of six pediatric patients

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