PDF(Pubmed)
Abstract：
UNASSIGNED: This study aimed to analyze the clinical course of a newborn with congenital scrub typhus caused by vertical transmission and explore early diagnosis and treatment strategies. The clinical data of the neonate were retrospectively analyzed and the related literature was reviewed.
UNASSIGNED: The newborn was a full-term one, with a good Apgar score at birth. The neonate had apnea at 3 h of life, requiring NICU care and IV antibiotics (piperacillin) for suspected sepsis. An examination revealed hepatosplenomegaly. Blood tests revealed anemia and thrombocytopenia and a chest x-ray showed patchy inflammation. On the second day of life, he developed a fever. On the third day of life, he required mechanical ventilation because his condition worsened after he presented with dyspnea, hypotension, depressed sensorium, and other signs of sepsis. Importantly, the neonate\'s mother had a history of scrub typhus at 31+ weeks of gestation. While the blood culture result was still pending, high-throughput sequencing of blood and cerebrospinal fluid was performed. To address the suspected scrub typhus infection, oral azithromycin dry suspension was added to the treatment regimen. High-throughput sequencing results on the 5th day of life confirmed a significant presence of 16SrRNA sequences in the blood, suggesting an Orientia tsutsugamushi infection. The neonate steadily recovered and was discharged 16 days after hospitalization. The neonate was followed up for 9 months, and the outcome was favorable with normal growth and development.
UNASSIGNED: This article reports a case of congenital Orientia tsutsugamushi infection, a rare condition caused by vertical transmission. Our review of the literature, combined with the presented case, brings the total number of documented congenital scrub typhus cases caused by vertical transmission to eight. Regrettably, one patient from this group unexpectedly died on the 10th day of hospitalization, resulting in a mortality rate of 12.5% (1/8). The special transmission mode and clinical manifestations of this disease will serve as an alert to doctors for timely diagnosis and treatment. Because of the non-specific clinical manifestations of congenital scrub typhus, limited understanding, low index of suspicion among clinicians, and a lack of diagnostic facilities, scrub typhus is seriously underdiagnosed in pregnant women, fetuses, and neonates.
UNASSIGNED: The newborn was a full-term one, with a good Apgar score at birth. The neonate had apnea at 3 h of life, requiring NICU care and IV antibiotics (piperacillin) for suspected sepsis. An examination revealed hepatosplenomegaly. Blood tests revealed anemia and thrombocytopenia and a chest x-ray showed patchy inflammation. On the second day of life, he developed a fever. On the third day of life, he required mechanical ventilation because his condition worsened after he presented with dyspnea, hypotension, depressed sensorium, and other signs of sepsis. Importantly, the neonate\'s mother had a history of scrub typhus at 31+ weeks of gestation. While the blood culture result was still pending, high-throughput sequencing of blood and cerebrospinal fluid was performed. To address the suspected scrub typhus infection, oral azithromycin dry suspension was added to the treatment regimen. High-throughput sequencing results on the 5th day of life confirmed a significant presence of 16SrRNA sequences in the blood, suggesting an Orientia tsutsugamushi infection. The neonate steadily recovered and was discharged 16 days after hospitalization. The neonate was followed up for 9 months, and the outcome was favorable with normal growth and development.
UNASSIGNED: This article reports a case of congenital Orientia tsutsugamushi infection, a rare condition caused by vertical transmission. Our review of the literature, combined with the presented case, brings the total number of documented congenital scrub typhus cases caused by vertical transmission to eight. Regrettably, one patient from this group unexpectedly died on the 10th day of hospitalization, resulting in a mortality rate of 12.5% (1/8). The special transmission mode and clinical manifestations of this disease will serve as an alert to doctors for timely diagnosis and treatment. Because of the non-specific clinical manifestations of congenital scrub typhus, limited understanding, low index of suspicion among clinicians, and a lack of diagnostic facilities, scrub typhus is seriously underdiagnosed in pregnant women, fetuses, and neonates.
摘要：
■本研究旨在分析由垂直传播引起的先天性斑疹伤寒的新生儿的临床过程，并探索早期诊断和治疗策略。回顾性分析新生儿的临床资料并复习相关文献。
■新生儿是足月新生儿,出生时阿普加得分很好。新生儿在生命3小时时出现呼吸暂停，对于可疑的败血症，需要NICU护理和IV抗生素（哌拉西林）。检查显示肝脾肿大。血液检查显示贫血和血小板减少症，胸部X光检查显示斑片状炎症。生命的第二天，他发烧了。生命的第三天，他需要机械通气，因为他出现呼吸困难后病情恶化，低血压,抑郁的感觉，和其他败血症的迹象。重要的是,新生儿的母亲在妊娠31周以上有斑疹伤寒病史。虽然血培养结果仍在等待，对血液和脑脊液进行高通量测序.为了解决疑似斑疹伤寒感染，治疗方案中加入口服阿奇霉素干混悬液.生命第5天的高通量测序结果证实血液中存在大量16SrRNA序列，提示是一种东方型的虫虫感染.新生儿稳定康复，住院16天后出院。新生儿随访9个月,结果良好，生长发育正常。
■本文报道了一例先天性东方痴呆的虫虫感染,垂直传播引起的罕见情况。我们对文献的回顾，结合所提出的案例，使记录的由垂直传播引起的先天性斑疹伤寒病例总数达到8例。遗憾的是,该组中的一名患者在住院的第10天意外死亡，导致死亡率为12.5%(1/8)。这种疾病的特殊传播方式和临床表现将成为医生及时诊断和治疗的警报。由于先天性斑疹伤寒的非特异性临床表现，有限的理解，临床医生的怀疑指数低，缺乏诊断设施，在孕妇中，斑疹伤寒被严重低估，胎儿,和新生儿。
■新生儿是足月新生儿,出生时阿普加得分很好。新生儿在生命3小时时出现呼吸暂停，对于可疑的败血症，需要NICU护理和IV抗生素（哌拉西林）。检查显示肝脾肿大。血液检查显示贫血和血小板减少症，胸部X光检查显示斑片状炎症。生命的第二天，他发烧了。生命的第三天，他需要机械通气，因为他出现呼吸困难后病情恶化，低血压,抑郁的感觉，和其他败血症的迹象。重要的是,新生儿的母亲在妊娠31周以上有斑疹伤寒病史。虽然血培养结果仍在等待，对血液和脑脊液进行高通量测序.为了解决疑似斑疹伤寒感染，治疗方案中加入口服阿奇霉素干混悬液.生命第5天的高通量测序结果证实血液中存在大量16SrRNA序列，提示是一种东方型的虫虫感染.新生儿稳定康复，住院16天后出院。新生儿随访9个月,结果良好，生长发育正常。
■本文报道了一例先天性东方痴呆的虫虫感染,垂直传播引起的罕见情况。我们对文献的回顾，结合所提出的案例，使记录的由垂直传播引起的先天性斑疹伤寒病例总数达到8例。遗憾的是,该组中的一名患者在住院的第10天意外死亡，导致死亡率为12.5%(1/8)。这种疾病的特殊传播方式和临床表现将成为医生及时诊断和治疗的警报。由于先天性斑疹伤寒的非特异性临床表现，有限的理解，临床医生的怀疑指数低，缺乏诊断设施，在孕妇中，斑疹伤寒被严重低估，胎儿,和新生儿。
