Innovative Diagnostic Approaches and Multimodal Therapy: A Case Report of Severe Pediatric Scrub Typhus with Complications

This case report describes an extremely rare instance of scrub typhus in a 12-year-old child. While scrub typhus is more commonly seen in adults, reports of severe complications in children are scarce. Scrub typhus is an infectious disease caused by Orientia tsutsugamushi, transmitted through the bite of infected chiggers. This report presents a severe pediatric case of scrub typhus complicated by septic shock, acute respiratory distress syndrome (ARDS), and hemophagocytic lymphohistiocytosis (HLH). The patient initially presented with umbilical redness and swelling, which later developed into a characteristic eschar, accompanied by high fever, hepatosplenomegaly, and lymphadenopathy. Metagenomic next-generation sequencing (mNGS) detected O. tsutsugamushi in the patient`s blood sample, and notably, this is the first case where O. tsutsugamushi was identified in sputum samples using mNGS in a similar context, providing strong evidence for early diagnosis. After receiving combined antibiotic therapy with doxycycline and rifampin, along with supportive treatments including invasive mechanical ventilation, plasma exchange, continuous renal replacement therapy (CRRT), and chemotherapy, the patient's condition gradually improved, leading to full recovery and discharge. This case underscores the importance of early and accurate diagnosis and multidimensional supportive treatment in pediatric patients with severe scrub typhus. It also highlights the need for heightened awareness among clinicians regarding severe pediatric scrub typhus, alongside public health education to raise awareness of the disease and its prevention, ultimately reducing its incidence and severe outcomes.