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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster

by
Siti Roszilawati Ramli
1,*,
Nuridayu Arifin
2,
Mohd Fahmi Ismail
2,
Shirley Yi Fen Hii
1,
Nur Suffia Sulaiman
3,
Ernieenor Faraliana Che Lah
4 and
Nik Abdul Hadi Nik Abdul Aziz
5
1
Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Shah Alam 40170, Selangor, Malaysia
2
Pekan District Health Office, Ministry of Health, Pekan 26600, Pahang, Malaysia
3
School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Selangor, Malaysia
4
Acarology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health, Shah Alam 40170, Selangor, Malaysia
5
Internal Medicine Department, Hospital Tengku Ampuan Afzan, Jalan Tanah Putih, Kuantan 25100, Pahang, Malaysia
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2025, 10(8), 208; https://doi.org/10.3390/tropicalmed10080208
Submission received: 18 May 2025 / Revised: 9 July 2025 / Accepted: 15 July 2025 / Published: 25 July 2025
(This article belongs to the Topic Vector-Borne Disease Spatial Epidemiology, Disease Ecology, and Zoonoses)
Versions Notes

Abstract

Background: Scrub typhus (ST) is caused by Orientia tsutsugamushi (OT) infection, which is transmitted to humans through the bites of infected chiggers. The clinical presentations range from mild to life-threatening multi-organ dysfunction. This report describes a cluster of ST cases involving five palm oil estate workers in Pekan district, Pahang, Malaysia. Methods: The clinical history, laboratory, and entomological investigation were conducted on the patients, including the index case and four suspected cases in the cluster. Polymerase chain reaction (PCR) tests for OT and genotyping were performed on the patients’ blood and urine samples. Serological testing by indirect immunoperoxidase (IIP) test against Rickettsial diseases was also conducted. Principal Findings: Patients presented with fever, myalgia, headache, rash, cough, and eschar. The index case developed severe ST complicated by acute kidney injury (AKI) and respiratory distress, requiring intubation and ventilation at the intensive care unit of a tertiary hospital. ST was confirmed through PCR analysis of a urine sample, showcasing a novel diagnostic approach. The other four cases were confirmed by a four-fold rise in immunoglobulin G (IgG) antibody titers. Conclusions: Palm oil estate workers are at high risk for chigger exposure in Malaysia. Awareness among clinicians and the public of ST is crucial for effective prevention, accurate diagnosis, and optimal management.
Keywords: severe scrub typhus; cluster case; Malaysia; Orientia tsutsugamushi severe scrub typhus; cluster case; Malaysia; Orientia tsutsugamushi

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MDPI and ACS Style

Ramli, S.R.; Arifin, N.; Ismail, M.F.; Hii, S.Y.F.; Sulaiman, N.S.; Che Lah, E.F.; Nik Abdul Aziz, N.A.H. Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster. Trop. Med. Infect. Dis. 2025, 10, 208. https://doi.org/10.3390/tropicalmed10080208

AMA Style

Ramli SR, Arifin N, Ismail MF, Hii SYF, Sulaiman NS, Che Lah EF, Nik Abdul Aziz NAH. Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster. Tropical Medicine and Infectious Disease. 2025; 10(8):208. https://doi.org/10.3390/tropicalmed10080208

Chicago/Turabian Style

Ramli, Siti Roszilawati, Nuridayu Arifin, Mohd Fahmi Ismail, Shirley Yi Fen Hii, Nur Suffia Sulaiman, Ernieenor Faraliana Che Lah, and Nik Abdul Hadi Nik Abdul Aziz. 2025. "Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster" Tropical Medicine and Infectious Disease 10, no. 8: 208. https://doi.org/10.3390/tropicalmed10080208

APA Style

Ramli, S. R., Arifin, N., Ismail, M. F., Hii, S. Y. F., Sulaiman, N. S., Che Lah, E. F., & Nik Abdul Aziz, N. A. H. (2025). Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster. Tropical Medicine and Infectious Disease, 10(8), 208. https://doi.org/10.3390/tropicalmed10080208

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