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  • Title: Metagenomic next-generation sequencing helped diagnose scrub typhus without eschar: A case report.
    Author: Wu J, Wu Y, Huang M.
    Journal: Int J Infect Dis; 2020 Jan; 90():1-4. PubMed ID: 31648003.
    Abstract:
    BACKGROUND: Scrub typhus is caused by Orientia tsutsugamushi. Clinical manifestations include fever, rash, eschar at the bite site, and other non-specific flu-like symptoms. The eschar is a dark, scab-like area at the bite site, and is the typical lesions that prompts a diagnosis of O. tsutsugamushi. Without eschar lesions, it is difficult to identify scrub typhus. However, metagenomic next-generation sequencing (mNGS) can be used to identify infections, and this novel method may help improve clinical diagnosis. CASE PRESENTATION: Here, we report a case of scrub typhus in a 51-year-old woman who presented to the emergency department with a week-long fever from an unknown cause. We used mNGS to search for an infectious etiology, and the mNGS suggested O. tsutsugamushi, which was unexpectedly detected. DISCUSSION AND CONCLUSION: This study suggests that mNGS may be a useful diagnostic tool to identify clinical, causative pathogens in fever, particular ones with atypical features.
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