Jaundice, Scrub Typhus, and Splenomegaly: Causes and Treatments

Jaundice, scrub typhus, splenomegaly?

I am from Kaohsiung and returned to Taiwan from Japan on November 23.
After that, I visited Chengqing Lake in Kaohsiung, the National Museum of Marine Biology and Aquarium in Pingtung, Chihpen in Taitung, Chulu Ranch, Pingtung, and Cijin.
On the night of December 10, I developed a fever and experienced persistent fever and chills.
After a blood test at the hospital, my platelet count was found to be only 108,000, raising suspicion of dengue fever.
I was subsequently hospitalized for observation, during which my platelet count continued to drop, reaching a low of 58,000.
Ultimately, due to the lack of typical dengue fever symptoms, I was suspected to have scrub typhus.
Tests revealed a bilirubin level of 2.8, and there was abnormal splenomegaly.

I would like to inquire about the factors contributing to jaundice, scrub typhus, and splenomegaly, as well as their treatment options.
Thank you for taking the time to respond to this message.

pao, 30~39 year old female. Ask Date: 2002/12/20

Dr. Zhao Chongliang reply Internal Medicine

Regarding diagnosis based on symptoms, I would like to introduce you to a website: the "Infectious Disease Differential Diagnosis Assistance System" from the Centers for Disease Control, Ministry of Health and Welfare, Taiwan (http://140.112.124.104/index-3.asp?item=2).
However, the symptoms and disease names are in English, so I hope you can collaborate with your physician to use all your symptoms, physical examinations, and laboratory tests to arrive at several possible diagnoses.
I attempted to infer based on the limited information you provided, resulting in a probability of 83% for yellow fever, 9% for malaria, 9% for hantavirus hemorrhagic fever (epidemic hemorrhagic fever), 7% for dengue fever, 6% for acute hepatitis A or B, and 2% for scrub typhus.
Of course, it is unlikely to contract yellow fever if you have not traveled to an endemic area (Japan is not one), so your physician's assistance in filling in all overlooked symptoms, physical examinations, and laboratory tests is necessary for a definitive diagnosis.
Jaundice and splenomegaly are symptoms that can be present in many diseases, including those mentioned above.
Scrub typhus has three English names: Scrub typhus, Tsutsugamushi disease, and mite-borne typhus.
It is caused by Rickettsia and typically presents with a characteristic eschar at the site of contact with infected mites.
This acute febrile illness occurs after a few days of incubation, accompanied by headache, sweating, conjunctival injection, and lymphadenopathy.
A week after the onset of fever, a dark red maculopapular rash appears on the trunk and spreads to the limbs, disappearing after a few days.
It is usually also associated with cough and pneumonia detectable by X-ray.
Without antibiotic treatment, fever can last for about 14 days.
In untreated cases, the mortality rate varies from 1% to 60%, depending on the region, Rickettsia strain, and exposure to the disease, with higher rates in the elderly.
The mites parasitize rodents, and humans are accidentally bitten.
There are reports of endemic cases in eastern Taiwan and the Penghu Islands, but there are also cases on Yangmingshan in Taipei.
Antibiotics used include tetracyclines such as tetracycline and doxycycline.

Reply Date: 2002/12/20

More Info

Jaundice, scrub typhus, and splenomegaly are interconnected medical conditions that can arise from various underlying causes. Understanding these conditions involves recognizing their symptoms, causes, and treatment options.

Jaundice is characterized by a yellowing of the skin and the whites of the eyes, resulting from an excess of bilirubin in the bloodstream. Bilirubin is a byproduct of the breakdown of red blood cells. The causes of jaundice can be categorized into three main types: pre-hepatic, hepatic, and post-hepatic.
1. Pre-hepatic jaundice occurs due to excessive breakdown of red blood cells, which can be seen in conditions like hemolytic anemia.

2. Hepatic jaundice results from liver dysfunction, which can be caused by viral hepatitis, alcoholic liver disease, or drug-induced liver injury.

3. Post-hepatic jaundice is due to obstruction of bile flow, often caused by gallstones or tumors in the bile duct.

Treatment for jaundice focuses on addressing the underlying cause. For instance, if jaundice is due to hepatitis, antiviral medications may be necessary. If it’s due to obstruction, surgical intervention may be required.

Scrub typhus is an infectious disease caused by the bacterium *Orientia tsutsugamushi*, transmitted through bites from infected mites. Symptoms typically include fever, headache, rash, and eschar (a dark, scab-like area at the site of the bite). In your case, the development of scrub typhus may explain the fever and the drop in platelet count, as this disease can lead to thrombocytopenia (low platelet count).

Diagnosis of scrub typhus is usually confirmed through serological tests or PCR. Treatment involves the use of antibiotics, with doxycycline being the first-line treatment. Early diagnosis and treatment are crucial to prevent complications.

Splenomegaly, or enlargement of the spleen, can occur due to various reasons, including infections, liver diseases, and hematological disorders. In the context of your symptoms, splenomegaly may be a response to the underlying infection (such as scrub typhus) or due to liver dysfunction associated with jaundice.
The treatment for splenomegaly depends on its cause. If it is due to an infection, treating the infection may lead to a reduction in spleen size. In some cases, if the spleen is significantly enlarged and causing symptoms, surgical removal (splenectomy) may be considered.

In summary, the interplay between jaundice, scrub typhus, and splenomegaly highlights the importance of a thorough medical evaluation. Given your recent travel history and the symptoms you’ve described, it is essential to follow up with healthcare providers for appropriate diagnostic tests and treatment plans. Monitoring your liver function, platelet count, and overall health will be crucial in managing these conditions effectively. Always ensure to communicate any new symptoms or concerns to your healthcare team, as timely intervention can significantly improve outcomes.

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