A case of scrub typhus presenting with acute respiratory distress syndrome and its management in intensive care unit

Orientia tsutsugamushi causes a zoonotic infection called scrub typhus, which is transmitted by trombiculid mite larvae. The infection is widely distributed throughout the Asia-Pacific region and has also been reported in various parts of India. The disease is an important cause of “tropical sepsis” and could produce severe complications such as encephalitis, pneumonia, myocarditis, cardiac arrhythmia, and acute respiratory distress syndrome (ARDS). A thorough physical examination is required by the physician, as the rash or eschar could sometimes be unnoticed or absent, and finding one could help in early diagnosis and preventing further complications with prompt treatment. Hereby, we present a case of scrub typhus that complicated into ARDS and was diagnosed on the basis of the presence of an eschar, a positive Weil–Felix result, and a positive quick diagnostic kit (immunochromatographic assay). We will also elaborate on the noninvasive management of the patient in the intensive care unit.