Coronary artery lesions in pediatric scrub typhus: A case series from Guangzhou, China
- 1Department of Infectious Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Abstract
Background: Scrub typhus, caused by Orientia tsutsugamushi, is a mite-borne rickettsial infection endemic to the Asia-Pacific region. While its systemic complications are well documented, coronary artery lesions (CALs) associated with scrub typhus in children remain poorly characterized. This study aimed to describe the clinical features, diagnostic challenges, and treatment outcomes of pediatric scrub typhus complicated by CALs. Methodology/Principal Findings: We retrospectively analyzed seven pediatric patients (aged 11 months to 8 years) with scrub typhus and echocardiographically confirmed CALs, admitted to Guangzhou Women and Children’s Medical Center, Guangzhou Medical University between 1January 2020 and 30 May 2026. Between 15 June 2025 and 1 July 2026, clinical data including epidemiological history, laboratory findings, imaging results, treatment regimens, and outcomes were collected from electronic medical records. Conclusions/Significance: Among the seven cases, CAL manifestations included coronary artery aneurysm (n = 2), coronary artery dilatation (n = 2), and coronary artery intimal thickening (n = 3). All seven patients were initially suspected of having Kawasaki disease.Six patients received intravenous immunoglobulin (IVIG), but all failed to respond. Among these six, four met the diagnostic criteria for Kawasaki disease (KD) or incomplete KD. Ultimately, all seven patients—including the one who did not receive IVIG—defervesced within 1–3 days of initiating antimicrobial therapy directed at scrub typhus.At follow-up, five patients with available echocardiography showed normalization of coronary arteries within one week to three months. These findings suggest that O. tsutsugamushi infection can trigger CALs indistinguishable from KD and that pathogen-directed therapy, rather than IVIG alone, is critical for fever resolution in such cases. Clinicians should maintain a high index of suspicion for scrub typhus in pediatric patients presenting with CALs, particularly when IVIG response is suboptimal. Author summary: Scrub typhus is a neglected tropical disease transmitted by infected mite larvae (chiggers) and is widespread across China and the Asia-Pacific region. Although it typically causes fever, rash, and multi-organ dysfunction, its capacity to damage coronary arteries in children — a complication most commonly associated with Kawasaki disease (KD) — has rarely been reported. In this study, we analyzed seven children treated at a major pediatric center in Guangzhou, China, who developed coronary artery aneurysms, dilatation, or intimal thickening following Orientia tsutsugamushi infection. Four patients who met the diagnostic criteria for KD or incomplete KD continued to have high fevers after standard immunoglobulin treatment, only improving once antibiotics targeting the bacterium were started. All patients eventually recovered. Among the six patients who underwent follow-up imaging, five showed normalization of coronary artery abnormalities. Our findings highlight that scrub typhus should be considered as a potential cause of coronary artery lesions in children, especially in endemic regions, and emphasize the importance of early microbiological diagnosis and specific antimicrobial therapy.
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BibTeX
@article{liu2026coronary,
title = {{Coronary artery lesions in pediatric scrub typhus: A case series from Guangzhou, China}},
author = {Shiying Liu and Qing Wang and Yu Gong and Xufang Li and Fansen Zeng and Yi Xu},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014784},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014784},
note = {CC BY},
}
RIS
TY - JOUR
TI - Coronary artery lesions in pediatric scrub typhus: A case series from Guangzhou, China
AU - Shiying Liu
AU - Qing Wang
AU - Yu Gong
AU - Xufang Li
AU - Fansen Zeng
AU - Yi Xu
PY - 2026
DA - 2026/10/07
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014784
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014784
AB - Background: Scrub typhus, caused by Orientia tsutsugamushi, is a mite-borne rickettsial infection endemic to the Asia-Pacific region. While its systemic complications are well documented, coronary artery lesions (CALs) associated with scrub typhus in children remain poorly characterized. This study aimed to describe the clinical features, diagnostic challenges, and treatment outcomes of pediatric scrub typhus complicated by CALs. Methodology/Principal Findings: We retrospectively analyzed seven pediatric patients (aged 11 months to 8 years) with scrub typhus and echocardiographically confirmed CALs, admitted to Guangzhou Women and Children’s Medical Center, Guangzhou Medical University between 1January 2020 and 30 May 2026. Between 15 June 2025 and 1 July 2026, clinical data including epidemiological history, laboratory findings, imaging results, treatment regimens, and outcomes were collected from electronic medical records. Conclusions/Significance: Among the seven cases, CAL manifestations included coronary artery aneurysm (n = 2), coronary artery dilatation (n = 2), and coronary artery intimal thickening (n = 3). All seven patients were initially suspected of having Kawasaki disease.Six patients received intravenous immunoglobulin (IVIG), but all failed to respond. Among these six, four met the diagnostic criteria for Kawasaki disease (KD) or incomplete KD. Ultimately, all seven patients—including the one who did not receive IVIG—defervesced within 1–3 days of initiating antimicrobial therapy directed at scrub typhus.At follow-up, five patients with available echocardiography showed normalization of coronary arteries within one week to three months. These findings suggest that O. tsutsugamushi infection can trigger CALs indistinguishable from KD and that pathogen-directed therapy, rather than IVIG alone, is critical for fever resolution in such cases. Clinicians should maintain a high index of suspicion for scrub typhus in pediatric patients presenting with CALs, particularly when IVIG response is suboptimal. Author summary: Scrub typhus is a neglected tropical disease transmitted by infected mite larvae (chiggers) and is widespread across China and the Asia-Pacific region. Although it typically causes fever, rash, and multi-organ dysfunction, its capacity to damage coronary arteries in children — a complication most commonly associated with Kawasaki disease (KD) — has rarely been reported. In this study, we analyzed seven children treated at a major pediatric center in Guangzhou, China, who developed coronary artery aneurysms, dilatation, or intimal thickening following Orientia tsutsugamushi infection. Four patients who met the diagnostic criteria for KD or incomplete KD continued to have high fevers after standard immunoglobulin treatment, only improving once antibiotics targeting the bacterium were started. All patients eventually recovered. Among the six patients who underwent follow-up imaging, five showed normalization of coronary artery abnormalities. Our findings highlight that scrub typhus should be considered as a potential cause of coronary artery lesions in children, especially in endemic regions, and emphasize the importance of early microbiological diagnosis and specific antimicrobial therapy.
SN - 1935-2735
SN - 1935-2727
ER -