A Case of Critical Japanese Spotted Fever in Zhejiang, China

Yani Zhou,1 Qi Wang,1 Yujuan Shen,1 Bin Shen,1 Yan Zhang,2 Weihong Wang,1 Xiaofeng Li1,3 1Department of Infectious Diseases, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China; 2Department of Nursing, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province, People’s Republic of China; 3Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Xiaofeng Li, Email xf_li0728@163.comBackground: Japanese spotted fever (JSF) is a rare disease, caused by Rickettsia japonica; no case has been reported in Zhejiang Province, China.Case Presentation: An elderly woman presented to the hospital with abdominal pain and fever. Her condition rapidly worsened with severe complications, such as multiple organ failure and central nervous system damage. The presence of R. japonica was quickly detected by metagenomic next-generation sequencing. On the basis of combined clinical manifestations and laboratory results, critical JSF was diagnosed and treated with doxycycline. The patient showed good prognosis. Typical symptoms (eschar and rash) were not observed in the early stage, consequently increasing the difficulty of clinical diagnosis.Conclusion: The delay of treatment caused by non-specific symptoms is an important factor affecting the progression of JSF. As an emerging pathogen detection method, mNGS has been successfully applied for disease diagnosis and treatment, and can be an important complement for the diagnosis of this disease.Keywords: Japanese spotted fever, Rickettsia japonica, spotted fever group Rickettsia, mNGS, fever, multiple organ failure, central nervous system damage