Scrub typhus, myocarditis and a possible drug interaction
Keywords:Cytochrome P450, Doxycycline, Myocarditis, Ivabradine, Scrub typhus
Scrub typhus, caused by O. Tsutsugamushi is a re-emerging disease which is being increasingly reported from different parts of India. This disease has a wide spectrum of presentation which can range from uncomplicated febrile illness to life-threatening sepsis with multi-organ dysfunction. Myocarditis has been described as one of the rare manifestations of this infection and very few cases have been reported. Myocarditis in scrub typhus is usually subclinical and therefore many times ignored. Here, we report of a case of scrub typhus presenting without the typical rash and eschar with features of myocarditis requiring treatment. We highlight a possible drug interaction between ivabradine and doxycycline which were used in this patient. We also highlight the possibility of other drug interactions between the various drugs used in the treatment of scrub typhus and its complications and stress the need to be vigilant when prescribing multiple drugs, especially in a disease with such a varied presentation and multiple complications that require the use of a number of drugs.
Chauhan M, Mahajan S, Manish S, Abrol RK. Scrub typhus: An emerging scourge. Int J App Basic Med Res. 2015;4(4):394-401.
Mahajan SK. Scrub typhus. J Assoc Physicians India 2005;53:954-8.
Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India. 2010;58:24-8.
Mahajan SK, Bakshi D. Acute reversible hearing loss in scrub typhus. J Assoc Physicians India. 2007;55:512-4.
Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, et al. Outbreak of scrub typhus in southern India during the cooler months. Ann NY Acad Sci. 2003;990:359-64.
Fang RC, Dennis DT, Lee JB. Electrocardiographic changes in scrub typhus patients. Southeast Asian J Trop Med Public Health. 1977;8:503-9.
Yotsukura M, Aoki N, Fukuzumi N, Ishikawa K. Review of a case of Tsutsugamushi disease showing myocarditis and confirmation of rickettsia by endomyocardial biopsy. Jpn Circ J. 1991;55:149-53.
Bharathi SL, Jayachandran S, Senthil N, Sujatha S. Scrub typhus causing myocarditis and ARDS: A case report. Heart India. 2013;1:85-6.
Larson JM, Tavakkoli A, Drane WE, Toskes PP, Moshiree B. Advantages of Azithromycin Over Erythromycin in Improving the Gastric Emptying Half-Time in Adult Patients With Gastroparesis. J Neurogastroenterol Motil. 2010;16(4):407-13.
Ogu CC, Maxa JL. Drug interactions due to cytochrome P450. Proc (BaylUniv Med Cent). 2000;13(4):421-3.
Tan KR, Magill AJ, Parise ME, Arguin PM. Doxycycline for Malaria Chemoprophylaxis and Treatment: Report from the CDC Expert Meeting on Malaria Chemoprophylaxis. Am J Trop Med Hyg 2011;84(4):517-31.
Deedwania P. Selective and Specific Inhibition of If with Ivabradine for the Treatment of Coronary Artery Disease or Heart Failure. Drugs. 2013;73(14):1569-86.
Medscape drug and diseases. Available at http://reference.medscape.com/drug/vibramycin-monodox-doxycycline-342548#3. Accessed 9 May 2016.
Rapsang AJ, Bhattacharyya P. Scrub typhus. Indian J Anaesth. 2013;57(2):127-34.