A 23 year old man presents with a productive cough with mucoid sputum for 2 days, in a background of high-grade fever, nausea and vomiting for 6 days. Furthermore, he experienced a mild generalized headache, myalgia and a widespread itchy rash for the last 10 days. He returned from a military training course in India 3 days ago. He has not obtained any treatment so far, except acetaminophen for fever. His medical history is otherwise unremarkable.
WBC: 13,000/mm3 (4000-11,000) N: 50% (50-70) L: 45% (20-40) Hb: 14.5g/dL (13.5-17.5) Platelets: 190,000/mm3 (150,000-400,000)
B/L non-homogenous infiltrates in lower zones of both lungs, R>L
The indirect Fluorescence Antibody Test (FAT) is reactive for Orientia tsutsugamushi
Culture results will be available in 3 days.