51
|
Kang SJ, Jin HM, Won EJ, Cho YN, Jung HJ, Kwon YS, Kee HJ, Ju JK, Kim JC, Kim UJ, Jang HC, Jung SI, Kee SJ, Park YW. Activation, Impaired Tumor Necrosis Factor-α Production, and Deficiency of Circulating Mucosal-Associated Invariant T Cells in Patients with Scrub Typhus. PLoS Negl Trop Dis 2016; 10:e0004832. [PMID: 27463223 PMCID: PMC4963088 DOI: 10.1371/journal.pntd.0004832] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/17/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Mucosal-associated invariant T (MAIT) cells contribute to protection against certain microorganism infections. However, little is known about the role of MAIT cells in Orientia tsutsugamushi infection. Hence, the aims of this study were to examine the level and function of MAIT cells in patients with scrub typhus and to evaluate the clinical relevance of MAIT cell levels. METHODOLOGY/PRINCIPAL FINDINGS Thirty-eight patients with scrub typhus and 53 health control subjects were enrolled in the study. The patients were further divided into subgroups according to disease severity. MAIT cell level and function in the peripheral blood were measured by flow cytometry. Circulating MAIT cell levels were found to be significantly reduced in scrub typhus patients. MAIT cell deficiency reflects a variety of clinical conditions. In particular, MAT cell levels reflect disease severity. MAIT cells in scrub typhus patients displayed impaired tumor necrosis factor (TNF)-α production, which was restored during the remission phase. In addition, the impaired production of TNF-α by MAIT cells was associated with elevated CD69 expression. CONCLUSIONS This study shows that circulating MAIT cells are activated, numerically deficient, and functionally impaired in TNF-α production in patients with scrub typhus. These abnormalities possibly contribute to immune system dysregulation in scrub typhus infection.
Collapse
Affiliation(s)
- Seung-Ji Kang
- Department of Infectious Diseases, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Hye-Mi Jin
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Eun Jeong Won
- Department of Laboratory Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Young-Nan Cho
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Hyun-Ju Jung
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Yong-Soo Kwon
- Department of Pulmonary and Critical Care Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Hae Jin Kee
- Heart Research Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Jung-Chul Kim
- Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Uh Jin Kim
- Department of Infectious Diseases, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Seung-Jung Kee
- Department of Laboratory Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Yong-Wook Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| |
Collapse
|
52
|
Watthanaworawit W, Kolakowska E, Hanboonkunupakarn B, Ling C, McGready R. Scrub typhus infection in pregnancy: the dilemma of diagnosis and treatment in a resource-limited setting. Clin Case Rep 2016; 4:584-8. [PMID: 27398202 PMCID: PMC4891484 DOI: 10.1002/ccr3.572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/13/2016] [Accepted: 04/19/2016] [Indexed: 01/30/2023] Open
Abstract
To save the life of both mother and fetus, the risks and benefits of the few antibiotics considered effective in the treatment of severe scrub typhus require consideration. In this case, chloramphenicol treatment averted maternal but not fetal mortality. Evidence‐based guidelines appropriate for resource‐limited endemic areas are required.
Collapse
Affiliation(s)
- Wanitda Watthanaworawit
- Shoklo Malaria Research Unit Mahidol-Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine Mahidol University Mae Sot Thailand
| | - Edyta Kolakowska
- Shoklo Malaria Research Unit Mahidol-Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine Mahidol University Mae Sot Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine Mahidol University Bangkok Thailand
| | - Clare Ling
- Shoklo Malaria Research Unit Mahidol-Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine Mahidol University Mae Sot Thailand
| | - Rose McGready
- Shoklo Malaria Research Unit Mahidol-Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine Mahidol University Mae Sot Thailand; Centre for Tropical Medicine Nuffield Department of Medicine University of Oxford Oxford UK
| |
Collapse
|
53
|
Accuracy of Conventional PCR Targeting the 16S rRNA Gene with the Ot-16sRF1 and Ot-16sRR1 Primers for Diagnosis of Scrub Typhus: a Case-Control Study. J Clin Microbiol 2015; 54:178-9. [PMID: 26491185 DOI: 10.1128/jcm.01754-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/17/2015] [Indexed: 12/22/2022] Open
Abstract
We retrospectively evaluated the accuracy of conventional PCR targeting the 16S rRNA gene (16S C-PCR) using the Ot-16sRF1/Ot-16sRR1 primers for diagnosing scrub typhus. The diagnosis of Orientia tsutsugamushi infection by 16S C-PCR presented an increased sensitivity of 87.0% and specificity of 100% compared with those obtained with other targets and is thus a simple and clinically useful method with good diagnostic accuracy.
Collapse
|
54
|
|
55
|
Abstract
Arthropod-borne bacterial diseases affect more than 25,000 Americans every year and thousands more around the world. These infections present a diagnostic dilemma for clinicians because they mimic many other pathologic conditions and are often low on or absent from the differential diagnosis list. Diagnosis is particularly challenging during pregnancy, as these infections may mimic common pregnancy-specific conditions, such as typical and atypical preeclampsia, or symptoms of pregnancy itself. Concerns regarding the safety in pregnancy of some indicated antibiotics add a therapeutic challenge for the prescriber, requiring knowledge of alternative therapeutic options for many arthropod-borne bacterial diseases. Physicians, especially those in endemic areas, must keep this class of infections in mind, particularly when the presentation does not appear classic for more commonly seen conditions. This article discusses presentation, diagnosis, and treatment of the most common of these arthropod-borne bacterial diseases, including Lyme disease, Rocky Mountain spotted fever, tick-borne relapsing fever, typhus, plague, cat-scratch disease, and Carrión disease.
Collapse
|
56
|
Olsen SJ, Campbell AP, Supawat K, Liamsuwan S, Chotpitayasunondh T, Laptikulthum S, Viriyavejakul A, Tantirittisak T, Tunlayadechanont S, Visudtibhan A, Vasiknanonte P, Janjindamai S, Boonluksiri P, Rajborirug K, Watanaveeradej V, Khetsuriani N, Dowell SF. Infectious causes of encephalitis and meningoencephalitis in Thailand, 2003-2005. Emerg Infect Dis 2015; 21:280-9. [PMID: 25627940 PMCID: PMC4313633 DOI: 10.3201/eid2102.140291] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Acute encephalitis is a severe neurologic syndrome. Determining etiology from among ≈100 possible agents is difficult. To identify infectious etiologies of encephalitis in Thailand, we conducted surveillance in 7 hospitals during July 2003-August 2005 and selected patients with acute onset of brain dysfunction with fever or hypothermia and with abnormalities seen on neuroimages or electroencephalograms or with cerebrospinal fluid pleocytosis. Blood and cerebrospinal fluid were tested for >30 pathogens. Among 149 case-patients, median age was 12 (range 0-83) years, 84 (56%) were male, and 15 (10%) died. Etiology was confirmed or probable for 54 (36%) and possible or unknown for 95 (64%). Among confirmed or probable etiologies, the leading pathogens were Japanese encephalitis virus, enteroviruses, and Orientia tsutsugamushi. No samples were positive for chikungunya, Nipah, or West Nile viruses; Bartonella henselae; or malaria parasites. Although a broad range of infectious agents was identified, the etiology of most cases remains unknown.
Collapse
Affiliation(s)
| | | | - Krongkaew Supawat
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Sahas Liamsuwan
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Tawee Chotpitayasunondh
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Somsak Laptikulthum
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Akravudh Viriyavejakul
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Tasanee Tantirittisak
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Supoch Tunlayadechanont
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Anannit Visudtibhan
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Punnee Vasiknanonte
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Supachai Janjindamai
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Pairoj Boonluksiri
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Kiatsak Rajborirug
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Veerachai Watanaveeradej
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Nino Khetsuriani
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Scott F. Dowell
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | | |
Collapse
|
57
|
Yang LP, Liang SY, Wang XJ, Li XJ, Wu YL, Ma W. Burden of disease measured by disability-adjusted life years and a disease forecasting time series model of scrub typhus in Laiwu, China. PLoS Negl Trop Dis 2015; 9:e3420. [PMID: 25569248 PMCID: PMC4288724 DOI: 10.1371/journal.pntd.0003420] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/15/2014] [Indexed: 11/18/2022] Open
Abstract
Background Laiwu District is recognized as a hyper-endemic region for scrub typhus in Shandong Province, but the seriousness of this problem has been neglected in public health circles. Methodology/Principal Findings A disability-adjusted life years (DALYs) approach was adopted to measure the burden of scrub typhus in Laiwu, China during the period 2006 to 2012. A multiple seasonal autoregressive integrated moving average model (SARIMA) was used to identify the most suitable forecasting model for scrub typhus in Laiwu. Results showed that the disease burden of scrub typhus is increasing yearly in Laiwu, and which is higher in females than males. For both females and males, DALY rates were highest for the 60–69 age group. Of all the SARIMA models tested, the SARIMA(2,1,0)(0,1,0)12 model was the best fit for scrub typhus cases in Laiwu. Human infections occurred mainly in autumn with peaks in October. Conclusions/Significance Females, especially those of 60 to 69 years of age, were at highest risk of developing scrub typhus in Laiwu, China. The SARIMA (2,1,0)(0,1,0)12 model was the best fit forecasting model for scrub typhus in Laiwu, China. These data are useful for developing public health education and intervention programs to reduce disease. Scrub typhus, also known as tsutsugamushi disease, is a zoonosis transmitted by chigger bites (larval trombiculid mites) and the pathogen Orientia tsutsugamushi (O. tsutsugamushi), a Gram-negative obligate intracellular bacterium. It is distributed widely in the Pacific regions of Asia, and the islands of the western Pacific and Indian Oceans. People with outdoor activities that involve contact with grasses or shrubs are at highest risk. Scrub typhus has existed in Southern China for thousands of years, but it has been noted to spread from the South to the North of China in recent decades. Though this research we studied the disease burden of scrub typhus with disability-adjusted life years (DALYs), and developed a forecasting time series model for human clinical disease in Laiwu, China. Results demonstrated that the disease burden of scrub typhus was increasing year by year in Laiwu, and it was higher in females than males. Moreover, DALY rates in females and males were highest for persons in the 60–69 years age group. Of all the seasonal autoregressive integrated moving average (SARIMA) models tested, the SARIMA(2,1,0)(0,1,0)12 model was the best fit for scrub typhus cases in Laiwu. The disease occurred mainly in autumn, with a peak in October.
Collapse
Affiliation(s)
- Li-Ping Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, People's Republic of China
- * E-mail:
| | - Si-Yuan Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xian-Jun Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
| | - Xiu-Jun Li
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yan-Ling Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, People's Republic of China
| | - Wei Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, People's Republic of China
| |
Collapse
|
58
|
Abstract
Scrub typhus is an acute febrile illness that, if untreated, can result in considerable morbidity and mortality. One of the primary reasons for delays in the treatment of this potentially fatal infection is the difficulty in diagnosing the condition. Diagnosis is often complicated because of the combination of non-specific symptoms that overlap with other infections commonly found in endemic areas and the poor available diagnostics. In the majority of the endemic settings, diagnosis still relies on the Weil-Felix test, which is neither sensitive nor specific. Other methods of testing have become available, but at this time, these remain insufficient to provide the rapid point-of-care diagnostics that would be necessary to significantly change the management of this infection by providers in endemic areas. This article reviews the currently available diagnostic tools for scrub typhus and their utility in the clinical setting.
Collapse
Affiliation(s)
- Jeshina Janardhanan
- Medicine Unit I and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | |
Collapse
|
59
|
Soong L, Wang H, Shelite TR, Liang Y, Mendell NL, Sun J, Gong B, Valbuena GA, Bouyer DH, Walker DH. Strong type 1, but impaired type 2, immune responses contribute to Orientia tsutsugamushi-induced pathology in mice. PLoS Negl Trop Dis 2014; 8:e3191. [PMID: 25254971 PMCID: PMC4177881 DOI: 10.1371/journal.pntd.0003191] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/14/2014] [Indexed: 12/22/2022] Open
Abstract
Scrub typhus is a neglected, but important, tropical disease, which puts one-third of the world's population at risk. The disease is caused by Orientia tsutsugamushi, an obligately intracellular Gram-negative bacterium. Dysregulation in immune responses is known to contribute to disease pathogenesis; however, the nature and molecular basis of immune alterations are poorly defined. This study made use of a newly developed murine model of severe scrub typhus and focused on innate regulators and vascular growth factors in O. tsutsugamushi-infected liver, lungs and spleen. We found no activation or even reduction in base-line expression for multiple molecules (IL-7, IL-4, IL-13, GATA3, ROR-γt, and CXCL12) at 2, 6 and 10 days post-infection. This selective impairment in type 2-related immune responses correlated with a significant activation of the genes for IL-1β, IL-6, IL-10, TNF-α, IFN-γ, as well as CXCR3- and CXCR1-related chemokines in inflamed tissues. The elevated angiopoietin (Ang)-2 expression and Ang-2/Ang-1 ratios suggested excessive inflammation and the loss of endothelial integrity. These alterations, together with extensive recruitment of myeloperoxidase (MPO)-expressing neutrophils and the influx of CD3+ T cells, contributed to acute tissue damage and animal death. This is the first report of selective alterations in a panel of immune regulators during early O. tsutsugamushi infection in intravenously inoculated C57BL/6 mice. Our findings shed new light on the pathogenic mechanisms associated with severe scrub typhus and suggest potential targets for therapeutic investigation.
Collapse
Affiliation(s)
- Lynn Soong
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
| | - Hui Wang
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Thomas R. Shelite
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Yuejin Liang
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Nicole L. Mendell
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Jiaren Sun
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Bin Gong
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Gustavo A. Valbuena
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Donald H. Bouyer
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - David H. Walker
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| |
Collapse
|
60
|
Faccini-Martínez ÁA, García-Álvarez L, Hidalgo M, Oteo JA. Syndromic classification of rickettsioses: an approach for clinical practice. Int J Infect Dis 2014; 28:126-39. [PMID: 25242696 DOI: 10.1016/j.ijid.2014.05.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/23/2014] [Accepted: 05/24/2014] [Indexed: 10/24/2022] Open
Abstract
Rickettsioses share common clinical manifestations, such as fever, malaise, exanthema, the presence or absence of an inoculation eschar, and lymphadenopathy. Some of these manifestations can be suggestive of certain species of Rickettsia infection. Nevertheless none of these manifestations are pathognomonic, and direct diagnostic methods to confirm the involved species are always required. A syndrome is a set of signs and symptoms that characterizes a disease with many etiologies or causes. This situation is applicable to rickettsioses, where different species can cause similar clinical presentations. We propose a syndromic classification for these diseases: exanthematic rickettsiosis syndrome with a low probability of inoculation eschar and rickettsiosis syndrome with a probability of inoculation eschar and their variants. In doing so, we take into account the clinical manifestations, the geographic origin, and the possible vector involved, in order to provide a guide for physicians of the most probable etiological agent.
Collapse
Affiliation(s)
| | - Lara García-Álvarez
- Infectious Diseases Department, Center of Rickettsioses and Vector-borne Diseases, Hospital San Pedro-CIBIR, Logroño, Spain
| | - Marylin Hidalgo
- Microbiology Department, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José A Oteo
- Infectious Diseases Department, Center of Rickettsioses and Vector-borne Diseases, Hospital San Pedro-CIBIR, Logroño, Spain.
| |
Collapse
|
61
|
Agarwal VK, Reddy GKM, Krishna MR, Ramareddy G, Saroj P, Bandaru VCSS. Predictors of scrub typhus: a study from a tertiary care center. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60704-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
62
|
Kumar V, Kumar V, Yadav AK, Iyengar S, Bhalla A, Sharma N, Aggarwal R, Jain S, Jha V. Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India. PLoS Negl Trop Dis 2014; 8:e2605. [PMID: 24498445 PMCID: PMC3907360 DOI: 10.1371/journal.pntd.0002605] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/10/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Infection-related acute kidney injury (AKI) is an important preventable cause of morbidity and mortality in the tropical region. The prevalence and outcome of kidney involvement, especially AKI, in scrub typhus is not known. We investigated all patients with undiagnosed fever and multisystem involvement for scrub typhus and present the pattern of renal involvement seen. METHODS From September 2011 to November 2012, blood samples of all the patients with unexplained acute febrile illness and/or varying organ involvement were evaluated for evidence of scrub typhus. A confirmed case of scrub typhus was defined as one with detectable Orientia tsutsugamushi deoxyribonucleic acid (DNA) in patient's blood sample by nested polymerase chain reaction (PCR) targeting the gene encoding 56-kDa antigen and without any alternative etiological diagnosis. Renal involvement was defined by demonstration of abnormal urinalysis and/or reduced glomerular filtration rate. AKI was defined as per Kidney Disease: Improving Global Outcomes (KDIGO) definition. RESULTS Out of 201 patients tested during this period, 49 were positive by nested PCR for scrub typhus. Mean age of study population was 34.1±14.4 (range 11-65) years. Majority were males and a seasonal trend was evident with most cases following the rainy season. Overall, renal abnormalities were seen in 82% patients, 53% of patients had AKI (stage 1, 2 and 3 in 10%, 8% and 35%, respectively). The urinalysis was abnormal in 61%, with dipstick positive albuminuria (55%) and microscopic hematuria (16%) being most common. Acute respiratory distress syndrome (ARDS) and shock were seen in 57% and 16% of patients, respectively. Hyperbilirubinemia was associated with AKI (p = 0.013). A total of 8 patients (including three with dialysis dependent AKI) expired whereas rest all made uneventful recovery. Jaundice, oliguria, ARDS and AKI were associated with mortality. However, after multivariate analysis, only oliguric AKI remained a significant predictor of mortality (p = 0.002). CONCLUSIONS Scrub typhus was diagnosed in 24% of patients presenting with unexplained febrile illness according to a strict case definition not previously used in this region. Renal abnormalities were seen in almost 82% of all patients with evidence of AKI in 53%. Our finding is contrary to current perception that scrub typhus rarely causes renal dysfunction. We suggest that all patients with unexplained febrile illness be investigated for scrub typhus and AKI looked for in scrub typhus patients.
Collapse
Affiliation(s)
- Vivek Kumar
- Departments of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinod Kumar
- Departments of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok K. Yadav
- Departments of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreenivasa Iyengar
- Departments of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Aggarwal
- Pulmonary and Critical Care Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- Departments of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- George Institute for Global Health, New Delhi, India
| |
Collapse
|
63
|
Affiliation(s)
- Robert O J Weinzierl
- Department of Life Sciences, Division of Biomolecular Sciences, Imperial College London , Sir Alexander Fleming Building, Exhibition Road, London SW7 2AZ, United Kingdom
| |
Collapse
|
64
|
Viswanathan S, Muthu V, Iqbal N, Remalayam B, George T. Scrub typhus meningitis in South India--a retrospective study. PLoS One 2013; 8:e66595. [PMID: 23799119 PMCID: PMC3682970 DOI: 10.1371/journal.pone.0066595] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/08/2013] [Indexed: 12/13/2022] Open
Abstract
Background Scrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reports Methods A retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness- a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits. Results Sixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol. Conclusion Meningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.
Collapse
Affiliation(s)
- Stalin Viswanathan
- Department of General Medicine, Indira Gandhi Medical College, Kathirkamam, Pondicherry, India.
| | | | | | | | | |
Collapse
|
65
|
Ikegaya S, Iwasaki H, Takada N, Yamamoto S, Ueda T. Tsutsugamushi disease caused by Shimokoshi-type Orientia tsutsugamushi: the first report in Western Japan. Am J Trop Med Hyg 2013; 88:1217-9. [PMID: 23589529 DOI: 10.4269/ajtmh.12-0740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
An 85-year-old female farmer was admitted to our hospital for fever, general fatigue, and skin rash. Cephalosporin was not effective and minocycline was dramatically effective. An eschar was discovered on her inguinal region after the defervescence. Laboratory examination of serum taken 12 days after onset of the illness showed elevated titers of antibodies against the Shimokoshi strain of Orientia tsutsugamushi. The gene sequence analysis of specimen from the patient's eschar revealed high similarity to the Shimokoshi strain by nested polymerase chain reaction. Therefore, this patient was diagnosed as a case of Shimokoshi-type tsutsugamushi disease, which has not previously been reported in Western Japan. Recently, cases of this type have also been confirmed in northeastern Japan, suggesting the need for further epidemiological studies.
Collapse
Affiliation(s)
- Satoshi Ikegaya
- Division of Hematology and Oncology, Division of Infection Control and Senior Fellow Laboratory, University of Fukui, Fukui, Japan.
| | | | | | | | | |
Collapse
|
66
|
Watt G, Kantipong P, Jirajarus K, Wongsawat E, Waywa D, Suputtamongkol Y. Acute scrub typhus in Northern Thailand: EKG changes. Am J Trop Med Hyg 2003; 95:769-773. [PMID: 12236430 DOI: 10.4269/ajtmh.16-0088] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/07/2016] [Indexed: 01/10/2023] Open
Abstract
The electrocardiographic (EKG) manifestations of scrub typhus were prospectively evaluated in 29 adult patients who acquired Orientia tsutsugamushi infection in Chiang Rai, Northern Thailand. EKGs were normal in 22 of the 29 patients (76%); minor non-specific changes were found in the other 7 patients; ie ST segment/T wave changes (10%), U waves (7%), and premature ventricular contractions (4%). These results suggest that EKG changes in scrub typhus acquired in areas of diminished antibiotic susceptibility are similar to those observed in O. tsutsugamushi infection acquired elsewhere.
Collapse
Affiliation(s)
- George Watt
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | | | - Ekkarat Wongsawat
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Duangdao Waywa
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yupin Suputtamongkol
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|