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Kaur J, Sharma N, Kanaujia R, Bisht K, Goel S, Biswal M, Sharma N. Molecular characterization of Orientia tsutsugamushi causing fatal scrub typhus in a young male affected by so-called "mystery fever" in North India. Indian J Med Microbiol 2023; 46:100418. [PMID: 37945112 DOI: 10.1016/j.ijmmb.2023.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 06/07/2023] [Accepted: 06/17/2023] [Indexed: 11/12/2023]
Abstract
Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi. Although the presence of eschar is considered pathognomic, diagnosis of scrub typhus is challenging due to overlapping presentation. The diagnosis is based on the serological and molecular assay. Here, we describe a case of a young male patient who was diagnosed with scrub typhus and developed complications in the course of the disease. We also performed molecular characterization of the strain which revealed a close relatedness to Karp-like Linh.DT strains were previously reported from Vietnam.
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Affiliation(s)
- Jasleen Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Nalin Sharma
- Department of Internal Medicine, PGIMER, Chandigarh, India.
| | | | - Kamlesh Bisht
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Shriya Goel
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Navneet Sharma
- Department of Internal Medicine, PGIMER, Chandigarh, India.
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Schmidt WP, Devamani CS, Elangovan D, Alexander N, Rose W, Prakash JAJ. Clinical characteristics of and antibody response to spotted fever group rickettsial infections in South India: Case series and serological cohort study. Trop Med Int Health 2021; 26:1616-1623. [PMID: 34597443 DOI: 10.1111/tmi.13682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The clinical and serological characteristics of spotted fever group rickettsial (SFGR) infections in South Asia are poorly understood. We studied the clinical presentation and the IgM/IgG response in cases enrolled at two health care centres in South India. METHOD We enrolled 77 patients. Fifty-seven of these patients were recruited at a tertiary care centre, the remaining 20 at a community hospital (secondary care level). Diagnostic tests included IgM and IgG enzyme-linked immunosorbent assay and polymerase chain reaction. Over a period of 1 year, 41 cases were followed up for repeated sero-analysis. RESULTS Median age was 9 years (range 1-79). A rash was present in 74% of cases (57/77). In cases aged <15 years, rash was present in 94% (44/47) vs. 43% (13/30) in cases aged ≥15 years. An eschar was found in two cases (3%). Severe infection or complications occurred in 10 cases (13%). These included central nervous system infection (6/77, 8%), kidney injury (3/77, 4%), shock (3/77, 4%), lung involvement (2/77, 3%) and peripheral gangrene (2/77, 3%). IgM antibody levels increased faster after fever onset than IgG antibodies, peaking at 50 and 60 days, respectively. After the peak, IgM and IgG levels showed a slow decline over one year with less than 50% of cases showing persistent IgG antibody levels. CONCLUSION Spotted fever group rickettsial infections in South India may be under-diagnosed, as many cases may not develop a rash. The proportion of cases developing severe infection seems lower than for scrub typhus in this region. IgG seroprevalence may substantially underestimate the proportion in a population with past SFGR infection.
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Affiliation(s)
- Wolf-Peter Schmidt
- Department of Emergency Medicine, Christian Medical College, Vellore, India.,Department for Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Carol S Devamani
- Rural Unit for Health & Social Affairs, Christian Medical College, Vellore, India
| | - Divyaa Elangovan
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Neal Alexander
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Winsley Rose
- Department of Pediatrics and Pediatric Infectious Diseases, Christian Medical College, Vellore, India
| | - John A J Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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Munoz-Pinto MF, Empadinhas N, Cardoso SM. The neuromicrobiology of Parkinson's disease: A unifying theory. Ageing Res Rev 2021; 70:101396. [PMID: 34171417 DOI: 10.1016/j.arr.2021.101396] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/11/2021] [Accepted: 06/19/2021] [Indexed: 02/07/2023]
Abstract
Recent evidence confirms that PD is indeed a multifactorial disease with different aetiologies and prodromal symptomatology that likely depend on the initial trigger. New players with important roles as triggers, facilitators and aggravators of the PD neurodegenerative process have re-emerged in the last few years, the microbes. Having evolved in association with humans for ages, microbes and their products are now seen as fundamental regulators of human physiology with disturbances in their balance being increasingly accepted to have a relevant impact on the progression of disease in general and on PD in particular. In this review, we comprehensively address early studies that have directly or indirectly linked bacteria or other infectious agents to the onset and progression of PD, from the earliest suspects to the most recent culprits, the gut microbiota. The quest for effective treatments to arrest PD progression must inevitably address the different interactions between microbiota and human cells, and naturally consider the gut-brain axis. The comprehensive characterization of such mechanisms will help design innovative bacteriotherapeutic approaches to selectively shape the gut microbiota profile ultimately to halt PD progression. The present review describes our current understanding of the role of microorganisms and their endosymbiotic relatives, the mitochondria, in inducing, facilitating, or aggravating PD pathogenesis.
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Warnasooriya S, Kularatne D, Kularatne S, Weerakoon K. Massive Tick Bites Causing Spotted Fever Rickettsial Infection: A Hazard in a Tea Plantation, Sri Lanka. Wilderness Environ Med 2021; 32:499-502. [PMID: 34334302 DOI: 10.1016/j.wem.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 03/07/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022]
Abstract
Tea plantations in Sri Lanka cover the central hills of the island, where spotted fever group (SFG) rickettsial infection is common. In most cases, the history of tick bite is obscure and eschars are not present. A 45-y-old female experienced massive tick bites while working in her tea plantation. She developed fever 2 d after exposure, but the diagnosis of SFG infection was not considered until a skin rash appeared on the eighth day. She had a very high titer of antirickettsial antibodies detected by immunofluorescence assay and responded to doxycycline. Here, we highlight the high risk of exposure to ticks and tick bites within tea estates and its causal relationship to SFG infection, which is increasing in Sri Lanka. Active case detection, notification, surveillance, and community awareness are imperative. Possible preventative measures for tick bites have to be introduced. There is a need to explore the effectiveness of local remedies currently in use.
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Affiliation(s)
- Sithara Warnasooriya
- Centre for Research in Tropical Medicine (CRTM), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Damsara Kularatne
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Kosala Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
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Epidemiology, Clinical Aspects, Laboratory Diagnosis and Treatment of Rickettsial Diseases in the Mediterranean Area During COVID-19 Pandemic: A Review of the Literature. Mediterr J Hematol Infect Dis 2020; 12:e2020056. [PMID: 32952967 PMCID: PMC7485464 DOI: 10.4084/mjhid.2020.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/04/2020] [Indexed: 01/12/2023] Open
Abstract
The purpose of the present review is to give an update regarding the classification, epidemiology, clinical manifestation, diagnoses, and treatment of the Rickettsial diseases present in the Mediterranean area. We performed a comprehensive search, through electronic databases (Pubmed – MEDLINE) and search engines (Google Scholar), of peer-reviewed publications (articles, reviews, and books). The availability of new diagnostic tools, including Polymerase Chain Reaction and nucleotide sequencing has significantly modified the classification of intracellular bacteria, including the order Rickettsiales with more and more new Rickettsia species recognized as human pathogens. Furthermore, emerging Rickettsia species have been found in several countries and are often associated with unique clinical pictures that may challenge the physician in the early detection of the diseases. Rickettsial infections include a wide spectrum of clinical presentations ranging from a benign to a potentially life treating disease that requires prompt recognition and proper management. Recently, due to the spread of SARS-CoV-2 infection, the differential diagnosis with COVID-19 is of crucial importance. The correct understanding of the clinical features, diagnostic tools, and proper treatment can assist clinicians in the management of Rickettsioses in the Mediterranean area.
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Clinical Characteristics and Predictors of Severity of Pediatric Scrub Typhus in a Tertiary Level Hospital in South India. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2020. [DOI: 10.5812/pedinfect.92752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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An Atypical Case of Rickettsial Spotted Fever Myocarditis Mimicking Weil's Disease. Case Rep Infect Dis 2019; 2019:9620245. [PMID: 31360559 PMCID: PMC6644265 DOI: 10.1155/2019/9620245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/02/2019] [Accepted: 06/24/2019] [Indexed: 11/18/2022] Open
Abstract
A 65-year-old previously healthy male presented to us on the fourth day of a febrile illness with headache, arthralgia, myalgia, nausea, cough, chest pain, sore throat, and passing of watery stools and dark urine with a history of exposure to leptospirosis during a dengue outbreak. On examination, there was dehydration and hypovolemia, and an ultrasound scan revealed capillary leakage. His liver transaminases, serum creatine, blood urea, C-reactive protein, and neutrophil percentage were high, and thrombocytopenia was present. Moreover, myocarditis has been detected too. Supportive therapy with intravenous ceftriaxone was administered, considering possible Weil's disease or dengue hemorrhagic fever with secondary bacterial infection. Serological tests, performed later, diagnosed him with a Rickettsia conorii infection and excluded dengue, leptospirosis, and hantavirus infections. Repeat 2D echocardiograms showed mild improvement of his cardiac failure after one month and a more improvement after eight months. Clinical features of the rickettsial spotted fever group (SFG) and leptospirosis overlap. Leptospirosis is common; thus, the risk of overlooking SFG and diagnosing leptospirosis is likely. Tests for differentiation are unavailable in Sri Lankan hospitals and in many other developing countries. Empirical doxycycline in suspected cases of SFG infections in areas where rickettsioses are prevalent can save lives as in this case.
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Bilateral Sensorineural Deafness in a Young Pregnant Female Presenting with a Fever: A Rare Complication of a Reemerging Disease-Spotted Fever Group Rickettsioses. Case Rep Infect Dis 2019; 2019:5923146. [PMID: 31019815 PMCID: PMC6452535 DOI: 10.1155/2019/5923146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/14/2019] [Accepted: 03/03/2019] [Indexed: 11/18/2022] Open
Abstract
Background Rickettsial illnesses are a group of arthropod-borne remerging diseases. They are subdivided into three groups as typhus, spotted fever, and scrub typhus group. Complications such as reversible bilateral deafness due to spotted fever rickettsioses are infrequently reported in the literature. Case Presentation We present a young pregnant female who developed bilateral sensorineural deafness on the fifth day of an acute febrile illness with a maculopapular rash. Rickettsia conorii IgG (>1/450) became highly positive, and she received oral azithromycin for ten days with complete resolution of fever and rash. The sensorineural deafness slowly improved over several months. Conclusion Sensorineural deafness is a rare complication of spotted fever group rickettsioses. Since usage of doxycycline is controversial in pregnancy, azithromycin gave a favourable recovery of fever. Sensorineural deafness took several months to resolve after completion of antibiotics.
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Herath HMLY, Jayasundara JMHD, Senadhira SDN, Kularatne SAM, Kularatne WKS. Spotted fever rickettsioses causing myocarditis and ARDS: a case from Sri Lanka. BMC Infect Dis 2018; 18:705. [PMID: 30594148 PMCID: PMC6311067 DOI: 10.1186/s12879-018-3631-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background Spotted fever group of rickettsial infections are emerging in Sri Lanka. We describe a patient with rapidly progressing ARDS and myocarditis secondary to spotted fever caused by Rickettsia conorii. ARDS and myocarditis are rare complications of Rickettsia conorii infections and only a few cases are reported to date. Case presentation A 53 years old manual worker presented with fever for 5 days and a skin rash. He was in circulatory failure on admission and developed severe hypoxaemia with gross changes in chest radiograph by next day requiring assisted ventilation. He had myocarditis causing left ventricular failure and acute respiratory distress syndrome. He was confirmed to have spotted fever rickettsial infection with rising titre of indirect immunofluorescence antibodies to Ricketssia conorii and made a complete recovery with appropriate antibiotic therapy and supportive care. Conclusion Rickettsial infections can present with diverse manifestations. Even the patients with severe organ involvements such as myocarditis and ARDS can be completely cured if timely identified and treated.
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Affiliation(s)
- H M L Y Herath
- Department of General Medicine, General Hospital (Teaching), Kandy, Sri Lanka.
| | - J M H D Jayasundara
- Department of General Medicine, General Hospital (Teaching), Kandy, Sri Lanka
| | - S D N Senadhira
- Department of General Medicine, General Hospital (Teaching), Kandy, Sri Lanka
| | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - W K S Kularatne
- Department of General Medicine, General Hospital (Teaching), Kandy, Sri Lanka
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Kularatne SAM, Fernando R, Selvaratnam S, Narampanawa C, Weerakoon K, Wickramasinghe S, Pathirage M, Weerasinghe V, Bandara A, Rajapakse J. Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible? BMC Infect Dis 2018; 18:418. [PMID: 30134848 PMCID: PMC6106839 DOI: 10.1186/s12879-018-3338-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022] Open
Abstract
Background Over the last two decades intra-aural tick infestation (otoacariasis) has been a common occurrence in the hilly central region in Sri Lanka. Very occasional detection of isolated unilateral facial nerve palsy associated with otoacariasis attributed to toxin damage of the nerve prompted us to study the clinico-epidemiology and aetio-pathology of the problem. Methods All cases having isolated unilateral facial nerve palsy associated with otoacariasis presented to, Ear Nose and Throat clinic at General Hospital Kandy, Sri Lanka from 2001 to 2016 were included in the study. The facial palsies were assessed with nerve conduction studies and, harvested ticks were identified. Results There were 29 patients with mean age of 46 years (range 22–76 years) with male to female ratio of 1:1.9. First 12 patients without specific treatment took 1–55 months for recovery and 4 had axonal degeneration. Last 5 patients were treated with doxycycline and recovered in 4 weeks. They had strong sero-conversion of immunofluorescence antibodies against spotted fever rickettsioses and the tick harvested from the last patient was PCR positive for rickettsial DNA. Identified ticks belonged to Dermacentor, Amblyomma, Rhipicephalus and Hyalomma species. Conclusions On contrary to popular toxin theory, we were able to demonstrate treatable rickettsial aetio-pathology as the cause of otoacariasis associated lower motor facial palsy in Sri Lanka.
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Affiliation(s)
- Senanayake A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
| | | | | | | | - Kosala Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Sujanthe Wickramasinghe
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Manoji Pathirage
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Vajira Weerasinghe
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Anura Bandara
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Jayanthe Rajapakse
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka
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Narayanasamy DK, Arun Babu T, Vijayadevagaran V, Kittu D, Ananthakrishnan S. Predictors of Severity in Pediatric Scrub Typhus. Indian J Pediatr 2018; 85:613-617. [PMID: 29368107 DOI: 10.1007/s12098-018-2612-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 01/02/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To identify the factors that can predict the severity of scrub typhus in children. METHODS This prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children <12y of age admitted with fever for more than 7d and positive IgM ELISA for scrub typhus were included in the study. These children were followed during the hospital course and their laboratory results, response to treatment and complications were documented. Cases of 'severe scrub typhus' were identified based on criteria from published adult and pediatric studies. RESULTS Out of 930 children with fever for more than 7d, IgM ELISA for scrub typhus was positive in 230 children. Ninety one (40.6%) cases fulfilled the criteria of 'severe scrub typhus' in children. Out of 45 factors, 27 potential factors were studied. The multivariate analysis identified 5 factors, breathlessness (OR: 6.85, 95%CI: 2.69 to 9.87), altered sensorium (OR: 11.48, 95% CI 3.43 to 10.19), leucocytosis (OR: 3.38, 95% CI 1.12 to 10.16), hypoalbuminemia (OR: 10.78, 95% CI 2.66 to 48.76), and hyponatremia (OR: 10.08, 95% CI 2.11 to 23.42) to be significantly associated with the 'severe scrub typhus' cases. CONCLUSIONS Breathlessness, altered sensorium, leucocytosis, hypoalbuminemia, and hyponatremia predict severity in childhood scrub typhus. Presence of these factors should alert the treating physician regarding the need for intensive monitoring, treatment or referral.
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Affiliation(s)
- Dinesh Kumar Narayanasamy
- Department of Pediatrics, Indira Gandhi Medical College and Research Institute (IGMC&RI), Pondicherry, India
| | - Thirunavukkarasu Arun Babu
- Department of Pediatrics, Indira Gandhi Medical College and Research Institute (IGMC&RI), Pondicherry, India.
| | | | - Devi Kittu
- Department of Preventive & Social Medicine, Indira Gandhi Medical College and Research Institute (IGMC&RI), Pondicherry, India
| | - Shanthi Ananthakrishnan
- Department of Pediatrics, Indira Gandhi Medical College and Research Institute (IGMC&RI), Pondicherry, India
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Paras ML, Hyle EP, Foreman RK, Coffey KC. Case 14-2018: A 68-Year-Old Woman with a Rash, Hyponatremia, and Uveitis. N Engl J Med 2018; 378:1825-1833. [PMID: 29742372 DOI: 10.1056/nejmcpc1800337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Molly L Paras
- From the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Harvard Medical School - both in Boston
| | - Emily P Hyle
- From the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Harvard Medical School - both in Boston
| | - Ruth K Foreman
- From the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Harvard Medical School - both in Boston
| | - K C Coffey
- From the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (M.L.P., E.P.H.) and Pathology (R.K.F., K.C.C.), Harvard Medical School - both in Boston
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Situation of Sri Lanka, where autochthonous malaria is no longer a problem, and other infections dominate, such as dengue, leptospirosis and rickettsioses. Curr Opin Infect Dis 2017; 29:446-52. [PMID: 27479026 DOI: 10.1097/qco.0000000000000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Sri Lanka achieved a major milestone in communicable disease control in 2012 by reporting zero incidence of autochthonous malaria. However, reduction of malaria was associated with concurrent increase of several tropical diseases. This review looks into the time trends and epidemiology of these communicable diseases in Sri Lanka. RECENT FINDINGS Reduction of malaria cases coincides with an increase of dengue, leptospirosis and rickettsioses in Sri Lanka. Although the case fatality rate of dengue has reduced and maintained below 1%, leptospirosis in clinical management is questionable. Despite having national focal points for control and prevention, these emerging diseases are completely out of control. Whether the holding back of vector control activities of malaria after a successful control programme is having an effect on emergence of other vector-borne diseases should be studied. SUMMARY The communicable disease control programme in Sri Lanka should be further strengthened with availability of proper and rapid diagnostic facilities. Malaria control could not be considered as a great achievement due to the fact that other emerging infectious diseases are replacing malaria.
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Revisiting clinico-epidemiological pattern of human rickettsial infections in the central region of Sri Lanka: a hospital based descriptive study. BMC Res Notes 2017; 10:400. [PMID: 28800776 PMCID: PMC5553752 DOI: 10.1186/s13104-017-2727-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 08/06/2017] [Indexed: 11/12/2022] Open
Abstract
Background This study revisits the clinico-epidemiology and serological patterns of rickettsioses in the central region of Sri Lanka and highlights the need of advanced diagnostics for precise identification of species responsible for rickettsioses. Methods The patients treated for rickettsioses between November 2009 and October 2011 were recruited for the study from Teaching Hospital, Peradeniya. Clinical characteristics and serology results were used for diagnosis. Results Study included 210 patients (mean age 44 years ± 3.2) and of them 188 (90%) had positive IgG and/or IgM sero-reactivity for spotted fever group (SFG). Of them, 134 had IgG titre ≥1/256 for SFG and presented with fever and skin rash. They also had headache [n = 119 (89%)], myalgia [n = 103 (77%)], arthralgia [n = 89 (66%)] of large joints, conjunctival injections [n = 83 (62%)], thrombocytopenia (n = 78.58%), anaemia (n = 14.10%), leukocytosis [n = 35 (26%)], leucopenia [n = 17 (13%)], elevated aspartate transaminase [n = 69 (52%)] and alanine transaminase [n = 73 (55%)]. Conclusions Predominance of SFG rickettsioses are reiterated, possibly transmitted by ticks. Joint disease is common with occasional fern leaf skin necrosis. Changing socio-economic conditions, vegetations, contact with domestic and wild animals, abundance of vectors would have contributed for emergence and sustenance of SFG in the region. Further research is needed to identify the causative agents and the mode of transmission.
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Widespread subcutaneous necrosis in spotted fever group Rickettsioses from the coastal belt of Sri Lanka- a case report. BMC Infect Dis 2017; 17:278. [PMID: 28412927 PMCID: PMC5392909 DOI: 10.1186/s12879-017-2375-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spotted fever group rickettsioses (SFGR) transmitted mostly by ticks are increasingly discovered around the World and some of them are either re-emerging or emerging in Sri Lanka. Accidental human infections caused by these vector borne zoonotic diseases generally give rise to nonspecific acute febrile illnesses which can be complicated by multi organ involvement carrying high morbidity and mortality. Nonspecific clinical features and non-availability of early diagnostic facilities are known to result in delay in the diagnosis of rickettsial infections. Therefore, awareness of their prevalence and more importantly their clinical features would be help in the early diagnosis and institution of appropriate therapy. CASE PRESENTATION A 39-year-old otherwise healthy female presented with an acute febrile illness complicated by severe small joint and large joint arthritis, jaundice, acute kidney injury and disseminated intravascular coagulation (DIC) mimicking palindromic rheumatism or severe sepsis. She later developed a widespread fern-leaf pattern necrotic skin rash with evidence of vasculitis on the palms and soles, aiding the clinical diagnosis of SFGR. She had very high antibody titres against R. conorii antigen confirming the diagnosis and recovered completely with anti-rickettsial therapy. CONCLUSION We feel that clinicians should be aware of the unusual clinical presentations such as purpura fulminans and 'fern-leaf' pattern necrotic skin rash of SFGR infection. Such knowledge would not only benefit those who practice in tropics with limited diagnostic facilities but also would improve the management of acute febrile illness in returning travelers who visit endemic areas.
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Nigam G, Sureshbabu S, Patras E, Peter S, Sobhana C. Meningoencephalitis, myositis, and rash-neurological presentation of Indian tick typhus. J Neurosci Rural Pract 2016; 7:476-8. [PMID: 27365979 PMCID: PMC4898130 DOI: 10.4103/0976-3147.181480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gaurav Nigam
- Department of Neurology, St Stephen's Hospital, New Delhi, India
| | | | - Elisheba Patras
- Department of Radiodiagnosis, St Stephen's Hospital, New Delhi, India
| | - Sudhir Peter
- Department of Pathology, Metropolis Labs Private Limited, Ernakulam, Kerala, India
| | - C Sobhana
- Department of Pathology, Metropolis Labs Private Limited, Ernakulam, Kerala, India
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CNS Manifestations in Orientia tsutsugamushi Disease (Scrub Typhus) in North India. Indian J Pediatr 2016; 83:634-9. [PMID: 26817467 DOI: 10.1007/s12098-015-2001-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/16/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To present the clinical, lab profile and outcome of a series of six children who had features of meningoencephalitis (median age of 10.5 y) diagnosed as confirmed scrub typhus (ST) by using a lgM ELISA commercial kit (InBiOS International Inc. USA). METHODS This was a prospective observational study conducted at a tertiary care hospital, over a period of 7 mo through April 2014. All the patients with undifferentiated febrile illness (aged 1-18 y) with fever of 5-21 d duration were evaluated. After thorough physical examination they were subjected to blood investigations such as complete blood count (CBC), blood culture, hepatic and kidney function tests, serum electrolytes, cerebrospinal fluid (CSF) analysis and IgM ELISA for scrub typhus, coagulogram and chest radiograph, wherever indicated. RESULTS During this period, of the total 81 confirmed cases based on a positive scrub IgM ELISA and/or eschar, 6 (7.4 %), had neurological involvement in the form of presence of neck stiffness, altered sensorium and/or seizures and the CSF findings were suggestive of meningoencephalitis and all had evidence of multiple organ dysfunction syndrome (MODS) needing intensive care. The CECT could be performed in four patients only showing evidence of effacement of sulci and evidence of brain edema. CONCLUSIONS This communication highlights that variable central nervous system (CNS) involvement is not uncommon in patients with scrub typhus with high mortality. CSF and neuro-radiology findings are nonspecific as these are also observed in patients with aseptic meningitis or encephalitis. Early suspection and institution of appropriate therapy without delay will lead to substantial reduction in the morbidity and mortality.
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Rossio R, Conalbi V, Castagna V, Recalcati S, Torri A, Coen M, Cassulini LR, Peyvandi F. Mediterranean spotted fever and hearing impairment: a rare complication. Int J Infect Dis 2015; 35:34-6. [DOI: 10.1016/j.ijid.2015.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/10/2015] [Indexed: 11/29/2022] Open
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Colomba C, Imburgia C, Trizzino M, Titone L. First case of Mediterranean spotted fever-associated rhabdomyolysis leading to fatal acute renal failure and encephalitis. Int J Infect Dis 2014; 26:12-3. [DOI: 10.1016/j.ijid.2014.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/26/2013] [Accepted: 01/24/2014] [Indexed: 11/17/2022] Open
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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]
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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.
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Affiliation(s)
- Stalin Viswanathan
- Department of General Medicine, Indira Gandhi Medical College, Kathirkamam, Pondicherry, India.
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