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Han S, Yang S, Wang Y, Xu Y. Case Report: Encephalitis with Initial Manifestation of Orientia Tsutsugamushi Infection Detected by Metagenomic Next-Generation Sequencing. Infect Drug Resist 2024; 17:749-760. [PMID: 38433784 PMCID: PMC10906725 DOI: 10.2147/idr.s450693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Scrub typhus, caused by Orientia tsutsugamushi, is characterized by fever, eschars, lymphadenopathy, and rash. The absence of eschars in some cases makes it difficult to distinguish it from other diseases, complicating the diagnosis process. Atypical Scrub typhus is difficult to diagnose and often leads to delayed treatment. Therefore, early diagnosis and treatment through effective detection methods have high clinical value. Here, a case of scrub typhus with encephalitis symptoms is reported. Patients and Methods A 64-year-old man and mNGS testing. Results A 64-year-old man developed cough, headache, and fever, dismissing it as a respiratory tract infection. Initial treatment with cephalosporin antibiotics had minimal effect. Admission to the respiratory department showed inflammation in blood tests. Subsequent CT and further treatment provided no improvement. Multidisciplinary discussions and neurology department guidance were conducted to consider the suspected diagnosis of encephalitis in the patient. After improving the mNGS detection, the patient was diagnosed with "Orientia tsutsugamushi encephalitis". After treatment with doxycycline, the patient's symptoms were alleviated. He remained afebrile in follow-up and adhered well to medical advice. Conclusion Our case demonstrates that it is difficult to distinguish Orientia tsutsugamushi encephalitis from central nervous system infectious diseases such as meningitis and encephalitis using conventional diagnostic methods, which may affect the treatment plan for the disease. mNGS is a useful and valuable method for early diagnosis of scrub typhus.
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Affiliation(s)
- Song Han
- The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People’s Republic of China
| | - Suge Yang
- The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People’s Republic of China
| | - Yun Wang
- Department of Neurology Medicine, The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People’s Republic of China
| | - Yingying Xu
- Department of Neurology Medicine, The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People’s Republic of China
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Zangpo T, Phuentshok Y, Dorji K, Dorjee C, Dorjee S, Jolly P, Morris R, Marquetoux N, McKenzie J. Environmental, Occupational, and Demographic Risk Factors for Clinical Scrub Typhus, Bhutan. Emerg Infect Dis 2023; 29:909-918. [PMID: 37081000 PMCID: PMC10124658 DOI: 10.3201/eid2905.221430] [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] [Indexed: 04/22/2023] Open
Abstract
Underdiagnosis and underreporting of scrub typhus has increasingly affected public health in Bhutan since its initial detection in 2008. Identifying scrub typhus risk factors would support early diagnosis and treatment for this nonspecific febrile disease, reducing the incidence of potentially fatal complications. We conducted a hospital-based, case‒control study during October‒December 2015 in 11 scrub typhus‒prone districts. We identified harvesting cardamom as the major risk factor (odds ratio 1,519; p<0.001); other factors were traditional housing, largely caused by an outside toilet location, as well as owning a goat and frequently sitting on grass. Harvesting vegetables, herding cattle in the forest, and female sex were protective. Age had a nonlinear effect; children and the elderly were more likely to seek treatment for clinical scrub typhus. This study has informed public health policies and awareness programs for healthcare workers through development of National Guidelines for Prevention, Treatment and Control of Scrub Typhus in Bhutan.
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Clinical Outcomes of Doxycycline, Azithromycin, and Chloramphenicol for the Treatment of Severe Patients with Scrub Typhus. Int J Antimicrob Agents 2022; 60:106647. [DOI: 10.1016/j.ijantimicag.2022.106647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022]
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Guan XG, Wei YH, Jiang BG, Zhou SX, Zhang AR, Lu QB, Zhou ZW, Chen JJ, Zhang HY, Ji Y, Yang Y, Fang LQ, Li H, Yang ZC, Liu W. Clinical characteristics and risk factors for severe scrub typhus in pediatric and elderly patients. PLoS Negl Trop Dis 2022; 16:e0010357. [PMID: 35486642 PMCID: PMC9053809 DOI: 10.1371/journal.pntd.0010357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Scrub typhus (ST) is a life-threatening infectious disease if appropriate treatment is unavailable. Large discrepancy of clinical severity of ST patients was reported among age groups, and the underlying risk factors for severe disease are unclear. Methods Clinical and epidemiological data of ST patients were collected in 55 surveillance hospitals located in Guangzhou City, China, from 2012 to 2018. Severe prognosis and related factors were determined and compared between pediatric and elderly patients. Results A total of 2,074 ST patients including 209 pediatric patients and 1,865 elderly patients were included, with a comparable disease severity rate of 11.0% (95% CI 7.1%–16.1%) and 10.3% (95% CI 9.0%–11.8%). Different frequencies of clinical characteristics including lymphadenopathy, skin rash, enlarged tonsils, etc. were observed between pediatric and elderly patients. Presence of peripheral edema and decreased hemoglobin were the most important predictors of severe illness in pediatric patients with adjusted ORs by 38.99 (9.96–152.67, p<0.001) and 13.22 (1.54–113.50, p = 0.019), respectively, while presence of dyspnea and increased total bilirubin were the potential determinants of severe disease in elderly patients with adjusted ORs by 11.69 (7.33–18.64, p<0.001) and 3.17 (1.97–5.11, p<0.001), respectively. Compared with pediatric patients, elderly patients were more likely to receive doxycycline (64.8% v.s 9.9%, p<0.001), while less likely to receive azithromycin therapy (5.0% v.s 41.1%, p<0.001). Conclusion The disease severity rate is comparable between pediatric and elderly ST patients, while different clinical features and laboratory indicators were associated with development of severe complications for pediatric and elderly patients, which is helpful for diagnosis and progress assessment of disease for ST patients. The study investigated different clinical features and risk factors for severe disease between pediatric and elderly patients with scrub typhus. We found that significantly higher frequencies of lymphadenopathy, skin rash, enlarged tonsils, etc. were observed in pediatric patients than elderly patients. Other non-specific signs, subjective complaints, and chest radiographic abnormality were overpresented in elderly patients. Risk factors for severe disease between pediatric and elderly patients with scrub typhus were different. Presence of peripheral edema and decreased hemoglobin were the most important factors for pediatric patients, while presence of dyspnea and increased total bilirubin for elderly patients. These findings reminded medical workers to acknowledge this important difference and to adopt an age specific method in the differential diagnosis and risk assessment for scrub typhus.
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Affiliation(s)
- Xiu-Gang Guan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Yue-Hong Wei
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Bao-Gui Jiang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Shi-Xia Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
- School of Public Health, Anhui Medical University, Hefei, China
| | - An-Ran Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Zi-Wei Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Jin-Jin Chen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Hai-Yang Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Yang Ji
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Yang Yang
- Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
- School of Public Health, Anhui Medical University, Hefei, China
- * E-mail: (LQF); (HL); (ZCY); (WL)
| | - Hao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
- * E-mail: (LQF); (HL); (ZCY); (WL)
| | - Zhi-Cong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
- * E-mail: (LQF); (HL); (ZCY); (WL)
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China
- * E-mail: (LQF); (HL); (ZCY); (WL)
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GroEL Chaperonin-Based Assay for Early Diagnosis of Scrub Typhus. Diagnostics (Basel) 2022; 12:diagnostics12010136. [PMID: 35054302 PMCID: PMC8775097 DOI: 10.3390/diagnostics12010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/22/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
Abstract
A point-of-care diagnostic for early and rapid diagnosis of scrub typhus caused by Orientia tsutsugamushi is required for prompt and proper treatment of patients presenting with undifferentiated febrile illnesses. In this study, an immunochromatographic antigen detection test kit (ICT AgTK) that targets the highly conserved O. tsutsugamushi 60 kDa GroEL chaperonin (heat shock protein 60) was developed. E. coli-derived recombinant GroEL expressed from DNA coding for the consensus sequence of 32 GroEL gene sequences extracted from the GenBank database was used to immunize rabbits and mice. Rabbit polyclonal antibodies (pAb) were used for preparing a gold-pAb conjugate, and the rGroEL-specific mouse monoclonal antibody was used as the antigen detection reagent at the ICT test line. In-house validation revealed that the ICT AgTK gave 85, 100 and 95% diagnostic sensitivity, specificity and accuracy, respectively, compared to the combined clinical features and standard IFA when tested on 40 frozen serum samples. The test kits correctly identified 10 scrub typhus samples out of 15 fresh plasma/buffy coat samples of patients with febrile illnesses. For independent laboratory validation, the ICT AgTK was sent to one provincial hospital. The ICT AgTK utilized by the hospital medical technologist correctly identified six scrub typhus samples out of 20 serum samples of patients with fever, as confirmed by specific IgM/IgG detection by IFA. The ICT AgTK is easy to perform with rapid turn-around time. It has the potential to be used as an important tool for on-site and early scrub typhus diagnosis by allowing testing of freshly collected samples (serum, plasma or buffy coat), especially in resource-limited healthcare settings.
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Musa TH, Ahmad T, Wana MN, Li W, Musa HH, Sharun K, Tiwari R, Dhama K, Chaicumpa W, Campbell MC, Wei P. The epidemiology, diagnosis and management of scrub typhus disease in China. Hum Vaccin Immunother 2021; 17:3795-3805. [PMID: 34124995 DOI: 10.1080/21645515.2021.1934355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Thirty-nine years ago, scrub typhus (ST), a disease, was not among the China's notifiable diseases. However, ST has reemerged to become a growing public health issue in the southwest part of China. The major factors contributing to an increased incidence and prevalence of this disease include rapid globalization, urbanization, expansion of humans into previously uninhabited areas, and climate change. The clinical manifestation of ST also consists of high fever, headache, weakness, myalgia, rash, and an eschar. In severe cases, complications (e.g. multi-organ failure, jaundice, acute renal failure, pneumonitis, myocarditis, and even death) can occur. The diagnosis of ST is mainly based on serological identification by indirect immunofluorescence assay and other molecular methods. Furthermore, several groups of antibiotics (e.g. tetracycline, chloramphenicol, macrolides, and rifampicin) are currently effective in treating this disease. This fact suggests the need for robust early diagnostic techniques, increased surveillance, and prompt treatment, and develop future vaccine.
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Affiliation(s)
- Taha Hussein Musa
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Biomedical Research Institute (BRI), Darfur College, Nyala, Sudan
| | - Tauseef Ahmad
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Mohammed Nasiru Wana
- Department of Biological Sciences, Faculty of Science, Abubakar Tafawa Balewa University, Bauchi, Nigeria
| | - Wei Li
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Hassan Hussein Musa
- Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Bareilly, India
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, UP Deen Dayal Upadhayaya Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU), Mathura, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, India
| | - Wanpen Chaicumpa
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pingmin Wei
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
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Devamani CS, Prakash JAJ, Alexander N, Stone W, Gunasekaran K, Rose W, Schmidt WP. High initial IgG antibody levels against Orientia tsutsugamushi are associated with an increased risk of severe scrub typhus infection. PLoS Negl Trop Dis 2021; 15:e0009283. [PMID: 33735183 PMCID: PMC8009433 DOI: 10.1371/journal.pntd.0009283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/30/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Scrub typhus is a dominant cause of febrile illness in many parts of Asia. Immunity is limited by the great strain diversity of Orientia tsutsugamushi. It is unclear whether previous infection protects from severe infection or enhances the risk. METHODS/PRINCIPAL FINDINGS We studied IgG antibody levels against O. tsutsugamushi at presentation in 636 scrub typhus patients using enzyme-linked immunosorbent assays (ELISA). The association between ELISA optical density (OD) and risk of severe infection was modelled using Poisson regression. OD was categorised as low (<1.0), intermediate (1.0 to 2.9), and high (≥3.0). OD was also modelled as a continuous variable (cubic spline). Median age of cases was 41 years (range 0-85), with 37% having severe infection. Compared to the low category, the age-adjusted risk of severe infection was 1.5 times higher in the intermediate category (95%CI 1.2, 1.9), and 1.3 times higher in the high category (95%CI 1.0, 1.7). The effect was stronger in cases <40 years, doubling the risk in the intermediate and high categories compared to the low category. The effect was more pronounced in cases tested within 7 days of fever onset when IgG ODs are more likely to reflect pre-infection levels. CONCLUSIONS/SIGNIFICANCE Intermediate and high IgG antibody levels at the time of diagnosis are associated with a higher risk of severe scrub typhus infection. The findings may be explained by severe infection eliciting an accelerated IgG response or by previous scrub typhus infection enhancing the severity of subsequent episodes.
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Affiliation(s)
- Carol S. Devamani
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - John A. J. Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - William Stone
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Winsley Rose
- Department of Pediatrics and Pediatric Infectious Diseases, Christian Medical College, Vellore, India
| | - Wolf-Peter Schmidt
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Adepoju K, Adelabu S, Mokubung C. Mapping Seriphium plumosum encroachment and interaction with wildfire and environmental factors in a protected mountainous grassland. ENVIRONMENTAL MONITORING AND ASSESSMENT 2020; 192:328. [PMID: 32372345 DOI: 10.1007/s10661-020-08253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
Accurate information on the distribution of invasive native species could provide important and effective procedures for managing savannah environment, especially in sensitive mountainous grasslands. The study detected and mapped Seriphium plumosum within a mountainous landscape and linked the georeferenced occurrence data with the corresponding site-specific environmental factors to predict the locations of unknown populations using a MaxEnt niche model. We also explored the relative contribution in terms of species interaction with its surrounding biophysical environment. The AUC value of 0.876 estimated for the species distribution is an indication of a good model fit. Our findings indicated that Seriphium plumosum preferred areas with higher temperature associated with recurrence fire events and limited soil moisture. It was concluded that the projected conditions of increasing temperature and fire events could promote widespread gain of niche space for Seriphium plumosum while at the same time altering community structure and composition, hydrological properties, and other vital ecosystem services in the study area.
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Affiliation(s)
- Kayode Adepoju
- Department of Geography, University of The Free State, QwaQwa Campus, Phuthaditjhaba, South Africa.
| | - Samuel Adelabu
- Department of Geography, University of The Free State, QwaQwa Campus, Phuthaditjhaba, South Africa
| | - Cynthia Mokubung
- Department of Geography, University of The Free State, QwaQwa Campus, Phuthaditjhaba, South Africa
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Schmidt WP, Devamani CS, Rose W, Alexander N, Prakash JAJ. Antibody response following scrub typhus infection: clinical cohort study. Trop Med Int Health 2019; 24:1455-1464. [PMID: 31660667 DOI: 10.1111/tmi.13322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Scrub typhus is a common cause of fever in Asia. The antibody response to infection and its effect on subsequent infection are unclear. We studied the IgM and IgG antibody response after infection, accounting for clinical severity. METHOD We studied 197 scrub typhus patients for up to 2 years post-infection. Overall, 501 blood samples were analysed for scrub typhus antibodies using ELISA. IgM and IgG ELISA optical densities (OD) were analysed using quantile regression. OD values of 1.0 (IgM) and 1.5 (IgG) were used to define seropositivity. RESULTS IgM OD values fell rapidly from an initial peak after infection. 50% of cases were IgM seronegative after 82 days. About 2 years after fever onset, 50% of cases had fitted IgG OD values of <1.5. Patients with high initial IgG OD values (≥2.5, used as a proxy for probable previous scrub typhus infection) had a more sustained IgG response than those with a low initial IgG OD, and more often presented with complications (18/36 = 50% vs. 28/91 = 30.8%, risk ratio = 1.63, 95% CI 1.04, 2.55, P = 0.035). This association was robust to adjusting for age (risk ratio 1.50, 95% CI 0.96, 2.33, P = 0.072). CONCLUSION Cross-sectional IgG seroprevalence data substantially underestimate the proportion in a population ever infected with scrub typhus. A high initial IgG as a potential marker for previous scrub typhus infection may be associated with long-term IgG persistence and a higher risk of complicated scrub typhus.
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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
- Department of Rural Unit for Health and Social Affairs, Christian Medical College, Vellore, India
| | - Winsley Rose
- Department of Pediatrics and Pediatric Infectious Diseases, Christian Medical College, Vellore, India
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - John A J Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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Dorji K, Phuentshok Y, Zangpo T, Dorjee S, Dorjee C, Jolly P, Morris R, Marquetoux N, McKenzie J. Clinical and Epidemiological Patterns of Scrub Typhus, an Emerging Disease in Bhutan. Trop Med Infect Dis 2019; 4:tropicalmed4020056. [PMID: 30934849 PMCID: PMC6631561 DOI: 10.3390/tropicalmed4020056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 01/31/2023] Open
Abstract
Scrub typhus (ST) is a vector-borne rickettsial infection causing acute febrile illness. The re-emergence of ST in the Asia-Pacific region represents a serious public health threat. ST was first detected in Bhutan in 2008. However, the disease is likely to be under-diagnosed and under-reported, and the true impact is difficult to estimate. At the end of 2014, the SD Bioline Tsutsugamushi TestTM rapid diagnostic test (RDT) kits became available in all hospitals to assist clinicians in diagnosing ST. We conducted a retrospective descriptive study, reviewing records from all hospitals of Bhutan to identify all RDT-positive clinical cases of ST in Bhutan in 2015. The aim was to evaluate the burden of ST in Bhutan, describe the demographic, spatial and temporal patterns of disease, and identify the typical clinical presentations. The annual incidence of RDT-positive cases of ST reporting to Bhutanese hospitals in 2015 was estimated to be 62 per 100,000 population at risk. The incidence of disease was highest in the southern districts with a subtropical climate and a high level of agricultural production. The highest proportion of cases (87%) was rural residents, with farmers being the main occupational category. The disease was strongly seasonal, with 97% of cases occurring between June and November, coinciding with the monsoon and agricultural production seasons. Common ST symptoms were not specific, and an eschar was noted by clinicians in only 7.4% of cases, which is likely to contribute to an under-diagnosis of ST. ST represents an important and neglected burden, especially in rural communities in Bhutan. The outcomes of this study will inform public health measures such as timely-awareness programmes for clinicians and the public in high-risk areas, to improve the diagnosis, treatment and clinical outcomes of this disease.
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Affiliation(s)
- Kezang Dorji
- School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand.
- Samdrup Jongkhar Hospital, Ministry of Health, Samdrup Jongkhar 41001, Bhutan.
| | - Yoenten Phuentshok
- School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand.
- National Centre for Animal Health, Department of Livestock, Ministry of Agriculture and Forests, Serbithang, Thimphu 11001, Bhutan.
| | - Tandin Zangpo
- School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand.
- Dechencholing BHU-I, Ministry of Health, Thimphu 11001, Bhutan.
| | - Sithar Dorjee
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu 11001, Bhutan.
| | - Chencho Dorjee
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu 11001, Bhutan.
| | - Peter Jolly
- School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand.
| | - Roger Morris
- Morvet Ltd., Consultancy Services in Health Risk Management and Food Safety Policy and Programs, Masterton 5885, New Zealand.
| | - Nelly Marquetoux
- School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand.
| | - Joanna McKenzie
- School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand.
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Soong L. Dysregulated Th1 Immune and Vascular Responses in Scrub Typhus Pathogenesis. THE JOURNAL OF IMMUNOLOGY 2019; 200:1233-1240. [PMID: 29431689 DOI: 10.4049/jimmunol.1701219] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022]
Abstract
Scrub typhus is an emerging, insect-transmitted disease caused by Orientia tsutsugamushi, a Gram- and LPS-negative bacterium that replicates freely within professional phagocytes and endothelial cells. Scrub typhus is prevalent with high mortality rates, but information regarding its molecular pathogenesis, microbial virulence determinants, and key immune responses is limited. Improved animal models have recently been developed that respectively resemble the pathological features of self-limiting or severe scrub typhus in humans. Strong activation of Th1 and CD8, but not Th2 and regulatory T, immune responses, accompanied by altered angiopoietin/Tie2-related regulation, are hallmarks of lethal infection in murine models. This review, based primarily on recent advances from clinical and experimental studies, highlights tissue- and endothelial cell-specific biomarkers that are indicative of immune dysregulation. The potential roles of neutrophils and damage-associated molecular pattern molecules at late stages of disease are discussed in the context of vascular leakage, pulmonary and renal injury, and scrub typhus pathogenesis.
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Affiliation(s)
- Lynn Soong
- Department of Microbiology and Immunology, Center for Tropical Diseases, Center for Biodefense and Emerging Infectious Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555; and .,Department of Pathology, Center for Tropical Diseases, Center for Biodefense and Emerging Infectious Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555
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12
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Devamani CS, Prakash JAJ, Alexander N, Suzuki M, Schmidt WP. Hospitalisations and outpatient visits for undifferentiated fever attributable to scrub typhus in rural South India: Retrospective cohort and nested case-control study. PLoS Negl Trop Dis 2019; 13:e0007160. [PMID: 30802243 PMCID: PMC6405239 DOI: 10.1371/journal.pntd.0007160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/07/2019] [Accepted: 01/15/2019] [Indexed: 01/30/2023] Open
Abstract
Background The burden of scrub typhus in endemic areas is poorly understood. This study aimed at estimating the proportion of hospitalisations and outpatient visits for undifferentiated fever in the community that may be attributable to scrub typhus. Methodology and principal findings The study was a retrospective cohort with a nested case-control study conducted in the South Indian state of Tamil Nadu. We conducted house-to-house screening in 48 villages (42965 people, 11964 households) to identify hospitalised or outpatient cases due to undifferentiated fever during the preceding scrub typhus season. We used scrub typhus IgG to determine past infection. We calculated adjusted odds ratios for the association between IgG positivity and case status. Odds ratios were used to estimate population attributable fractions (PAF) indicating the proportion of hospitalised and outpatient fever cases attributable to scrub typhus. We identified 58 cases of hospitalisation and 236 outpatient treatments. 562 people were enrolled as control group to estimate the background IgG sero-prevalence. IgG prevalence was 20.3% in controls, 26.3% in outpatient cases and 43.1% in hospitalised cases. The PAFs suggested that 29.5% of hospitalisations and 6.1% of outpatient cases may have been due to scrub typhus. In villages with a high IgG prevalence (defined as ≥15% among controls), the corresponding PAFs were 43.4% for hospitalisations and 5.6% for outpatients. The estimated annual incidence of scrub typhus was 0.8/1000 people (0.3/1000 in low, and 1.3/1000 in high prevalence villages). Evidence for recall error suggested that the true incidences may be about twice as high as these figures. Conclusions The study suggests scrub typhus as an important cause for febrile hospitalisations in the community. The results confirm the adequacy of empirical treatment for scrub typhus in hospitalised cases with undifferentiated fever. Since scrub typhus may be rare among stable outpatients, the use of empirical treatment remains doubtful in these. Scrub typhus is an important cause of fever in many Asian countries, including China, India, Vietnam and Japan. It is caused by the intra-cellular bacteria Orientia tsutsugamushi and is transmitted to humans by mite larvae (chiggers) which attach to the skin of the host. Scrub typhus is potentially life-threatening but treatable with relatively cheap antibiotics such as doxycycline. The incidence of scrub typhus in the community is not known as most studies were done at hospitals and health posts lacking a clearly defined source-population for patients seeking health care for fever. In this study, the proportion of fever cases due to scrub typhus and the incidence of the infection were estimated by retrospective case identification in a population of 42000 people living in 48 villages in the South Indian state of Tamil Nadu. We found that about 30% to 40% of hospitalisations for undifferentiated fever may be due to scrub typhus. In contrast, scrub typhus accounted for only about 5% of outpatient fever cases. Our findings confirm the need for large population-based cohort studies to better understand the epidemiology of scrub typhus in endemic settings.
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Affiliation(s)
| | - John A. J. Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Wolf-Peter Schmidt
- Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Yu H, Sun C, Liu W, Li Z, Tan Z, Wang X, Hu J, Shi S, Bao C. Scrub typhus in Jiangsu Province, China: epidemiologic features and spatial risk analysis. BMC Infect Dis 2018; 18:372. [PMID: 30081828 PMCID: PMC6080521 DOI: 10.1186/s12879-018-3271-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/25/2018] [Indexed: 01/08/2023] Open
Abstract
Background With the increasing incidence of scrub typhus in recent years, it is of great value to analyse the spatial and temporal distribution of scrub typhus by applying micro-geographical studies at a reasonably fine scale, and to guide the control and management. Methods We explored the use of maximum entropy modelling method to confirm the spatial and temporal distribution of scrub typhus according to the occurrence locations of human cases in Jiangsu Province. The risk prediction map under specific environmental factors was therefore drawn by projecting the training model across China. The area under the curve and the omission rate were used to validate the model. Meanwhile, Jackknife tests were applied to enumerate the contribution of different environmental variables, then to predict the final model. The predicted results were validated by using China’s known occurrence locations. Results A total of 566 occurrence locations with known 4865 scrub typhus occurrence records were used in our study. The number of female cases was higher than male cases, with a proportion of 1.17:1, and people in any age group could be infected. The number of cases presented an inverted-U relation with age. The percentage of cases aged from 60 to 69 years old was the highest, accounting for 30.50% of all cases. Ecological niche modelling results indicated that the locations of scrub typhus cases, which was of great importance in the disease transmission cycle, had a certain ecological niche with environmental elements in many dimensions. Moreover, the key environmental factors for determining scrub typhus occurrence were temperature (including temperature seasonality, min temperature of coldest month, mean diurnal range, and monthly mean temperature), precipitation of wettest month, and land cover types. The risk prediction maps indicated that mid-eastern China was the potential risk areas for scrub typhus of “autumn type”. Meanwhile, in our results, Guangdong Province was the high-risk region for “autumn type” scrub typhus, where cases were mainly reported as “summer type”. Conclusion The combination of climatic and geographic factors with GIS methods is an appropriate option to analyse and estimate the spatial and temporal distribution of scrub typhus.
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Affiliation(s)
- Huiyan Yu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Changkui Sun
- Department of Remote Sensing Imagery, Provincial Geomatics Center of Jiangsu, Nanjing, 210013, China.
| | - Wendong Liu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Zhifeng Li
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Zhongming Tan
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Xiaochen Wang
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jianli Hu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China.
| | - Shanqiu Shi
- Department of Remote Sensing Imagery, Provincial Geomatics Center of Jiangsu, Nanjing, 210013, China
| | - Changjun Bao
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
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van Eekeren LE, de Vries SG, Wagenaar JFP, Spijker R, Grobusch MP, Goorhuis A. Under-diagnosis of rickettsial disease in clinical practice: A systematic review. Travel Med Infect Dis 2018; 26:7-15. [PMID: 29486240 DOI: 10.1016/j.tmaid.2018.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rickettsial diseases present as acute febrile illnesses, sometimes with inoculation eschars. METHODS We performed a systematic review of studies published between 1997 and 2017 to assess the underestimation of non-eschar rickettsial disease (NERD) relative to eschar rickettsial disease (ERD), as a cause of acute fever in patients with rickettsial diseases that commonly present with eschar(s): scrub typhus (ST), Mediterranean spotted fever (MSF), and African tick-bite fever. We compared ERD/NERD ratios according to study design: 'complete approach' studies, with testing performed in all patients with 'unspecified febrile illness'; versus 'clinical judgement' studies, with testing performed if patients presented with specific symptoms. RESULTS In 'complete approach' studies, ERD/NERD ratios were significantly lower, suggesting a considerable under-diagnosis of NERD in 'clinical judgement' studies. Based on these results, we estimate that the diagnosis of rickettsial disease was missed in 66.5% of patients with ST, and in 57.9% of patients with MSF. CONCLUSIONS Study design influences the reported eschar rates in ST and MSF significantly. NERD is likely to be a vastly underdiagnosed entity, and clinicians should consider and test for the disease more often. PROSPERO REGISTRATION NUMBER CRD 42016053348.
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Affiliation(s)
- Louise E van Eekeren
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Sophia G de Vries
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Jiri F P Wagenaar
- Leptospirosis Reference Center, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - René Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands.
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Huang XD, Cheng P, Zhao YQ, Li WJ, Zhao JX, Liu HM, Kou JX, Gong MQ. Chigger Mite (Acari: Trombiculidae) Survey of Rodents in Shandong Province, Northern China. THE KOREAN JOURNAL OF PARASITOLOGY 2017; 55:555-559. [PMID: 29103271 PMCID: PMC5678473 DOI: 10.3347/kjp.2017.55.5.555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 09/08/2017] [Accepted: 10/11/2017] [Indexed: 11/23/2022]
Abstract
Chigger mites are parasites of rodents and other vertebrates, invertebrates, and other arthropods, and are the only vectors of scrub typhus, in addition to other zoonoses. Therefore, investigating their distribution, diversity, and seasonal abundance is important for public health. Rodent surveillance was conducted at 6 districts in Shandong Province, northern China (114–112°E, 34–38°N), from January to December 2011. Overall, 225/286 (78.7%) rodents captured were infested with chigger mites. A total of 451 chigger mites were identified as belonging to 5 most commonly collected species and 3 genera in 1 family. Leptotrombidium scutellare and Leptotrombidium intermedia were the most commonly collected chigger mites. L. scutellare (66.2%, 36.7%, and 49.0%) was the most frequently collected chigger mite from Apodemus agrarius, Rattus norvegicus, and Microtus fortis, respectively, whereas L. intermedia (61.5% and 63.2%) was the most frequently collected chigger mite from Cricetulus triton and Mus musculus, respectively. This study demonstrated a relatively high prevalence of chigger mites that varied seasonally in Shandong Province, China.
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Affiliation(s)
- Xiao-Dan Huang
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Peng Cheng
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Yu-Qiang Zhao
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Wen-Juan Li
- Institute of Forensic Medicine and Laboratory Medicine, Jining Medical University, Jining, Shandong Province 272067, People's Republic of China
| | - Jiu-Xu Zhao
- Jining Health School, Jining, Shandong Province 272031, People's Republic of China
| | - Hong-Mei Liu
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Jing-Xuan Kou
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Mao-Qing Gong
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
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Abstract
Scrub typhus is an acute febrile illness in the “tsutsugamushi triangle”, transmitted by chiggers that can be treated effectively if detected early. Laboratory testing, including molecular and serological assays, is needed for confirming the diagnosis, especially in the absence of the pathognomonic eschar. In this review, factors that play a role in disease occurrence and clinical clues for diagnosis, in addition to risk factors contributing to disease severity, including mortality, are discussed in detail. Moreover, issues related to diagnostic assays, treatment, and mixed infections are also enumerated and described.
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Chen H, Ning Z, Qiu Y, Liao Y, Chang H, Ai Y, Wei Y, Deng Y, Shen Y. Elevated levels of von Willebrand factor and high mobility group box 1 (HMGB1) are associated with disease severity and clinical outcome of scrub typhus. Int J Infect Dis 2017; 61:114-120. [PMID: 28652214 DOI: 10.1016/j.ijid.2017.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/11/2017] [Accepted: 06/16/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES This study aimed to investigate whether von Willebrand factor (vWF) and high mobility group box 1 (HMGB1) are associated with the severity and clinical outcome of scrub typhus and to seek novel biomarkers for surveillance and prediction of the prognosis of this infection. METHODS Serum concentrations of vWF and HMGB1 were measured twice by ELISA for scrub typhus patients (n=103), once prior to doxycycline therapy and then on day 7 of doxycycline therapy; concentrations were measured once for healthy controls (n=32). RESULTS Among the total 103 patients enrolled, 38 had disease complicated by multiple organ dysfunction syndrome (MODS). Serum concentrations of vWF and HMGB1 were significantly higher in all the patients than in the healthy controls, both prior to doxycycline treatment and on day 7 of doxycycline treatment (p<0.01). Furthermore, serum levels of vWF, HMGB1, and creatinine (SCr) in the patients with MODS increased distinctly, while the platelet (PLT) count diminished markedly compared to the levels in patients without MODS (p<0.01). The concentration of vWF was positively correlated with that of HMGB1 (r=0.764, p<0.001) and SCr (r=0.528, p<0.001), but negatively correlated with the PLT count (r=-0.632, p<0.001). Both HMGB1 and vWF were significantly associated with mortality in scrub typhus (area under the curve (AUC)=0.864, p=0.001, and AUC=0.862, p=0.001, respectively). CONCLUSIONS Elevated levels of vWF and HMGB1 are associated with the severity and clinical outcome of scrub typhus. These represent possible new biomarkers for use in the assessment and prognostic prediction of this infection.
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Affiliation(s)
- Hongliu Chen
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Zong Ning
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Ying Qiu
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yuanli Liao
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Haihua Chang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yuanyuan Ai
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yinghua Wei
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yiming Deng
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Ying Shen
- General Practice School of Guangxi Medical University, Nanning, Guangxi Province, 530021, China.
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Lee HJ, Park CY, Park SG, Yoon NR, Kim DM, Chung CH. Activation of the coagulation cascade in patients with scrub typhus. Diagn Microbiol Infect Dis 2017; 89:1-6. [PMID: 28679481 DOI: 10.1016/j.diagmicrobio.2017.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 01/10/2023]
Abstract
This retrospective study aimed to evaluate the levels of coagulation factors and presence of disseminated intravascular coagulation (DIC) in patients with scrub typhus. We included patients confirmed to have scrub typhus at the Chosun University Hospital between September 2004 and December 2009. The DIC scores were evaluated in 365 patients and 36 healthy controls. The median concentrations of fibrinogen, d-dimer, and fibrin/fibrinogen degradation products (FDP) were compared between patients and healthy controls (p<0.001 for all tests). Patients with scrub typhus had longer prothrombin time and lower platelet counts than the controls. Major bleeding was observed in 18/365 patients with scrub typhus. Fifty-one (14.0%) patients presented with severe complications of scrub typhus. Overt DIC and thrombocytopenia (<100,000 platelets/mm3) were observed more frequently in patients with bleeding and severe illness. Furthermore, median platelet counts were low in both groups. Approximately 2.7% (n=10) and 16.4% (n=60) patients with scrub typhus had overt DIC, as defined by the International Society on Thrombosis and Hemostasis DIC score (DIC1) and the DIC-scoring template with a fibrinogen/C-reactive protein-ratio (DIC2), respectively. Three (16.7%) and 10 (55.6%) patients with bleeding had overt DIC, as defined by the DIC1 and DIC2, respectively. Seven (13.7%) and 26 (51%) patients with severe illness had overt DIC, as defined by DIC1 and DIC2, respectively. In conclusion, activation of the coagulation system is an important feature of scrub typhus and is correlated with severe disease, including bleeding. This is the first study to report a relationship between DIC and scrub typhus.
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Affiliation(s)
- Hee-Jeong Lee
- Department of Internal Medicine, Chosun University Hospital, Gwangju 501-717, Republic of Korea
| | - Chi-Young Park
- Department of Internal Medicine, Chosun University Hospital, Gwangju 501-717, Republic of Korea
| | - Sang-Gon Park
- Department of Internal Medicine, Chosun University Hospital, Gwangju 501-717, Republic of Korea
| | - Na-Ra Yoon
- Department of Internal Medicine, Chosun University Hospital, Gwangju 501-717, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, Chosun University Hospital, Gwangju 501-717, Republic of Korea
| | - Choon-Hae Chung
- Department of Internal Medicine, Chosun University Hospital, Gwangju 501-717, Republic of Korea
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Zhao D, Zhang Y, Yin Z, Zhao J, Yang D, Zhou Q. Clinical Predictors of Multiple Organ Dysfunction Syndromes in Pediatric patients with Scrub Typhus. J Trop Pediatr 2017; 63:167-173. [PMID: 27697827 DOI: 10.1093/tropej/fmw066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Scrub typhus can produce multiple organ dysfunction syndrome (MODS). Early recognition of the patients at risk of MODS would be helpful in providing timely management and reducing the mortality. In all, 449 children with scrub typhus were enrolled at three hospitals in Yunnan, China from January 2010 to January 2015. The patients' clinical status of organ system dysfunction was evaluated on the day of discharge from hospital by using standard criteria. The patients were classified into MODS present (64 cases, 14.3%) or MODS absent (385 cases, 85.7%). Multivariate logistic regression analyses revealed that the prognostic factors for MODS included skin rash (odds ratio, OR = 3.3, p = 0.037), time interval form treatment to defervescence (OR = 1.2, p = 0.035), hemoglobin (OR = 0.54, p = 0.041), platelet counts (OR = 0.06, p < 0.001), aspartate-aminotransferase (OR = 4.7, p = 0.011) and total bilirubin (OR = 2.3, p = 0.013). By describing risk factors resulting in MODS in pediatric scrub typhus, our study provides clinicians with important information to improve the clinical monitoring and prognostication of MODS.
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Affiliation(s)
- Dongying Zhao
- Xin Hua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
| | - Yongjun Zhang
- Xin Hua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China.,MOE and Shanghai Key Laboratory of Children's Environmental Health, Shanghai, 200092, China
| | | | - Jing Zhao
- Longling People's Hospital, Yunnan, 678300, China
| | - Defeng Yang
- Longling People's Hospital, Yunnan, 678300, China
| | - Qun Zhou
- Baoshan People's Hospital, Yunnan, 678000, China
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Abstract
BACKGROUND Identifying an eschar in scrub typhus is useful for initiation of prompt and appropriate antibiotic therapy. METHODS The distribution of eschars in all children <15 years of age admitted with confirmed scrub typhus over a 5 year period is described. RESULTS Of 431 children admitted with scrub typhus, eschars were present in 176 (40.8%) children with the following distribution: head, face and neck, 33 (19.1%); axillae, 37 (21%); chest and abdomen, 21 (11.9%); genitalia, inguinal region and buttocks, 58 (33%); back, 8 (4.5%); upper extremities, 13 (7.4%); and lower extremities, 5 (2.8%). The commonest sites of eschars were scrotum (27 of 106; 25.5%) and axillae (15 of 106; 14.2%) in males and axillae (22 of 70; 31.4%) and groin (16 of 70; 22.9%) in females. Eschars were seen within skin folds in 100 of 176 (56.8%) children. CONCLUSION Children should be carefully examined for the presence of eschar especially in the skin folds of the genitalia, axillae and groin to make an early diagnosis of scrub typhus.
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Affiliation(s)
- Winsley Rose
- Department of Pediatrics, Christian Medical College, Vellore 632004, India
| | - Roshni J Rajan
- Department of Pediatrics, Christian Medical College, Vellore 632004, India
| | - Anu Punnen
- Department of Pediatrics, Christian Medical College, Vellore 632004, India
| | - Urmi Ghosh
- Department of Pediatrics, Christian Medical College, Vellore 632004, India
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