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Zeng BS, Zeng BY, Hung CM, Kuo HC, Chen YW, Suen MW, Shiue YL, Tseng PT, Chen CH. The efficacy and tolerability of antibiotics in scrub typhus: An updated network meta-analysis of randomized controlled trials. Int J Infect Dis 2022; 122:461-468. [PMID: 35724826 DOI: 10.1016/j.ijid.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Inadequate treatment of scrub typhus results in severe complications such as septic shock and is also associated with a high median mortality rate of 6%. However, there has been no conclusive evidence about the superiority of different antibiotics in managing scrub typhus in terms of efficacy and tolerability. METHODS The current network meta-analysis (NMA) was conducted using the frequentist method. The included participants were pediatric and adult patients infected with scrub typhus. The primary outcome was the cure rate in the patients included. The subgroup analysis was done according to pediatric or adult patients. RESULTS Overall, 14 randomized controlled trials (RCTs) with 1264 participants were included in this study. The NMA revealed that all the investigated antibiotics were associated with cure rates similar to those of doxycycline. The chloramphenicol and minocycline were ranked to be associated with the highest cure rate in the pediatric subgroup and adult subgroup, respectively. Second-generation quinolones, including ofloxacin and ciprofloxacin and chloramphenicol were associated with significantly lower adverse event rates than doxycycline. CONCLUSION The current update NMA provides evidence for the efficacy of chloramphenicol and minocycline in scrub typhus management. However, future large-scale RCTs with longer follow-up times are warranted. TRIAL REGISTRATION PROSPERO CRD42020222410. The current study was approved by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No. B-109-29).
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Affiliation(s)
- Bing-Syuan Zeng
- Department of Internal Medicine, E-DA Cancer Hospital, Kaohsiung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Bing-Yan Zeng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan
| | - Chao-Ming Hung
- Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hung-Chang Kuo
- Department of Neurology, E-Da Cancer Hospital/School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
| | - Mein-Woei Suen
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Gender Equality Education and Research Center, Asia University, Taichung, Taiwan; Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Ping-Tao Tseng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Chang-Hua Chen
- Program in Translational Medicine, National Chung Hsing University, Taichung City, Taiwan; Rong Hsing Research Center For Translational Medicine, National Chung Hsing University, Taichung City, Taiwan; Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
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Yang J, Luo L, Chen T, Li L, Xu X, Zhang Y, Cao W, Yue P, Bao F, Liu A. Efficacy and Safety of Antibiotics for Treatment of Scrub Typhus: A Network Meta-analysis. JAMA Netw Open 2020; 3:e2014487. [PMID: 32857146 PMCID: PMC7455851 DOI: 10.1001/jamanetworkopen.2020.14487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Antibiotics have been used for many years to treat scrub typhus, but their efficacy and safety have not been studied thoroughly. OBJECTIVE To compare and rank different antibiotics to identify which one can safely eliminate Orientia tsutsugamushi and efficiently alleviate fever in patients with scrub typhus. DATA SOURCES An electronic search of PubMed and Embase was conducted, from database inception to July 12, 2019. The study was conducted from July 12 to September 2, 2019. STUDY SELECTION Randomized clinical trials and retrospective studies that evaluated the use of antibiotics for treatment in patients diagnosed with scrub typhus caused by O tsutsugamushi were included. Records of articles in English were considered eligible. Studies were assessed independently by 2 reviewers, with disagreement resolved by consensus. Of 6408 studies initially identified, 10 randomized clinical trials and 4 retrospective study met the criteria for further analysis. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension statement for systematic reviews incorporating network meta-analyses of health care interventions. Data were independently extracted by 2 reviewers and synthesized with frequentist random-effects network meta-analyses. MAIN OUTCOMES AND MEASURES The primary outcome was efficacy of the antibiotic, considered as the number of patients who achieved complete healing with an antibiotic. Safety, defined as the prevalence of adverse events associated with the antibiotics, was the secondary outcome, and defervescence time was the tertiary outcome. P scores (scale of 0 to 1, with 1 indicating superiority to other treatments) were used to rank the efficacy, safety, and defeverescence time of the antibiotics. RESULTS Three searches for articles in Embase and PubMed identified 10 randomized clinical trials (888 participants) and 4 retrospective studies (323 participants) for further analyses. No particular treatment regimen showed a significant advantage or disadvantage with regard to efficacy or safety. However, meta-analysis of retrospective studies indicated that clarithromycin (P score = 0.8730) alleviated fever more efficiently than other antibiotics. CONCLUSIONS AND RELEVANCE No treatment regimen reported in this network meta-analysis showed a significant advantage or disadvantage with regard to efficacy or safety. However, clarithromycin might be a better choice than the other drugs for alleviating fever.
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Affiliation(s)
- Jiaru Yang
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Major Children Diseases Research, The Childrens Hospital of Kunming, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Lisha Luo
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Taigui Chen
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Lianbao Li
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Xin Xu
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Yu Zhang
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Wenjing Cao
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Peng Yue
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Fukai Bao
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Major Children Diseases Research, The Childrens Hospital of Kunming, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Aihua Liu
- Institute for Tropical Medicine, Kunming Medical University School of Basic Medical Sciences, Kunming, China
- Yunnan Province Key Laboratory for Major Children Diseases Research, The Childrens Hospital of Kunming, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
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Duong V, Mai TTX, Blasdell K, Lo LV, Morvan C, Lay S, Anukool W, Wongprompitak P, Suputtamongkol Y, Laurent D, Richner B, Ra C, Chien BT, Frutos R, Buchy P. Molecular epidemiology of Orientia tsutsugamushi in Cambodia and Central Vietnam reveals a broad region-wide genetic diversity. INFECTION GENETICS AND EVOLUTION 2011; 15:35-42. [PMID: 21241829 DOI: 10.1016/j.meegid.2011.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 12/23/2010] [Accepted: 01/04/2011] [Indexed: 11/27/2022]
Abstract
Scrub typhus is an acute infectious disease caused by an obligate intracellular bacterium Orientia tsutsugamushi following the bite of infected trombiculid mites of the genus Leptotrombidium. This zoonotic disease is a major cause of febrile illness in the Asia-Pacific region, with a large spectrum of clinical manifestations from unapparent or mild disease to fatal disease. O. tsutsugamushi is characterized by a very high genomic plasticity and a large number of antigenic variants amongst strains. The 56-kDa type specific antigen (TSA) gene, encoding the major antigenic protein, was used as reference to investigate the genetic relationships between the strains and to genotype O. tsutsugamushi isolates. The open reading frame of the 56-kDa TSA gene of 41 sequences (28 Cambodian and 13 Vietnamese strains) from patient samples were sequenced and used for genotyping. The 28 Cambodian isolates clustered into 5 major groups, including Karp (43.5%), JG-v (25%), Kato/TA716 (21.5%), TA763 (3.5%) and Gilliam (3.5%). Karp (77%), TA763 (15.5%) and JG-v (7.5%) strains were identified amongst the 13 Vietnamese isolates. This is the first countrywide genotyping description in Cambodia and in Central Vietnam. These results demonstrate the considerable diversity of genotypes in co-circulation in both countries. The genotyping result might raise awareness amongst Cambodian and Vietnamese clinicians of the high genetic diversity of circulating O. tsutsugamushi strains and provides unique and beneficial data for serological and molecular diagnosis of scrub typhus infections as well as raw materials for future studies and vaccine development.
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Affiliation(s)
- Veasna Duong
- Institut Pasteur in Cambodia, Virology Unit, 5 Monivong Blvd., Phnom Penh, Cambodia
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Lee CK, Park JM. A Case of Tsutsugamushi Disease Associated With Intermediate Uveitis and Retinal Detachment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.5.784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chang-Kyu Lee
- Department of Ophthalmology, Maryknoll Hospital, Busan, Korea
| | - Jung Min Park
- Department of Ophthalmology, Maryknoll Hospital, Busan, Korea
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