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Aragane M, Matsumoto L, Yasuda H, Nosaka M, Ishida Y, Yamamoto H, Kondo T, Ishigami A. An autopsy case of fatal Japanese spotted fever in Wakayama. Leg Med (Tokyo) 2024; 66:102355. [PMID: 38043152 DOI: 10.1016/j.legalmed.2023.102355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/26/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023]
Abstract
Japanese spotted fever (JSF) is potentially fatal infection transmitted by tick bites which vectors Rickettsia (R.) japonica. Since JSF was first described in 1984, the incidence has gradually been increased. We experienced a case of JSF of fatal outcome. A female in 70's was found dead on her bed, whose house was so called 'hoarding house' filled with many waists and unused items. The following day, the autopsy was performed. As representative symptom of external findings, skin rashes were seen on the trunk and extremities, and there were tick-bite eschars on the left upper arm. Internal findings showed no specific findings in each organ. Histopathological examination demonstrated massive inflammatory cell infiltrates mainly consisted of neutrophils in the dermis beneath the external eschar. Furthermore, destruction of glomeruli in kidney with microhemorrhage from mesangial regions was observed. The numerous inflammatory infiltrates were also observed in pulmonary interstitium, which were accompanied with histopathologic features of vasculitis. Biochemical examination showed severe systemic inflammation as monitored by elevated CRP of 16 mg/dL and renal dysfunction by BUN of 171.2 mg/dL and creatinine of 6.07 mg/dL. Subsequently polymerase chain reaction revealed specifically amplified signals for R. japonica from the samples of tick-bites eschar and blood. Thus, we diagnosed her cause of death as JSF which had been occurred multiorgan failure such as acute renal failure and possibly acute respiratory failure. (224 terms).
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Affiliation(s)
- Miki Aragane
- Department of Forensic Medicine, Wakayama Medical University, Japan
| | - Lennon Matsumoto
- Department of Forensic Medicine, Wakayama Medical University, Japan
| | - Haruki Yasuda
- Department of Forensic Medicine, Wakayama Medical University, Japan
| | - Mizuho Nosaka
- Department of Forensic Medicine, Wakayama Medical University, Japan
| | - Yuko Ishida
- Department of Forensic Medicine, Wakayama Medical University, Japan
| | - Hiroki Yamamoto
- Department of Forensic Medicine, Wakayama Medical University, Japan
| | - Toshikazu Kondo
- Department of Forensic Medicine, Wakayama Medical University, Japan
| | - Akiko Ishigami
- Department of Forensic Medicine, Wakayama Medical University, Japan.
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2
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Song X, Xie S, Huang X, Chen Z. The diagnosis and treatment of scrub typhus should be emphasized in non-endemic areas: A retrospective case series study. Medicine (Baltimore) 2023; 102:e32988. [PMID: 36827009 PMCID: PMC11309664 DOI: 10.1097/md.0000000000032988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/15/2023] [Accepted: 01/26/2023] [Indexed: 02/25/2023] Open
Abstract
The morbidity of tsutsugamushi is increasing and is no longer limited to endemic areas. Delayed diagnosis and inappropriate treatment can cause severe complications and increase mortality rates. We conducted a retrospective case series of patients with scrub typhus at our institution to report our experience and discuss the diagnostic modalities. We encountered 21 cases of scrub typhus at our institution between 2014 and 2022. The average age of the patients was 52 years (range: 22-63 years), 11 (52%) were farmers, and 11 (52%) had clear outdoor activities. Twenty (95%) patients had an ineffective history of general antibiotic treatment. The classic presentation was repeated fever in 95% of patients. Seventeen patients (81%) had eschar mainly on the groin (35%) and armpit (35%). Common laboratory findings included eosinophilia (95%), elevated alanine aminotransferase (95%), elevated aspartate aminotransferase (86%), thrombocytopenia (76%), lower hemoglobin (71%), and neutrophilia (38%). Six (29%) patients received the treatment of tigecycline, 4 (19%) patients received the treatment of doxycycline, and 11 (52%) patients received the treatment of minocycline. After 3 days of specific treatment, the eosinophilic levels showed a recovery trend. Twenty (95%) patients fully recovered, and 1 (5%) died. Careful physical examination and medical history are important for the early diagnosis of scrub typhus; clinicians in non-endemic areas need to strengthen their understanding of scrub typhus.
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Affiliation(s)
- Xin Song
- Medical Department of Nanchang University, Nanchang, Jiangxi, China
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
| | - Shu Xie
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Xinhui Huang
- Medical Department of Nanchang University, Nanchang, Jiangxi, China
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
| | - Zhi Chen
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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3
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Ruan GP, Yao X, Mo P, Wang K, Yang ZL, Tian NN, Liu-Gao MY, Wang JX, Cai XM, Li ZA, Pang RQ, Pan XH. Establishment of a Systemic Inflammatory Response Syndrome Model and Evaluation of the Efficacy of Umbilical Cord Mesenchymal Stem Cell Transplantation. Cells Tissues Organs 2021; 210:118-134. [PMID: 34182545 DOI: 10.1159/000514619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/21/2021] [Indexed: 11/19/2022] Open
Abstract
Based on the characteristics of modern weapon injury, a repetitive model of traumatic systemic inflammatory response syndrome (SIRS) and an evaluation system were established. The models were treated with GFP-labeled tree shrew umbilical cord mesenchymal stem cells (UCMSCs). Forty out of 50 tree shrews were used to make a unilateral femoral comminuted fracture. Lipopolysaccharide was injected intravenously to create a traumatic SIRS model. The other 10 shrews were used as normal controls. After the model was established for 10 days, 20 tree shrews were injected intravenously with GFP-labeled UCMSCs, and 18 tree shrews were not injected as the model control group. The distribution of GFP-labeled cells in vivo was measured at 2 and 10 days after injection. Twenty days after treatment, the model group, the normal control group, and the treatment group were taken to observe the pathological changes in each tissue, and blood samples were taken for the changes in liver, renal, and heart function. Distribution of GFP-positive cells was observed in all tissues at 2 and 10 days after injection. After treatment, the HE staining results of the treatment group were close to those of the normal group, and the model group had a certain degree of lesions. The results of liver, renal, and heart function tests in the treatment group were returned to normal, and the results in the model group were abnormally increased. UCMSCs have a certain effect on the treatment of traumatic SIRS and provide a new technical solution for modern weapon trauma treatment.
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Affiliation(s)
- Guang-Ping Ruan
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Xiang Yao
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Ping Mo
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Kai Wang
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Zai-Ling Yang
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Ni-Ni Tian
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Mi-Yang Liu-Gao
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Jin-Xiang Wang
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Xue-Min Cai
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Zi-An Li
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Rong-Qing Pang
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
| | - Xing-Hua Pan
- Kunming Key Laboratory of Stem Cell and Regenerative Medicine, 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China.,Stem Cells and Immune Cells Biomedical Techniques Integrated Engineering Laboratory of State and Regions, Kunming, China.,Cell Therapy Technology Transfer Medical Key Laboratory of Yunnan Province, Kunming, China
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Li W, Huang L, Zhang W. Scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia: a case report and review of the literature. J Med Case Rep 2019; 13:358. [PMID: 31810465 PMCID: PMC6898947 DOI: 10.1186/s13256-019-2299-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 10/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scrub typhus is an acute infectious zoonotic disease caused by Orientia tsutsugamushi. Multi-organ dysfunction secondary to scrub typhus is hard to diagnose and has a high mortality rate. Only one case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia has been reported thus far. In this study, we report a second case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia, and we summarize its diagnosis and treatment. CASE PRESENTATION A 43-year-old Han Chinese woman, a sanitation worker, was admitted to our hospital after 7 days of a skin infection and 5 days of a sore throat with fever and dizziness. A physical examination revealed the presence of an eschar on the right side of her neck. She had a history of insect bites during her sanitation work. A diagnostic evaluation identified scrub typhus as the primary illness, which was associated with multi-organ dysfunction syndrome and immune thrombocytopenia. She recovered completely after 15 days of treatment and extensive symptomatic supportive care. CONCLUSION We report a second case of tsutsugamushi disease with multi-organ dysfunction syndrome and immune thrombocytopenia, which resolved after treatment and extensive care.
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Affiliation(s)
- Weijia Li
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
| | - Lei Huang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
| | - Weixing Zhang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
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5
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Mendell NL, Bouyer DH, Walker DH. Murine models of scrub typhus associated with host control of Orientia tsutsugamushi infection. PLoS Negl Trop Dis 2017; 11:e0005453. [PMID: 28282373 PMCID: PMC5362142 DOI: 10.1371/journal.pntd.0005453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/22/2017] [Accepted: 03/03/2017] [Indexed: 01/19/2023] Open
Abstract
Background Scrub typhus, a febrile illness of substantial incidence and mortality, is caused by infection with the obligately intracellular bacterium Orientia tsutsugamushi. It is estimated that there are more than one million cases annually transmitted by the parasitic larval stage of trombiculid mites in the Asia-Pacific region. The antigenic and genetic diversity of the multiple strains of O. tsutsugamushi hinders the advancement of laboratory diagnosis, development of long-lasting vaccine-induced protection, and interpretation of clinical infection. Despite the life-threatening severity of the illness in hundreds of thousands of cases annually, 85–93% of patients survive, often without anti-rickettsial treatment. To more completely understand the disease caused by Orientia infection, animal models which closely correlate with the clinical manifestations, target cells, organ involvement, and histopathologic lesions of human cases of scrub typhus should be employed. Previously, our laboratory has extensively characterized two relevant C57BL/6 mouse models using O. tsutsugamushi Karp strain: a route-specific intradermal model of infection and persistence and a hematogenously disseminated dose-dependent lethal model. Principal findings To complement the lethal model, here we illustrate a sublethal model in the same mouse strain using the O. tsutsugamushi Gilliam strain, which resulted in dose-dependent severity of illness, weight loss, and systemic dissemination to endothelial cells of the microcirculation and mononuclear phagocytic cells. Histopathologic lesions included expansion of the pulmonary interstitium by inflammatory cell infiltrates and multifocal hepatic lesions with mononuclear cellular infiltrates, renal interstitial lymphohistiocytic inflammation, mild meningoencephalitis, and characteristic typhus nodules. Significance These models parallel characteristics of human cases of scrub typhus, and will be used in concert to understand differences in severity which lead to lethality or host control of the infection and to address the explanation for short duration of heterologous immunity in Orientia infection. Scrub typhus is an acute febrile illness with considerable mortality, and no available vaccine, caused by the obligately intracellular bacterium, Orientia tsutsugamushi. Despite the life-threatening severity of the illness in approximately one million cases annually, 85–93% of patients survive. The lack of appropriate animal models of scrub typhus has left a void in the fundamental knowledge necessary to develop a vaccine, such as mechanisms which contribute to disease severity and immunity. Here, we report a sublethal inbred murine model for scrub typhus using the intradermal and intravenous routes of inoculation, which are comparable to the natural route of chigger-bite transmission and subsequent hematogenous spread. This model, infection of mice with O. tsutsugamushi Gilliam strain, can be employed in conjunction with the lethal model of O. tsutsugamushi Karp strain to perform in-depth mechanistic studies related to strain cross-protection, lethality, pathogenesis and specific immunological investigations of the host immune response.
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Affiliation(s)
- Nicole L. Mendell
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Donald H. Bouyer
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - David H. Walker
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
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6
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Wu CY, Hsu WL, Wang CH, Liang JL, Tsai MH, Yen CJ, Li HW, Chiu SJ, Chang CH, Huang YB, Lin MW, Yoshioka T. A Novel Strategy for TNF-Alpha Production by 2-APB Induced Downregulated SOCE and Upregulated HSP70 in O. tsutsugamushi-Infected Human Macrophages. PLoS One 2016; 11:e0159299. [PMID: 27472555 PMCID: PMC4966960 DOI: 10.1371/journal.pone.0159299] [Citation(s) in RCA: 4] [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: 02/17/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022] Open
Abstract
Orientia (O.) tsutsugamushi-induced scrub typhus is endemic across many regions of Asia and the Western Pacific, where an estimated 1 million cases occur each year; the majority of patients infected with O. tsutsugamushi end up with a cytokine storm from a severe inflammatory response. Previous reports have indicated that blocking tumor necrosis factor (TNF)-α reduced cell injury from a cytokine storm. Since TNF-α production is known to be associated with intracellular Ca2+ elevation, we examined the effect of store-operated Ca2+ entry (SOCE) inhibitors on TNF-α production in O. tsutsugamushi-infected macrophages. We found that 2-aminoethoxydiphenyl borate (2-APB), but not SKF96365, facilitates the suppression of Ca2+ mobilization via the interruption of Orai1 expression in O. tsutsugamushi-infected macrophages. Due to the decrease of Ca2+ elevation, the expression of TNF-α and its release from macrophages was repressed by 2-APB. In addition, a novel role of 2-APB was found in macrophages that causes the upregulation of heat shock protein 70 (HSP70) expression associated with ERK activation; upregulated TNF-α production in the case of knockdown HSP70 was inhibited with 2-APB treatment. Furthermore, elevated HSP70 formation unexpectedly did not help the cell survival of O. tsutsugamushi-infected macrophages. In conclusion, the parallelism between downregulated Ca2+ mobilization via SOCE and upregulated HSP70 after treatment with 2-APB against TNF-α production was found to efficiently attenuate an O. tsutsugamushi-induced severe inflammatory response.
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Affiliation(s)
- Ching-Ying Wu
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dermatology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wen-Li Hsu
- Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- The Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | | | - Ming-Hsien Tsai
- Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Jung Yen
- Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiu-Wen Li
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Siou-Jin Chiu
- Institute of Physics, Academia Sinica, Taipei, Taiwan
| | - Chung-Hsing Chang
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yaw-Bin Huang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Wei Lin
- Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (TY); (MWL)
| | - Tohru Yoshioka
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (TY); (MWL)
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7
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Tsai MH, Chang CH, Tsai RK, Hong YR, Chuang TH, Fan KT, Peng CW, Wu CY, Hsu WL, Wang LS, Chen LK, Yu HS. Cross-Regulation of Proinflammatory Cytokines by Interleukin-10 and miR-155 in Orientia tsutsugamushi-Infected Human Macrophages Prevents Cytokine Storm. J Invest Dermatol 2016; 136:1398-1407. [PMID: 26921773 DOI: 10.1016/j.jid.2015.11.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 10/22/2015] [Accepted: 11/06/2015] [Indexed: 11/28/2022]
Abstract
Scrub typhus is caused by the obligate intracellular bacterium Orientia tsutsugamushi. Macrophages are host cells for its replication and clearance. Severe complications in patients are mainly caused by a cytokine storm resulting from overproduction of proinflammatory cytokines; nevertheless, the molecular mechanism for the occurrence remains obscure. Herein, we investigate the interactive regulation of cytokines and micro-RNA (miR) in human macrophages infected with low and high doses of O. tsutsugamushi. During low dose infection, macrophages produce high levels of IL-10 through extracellular signal-regulated kinase activation, which inhibits proinflammatory cytokine production and facilitates pathogen replication. Increasing levels of pathogen results in reduced levels of IL-10, and macrophages begin to generate high levels of proinflammatory cytokines through NF-κB activation. However, during a high dose infection, macrophages produce high levels of miR-155 to slow the proinflammatory response. The extracellular signal-regulated kinase/IL-10 axis suppresses the NF-κB/tumor necrosis factor alpha axis via activation of signal transducer and activator of transcription 3. Both IL-10 and miR-155 inhibit the NF-κB signaling pathway. Furthermore, IL-10 is a potent inhibitor of miR-155. Patients susceptible to a cytokine storm, peripheral blood mononuclear cells showed significantly lower IL-10 and miR-155 responses to O. tsutsugamushi challenge. Thus, IL-10 and miR-155 operate inhibitory mechanisms to achieve a proper defense mechanism and prevent a cytokine storm.
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Affiliation(s)
- Ming-Hsien Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hsing Chang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Research Center for Applied Sciences, Academic Sinica, Taipei, Taiwan.
| | - Rong-Kung Tsai
- Institute of Medical Sciences, School of Medicine, Tzu Chi University, Hualien, Taiwan; Institute of Eye Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
| | - Yi-Ren Hong
- Department of Biochemistry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Chuang
- Immunology Research Center, National Health Research Institutes, Zhunan, Taiwan
| | - Kan-Tang Fan
- Department of Dermatology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chi-Wen Peng
- Institute of Medical Sciences, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ching-Ying Wu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Li Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lih-Shinn Wang
- Department of Internal Medicine, Section of Infectious Diseases, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Li-Kuang Chen
- Department of Medical Laboratory, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hsin-Su Yu
- Research Center for Applied Sciences, Academic Sinica, Taipei, Taiwan; National Environmental Health Research Center, National Health Research Institutes, Zhunan, Taiwan
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8
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Shelite TR, Saito TB, Mendell NL, Gong B, Xu G, Soong L, Valbuena G, Bouyer DH, Walker DH. Hematogenously disseminated Orientia tsutsugamushi-infected murine model of scrub typhus [corrected]. PLoS Negl Trop Dis 2014; 8:e2966. [PMID: 25010338 PMCID: PMC4091938 DOI: 10.1371/journal.pntd.0002966] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/24/2014] [Indexed: 11/18/2022] Open
Abstract
Orientia tsutsugamushi, the etiologic agent of scrub typhus, is a mite-borne rickettsia transmitted by the parasitic larval stage of trombiculid mites. Approximately one-third of the world's population is at risk of infection with Orientia tsutsugamushi, emphasizing its importance in global health. In order to study scrub typhus, Orientia tsutsugamushi Karp strain has been used extensively in mouse studies with various inoculation strategies and little success in inducing disease progression similar to that of human scrub typhus. The objective of this project was to develop a disease model with pathology and target cells similar to those of severe human scrub typhus. This study reports an intravenous infection model of scrub typhus in C57BL/6 mice. This mouse strain was susceptible to intravenous challenge, and lethal infection occurred after intravenous inoculation of 1.25×106 focus (FFU) forming units. Signs of illness in lethally infected mice appeared on day 6 with death occurring ∼6 days later. Immunohistochemical staining for Orientia antigens demonstrated extensive endothelial infection, most notably in the lungs and brain. Histopathological analysis revealed cerebral perivascular, lymphohistiocytic infiltrates, focal hemorrhages, meningoencephalitis, and interstitial pneumonia. Disseminated infection of endothelial cells with Orientia in C57BL/6 mice resulted in pathology resembling that of human scrub typhus. The use of this model will allow detailed characterization of the mechanisms of immunity to and pathogenesis of O. tsutsugamushi infection. Scrub typhus is a disease found in Southeast Asia that infects over 1 million people each year. This disease is caused by the intracellular pathogen Orientia tsutsugamushi transmitted by the bite of chigger mites. Scrub typhus is characterized by pulmonary disease and in severe cases, multiorgan system failure. The current research model utilizes an intraperitoneal route of inoculation of mice to study the host response to Orientia infection. Infection via this route results in severe peritonitis that does not occur in human scrub typhus. The development of animal models that accurately portray human disease is an important step toward understanding and managing disease. In this manuscript we describe a new mouse model that results in scrub typhus-like pathology following intravenous inoculation of mice. This model presents dose-dependent mortality with scrub typhus-like pathology that parallels human disease. Utilization of this model will provide a valuable research tool for characterizing the immune response and pathogenesis induced by O. tsutsugamushi allowing development of better treatment and an effective vaccine.
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Affiliation(s)
- Thomas R. Shelite
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Microbiology and Immunology, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Tais B. Saito
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Nicole L. Mendell
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Bin Gong
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Guang Xu
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Lynn Soong
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Microbiology and Immunology, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Gustavo Valbuena
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Donald H. Bouyer
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - David H. Walker
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
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Dhakal M, Dhakal OP, Bhandari D. Pancreatitis in scrub typhus: a rare complication. BMJ Case Rep 2014; 2014:bcr-2013-201849. [PMID: 24692372 DOI: 10.1136/bcr-2013-201849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Scrub typhus is a zoonosis transmitted by a trombiculid mite which introduces bacteria of Orientia tsutsugamushi by its bite. The acute febrile illness is characterised by eschar at the site of the bite with maculopapular rashes and local and/or generalised lymphadenopathy. The disease is endemic in the tsutsugamushi triangle. Sikkim, a small Himalayan north-eastern state, is also not unaffected where outbreaks of the disease have been reported. The clinical spectrum of the disease ranges from mild to fatal depending on the virulence of the bacterial strain, susceptibility of the host and promptness of the treatment. In severe cases, there can be multiple organ involvement. Pancreatitis is a serious and unusual complication of this disease, which was seen in our presentation. A 22-year-old man, diagnosed to have scrub typhus, developed pancreatitis in the second week of the illness and responded well to medical treatment.
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Affiliation(s)
- Mona Dhakal
- Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
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Vikrant S, Dheer SK, Parashar A, Gupta D, Thakur S, Sharma A, Kaushal SS, Kanga A. Scrub typhus associated acute kidney injury--a study from a tertiary care hospital from western Himalayan State of India. Ren Fail 2013; 35:1338-43. [PMID: 23952649 DOI: 10.3109/0886022x.2013.828257] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To report the clinical profile of acute kidney injury (AKI) associated with scrub typhus. METHODS Retrospective study of hospitalized patients of acute febrile illness who were diagnosed scrub typhus and had AKI. RESULTS 174 (35%) patients (75.9% female), mean age (41.4 ± 15.9 years) were studied. The laboratory abnormalities were: anemia (63.2%), leukocytosis (44.3%), thrombocytopenia (61.5%), hyponatremia (35.6%), hypernatremia (2.9%), and hypokalemia (12.1%), hyperkalemia (11.5%), hypoalbuminemia (56.9%), hepatic dysfunction (70%) and metabolic acidosis (28.7%). The complications of hypotension (5.7%), septic shock (3.4%), pneumonia (10.9%), acute respiratory distress syndrome (ARDS) (11.5%), meningoencephalitis (6.9%), encephalopathy (5.2%), gastrointestinal bleed (1.3%), myocarditis (3.4%), disseminated intravascular coagulation (2.9%) and multi organ failure (MOF) (10.3%) developed during course of hospitalization in these patients. Twenty-five (14.4%) patients required intensive care support (ICU) support and seven (4%) patients were dialyzed. 146 (83.9%) patients survived. Twenty-eight (16.1%) patients died. There was a significant difference in the age, various hematological & biochemical abnormalities, complications and need for ICU support in the non-survival group as compared the survival group. CONCLUSION This study shows that AKI in scrub typhus is common and a severe disease. Age, a shorter hospital stay, severities of leukocytosis, thrombocytopenia, azotemia, hypoalbuminemia, hepatic dysfunction and the complications of ARDS, encephalopathy, MOF and need for ICU support are the factors associated with mortality.
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