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Ghanem-Zoubi N, Atiya-Nasagi Y, Stoyanov E, Szwarcwort M, Darawsha B, Paul M, Shinar E. Cross-Sectional Study of Q Fever Seroprevalence among Blood Donors, Israel, 2021. Emerg Infect Dis 2024; 30:941-946. [PMID: 38666592 PMCID: PMC11060453 DOI: 10.3201/eid3005.230645] [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: 05/02/2024] Open
Abstract
We evaluated Q fever prevalence in blood donors and assessed the epidemiologic features of the disease in Israel in 2021. We tested serum samples for Coxeilla burnetii phase I and II IgG using immunofluorescent assay, defining a result of >200 as seropositive. We compared geographic and demographic data. We included 1,473 participants; 188 (12.7%) were seropositive. The calculated sex- and age-adjusted national seroprevalence was 13.9% (95% CI 12.2%-15.7%). Male sex and age were independently associated with seropositivity (odds ratio [OR] 1.6, 95% CI 1.1-2.2; p = 0.005 for male sex; OR 1.2, 95% CI 1.01-1.03; p<0.001 for age). Residence in the coastal plain was independently associated with seropositivity for Q fever (OR 1.6, 95% CI 1.2-2.3; p<0.001); residence in rural and farming regions was not. Q fever is highly prevalent in Israel. The unexpected spatial distribution in the nonrural coastal plain suggests an unrecognized mode of transmission.
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Affiliation(s)
| | | | - Evgeniy Stoyanov
- Rambam Health Care Campus, Haifa, Israel (N. Ghanem-Zoubi, M. Szwarcwort, M. Paul)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa (N. Ghanem-Zoubi, B. Darawsha, M. Paul)
- Israel Institute for Biological Research, Ness-Ziona, Israel (Y. Atiya-Nasagi)
- Magen David Adom National Blood Services, Ramat Gan, Israel (E. Stoyanov, E. Shinar)
| | - Moran Szwarcwort
- Rambam Health Care Campus, Haifa, Israel (N. Ghanem-Zoubi, M. Szwarcwort, M. Paul)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa (N. Ghanem-Zoubi, B. Darawsha, M. Paul)
- Israel Institute for Biological Research, Ness-Ziona, Israel (Y. Atiya-Nasagi)
- Magen David Adom National Blood Services, Ramat Gan, Israel (E. Stoyanov, E. Shinar)
| | - Basel Darawsha
- Rambam Health Care Campus, Haifa, Israel (N. Ghanem-Zoubi, M. Szwarcwort, M. Paul)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa (N. Ghanem-Zoubi, B. Darawsha, M. Paul)
- Israel Institute for Biological Research, Ness-Ziona, Israel (Y. Atiya-Nasagi)
- Magen David Adom National Blood Services, Ramat Gan, Israel (E. Stoyanov, E. Shinar)
| | - Mical Paul
- Rambam Health Care Campus, Haifa, Israel (N. Ghanem-Zoubi, M. Szwarcwort, M. Paul)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa (N. Ghanem-Zoubi, B. Darawsha, M. Paul)
- Israel Institute for Biological Research, Ness-Ziona, Israel (Y. Atiya-Nasagi)
- Magen David Adom National Blood Services, Ramat Gan, Israel (E. Stoyanov, E. Shinar)
| | - Eilat Shinar
- Rambam Health Care Campus, Haifa, Israel (N. Ghanem-Zoubi, M. Szwarcwort, M. Paul)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa (N. Ghanem-Zoubi, B. Darawsha, M. Paul)
- Israel Institute for Biological Research, Ness-Ziona, Israel (Y. Atiya-Nasagi)
- Magen David Adom National Blood Services, Ramat Gan, Israel (E. Stoyanov, E. Shinar)
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D'Cruz S, Sreedevi K, Lynette C, Gunasekaran K, Prakash JAJ. Climate influences scrub typhus occurrence in Vellore, Tamil Nadu, India: analysis of a 15-year dataset. Sci Rep 2024; 14:1532. [PMID: 38233417 PMCID: PMC10794692 DOI: 10.1038/s41598-023-49333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024] Open
Abstract
Climate is one of the major factors determining the prevalence and seasonality of vector borne diseases like scrub typhus (ST). We analyzed, the association of the meteorological factors like temperature, rainfall and humidity with scrub typhus using the 15 years scrub typhus data from a tertiary care hospital in Vellore, South India. Demographic data of permanent residents of Vellore, who had IgM ELISA results for scrub typhus for the time period of May 2005 to April 2020 were included. Meteorological data was correlated with the monthly scrub typhus cases; negative binomial regression model was used to predict the relation between scrub typhus occurrence and climate factors. Maximum number of ST cases were reported between the months August and February with October recording the highest number of cases. Elderly people, farmers, agricultural workers and housewives were at higher risk for scrub typhus. For an increase of 1 °C in mean temperature, the monthly ST cases reduced by 18.8% (95% CI - 24.1, - 13.2%). On the contrary, for 1 percent increase in mean relative humidity (RH), there is an increase of 7.6% (95% CI 5.4, 9.9%) of monthly ST cases. Similarly, an increase of 1 mm of rainfall contributed to 0.5 to 0.7% of monthly ST cases (after 2 months) depending on the variables included in the analysis. This study provides information that meteorological factors influence ST occurrence in Vellore. The rise of scrub typhus cases is maximal 2 months post rainfall. Whereas a rise in relative humidity, causes a rise in scrub typhus cases in same month, while rise in temperature has a negative impact on scrub typhus during the same month. These findings based on a retrospective analysis need validation by prospective studies.
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Affiliation(s)
- Solomon D'Cruz
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Kotamreddy Sreedevi
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Cheryl Lynette
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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Oakley R, Dreyfus A, Concha G, Poppert S, Plag M, Meile C, Graves S, Paris DH, Kann S. Seroprevalence of Coxiella burnetii in an Indigenous Population from the Sierra Nevada De Santa Marta, Colombia. Am J Trop Med Hyg 2024; 110:155-158. [PMID: 37983923 DOI: 10.4269/ajtmh.23-0252] [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: 04/26/2023] [Accepted: 09/08/2023] [Indexed: 11/22/2023] Open
Abstract
Coxiella burnetii is an underreported zoonotic pathogen in many rural regions globally. We investigated C. burnetii exposure in a remote indigenous tribe residing in the Sierra Nevada de Santa Marta, Colombia. The high seroprevalence of 35% (95% CI, 27-43%) demonstrates the need for One Health studies to identify risk factors, clinical impact, and potential medical, veterinary, and environmental interventions.
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Affiliation(s)
- Regina Oakley
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Anou Dreyfus
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Vetsuisse Faculty, University of Zürich, Zurich, Switzerland
- Institut Pasteur, Antananarivo, Madagascar
| | - Gustavo Concha
- Organización Wiwa Yugumaiun Bunkuanarua Tairona, Valledupar, Colombia
| | - Sven Poppert
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Michèle Plag
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Celine Meile
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Rothen Medizinische Laboratorien AG, Basel, Switzerland
| | - Stephen Graves
- Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
| | - Daniel H Paris
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Simone Kann
- medmissio Institute for Global Health, Würzburg, Germany
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Geography and prevalence of rickettsial infections in Northern Tamil Nadu, India: a cross-sectional study. Sci Rep 2022; 12:20798. [PMID: 36460687 PMCID: PMC9718799 DOI: 10.1038/s41598-022-21191-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Rickettsial infections and Q fever are a common cause of acute febrile illness globally. Data on the role of climate and altitude on the prevalence of these infections in lacking from Southern India. In this study, we determined the sero-prevalence of scrub typhus (ST), spotted fever (SF), murine typhus (MT) and Q Fever (QF) in 8 eight geographical regions of North Tamil Nadu by detecting IgG antibodies using ELISA. Totally we tested 2565 people from 86 localities. Among the 27.3% positives, approximately 5% were IgG positive for two or more infections. Sero-prevalence to rickettsioses and Q fever was highest for individuals from rural areas and increased with age (> 30 years). Those in the Nilgiris highlands (wetter and cooler) and Erode, which has the most land under irrigation, demonstrated the least exposure to rickettsioses and Q fever. Lowland plains (AOR: 8.4-22.9; 95% CI 3.1-55.3) and highland areas up to 1000 m (AOR: 6.1-10.3; 95% CI 2.4-23.9) showed the highest risk of exposure to scrub typhus. For spotted fever, the risk of exposure was highest in Jawadhi (AOR:10.8; 95% CI 2.6-44.3) and Kalrayan (AOR:16.6; 95% CI 4.1-66.2). Q fever positivity was most likely to be encountered in Salem (AOR: 5.60; 95% CI 1.01-31.08) and Kalrayan hills (AOR:12.3; 95% CI 2.9-51.6). Murine typhus risk was significant only in Tiruvannamalai (AOR:24.2; 95% CI 3.3-178.6). Our study suggests that prevalence of rickettsial infections and Q fever is low in areas which receive rainfall of ≥ 150 cm/year, with average minimum and maximum temperatures between 15 and 25 °C and elevation in excess of 2000 m. It is also less in well irrigated lowlands with dry climate. These preliminary findings need confirmation by active surveillance in these areas.
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Aetiologies and Risk Factors of Prolonged Fever Admission in Samtse Hospital, Bhutan, 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137859. [PMID: 35805518 PMCID: PMC9266161 DOI: 10.3390/ijerph19137859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 12/10/2022]
Abstract
Febrile illness is a common cause of hospital admission in developing countries, including Bhutan. Prolonged fever admission can add considerable strain on healthcare service delivery. Therefore, identifying the underlying cause of prolonged hospital stays can improve the quality of patient care by providing appropriate empirical treatment. Thus, the study’s aims were to evaluate the aetiologies and factors of prolonged fever admission in Samtse Hospital, Bhutan. Fever admission data from 1 January to 31 December 2020 were retrieved from the Samtse Hospital database. Prolonged hospital stay was defined as those with >5 days of hospital admission. Univariable and multivariable logistic regression was used to identify risk factors for a prolonged hospital stay. Of 290 records, 135 (46.6%) were children (≤12 years), 167 (57.6%) were males, and 237 (81.7%) patients were from rural areas. The common aetiologies for fever admissions were respiratory tract infection (85, 29.3%) and acute undifferentiated febrile illness (48, 16.6%). The prolonged stay was reported in 87 (30.0%) patients. Patients from rural areas (adjusted odds ratio [AOR] = 4.02, 95% CI = 1.58−10.24) and those with respiratory tract infections (AOR = 5.30, 95% CI = 1.11−25.39) and urinary tract infections and kidney disease (AOR = 8.16, 95% CI = 1.33−49.96) had higher odds of prolonged hospital stay. This epidemiological knowledge on prolonged hospital stay can be used by the physician for the management of fever admission in Samtse Hospital.
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Jatsho J. An unusual presentation of scrub typhus in a child: a case report. BMC Pediatr 2022; 22:77. [PMID: 35114958 PMCID: PMC8812046 DOI: 10.1186/s12887-022-03139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background Scrub Typhus (ST) is an acute, febrile zoonotic disease caused by the bacterium Orientia tsutsugamushi which is endemic to the Asia-Pacific region. Infected adults rarely present with sensorineural hearing loss and otalgia. Though few cases of pediatric cases are known to present with otalgia, no pediatric cases of sensorineural deafness complicating ST have been reported to date. Case presentation A 5-year-old, previously healthy girl presented with a one-week history of high-grade intermittent fever, Headache and right ear pain with a recent onset of reduced hearing. She had a fever up to 39 °C, cervical lymphadenopathy, bilateral pleural effusion with diffuse infiltrations, and mild hepatosplenomegaly with no evidence of rash. Her initial examination was normal except for mildly enlarged tonsils. Unilateral right ear hearing loss was noted using Weber’s test. Evidence of progressive, mild anemia, and raised inflammatory markers was noted. Diagnosis of scrub typhus was confirmed by positive detection of Orentia tsutsugamushi IgM antibodies on rapid diagnostic test and the presence of chigger mite in the right external auditory canal on repeat examination. She responded dramatically to the empirical treatment of ceftriaxone and doxycycline. On follow-up, she did not have any residual hearing loss and her ear pain had resolved completely. Conclusion Acute onset hearing loss or severe otalgia with or without findings should be an important diagnostic clue for suspecting scrub typhus in patients who present with a history of fever especially in endemic areas.
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Affiliation(s)
- Jimba Jatsho
- Department of Pediatrics, Phuentsholing Hospital, Ministry of Health, Phuentsholing, Bhutan.
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An Update on the Laboratory Diagnosis of Rickettsia spp. Infection. Pathogens 2021; 10:pathogens10101319. [PMID: 34684267 PMCID: PMC8541673 DOI: 10.3390/pathogens10101319] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/25/2021] [Accepted: 10/11/2021] [Indexed: 01/10/2023] Open
Abstract
Rickettsia species causing human illness are present globally and can cause significant disease. Diagnosis and identification of this intracellular bacteria are challenging with many available diagnostic modalities suffering from several shortcomings. Detection of antibodies directed against Rickettsia spp. via serological methods remains widely used with a broad range of sensitivity and specificity values reported depending on the assay. Molecular methods, including polymerase chain reaction (PCR) testing, enables species-specific identification with a fast turnaround time; however, due to resource requirements, use in some endemic settings is limited. Reports on the use of next-generation sequencing (NGS) and metagenomics to diagnose Rickettsia spp. infection have been increasing. Despite offering several potential advantages in the diagnosis and surveillance of disease, genomic approaches are currently only limited to reference and research laboratories. Continued development of Rickettsia spp. diagnostics is required to improve disease detection and epidemiological surveillance, and to better understand transmission dynamics.
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Identification of Immunogenic Linear B-Cell Epitopes in C. burnetii Outer Membrane Proteins Using Immunoinformatics Approaches Reveals Potential Targets of Persistent Infections. Pathogens 2021; 10:pathogens10101250. [PMID: 34684199 PMCID: PMC8540810 DOI: 10.3390/pathogens10101250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
Coxiella burnetii is a global, highly infectious intracellular bacterium, able to infect a wide range of hosts and to persist for months in the environment. It is the etiological agent of Q fever—a zoonosis of global priority. Currently, there are no national surveillance data on C. burnetii’s seroprevalence for any South American country, reinforcing the necessity of developing novel and inexpensive serological tools to monitor the prevalence of infections among humans and animals—especially cattle, goats, and sheep. In this study, we used immunoinformatics and computational biology tools to predict specific linear B-cell epitopes in three C. burnetii outer membrane proteins: OMP-H (CBU_0612), Com-1 (CBU_1910), and OMP-P1 (CBU_0311). Furthermore, predicted epitopes were tested by ELISA, as synthetic peptides, against samples of patients reactive to C. burnetii in indirect immunofluorescence assay, in order to evaluate their natural immunogenicity. In this way, two linear B-cell epitopes were identified in each studied protein (OMP-H(51–59), OMP-H(91–106), Com-1(57–76), Com-1(191–206), OMP-P1(197–209), and OMP-P1(215–227)); all of them were confirmed as naturally immunogenic by the presence of specific antibodies in 77% of studied patients against at least one of the identified epitopes. Remarkably, a higher frequency of endocarditis cases was observed among patients who presented an intense humoral response to OMP-H and Com-1 epitopes. These data confirm that immunoinformatics applied to the identification of specific B-cell epitopes can be an effective strategy to improve and accelerate the development of surveillance tools against neglected diseases.
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Wilairatana P, Kuraeiad S, Rattaprasert P, Kotepui M. Prevalence of malaria and scrub typhus co-infection in febrile patients: a systematic review and meta-analysis. Parasit Vectors 2021; 14:471. [PMID: 34521454 PMCID: PMC8442375 DOI: 10.1186/s13071-021-04969-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little information is available about malaria and scrub typhus co-infection. This study aimed to investigate the pooled prevalence of malaria and scrub typhus co-infection in febrile patients. Further, it aimed to estimate the prevalence of scrub typhus infection among patients with malaria and the odds of co-infection. This will aid the diagnosis and management of co-infected patients in endemic areas. METHODS We searched for relevant studies in three databases: PubMed, Scopus, and Web of Science. We assessed the quality of the included studies using the Joanna Briggs Institute checklist for analytical cross-sectional studies. We estimated (1) the pooled prevalence of malaria and scrub typhus co-infection, (2) the pooled prevalence of scrub typhus infection in malaria-positive patients, and (3) the pooled odds of co-infection using the DerSimonian-Laird method for random-effects models. The study results and summary estimates were visualized on a forest plot as point estimates (effect size, prevalence) and 95% confidence intervals (CI). We assessed the heterogeneity of the studies by Cochrane Q or I2 statistics. We performed subgroup analyses of countries and scrub typhus diagnostic tests to explore the sources of heterogeneity of the included studies. We assessed publication bias if more than 10 studies were used to estimate the outcome. All data analyses were conducted using Stata version 14 (StataCorp, College Station, TX, USA). RESULTS Of the 542 studies retrieved from three databases, we included 14 meeting the inclusion criteria in the systematic review and meta-analysis. The pooled prevalence of malaria and scrub typhus co-infection (56 cases) among febrile patients (7920 cases) was 1% (95% CI: 0-1%, I2: 78.28%), while the pooled prevalence of scrub typhus infection (321 cases) in patients with malaria (1418 cases) was 21% (95% CI: 12-30%, I2: 98.15%). Subgroup analysis showed that the pooled prevalence of scrub typhus infection among patients with malaria in India was 8% (95% CI: 4-13%, I2: 85.87%, nine studies with 59/794 cases), while the pooled prevalence of scrub typhus infection among patients with malaria in Thailand was 35% (95% CI: 7-64%, I2: 98.9%, four studies with 262/624 cases). The co-infections did not occur by chance (P = 0.013, odds: 0.43, 95% CI: 0.22-0.84%, I2: 60.9%). In the sensitivity analysis, the pooled prevalence of malaria and scrub typhus co-infection among febrile patients was 0% (95% CI: 0-1%, I2: 59.91%). CONCLUSIONS The present study showed the pooled prevalence and a significant association between malaria and scrub typhus. The results show the status of co-infection. Further research into co-infection in endemic areas is needed, in particular, to determine whether co-infection can accelerate disease progression or protect against severe disease.
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Affiliation(s)
- Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Saruda Kuraeiad
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, 80160, Thailand
| | - Pongruj Rattaprasert
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Manas Kotepui
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, 80160, Thailand.
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Chang YC, Sun W, Lin JN, Chen YH, Lai CH, Lee CH. Epidemiology and risk factors of scrub typhus in Taiwan: A nationwide database study from 1996 to 2014. Zoonoses Public Health 2021; 68:876-883. [PMID: 34223707 DOI: 10.1111/zph.12876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/24/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Scrub typhus (ST) is one of the most underdiagnosed, potentially fatal febrile diseases in the Asia-Pacific region. We conducted a comprehensive review of the risk factors of ST over 19 years using data from a nationwide database. METHODS We used data on ST from the nationwide database of the Taiwan Centers for Disease Control from 1996 to 2014 to analyse the incidence rates and relative risks of ST according to different regions. The trends of incidence rates over the study period were also evaluated. The distribution of confirmed ST cases was mapped using geographic information system software. The characteristics of confirmed ST cases and non-ST cases (cases with suspected ST but negative test findings) were compared. RESULTS Among the 38,127 reported cases, there were 6,791 (17.8%) confirmed ST cases. The overall incidence rate of ST in Taiwan was 1.49 per 100,000 residents per year. The trend of incidence rates increased over time. The Island region had the highest incidence rate (56.55 per 100,000 residents per year), followed by the Eastern region (15.13 per 100,000 residents per year). More confirmed ST cases were distributed in mountainous areas of Taiwan Main Island and Island region. Compared to non-ST cases, individuals with confirmed ST were younger (median [interquartile range] age: 44 [26-57] years versus 45 [30-60] years, p < .001) and more likely to engage in at-risk occupations (29.4% versus 13.3%, p < .001), including farming and animal husbandry (16.6% versus 9.0%, p < .001) and the armed forces (12.3% versus 3.5%, p < .001); however, they had a lower rate of animal contact (12.8% versus 20.1%, p < .001). CONCLUSIONS ST is an endemic disease in Taiwan, particularly in the Island region, Eastern region and mountainous areas. Patients engaged in at-risk occupations and presenting with acute febrile diseases should undergo investigations for ST.
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Affiliation(s)
- Yi-Chin Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wu Sun
- Infection Control Department, Pao-Chien Hospital, Pingtung County, Taiwan
| | - Jiun-Nong Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.,Department of Critical Care Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Sepsis Research Center, Center of Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hsu Lai
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Division of Infection Control Laboratory, E-Da Hospital, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
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Sharma PK, Tilak R. Outbreak prone communicable diseases of public health importance in the northern districts of West Bengal - Current status & the way forward. Indian J Med Res 2021; 153:358-366. [PMID: 33906999 PMCID: PMC8204839 DOI: 10.4103/ijmr.ijmr_607_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
India is perilously poised on the threshold of an explosion of infectious diseases, some of which have witnessed re-emergence while others await apposite opportunity to do so. The State of West Bengal is uniquely positioned with its innate geographical vulnerabilities that favour outbreaks of a host of infectious diseases. The northern districts of this State are well known endemic areas for many outbreak prone communicable diseases like malaria, Japanese encephalitis, scrub typhus, dengue and kala-azar. An outbreak of Nipah virus in the recent past is a pointer towards the emerging and re-emerging threat in these regions and warrants urgent prioritization for surveillance and monitoring of these diseases. Identification of risk factors, challenges in delivery of primary healthcare, implementation of intervention strategies along with strengthening of healthcare setup are also the need of the hour. Multisectoral initiatives with emphasis on understanding the complex and rapidly evolving human-animal-vector dynamics as envisaged under the ‘One Health’ concept are indubitably important pillars in the effective management of these emerging public health challenges.
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Affiliation(s)
- Puran Kumar Sharma
- Pasteur Institute, Department of Health & Family Welfare, Kolkata, West Bengal, India
| | - Rina Tilak
- Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
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Khan SA, Murhekar MV, Bora T, Kumar S, Saikia J, Kamaraj P, Sabarinanthan R. Seroprevalence of Rickettsial Infections in Northeast India: A Population-Based Cross-Sectional Survey. Asia Pac J Public Health 2021; 33:516-522. [PMID: 34018413 DOI: 10.1177/10105395211015864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A cross-sectional survey was undertaken to estimate seroprevalence of immunoglobulin G antibodies against scrub typhus, spotted fever group rickettsiae, and typhus group rickettsiae in randomly selected 48 clusters in 12 districts of 3 Northeast states of India: Assam, Meghalaya, and Tripura. Individuals in 3 age groups (5-8, 9-17, and 18-45 years) were selected from each cluster. Sera (N = 2360) tested were collected as part of a national survey on dengue seroprevalence conducted between September 2017 and February 2018. Overall, seroprevalence of 2.5% was detected against rickettsioses, with highest positivity against spotted fever group rickettsiae, followed by scrub typhus and typhus group rickettsiae. Seroprevalence was highest in Tripura (3.7%), followed by Assam (2.6%) and Meghalaya (1.04%). Adults of 18 to 45 years of age were found to be most affected (3.8%). The study findings indicate the need for increasing testing facilities for active case detection at hospital levels. Efforts on implementing effective preventing strategies are suggested to be targeted in disease-specific endemic foci.
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Affiliation(s)
- Siraj A Khan
- Indian Council of Medical Research-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | - Manoj V Murhekar
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | - Trishna Bora
- Indian Council of Medical Research-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | - Santhosh Kumar
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | - Jahnabi Saikia
- Indian Council of Medical Research-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | - P Kamaraj
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | - R Sabarinanthan
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
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13
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National Seroprevalence of Coxiella burnetii in Chile, 2016-2017. Pathogens 2021; 10:pathogens10050531. [PMID: 33924790 PMCID: PMC8145303 DOI: 10.3390/pathogens10050531] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022] Open
Abstract
Coxiella burnetii is an intracellular bacterium and the cause of the zoonotic infection, Q fever. National surveillance data on C. burnetii seroprevalence is currently not available for any South American country, making efforts of public health to implement strategies to mitigate infections in different at-risk groups within the population extremely challenging. In the current study, we used two commercial anti-C. burnetii immunoassays to screen sera collected from a sample of the Chilean population as part of a 2016–2017 national health survey (n = 5166), nationwide and age-standardized. The seroprevalence for C. burnetii for persons ≥ 15 years was estimated to be 3.0% (95% CI 2.2–4.0), a level similar to national surveys from The Netherlands (2.4%) and USA (3.1%), but lower than Australia (5.6%). A linear increase of C. burnetii seropositivity was associated with an individual’s age, with the peak seroprevalence 5.6% (95% CI 3.6–8.6) observed in the ≥65 years’ group. C. burnetii seropositivity was significantly higher in the southern macro-zone 6.0% (95% CI 3.3–10.6) compared to metropolitan region 1.8% (95% CI 0.9–3.3), the former region being home to significant livestock industries, particularly dairy farming. These data will be useful to inform targeted strategies for the prevention of Q fever in at-risk populations in Chile.
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14
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Turebekov N, Abdiyeva K, Yegemberdiyeva R, Kuznetsov A, Dmitrovskiy A, Yeraliyeva L, Shapiyeva Z, Batyrbayeva D, Tukhanova N, Shin A, Musralina L, Hoelscher M, Froeschl G, Dobler G, Freimueller K, Wagner E, Frey S, Essbauer S. Occurrence of Anti-Rickettsia spp. Antibodies in Hospitalized Patients with Undifferentiated Febrile Illness in the Southern Region of Kazakhstan. Am J Trop Med Hyg 2021; 104:2000-2008. [PMID: 33901004 DOI: 10.4269/ajtmh.20-0388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/09/2021] [Indexed: 12/16/2022] Open
Abstract
Undifferentiated febrile illness still represents a demanding medical problem all over the world, but primarily in low- and middle-income countries. Scientific and clinical investigations related to undifferentiated febrile illness and rickettsial diseases in Kazakhstan are lacking. This study reflects the investigation of antibodies against spotted fever group (SFG) and typhus group (TG) rickettsiae in patients with undifferentiated febrile illness in the southern region of Kazakhstan (Almaty and Kyzylorda oblasts). Paired serum samples were gathered from 13 hospitals in these two oblasts and explored for the presence of IgM and IgG antibodies against typhus group and IgG antibodies against spotted fever group rickettsiae using ELISA. Patient's questionnaires were statistically analyzed. In total, 802 inpatients from Almaty (N = 9) and Kyzylorda (N = 4) hospitals were included in this research. Based on ELISA results, 250 patients out of 802 (31.2%) from both oblasts had IgG antibodies against SFG rickettsiae. Results from 11 (1.4%) patients indicated acute infection with tick-borne rickettsiosis. Regarding TG rickettsiae (R. typhi), a past infection was detected in 248 (30.9%) febrile patients and acute infection in 22 (2.7%) patients in the two selected oblasts. The data indicated that SFG and TG rickettsioses are present in Kazakhstan. Kazakh physicians should be aware of these emerging diseases in both investigated oblasts because the occurrence of these diseases is not suspected during day-to-day clinical practice. The identification of rickettsial pathogens and implementation of modern laboratory methods for the diagnostics of rickettsioses are in need throughout Kazakhstan.
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Affiliation(s)
- Nurkeldi Turebekov
- 1Central Reference Laboratory, National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - Karlygash Abdiyeva
- 1Central Reference Laboratory, National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - Ravilya Yegemberdiyeva
- 2Department of Infectious and Tropical Diseases, Kazakh National Medical University, Almaty, Kazakhstan
| | - Andrey Kuznetsov
- 3National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - Andrey Dmitrovskiy
- 3National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - Lyazzat Yeraliyeva
- 4Department of Children's Infectious Diseases, Kazakh National Medical University, Almaty, Kazakhstan
| | - Zhanna Shapiyeva
- 5Scientific Practical Center of Sanitary Epidemiological Expertise and Monitoring, Almaty, Kazakhstan
| | - Dinara Batyrbayeva
- 6Scientific Clinical Diagnostic Laboratory, Kazakh National Medical University, Almaty, Kazakhstan
| | - Nur Tukhanova
- 7Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany
| | - Anna Shin
- 7Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lyazzat Musralina
- 8Al-Farabi Kazakh National University, Almaty, Kazakhstan.,9Institute of General Genetics and Cytology, Almaty, Kazakhstan
| | - Michael Hoelscher
- 10Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, German Center for Infection Research, Munich Partner site, Munich, Germany
| | - Guenter Froeschl
- 7Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany.,10Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, German Center for Infection Research, Munich Partner site, Munich, Germany
| | - Gerhard Dobler
- 11Bundeswehr Institute of Microbiology, Department Virology & Rickettsiology, German Center for Infection Research, Munich Partner site, Munich, Germany
| | - Klaus Freimueller
- 11Bundeswehr Institute of Microbiology, Department Virology & Rickettsiology, German Center for Infection Research, Munich Partner site, Munich, Germany
| | - Edith Wagner
- 11Bundeswehr Institute of Microbiology, Department Virology & Rickettsiology, German Center for Infection Research, Munich Partner site, Munich, Germany
| | - Stefan Frey
- 11Bundeswehr Institute of Microbiology, Department Virology & Rickettsiology, German Center for Infection Research, Munich Partner site, Munich, Germany.,12Bundeswehr Research Institute for Protective Technologies and CBRN Protection, Munster, Germany
| | - Sandra Essbauer
- 11Bundeswehr Institute of Microbiology, Department Virology & Rickettsiology, German Center for Infection Research, Munich Partner site, Munich, Germany
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15
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Sahu R, Rawool DB, Dhaka P, Yadav JP, Mishra SP, Kumar M, Vergis J, Malik SS, Barbuddhe SB. Current perspectives on the occurrence of Q fever: highlighting the need for systematic surveillance for a neglected zoonotic disease in Indian subcontinent. ENVIRONMENTAL MICROBIOLOGY REPORTS 2021; 13:138-158. [PMID: 33314653 DOI: 10.1111/1758-2229.12918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
Coxiellosis or Q fever is an important global occupational zoonotic disease caused by one of the most contagious bacterial pathogens - Coxiella burnetii, which ranks one among the 13 global priority zoonoses. The detection of C. burnetii infection is exhibiting an increasing trend in high-risk personnel around the globe. It has increasingly been detected from foods of animal origin (including bulk milk, eggs, and meat) as well as tick vectors in many parts of the world. Coxiellosis is reported to be an important public health threat causing spontaneous abortions in humans and potential reproductive failure, which would result in production losses among livestock. Further, comprehensive coverage of the reports and trends of Q fever in developing countries, where this infection is supposed to be widely prevalent appears scarce. Also, the pathogen remains grossly neglected and underreported. Moreover, policymakers and funding agencies do not view it as a priority problem, especially in the Indian subcontinent, including Sri Lanka, Bhutan, Pakistan, Nepal, Bangladesh and Maldives. Here, we review the occurrence and epidemiology of the disease in a global context with special emphasis on its status in the Indian subcontinent.
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Affiliation(s)
- Radhakrishna Sahu
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
| | - Deepak Bhiwa Rawool
- ICAR- National Research Centre on Meat, Hyderabad, Telangana, 500 092, India
| | - Pankaj Dhaka
- School of Public Health and Zoonoses, College of Veterinary Science, GADVASU, Ludhiana, Punjab, 141004, India
| | - Jay Prakash Yadav
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
| | - Sidharth Prasad Mishra
- Department of Animal Genetics and Breeding, West Bengal University of Animal and Fishery Sciences, Kolkata, West Bengal, 700037, India
| | - Manesh Kumar
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
| | - Jess Vergis
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
| | - Satyaveer Singh Malik
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
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16
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Park JH, Gill B, Acharya D, Yoo SJ, Lee K, Lee J. Seroprevalence and Factors Associated with Scrub Typhus Infection among Forestry Workers in National Park Offices in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063131. [PMID: 33803616 PMCID: PMC8003109 DOI: 10.3390/ijerph18063131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Scrub typhus is caused by the arthropod-borne bacterium Orientia tsutsugamushi and is an endemic infectious disease in the Asia-Pacific area. This study aimed to investigate the seroprevalence of scrub typhus and identify associated risk and protective factors among forestry workers, a neglected risk group for scrub typhus, in National Park Offices in South Korea. A nationwide cross-sectional serosurvey was carried out on 1945 National Park Office forestry workers (NPOFWs) in South Korea during December 2016. We visited 29 main offices and used a structured questionnaire to collect data regarding general characteristics, work activities, work hygiene-related factors, and other potential risk factors. Serum samples from NPOFWs were tested using indirect immunofluorescence assay to detect O. tsutsugamushi immunoglobulin (Ig) G and M antibodies. Of the 1945 NPOFWs, 718 (36.9%) participated in this cross-sectional study. The seroprevalence, defined as ≥1:256 for IgG and/or ≥1:16 for IgM, was 4.9% (35/718). In multivariate logistic analysis, longer duration of work in national parks (≥15 years; odds ratio (OR), 4.19; 95% confidence interval (CI), 1.71-10.28) and dry field farming (OR, 2.47; 95% CI, 1.12-5.46) were significantly associated with a higher risk of scrub typhus infection. Furthermore, the risk of scrub typhus infection was significantly lower among NPOFWs who washed working clothes daily (OR, 0.37; 95% CI, 0.18-0.75). This study indicated that scrub typhus is an important disease among NPOFWs in South Korea. Work hygiene, especially washing working clothes daily, needs to be emphasized among NPOFWs. Additionally, more precautions are required to diminish the rate of scrub typhus infection among NPOFWs who perform dry field farming.
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Affiliation(s)
- Ji-Hyuk Park
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju 38066, Korea; (D.A.); (S.-J.Y.); (K.L.)
- Correspondence: (J.-H.P.); (J.L.); Tel.: +82-54-703-7802 (J.-H.P.); +82-44-202-2865 (J.L.)
| | - Byoungchul Gill
- Division of Bacterial Diseases, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea;
| | - Dilaram Acharya
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju 38066, Korea; (D.A.); (S.-J.Y.); (K.L.)
| | - Seok-Ju Yoo
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju 38066, Korea; (D.A.); (S.-J.Y.); (K.L.)
| | - Kwan Lee
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju 38066, Korea; (D.A.); (S.-J.Y.); (K.L.)
| | - Jeongmin Lee
- Division of Bacterial Diseases, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea;
- Division of Healthcare Technology Development, Ministry of Health and Welfare, Sejong 30113, Korea
- Correspondence: (J.-H.P.); (J.L.); Tel.: +82-54-703-7802 (J.-H.P.); +82-44-202-2865 (J.L.)
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17
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Dreyfus A, Ruf MT, Mayer-Scholl A, Zitzl T, Loosli N, Bier NS, Hiereth S, Ulrich S, Poppert S, Straubinger RK, Stenos J, Tshokey T. Exposure to Leptospira spp. and Associated Risk Factors in the Human, Cattle and Dog Populations in Bhutan. Pathogens 2021; 10:pathogens10030308. [PMID: 33800914 PMCID: PMC8000015 DOI: 10.3390/pathogens10030308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/30/2022] Open
Abstract
Leptospirosis is a neglected worldwide zoonotic bacterial disease with a high prevalence in subtropical and tropical countries. The prevalence of Leptospira spp. in humans, cattle and dogs is unknown in Bhutan. Therefore, we sought to find out whether humans, cattle or dogs had been infected in the past with leptospires by measuring antibodies in the serum. We therefore collected blood from 864 humans ≥13 years of age, 130 bovines and 84 dogs from different rural and urban areas in Bhutan and tested the serum for antibodies specific for leptospires with a screening of enzyme-linked immunosorbent assays (ELISA) and a confirmatory microscopic agglutination test (MAT). In humans, 17.6% were seropositive by ELISA and 1.6% by MAT. The seropositivity was stronger in bovines (36.9%) and dogs (47.6%). "Having had a fever recently" (OR 5.2, p = 0.004), "working for the military" (OR 26.6, p = 0.028) and "being unemployed" (OR 12.9, p = 0.041) (reference category = housemaker) were statistically significantly associated with seropositivity when controlled for the effects of other risk factors. However, due to the small number of positive test results, the findings on risk factors should be interpreted with caution. Based on the serogroups found in the three species, dogs could be a source of infection for humans, or dogs and humans are exposed to the same environmental risk factors Clinical leptospirosis in humans and domestic animals should be investigated by testing blood and urine for the presence of leptospires by molecular methods (qPCR).
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Affiliation(s)
- Anou Dreyfus
- Department of Medicine, Swiss Tropical and Public Health Institute, 4055 Basel, Switzerland; (M.-T.R.); (N.L.); (S.P.)
- Medical Faculty, University of Basel, 4055 Basel, Switzerland
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, Antananarivo 101, Madagascar
- Correspondence:
| | - Marie-Thérèse Ruf
- Department of Medicine, Swiss Tropical and Public Health Institute, 4055 Basel, Switzerland; (M.-T.R.); (N.L.); (S.P.)
- Medical Faculty, University of Basel, 4055 Basel, Switzerland
| | - Anne Mayer-Scholl
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (A.M.-S.); (N.S.B.)
| | - Theresa Zitzl
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University, 35392 Giessen, Germany;
- Chair for Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Faculty of Veterinary Medicine, Ludwig-Maximilians University Munich, 80539 Munich, Germany; (S.H.); (S.U.); or (R.K.S.)
| | - Nadine Loosli
- Department of Medicine, Swiss Tropical and Public Health Institute, 4055 Basel, Switzerland; (M.-T.R.); (N.L.); (S.P.)
- Medical Faculty, University of Basel, 4055 Basel, Switzerland
| | - Nadja Seyhan Bier
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany; (A.M.-S.); (N.S.B.)
| | - Stephanie Hiereth
- Chair for Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Faculty of Veterinary Medicine, Ludwig-Maximilians University Munich, 80539 Munich, Germany; (S.H.); (S.U.); or (R.K.S.)
| | - Sebastian Ulrich
- Chair for Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Faculty of Veterinary Medicine, Ludwig-Maximilians University Munich, 80539 Munich, Germany; (S.H.); (S.U.); or (R.K.S.)
| | - Sven Poppert
- Department of Medicine, Swiss Tropical and Public Health Institute, 4055 Basel, Switzerland; (M.-T.R.); (N.L.); (S.P.)
- Medical Faculty, University of Basel, 4055 Basel, Switzerland
| | - Reinhard K. Straubinger
- Chair for Bacteriology and Mycology, Institute for Infectious Diseases and Zoonoses, Faculty of Veterinary Medicine, Ludwig-Maximilians University Munich, 80539 Munich, Germany; (S.H.); (S.U.); or (R.K.S.)
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, VIC 3220, Australia;
| | - Tshokey Tshokey
- Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu 11001, Bhutan;
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu 11001, Bhutan
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18
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Namgyal J, Tenzin T, Checkley S, Lysyk TJ, Rinchen S, Gurung RB, Dorjee S, Couloigner I, Cork SC. A knowledge, attitudes, and practices study on ticks and tick-borne diseases in cattle among farmers in a selected area of eastern Bhutan. PLoS One 2021; 16:e0247302. [PMID: 33617588 PMCID: PMC7899374 DOI: 10.1371/journal.pone.0247302] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/04/2021] [Indexed: 11/19/2022] Open
Abstract
Livestock farming plays an important role in supporting the livelihood of resource-poor subsistence farmers in Bhutan. However, ticks and tick-borne diseases (TBDs) are one of the major constraints to livestock farming due to their negative effect on health and production. To date, no study has been conducted in Bhutan to assess farmers' knowledge, attitude, and practices (KAP) about ticks and TBDs in cattle, although such information is essential in ensuring the development and adoption of effective prevention and control measures. Therefore, a KAP survey was conducted among 246 cattle owners in the Samkhar sub-district of eastern Bhutan in June 2019, using a structured questionnaire. Based on our scoring criteria, 52% [95%CI: 45.5-58.4] had adequate knowledge about ticks as potential vectors of diseases. Logistic regression analysis showed that the individuals who practiced a stall-feeding system of cattle rearing were 2.8 times [OR = 2.8 (95%CI: 1.66-4.78)] more likely to have adequate knowledge than others. Sixty-eight percent [95%CI: 62.5-74.4] had a favorable attitude toward tick prevention and control programs. Men were 1.95 times [OR = 1.95 (95%CI: 1.09-3.55)] more likely to have a favorable attitude than women, and the individuals who practiced a stall-feeding system were 2.59 times [OR = 2.59 95%CI: 1.45-4.78)] more likely to have a favorable attitude than others, after adjusting for the effect of other variables in the model. Overall, only 38% [95%CI 32.5-45] of the respondents reported tick infestation as one of the most important animal health problems, but 100% reported using acaricides to control ticks in cattle. Despite a high level of acaricide usage, the level of knowledge was low among the farmers interviewed. Findings from this study underline the importance of considering identified knowledge gaps and initiating education efforts to improve the adoption of effective tick prevention and control measures among farmers.
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Affiliation(s)
- Jamyang Namgyal
- Department of Livestock, District Veterinary Hospital, Ministry of Agriculture and Forests, Trashigang, Bhutan
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
| | - Tenzin Tenzin
- Department of Livestock, National Centre for Animal Health, Ministry of Agriculture and Forests, Thimphu, Bhutan
| | - Sylvia Checkley
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
| | - Tim J Lysyk
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
| | - Sangay Rinchen
- Department of Livestock, National Centre for Animal Health, Ministry of Agriculture and Forests, Thimphu, Bhutan
| | - Ratna B Gurung
- Department of Livestock, National Centre for Animal Health, Ministry of Agriculture and Forests, Thimphu, Bhutan
| | - Sithar Dorjee
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Isabelle Couloigner
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
- Department of Geography, University of Calgary, Alberta, Canada
| | - Susan C Cork
- Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada
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19
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Elders PND, Swe MMM, Phyo AP, McLean ARD, Lin HN, Soe K, Htay WYA, Tanganuchitcharnchai A, Hla TK, Tun NN, Nwe TT, Moe MM, Thein WM, Zaw NN, Kyaw WM, Linn H, Htwe YY, Smithuis FM, Blacksell SD, Ashley EA. Serological evidence indicates widespread distribution of rickettsioses in Myanmar. Int J Infect Dis 2020; 103:494-501. [PMID: 33310022 PMCID: PMC7862081 DOI: 10.1016/j.ijid.2020.12.013] [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: 11/04/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022] Open
Abstract
Diagnosis of rickettsial infections is difficult in low-resource settings; this leads to delays in receiving appropriate treatment. Before this study, the distribution of rickettsioses in Myanmar was not known. This serosurvey shows that rickettsioses are widespread in Myanmar. Particularly high prevalence of scrub typhus was found in central and northern regions.
Background Little research has been published on the prevalence of rickettsial infections in Myanmar. This study determined the seroprevalence of immunoglobulin G (IgG) antibodies to rickettsial species in different regions of Myanmar. Methods Seven hundred leftover blood samples from patients of all ages in primary care clinics and hospitals in seven regions of Myanmar were collected. Samples were screened for scrub typhus group (STG), typhus group (TG) and spotted fever group (SFG) IgG antibodies using enzyme-linked immunosorbent assays (ELISA). Immunofluorescence assays were performed for the same rickettsial groups to confirm seropositivity if ELISA optical density ≥0.5. Results Overall IgG seroprevalence was 19% [95% confidence interval (CI) 16–22%] for STG, 5% (95% CI 3–7%) for TG and 3% (95% CI: 2–5%) for SFG. The seroprevalence of STG was particularly high in northern and central Myanmar (59% and 19–33%, respectively). Increasing age was associated with higher odds of STG and TG seropositivity [per 10-year increase, adjusted odds ratio estimate 1.68 (p < 0.01) and 1.24 (p = 0.03), respectively]. Conclusion Rickettsial infections are widespread in Myanmar, with particularly high seroprevalence of STG IgG antibodies in central and northern regions. Healthcare workers should consider rickettsial infections as common causes of fever in Myanmar.
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Affiliation(s)
| | | | | | - Alistair R D McLean
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Kyaw Soe
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | | | - Ampai Tanganuchitcharnchai
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thel K Hla
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar
| | - Ni Ni Tun
- Medical Action Myanmar, Yangon, Myanmar
| | - Thin Thin Nwe
- Magway General Hospital and University of Medicine, Magway, Myanmar; University of Medicine 2, Yangon, Myanmar
| | - Myat Myat Moe
- Magway General Hospital and University of Medicine, Magway, Myanmar
| | - Win May Thein
- Mandalay General Hospital and University of Medicine, Mandalay, Myanmar
| | - Ni Ni Zaw
- Mandalay General Hospital and University of Medicine, Mandalay, Myanmar
| | | | - Htun Linn
- Monywa General Hospital, Monywa, Myanmar
| | | | - Frank M Smithuis
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Medical Action Myanmar, Yangon, Myanmar
| | - Stuart D Blacksell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Elizabeth A Ashley
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao Democratic People's Republic.
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20
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Devamani CS, Schmidt WP, Ariyoshi K, Anitha A, Kalaimani S, Prakash JAJ. Risk Factors for Scrub Typhus, Murine Typhus, and Spotted Fever Seropositivity in Urban Areas, Rural Plains, and Peri-Forest Hill Villages in South India: A Cross-Sectional Study. Am J Trop Med Hyg 2020; 103:238-248. [PMID: 32458785 PMCID: PMC7356468 DOI: 10.4269/ajtmh.19-0642] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Scrub typhus and spotted fever group rickettsioses are thought to be common causes of febrile illness in India, whereas they rarely test for murine typhus. This cross-sectional study explored the risk factors associated with scrub typhus, tick-borne spotted fever, and murine typhus seropositivity in three different geographical settings, urban, rural, and hill villages in Tamil Nadu, South India. We enrolled 1,353 participants living in 48 clusters. The study included a questionnaire survey and blood sampling. Blood was tested for Orientia tsutsugamushi (scrub typhus), Rickettsia typhi (murine typhus), and spotted fever group Rickettsia IgG using ELISA. The seroprevalence of scrub typhus, spotted fever, and murine typhus were 20.4%, 10.4%, and 5.4%, respectively. Scrub typhus had the highest prevalence in rural areas (28.1%), and spotted fever was most common in peri-forested areas (14.9%). Murine typhus was more common in rural (8.7%) than urban areas (5.4%) and absent in peri-forested hill areas. Agricultural workers had a higher relative risk for scrub typhus, especially in urban areas. For murine typhus, proximity to a waterbody and owning a dog were found to be major risk factors. The main risk factors for spotted fever were agricultural work and living in proximity to a forest. Urban, rural plains, and hill settings display distinct epidemiological pattern of Orientia and rickettsial infections. Although scrub typhus and spotted fever were associated with known risk factors in this study, the findings suggest a different ecology of murine typhus transmission compared with other studies conducted in Asia.
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Affiliation(s)
| | - Wolf-Peter Schmidt
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Arumugam Anitha
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Saravanan Kalaimani
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - John A J Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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Abstract
Purpose of Review The non-specific presentation of acute Q fever makes it difficult to diagnose in children, but untreated Q fever can result in chronic infections that have severe complications. Recent Findings Pediatric Q fever cases continue to be infrequently reported in the literature, and primarily document cases of persistent infections with Coxiella burnetii. Standardized treatment protocols for chronic Q fever in children still do not exist. Doxycycline and hydroxychloroquine are the treatment combination most utilized by healthcare providers to treat Q fever endocarditis or osteomyelitis in children, but a variety of other antibiotic combinations have been reported with varying results. The use of adjunctive therapies, such as such as interferon gamma, has produced mixed outcomes. Summary The true impact of Coxiella burnetii on the health of children remains unknown; long-term longitudinal follow-up of children with acute or chronic Q fever has not been reported. Both the acute and chronic forms of Q fever are underreported and underdiagnosed. Healthcare providers should consider Q fever in pediatric patients with culture-negative endocarditis or osteomyelitis.
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Abstract
Q fever (caused by Coxiella burnetii) is thought to have an almost world-wide distribution, but few countries have conducted national serosurveys. We measured Q fever seroprevalence using residual sera from diagnostic laboratories across Australia. Individuals aged 1–79 years in 2012–2013 were sampled to be proportional to the population distribution by region, distance from metropolitan areas and gender. A 1/50 serum dilution was tested for the Phase II IgG antibody against C. burnetii by indirect immunofluorescence. We calculated crude seroprevalence estimates by age group and gender, as well as age standardised national and metropolitan/non-metropolitan seroprevalence estimates. Of 2785 sera, 99 tested positive. Age standardised seroprevalence was 5.6% (95% confidence interval (CI 4.5%–6.8%), and similar in metropolitan (5.5%; 95% CI 4.1%–6.9%) and non-metropolitan regions (6.0%; 95%CI 4.0%–8.0%). More males were seropositive (6.9%; 95% CI 5.2%–8.6%) than females (4.2%; 95% CI 2.9%–5.5%) with peak seroprevalence at 50–59 years (9.2%; 95% CI 5.2%–13.3%). Q fever seroprevalence for Australia was higher than expected (especially in metropolitan regions) and higher than estimates from the Netherlands (2.4%; pre-outbreak) and US (3.1%), but lower than for Northern Ireland (12.8%). Robust country-specific seroprevalence estimates, with detailed exposure data, are required to better understand who is at risk and the need for preventive measures.
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Tshokey T, Stenos J, Tenzin T, Drukpa K, Gurung RB, Graves SR. Serological Evidence of Rickettsia, Orientia, and Coxiella in Domestic Animals from Bhutan: Preliminary Findings. Vector Borne Zoonotic Dis 2018; 19:95-101. [PMID: 30148695 DOI: 10.1089/vbz.2018.2336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is no information on rickettsial diseases in domestic animals in Bhutan. This study provides preliminary serological data on exposure of domestic animals to Rickettsia, Orientia, and Coxiella. Animal sera were collected opportunistically from Bhutan and tested in the Australian Rickettsial Reference Laboratory for IgG antibodies against spotted fever group (SFG) and typhus group (TG) Rickettsia, scrub typhus group (STG), and Q fever (QF). Of the 294 animals tested, 136 (46%) showed serological evidence of past exposure to one or more rickettsiae: 106 (36%), 62 (21%), 45 (15%), and 11 (4%) being positive against SFG Rickettsia, Orientia, TG Rickettsia, and Coxiella, respectively. Dogs appeared to exhibit the highest seropositivity against SFG (55%) and TG Rickettsia (45%), horses against STG (91%), while goats were mostly positive for Coxiella (9%). Dogs also appeared to have high risk of being exposed to SFG Rickettsia (odd ratios [OR] 5.71, 95% confidence interval [CI] 3.02-10.80, p < 0.001), TG Rickettsia (OR 48.74, 95% CI 11.29-210.32, p < 0.001), and STG (OR 6.80, 95% CI 3.32-13.95, p < 0.001), but not against QF (OR 1.95, 95% CI 0.42-8.95, p = 0.390). Differences in seropositivity rates between animal species may have been significant for SFG, TG, and STG, but not for QF. The differences in the seropositivity rates of the four infections between districts appeared to be significant for TG and STG, but not for SFG and QF. The seropositivity rates of domestic animals to the four rickettsial infections were consistent with similar studies on the human population in the same areas and appear to demonstrate a high prevalence of exposure to rickettsiae in Bhutan. These preliminary findings constitute baseline data for Bhutan. The findings of this study call for an increased human-livestock sector collaboration in rickettsial diseases research aimed at developing diagnostic and therapeutic guidelines and formulating preventive and control measures through a One Health approach.
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Affiliation(s)
- Tshokey Tshokey
- 1 Faculty of Health and Medicine, University of Newcastle , Newcastle, Australia .,2 Australian Rickettsial Reference Laboratory, University Hospital Geelong , Geelong, Australia .,3 Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) , Thimphu, Bhutan
| | - John Stenos
- 2 Australian Rickettsial Reference Laboratory, University Hospital Geelong , Geelong, Australia
| | - Tenzin Tenzin
- 4 Department of Livestock, National Centre for Animal Health (NCAH) , Thimphu, Bhutan
| | - Kinzang Drukpa
- 4 Department of Livestock, National Centre for Animal Health (NCAH) , Thimphu, Bhutan
| | - Ratna Bahadur Gurung
- 4 Department of Livestock, National Centre for Animal Health (NCAH) , Thimphu, Bhutan
| | - Stephen R Graves
- 1 Faculty of Health and Medicine, University of Newcastle , Newcastle, Australia .,2 Australian Rickettsial Reference Laboratory, University Hospital Geelong , Geelong, Australia
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Rickettsial Infections and Q Fever Amongst Febrile Patients in Bhutan. Trop Med Infect Dis 2018; 3:tropicalmed3010012. [PMID: 30274410 PMCID: PMC6136613 DOI: 10.3390/tropicalmed3010012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/10/2018] [Accepted: 01/21/2018] [Indexed: 12/04/2022] Open
Abstract
There is limited evidence of rickettsial diseases in Bhutan. We explored the contribution of rickettsioses as a cause of undifferentiated febrile illness in patients presenting to 14 Bhutanese hospitals from October 2014 to June 2015. Obvious causes of fever were excluded clinically. Clinico-demographic information and acute blood samples were collected. Samples were tested by immunofluorescence assay (IFA) and qPCR against scrub typhus group (STG), spotted fever group (SFG) and typhus group (TG) rickettsiae, and Q fever (QF). Of the 1044 patients, 539 (51.6%) were female and the mean age was 31.5 years. At least 159 (15.2%) of the patients had evidence of a concurrent rickettsial infection. Of these, 70 (6.7%), 46 (4.4%), 4 (0.4%), and 29 (2.8%) were diagnosed as acute infections with STG, SFG, TG, and QF respectively. Ten (1.0%) patients were seropositive for both SFG and TG. Seven of the 70 STG patients were positive by qPCR. Eschar (p < 0.001), myalgia (p = 0.003), and lymphadenopathy (p = 0.049) were significantly associated with STG, but no specific symptoms were associated with the other infections. Disease incidences were not different between age groups, genders, occupations, and districts, except for students with significantly lower odds of infection with STG (OR = 0.43; 95% CI = 0.20, 0.93; p = 0.031). Rickettsioses were responsible for at least 15% of undifferentiated febrile illnesses in Bhutan, scrub typhus being the commonest. Health authorities should ensure that health services are equipped to manage these infections.
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