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Yan S, Lu Q, Tao Q, Lu Y, Gao B, Wang S, Cai X, Ai L, Xiong X, Cao M, Tan W. An immunochromatographic test for serological diagnosis of scrub typhus. J Immunol Methods 2024; 528:113653. [PMID: 38430991 DOI: 10.1016/j.jim.2024.113653] [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: 09/03/2023] [Revised: 01/24/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
A fluorescent immunochromatographic test (FM-ICT) was developed for rapid detection of anti-Orientia tsutsugamushi antibodies in serum samples. The FM-ICT was constructed based on the dual-antigen sandwich method. Truncated 56 kDa outer membrane protein of O. tsutsugamushi strain SJ, was expressed in E. coli and mixed with those of Ptan and Gillam strains. A thin line of the protein mixture was precisely sprayed across a nitrocellulose membrane making this the "Test" line. Polyclonal antibodies (pAbs) to O.tsutsugamushi were sprayed in another line across the membrane making this the "Control" line. Fluorescent microspheres conjugated 56 kDa proteins reacting with sample serum will be captured on the "Test" line if the sample contains antibodies to O.tsutsugamushi. Several experimental parameters were optimized. After optimizing the reaction procedure, the results are visible, within 6 min, with the naked eye under ultraviolet light. The limit of detection (LOD) was determined to be 7.63 ng/mL with prepared polyclonal antibodies. No cross-reaction was observed with sera samples from other febrile diseases. In clinical evaluations, the strips showed 94.92% sensitivity (106/112) and 93.75% specificity (56/60). The FM-ICT we developed will provide a new tool for on-site diagnosis of scrub typhus.
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Affiliation(s)
- Shuhao Yan
- College Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, Jiangsu, PR China
| | - Qingyu Lu
- College Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, Jiangsu, PR China
| | - Qingyuan Tao
- College Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, Jiangsu, PR China
| | - Yawei Lu
- College Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, Jiangsu, PR China
| | - Bao Gao
- College Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, Jiangsu, PR China
| | - Sibo Wang
- College Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, Jiangsu, PR China
| | - Xusheng Cai
- College Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, Jiangsu, PR China
| | - Lele Ai
- Nanjing Bioengineering (Gene) Technology Center for Medicine, Nanjing 210002, PR China
| | - Xiaohui Xiong
- College Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, Jiangsu, PR China
| | - Min Cao
- College Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, Jiangsu, PR China.
| | - Weilong Tan
- Nanjing Bioengineering (Gene) Technology Center for Medicine, Nanjing 210002, PR China.
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Dinesh Bhanushali J, Ghewade B, Jadhav U. Case Report: Scrub Typhus manifesting as Acute Respiratory Distress Syndrome (ARDS) with corresponding radiological findings. F1000Res 2024; 12:1596. [PMID: 39282517 PMCID: PMC11399754 DOI: 10.12688/f1000research.141986.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 09/19/2024] Open
Abstract
Background Scrub typhus is a life-threatening infectious disease endemic in the Asia-Pacific region. It typically presents with nonspecific symptoms such as fever, headache, and myalgia, making early diagnosis challenging. Acute Respiratory Distress Syndrome (ARDS) is a severe pulmonary condition characterized by acute-onset hypoxemia, bilateral lung infiltrates on radiology, and increased pulmonary capillary permeability. Case Presentation An 18-year-old female student in central India presented with a seven-day history of recurrent fever, chills, dry cough, and severe shortness of breath, escalating to Modified Medical Research Council dyspnea grade III-IV. After unsuccessful local clinic treatment, a chest radiograph revealed bilateral pneumonia. On admission, she displayed tachycardia, tachypnea, hypotension, and hypoxia requiring non-invasive ventilation (NIV). Computed tomography confirmed scrub typhus-associated pneumonia, and serological testing was positive for scrub typhus. She was diagnosed with moderate ARDS and began treatment. Symptomatic improvement was seen in the ICU, and she was discharged on day 10 with radiological and clinical resolution. Management and Outcomes She received intravenous doxycycline and oral azithromycin for scrub typhus and any potential concurrent lung infection. In the ICU, she required continuous NIV and supplemental oxygen, with significant symptomatic improvement, evidenced by reduced tachypnoea and oxygen requirements after 72 hours. She was weaned off NIV and monitored for an additional four days. After satisfactory oxygen saturation on room air, she was discharged on the tenth day. High-resolution CT scan demonstrated resolution of ground glass opacities and consolidation. Sequential chest radiographs exhibited gradual reduction in bilateral alveolar infiltrates over time, in parallel with clinical improvement. Laboratory findings, including reduced CRP and D-dimer values, and a normal hemogram on discharge indicated a resolution of leukopenia. Conclusion This case underscores the importance of early recognition and intervention in scrub typhus-associated ARDS and highlights the utility of timely diagnostic imaging in monitoring the progress of the disease.
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Affiliation(s)
- Jay Dinesh Bhanushali
- Respiratory Medicine, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra, 442001, India
| | - Babaji Ghewade
- Respiratory Medicine, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra, 442001, India
| | - Ulhas Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra, 442001, India
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Zhang Y, Hai Y, Duan B, Long H, Xie X, Teng Z, Yin F, Wang M, Xiong Y, Shao Z, Guo W, Qin A. A seminested recombinase polymerase amplification assay to detect rickettsial pathogens in clinical samples. Diagn Microbiol Infect Dis 2023; 107:116067. [PMID: 37751629 DOI: 10.1016/j.diagmicrobio.2023.116067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
Treatment at the early stage of onset is vital for the prognosis of rickettsioses. But the absence of specific clinical symptoms complicates the diagnosis of this condition. Herein we established a seminested recombinase polymerase amplification assay (snRPA-nfo) that enables quick detection and differentiation of rickettsial pathogens in clinical samples with high sensitivity and specificity. The conserved 17-kDa protein gene of Rickettsia sibirica and the 47-kDa protein gene of Orientia tsutsugamushi were targeted for the duplex RPA-nfo assay. The snRPA-nfo assay exhibited an increased LOD in spiked blood samples, up to 1000-fold in comparison to standard RPA-nfo, and a better detection rate (83.3%, 5/6) than TaqMan PCR (16.6%, 1/6, Ct ≤ 35) in clinically confirmed patient blood samples. Thus, snRPA-nfo assay represents a promising alternative to TaqMan PCR in the early diagnosis of rickettsioses for point-of-care testing as well as in resource-limited settings.
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Affiliation(s)
- Ying Zhang
- Center for Disease Control and Prevention of Xilingol League, Xilinhaote, Inner Mongolia, China; State Key Laboratory of Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Hai
- Center for Disease Control and Prevention of Inner Mongolia, Hohhot, Inner Mongolia, China
| | - Biao Duan
- Institute of Endemic Diseases Control and Prevention of Yunnan, Dali, Yunnan, China
| | - Hu Long
- Center for Disease Control and Prevention of Guilin City, Guilin, Guangxi, China
| | - Xiaofei Xie
- State Key Laboratory of Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; Hainan Medical College, Haikou, Hainan, China
| | - Zhongqiu Teng
- State Key Laboratory of Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feifei Yin
- Hainan Medical College, Haikou, Hainan, China
| | - Mingliu Wang
- Center for Disease Control and Prevention of Guangxi, Nanning, Guangxi, China
| | - Yanwen Xiong
- State Key Laboratory of Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhujun Shao
- State Key Laboratory of Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weidong Guo
- Center for Disease Control and Prevention of Xilingol League, Xilinhaote, Inner Mongolia, China; Institute of Endemic Diseases Control and Prevention of Yunnan, Dali, Yunnan, China.
| | - Aiping Qin
- State Key Laboratory of Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Wang YC, Li JH, Qin Y, Qin SY, Chen C, Yang XB, Ma N, Dong MX, Lei CC, Yang X, Sun HT, Sun ZY, Jiang J. The Prevalence of Rodents Orientia tsutsugamushi in China During Two Decades: A Systematic Review and Meta-Analysis. Vector Borne Zoonotic Dis 2023; 23:619-633. [PMID: 37625029 DOI: 10.1089/vbz.2023.0057] [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: 08/27/2023] Open
Abstract
Background: Orientia tsutsugamushi is a zoonotic intracellular pathogen that requires parasitism in eukaryotic cells to reproduce. In recent years, tsutsugamushi disease reported in many places nationwide has crossed the Yangtze River, continuously, spreading to the North China. Now this phenomenon has aroused people's attention. Materials and Methods: In this study, meta-analysis was used to analyze the infection of rodents (vectors) in China, to clarify the transmission rule of O. tsutsugamushi. Results: This study included literature from six databases (PubMed, Web of Science, Science Direct, Wanfang, CNKI, and VIP). A total of 55 articles were included in the study from 610 retrieved articles. The total infection rate of O. tsutsugamushi in rodents was 5.5% (1206/20,620, 95% confidence interval [CI]: 0.0553-0.0617). The prevalence of O. tsutsugamushi in rodents before 2013 (7.73%, 95% CI: 4.11-12.37) was higher than after 2013 (2.11%, 95% CI: 0.64-4.41). O. tsutsugamushi spread among a variety of rodents, among which Rattus losea (13.3%, 95% CI: 4.33-26.26), Rattus tanezumi (5.69%, 95% CI: 1.37-12.72), and Apodemus agrarius (5.32%, 95% CI: 2.26-9.58) infection rate was higher. Kawasaki (8.32%, 95% CI: 1.42-20.17), Karp (7.36%, 95% CI: 2.62-14.22), Kato (2.54%, 95% CI: 0.08-8.28), and Gilliam (2.13%, 95% CI: 0.42-5.09) were the main prevalent genotypes in China. The prevalence of O. tsutsugamushi in rodents was seasonal, increasing gradually in summer (2.39%, 95% CI: 0.46-5.77), peaking in autumn (4.59%, 95% CI: 1.15-10.16), and then declining. The positive rate of immunofluorescence assay (25.07%, 95% CI: 8.44-46.88) was the highest among the detection methods, and it was statistically significant (p < 0.05). Based on the subgroup of geographical factors and climatic factors, the probability of O. tsutsugamushi infection in rodents was the highest when the temperature >19℃ (8.20%, 95% CI: 1.22-20.52), the altitude <100 millimeters (7.23%, 95% CI: 3.45-12.26), the precipitation >700 millimeters (12.22%, 95% CI: 6.45-19.50), and the humidity 60-70% (7.80%, 95% CI: 4.17-12.44). Conclusions: Studies have shown that rodents carrying O. tsutsugamushi are common. People should prevent and control rodents in life and monitor rodents carrying O. tsutsugamushi for a long time.
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Affiliation(s)
- Yan-Chun Wang
- School of Pharmacy, Qingdao University, Qingdao, PR China
- Changchun Sci-Tech University, Shuangyang, PR China
- Department of Technology, Ningbo Sansheng Biotechnology Co., Ltd, Ningbo, PR China
| | - Jing-Hao Li
- Center for Biological Disaster Prevention and Control, National Forestry and Grassland Administration, Shenyang, PR China
| | - Ya Qin
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, PR China
| | - Si-Yuan Qin
- Center for Biological Disaster Prevention and Control, National Forestry and Grassland Administration, Shenyang, PR China
| | - Chao Chen
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, PR China
| | - Xin-Bo Yang
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, PR China
| | - Ning Ma
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, PR China
| | - Ming-Xin Dong
- School of Pharmacy, Qingdao University, Qingdao, PR China
- Department of Technology, Ningbo Sansheng Biotechnology Co., Ltd, Ningbo, PR China
| | - Cong-Cong Lei
- Center for Biological Disaster Prevention and Control, National Forestry and Grassland Administration, Shenyang, PR China
| | - Xing Yang
- Department of Medical Microbiology and Immunology, School of Basic Medicine, Dali University, Dali, PR China
| | - He-Ting Sun
- Center for Biological Disaster Prevention and Control, National Forestry and Grassland Administration, Shenyang, PR China
| | - Zhi-Yong Sun
- Department of Technology, Ningbo Sansheng Biotechnology Co., Ltd, Ningbo, PR China
| | - Jing Jiang
- Changchun Sci-Tech University, Shuangyang, PR China
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Husain U, Arpita, Kalyan RK. An alarming surge of scrub typhus cases presenting as acute encephalitis in children. Trop Doct 2023; 53:505-508. [PMID: 37644872 DOI: 10.1177/00494755231194197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Scrub typhus, which is prevalent in the Asia Pacific region is most feared owing to its life-threatening neurological complications. We present four cases of scrub typhus with acute encephalitis, including one with multiorgan failure and another serologically proven co-infection with Hepatitis C. Treatment of scrub typhus is not, however, so difficult, so its early diagnosis is paramount.
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Affiliation(s)
- Uneza Husain
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Arpita
- Department of Paediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Raj Kumar Kalyan
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Dai J, Yao C, Ling H, Li B, Chen R, Shi F. A rare case of severe leptospirosis infection presenting as septic shock in a non-endemic area: a case report and literature review. BMC Infect Dis 2023; 23:503. [PMID: 37525113 PMCID: PMC10391985 DOI: 10.1186/s12879-023-08367-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/02/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Leptospirosis is a zoonosis caused by spirochete "genus" leptospira. The clinical presentations of leptospirosis range from an influenza-like presentation of fever and myalgia, to severe forms. Leptospirosis can potentially lead to a misdiagnosis or delay in diagnosis when clinical similarities exist. CASE PRESENTATION A 63-year-old man presented with fever, shock and thrombocytopenia followed by diffuse pulmonary hemorrhage. Peripheral blood Metagenomic Next-generation Sequencing (mNGS) reported Leptospira interrogans. The patient was treated with piperacillin-tazobactam (TZP) plus doxycycline and improved dramatically after 7 days. CONCLUSION We conclude that leptospirosis can potentially lead to a misdiagnosis or delay in diagnosis. Correctly evaluation of thrombocytopenia in acute febrile illnesses facilitates the differential diagnosis of leptospirosis. mNGS can accurately detect Leptospira DNA during the early stage of the infection.
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Affiliation(s)
- Junjie Dai
- The Second Clinical Medical College, Jinan University, Shenzhen, 518020, Guangdong, China
- Department of Infectious diseases, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Can Yao
- Department of Infectious diseases, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Huaxiang Ling
- The Second Clinical Medical College, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Binbin Li
- Department of Infectious diseases, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China
| | - Rongchang Chen
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
| | - Fei Shi
- Department of Infectious diseases, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
- Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
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Vasireddy A, Pai K, Shetty VM, Acharya RV, Kusugodlu R, Doddamani A, Madhyastha SP. Leukocytoclastic Vasculitis: A peculiar presentation of scrub typhus. Sultan Qaboos Univ Med J 2023; 23:109-112. [PMID: 36865420 PMCID: PMC9974041 DOI: 10.18295/squmj.1.2022.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/16/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Scrub typhus is a disease endemic to the Indian subcontinent caused by the obligate intracellular pleomorphic organism, Orientia tsutsugamushi. Scrub typhus, among other acute febrile illnesses, manifests as prodromal symptoms of fever, malaise, myalgia and anorexia followed by a distinct maculopapular rash, hepatosplenomegaly and lymphadenopathy. We report the case of a patient presenting to tertiary care hospital in southern India in 2021 who developed a rare cutaneous vasculitis secondary to infection with Orientia tsutsugamushi. After performing the Weil-Felix test, a diagnostic titre of >1:640 against OXK was obtained. Furthermore, a skin biopsy was carried out which confirmed the diagnosis of leukocytoclastic vasculitis. The patient was treated with doxycycline and showed drastic improvement in his symptoms.
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Affiliation(s)
- Anila Vasireddy
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Kanthilatha Pai
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Varsha M. Shetty
- Department of Dermatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Raviraja V. Acharya
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Ramamoorthi Kusugodlu
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Akhila Doddamani
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Sharath P. Madhyastha
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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8
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Wang Z, Zhang W, Lu N, Lv R, Wang J, Zhu C, Ai L, Mao Y, Tan W, Qi Y. A potential tool for predicting epidemic trends and outbreaks of scrub typhus based on Internet search big data analysis in Yunnan Province, China. Front Public Health 2022; 10:1004462. [PMID: 36530696 PMCID: PMC9751444 DOI: 10.3389/fpubh.2022.1004462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Scrub typhus, caused by Orientia tsutsugamushi, is a neglected tropical disease. The southern part of China is considered an important epidemic and conserved area of scrub typhus. Although a surveillance system has been established, the surveillance of scrub typhus is typically delayed or incomplete and cannot predict trends in morbidity. Internet search data intuitively expose the public's attention to certain diseases when used in the public health area, thus reflecting the prevalence of the diseases. Methods In this study, based on the Internet search big data and historical scrub typhus incidence data in Yunnan Province of China, the autoregressive integrated moving average (ARIMA) model and ARIMA with external variables (ARIMAX) model were constructed and compared to predict the scrub typhus incidence. Results The results showed that the ARIMAX model produced a better outcome than the ARIMA model evaluated by various indexes and comparisons with the actual data. Conclusions The study demonstrates that Internet search big data can enhance the traditional surveillance system in monitoring and predicting the prevalence of scrub typhus and provides a potential tool for monitoring epidemic trends of scrub typhus and early warning of its outbreaks.
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Affiliation(s)
- Zixu Wang
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China,Bengbu Medical College, Bengbu, China
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Nianhong Lu
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China,Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Ruichen Lv
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China,Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Junhu Wang
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China,Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Changqiang Zhu
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China,Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Lele Ai
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China,Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Yingqing Mao
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China,Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Weilong Tan
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China,Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China,*Correspondence: Weilong Tan
| | - Yong Qi
- Huadong Research Institute for Medicine and Biotechniques, Nanjing, China,Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China,Yong Qi
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9
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Lu D, Wang T, Luo Z, Ye F, Qian J, Zhang J, Wang C. Evaluation of the Therapeutic Effect of Antibiotics on Scrub Typhus: A Systematic Review and Network Meta-Analysis. Front Public Health 2022; 10:883945. [PMID: 35570886 PMCID: PMC9092376 DOI: 10.3389/fpubh.2022.883945] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background To explore the efficacy and safety of drugs in patients with scrub typhus. Methods For this systematic review and network meta-analysis, we searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, China National Knowledge Infrastructure (CNKI), and Wanfang data (WF) up to December 2021. All randomized controlled trials (RCTs) of antibiotics used to treat scrub typhus were included without language or date restrictions. The overall effectiveness was evaluated from 4 perspectives: cure rate (CR), defervescence time (DT), gastrointestinal symptoms–adverse events (GS-AD), and abnormal blood count–adverse events (ABC-AD). The quality of evidence was evaluated using the Cochrane Risk of Bias tool and GRADE system. Results Sixteen studies involving 1,582 patients were included to evaluate 7 drugs, namely, azithromycin, doxycycline, chloramphenicol, tetracycline, rifampin, moxifloxacin, and telithromycin. In this network meta-analysis, rifampicin (82%) and chloramphenicol (65%) were more effective in terms of CR, and moxifloxacin (3%) from the quinolone family was the worst. Azithromycin caused the fewest events in terms of ABC-AD. No differences were found in this network meta-analysis (NMA) in terms of DT and GS-AD. Conclusions Rifampicin was associated with the highest CR benefit and the lowest risk of DT when used to treat patients with scrub typhus, except in areas where tuberculosis (TB) was endemic. Azithromycin was found to be better in CR and was associated with a lower probability of GS-AD and ABC-AD; therefore, it may be considered to treat pregnant women and children. Moxifloxacin had a much lower CR than other drugs and is, therefore, not recommended for the management of scrub typhus. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021287837.
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Affiliation(s)
- Dafeng Lu
- School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater, Nanjing, China
| | - Taiwu Wang
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater, Nanjing, China
| | - Zhenghan Luo
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater, Nanjing, China
| | - Fuqiang Ye
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater, Nanjing, China
| | - Jiaojiao Qian
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jinhai Zhang
- Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater, Nanjing, China
| | - Chunhui Wang
- School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Infectious Disease Prevention and Control, Center for Disease Control and Prevention of Eastern Theater, Nanjing, China
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10
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Jang WS, Lim DH, Choe YL, Nam J, Moon KC, Kim C, Choi M, Park I, Park DW, Lim CS. Developing a multiplex loop-mediated isothermal amplification assay (LAMP) to determine severe fever with thrombocytopenia syndrome (SFTS) and scrub typhus. PLoS One 2022; 17:e0262302. [PMID: 35171943 PMCID: PMC8849512 DOI: 10.1371/journal.pone.0262302] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) and scrub typhus are endemic zoonotic diseases that pose significant public health threats in East Asia. As these two diseases share common clinical features, as well as overlapping disease regions, it is difficult to differentiate between SFTS and scrub typhus. A multiplex reverse-transcription loop‑mediated isothermal amplification (RT-LAMP) assay was developed to detect large segments and GroES genes for SFTS virus (SFTSV) and Orientia tsutsugamushi (OT). The performance of the RT-LAMP assay was compared and evaluated with those of commercial PowerChek™ SFTSV real-time PCR and LiliF™ TSUTSU nested PCR for 23 SFTS and 12 scrub typhus clinical samples, respectively. The multiplex SFTSV/OT/Internal control (IC) RT-LAMP assay showed comparable sensitivity (91.3%) with that of commercial PowerChek™ SFTSV Real-time PCR (95.6%) and higher sensitivity (91.6%) than that of LiliF™ TSUTSU nested PCR (75%). In addition, the multiplex SFTSV/OT RT-LAMP assay showed 100% specificity and no cross-reactivity for blood from uninfected healthy patients and samples from patients infected with other fever viruses. Thus, the multiplex SFTSV/OT/IC RT-LAMP assay could serve as a useful point-of-care molecular diagnostic test for SFTS and scrub typhus.
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Affiliation(s)
- Woong Sik Jang
- Emergency Medicine, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Da Hye Lim
- Departments of Laboratory Medicine, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Lan Choe
- Departments of Laboratory Medicine, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jeonghun Nam
- Department of Song‐do Bio Engineering, Incheon Jaeneung University, Incheon, Korea
- Artificial Intelligence (AI)‐Bio Research Center, Incheon Jaeneung University, Incheon, Korea
| | - Kyung Chul Moon
- Emergency Medicine, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Chaewon Kim
- Departments of Laboratory Medicine, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Minkyeong Choi
- Departments of Laboratory Medicine, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Insu Park
- Departments of Laboratory Medicine, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Chae Seung Lim
- Departments of Laboratory Medicine, College of Medicine, Korea University Guro Hospital, Seoul, Korea
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11
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Ramkumarsingh Tomar L, Jatinbhai Shah D, Agarwal U, Gogia A, Rohatgi A, Agrawal CS. Scrub typhus meningoencephalitis presenting as opsoclonus myoclonus syndrome: A video-based case. Trop Doct 2021; 52:192-195. [PMID: 34355588 DOI: 10.1177/00494755211034381] [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: 11/16/2022]
Abstract
Opsoclonus myoclonus syndrome secondary to scrub typhus infection is a rare clinical entity. Hence, it is important to know its clinical manifestations and complications, so that it can be properly managed. We report a 28-year-old female whose initial manifestation was only fever, which subsided in four days. Two days later, she developed opsoclonus myoclonus syndrome. This was managed with doxycycline and clonazepam, but as it persisted, intravenous immunoglobulin was added. She showed excellent response to treatment.
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Affiliation(s)
| | | | - Utkarsh Agarwal
- Department of Neurology, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
| | - Atul Gogia
- Department of Internal Medicine, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
| | - C S Agrawal
- Department of Neurology, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
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12
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Li Z, Xin H, Sun J, Lai S, Zeng L, Zheng C, Ray SE, Weaver ND, Wang L, Yu J, Feng Z, Hay SI, Gao GF. Epidemiologic Changes of Scrub Typhus in China, 1952-2016. Emerg Infect Dis 2021; 26:1091-1101. [PMID: 32441637 PMCID: PMC7258452 DOI: 10.3201/eid2606.191168] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Scrub typhus, a miteborne rickettsiosis, has emerged in many areas globally. We analyzed the incidence and spatial–temporal distribution of scrub typhus in China during 1952–1989 and 2006–2016 using national disease surveillance data. A total of 133,623 cases and 174 deaths were recorded. The average annual incidence was 0.13 cases/100,000 population during 1952–1989; incidence increased sharply from 0.09/100,000 population in 2006 to 1.60/100,000 population in 2016. The disease, historically endemic to southern China, has expanded to all the provinces across both rural and urban areas. We identified 3 distinct seasonal patterns nationwide; infections peaked in summer in the southwest, summer-autumn in the southeast, and autumn in the middle-east. Persons >40 years of age and in nonfarming occupations had a higher risk for death. The changing epidemiology of scrub typhus in China warrants an enhanced disease control and prevention program.
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Abstract
PURPOSE OF REVIEW Scrub typhus, caused by Orientia tsutsugamushi, is a widely neglected disease which is gaining global momentum because of its resurgence patterns. The disease is now being reported in newer regions as well as areas previously endemic areas. In this review, we aim to comprehensively review the data available to assist physicians in making an accurate diagnosis and appropriate management of the disease. RECENT FINDINGS Several diagnostic tests have been developed for confirming scrub typhus. However, there is lack of clarity on which tests are most appropriate in a given clinical scenario. A recent study has demonstrated that in early disease (<7 days) when serological tests remain negative, the quantitative polymerase chain reaction is the most sensitive test. Among the serological tests, both IgM enzyme-linked immunosorbent assay as well as rapid diagnostic tests revealed excellent sensitivities and specificities. SUMMARY With the reemergence of scrub typhus, a high degree of clinical suspicion is required to appropriately diagnose this disease which presents as an acute febrile illness. It can progress to develop various complications leading to multi-organ dysfunction syndrome. Mild illness responds well to antibiotic treatment with doxycycline and azithromycin. Further studies are required to determine the most optimal therapy in severe scrub typhus infections and superiority of one drug over the other.
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Abstract
Rickettsial diseases, caused by a variety of obligate intracellular, Gram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma are considered some of the most covert emerging and re-emerging diseases. Scrub typhus, murine flea-borne typhus and Indian tick typhus are commonly being reported and during the last decade. Scrub typhus (ST) has emerged as a serious public health problem in India. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45% with multiple organ dysfunction, if the specific treatment is delayed. Early clinical suspicion, timely diagnosis followed by institution of specific antimicrobial therapy shortens the course of the disease, lowers the risk of complications and reduces morbidity and mortality due to rickettsial diseases. Still there is large gap in our knowledge of Rickettsioses and the vast variability and non-specific presentation of these have often made it difficult to diagnose clinically. The present review describes the epidemiology, clinical manifestations, diagnostic modalities and treatment of Scrub typhus which is a vastly underdiagnosed entity and clinicians should suspect and test for the disease more often.
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Affiliation(s)
- Ashwani K Sood
- Department of Pediatrics and Adolescent Medicine, Indira Gandhi Medical College, Shimla, India.
| | - Amit Sachdeva
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, India
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15
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Kala D, Gupta S, Nagraik R, Verma V, Thakur A, Kaushal A. Diagnosis of scrub typhus: recent advancements and challenges. 3 Biotech 2020; 10:396. [PMID: 32834918 PMCID: PMC7431554 DOI: 10.1007/s13205-020-02389-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Scrub typhus is a mite-borne, acute febrile illness caused by the bacterium Orientia tsutsugamushi. It is a re-emerging infectious disease of the tsutsugamushi triangle. Scrub typhus is transmitted through bites of contaminated chiggers (larval stage). Diagnosis of scrub typhus is challenging as its symptoms mimic with other acute febrile illnesses. Several methods are effectual for diagnosis of scrub typhus that includes enzyme-linked immunosorbent assay (ELISA), immunofluorescence assay (IFA), immunochromatographic test (ICT), Weil-Felix, polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP). Weil-Felix test was initially used for the diagnosis of scrub typhus in underdeveloped countries but not preferred due to a lack of both specificity and sensitivity. Other immuno-based methods like IFA and ELISA are most outrank for detection of scrub typhus due to their higher sensitivity and specificity, but not vigorous to lay bare the infection at early stages and need the convalescent sampling for verification of positive samples. On another deed, PCR based methods becoming acceptable over era due to its dexterity of early-stage diagnosis with higher specificity and sensitivity but lack its applicability in circumstances of scrub typhus due to the variegated genetic makeup of Orientia tsutsugamushi among its serotypes. The present review focused on various detection methods along with their advantages and disadvantages used in the diagnosis of scrub typhus. A comparison between available methods of diagnosis with challenges in the detection of scrub typhus is also summarized.
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Affiliation(s)
- Deepak Kala
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
| | | | | | | | - Atul Thakur
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
| | - Ankur Kaushal
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
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16
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Eisermann P, Rauch J, Reuter S, Eberwein L, Mehlhoop U, Allartz P, Muntau B, Tappe D. Complex Cytokine Responses in Imported Scrub Typhus Cases, Germany, 2010-2018. Am J Trop Med Hyg 2020; 102:63-68. [PMID: 31769398 PMCID: PMC6947778 DOI: 10.4269/ajtmh.19-0498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Scrub typhus is a life-threatening zoonotic disease, which is caused by Orientia tsutsugamushi, an obligatory intracellular Gram-negative bacterium. It is transmitted by Leptotrombidium mites in endemic regions of Southeast Asia. So far, data on imported scrub typhus cases to non-endemic areas and immunological descriptions are rare. Eleven scrub typhus cases that had been diagnosed by the German National Reference Center for Tropical Pathogens between 2010 and 2018 were retrospectively reviewed for clinical symptoms, laboratory changes, and travel destinations. Patient sera were included if follow-up samples showed simultaneous seroconversion for IgM and IgG antibody responses by immunofluorescence assays or concurrence with the first serum sample. The median of seroconversion was week 2 after symptom onset. Cytokine levels were measured over time, demonstrating simultaneously upregulated major Th1, Th2, and Th17 cytokines in the acute phase of infection followed by normalization during convalescence. This study underlines the complex mixed cytokine response elicited by scrub typhus and highlights clinical and diagnostic aspects of imported infections with O. tsutsugamushi.
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Affiliation(s)
- Philip Eisermann
- National Reference Center for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jessica Rauch
- National Reference Center for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Stefan Reuter
- 4th Department of Internal Medicine, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Lukas Eberwein
- 4th Department of Internal Medicine, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Ute Mehlhoop
- National Reference Center for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Petra Allartz
- National Reference Center for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Birgit Muntau
- National Reference Center for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Dennis Tappe
- National Reference Center for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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17
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Srinivasan S, Kalaimani S, Jude Prakash JA, Menon T. Comparison of nested polymerase chain reaction and real-time polymerase chain reaction targeting 47kda gene for the diagnosis of scrub typhus. Indian J Med Microbiol 2019; 37:50-53. [PMID: 31424010 DOI: 10.4103/ijmm.ijmm_19_170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Scrub typhus is a zoonotic infection caused by Orientia tsutsugamushi which is transmitted by Leptotrombidium mites. The disease manifests as a mild-to-severe illness with non-specific clinical symptoms. Rapid diagnosis and prompt treatment are essential for patient management. Both serological and molecular methods are used for the diagnosis of scrub typhus. The present study assessed the usefulness of detection of the gene encoding the 47kDa outer-membrane protein (OMP) for the laboratory diagnosis of scrub typhus. Materials and Methods Nested polymerase chain reaction (nPCR) and real-time PCR targeting 47 kDa OMP antigen gene of O. tsutsugamushi were performed on ethylenediaminetetraacetic acid blood samples. Results Six of the 103 (5.8%) patients showed the presence of 47kDa gene by nPCR. Seventy of 103 (67.9%) cases showed the presence of 47kDa gene by qPCR. Among the 70 positive cases, the majority of them were females (40/70, 57.1%). The highest number of positive cases was observed during October-February. Conclusion Real-time PCR targeting O. tsutsugamushi-specific 47-kDa gene is more sensitive than nPCR and may be the assay of choice for the detection of the organism in patients with suspected scrub typhus.
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Affiliation(s)
- Seethalakshmi Srinivasan
- Department of Microbiology, Dr. AL Mudaliar PG Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu, India
| | - Saravanan Kalaimani
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Thangam Menon
- Department of Microbiology, Dr. AL Mudaliar PG Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu, India
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18
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Sea-liang N, Sereemaspun A, Patarakul K, Gaywee J, Rodkvamtook W, Srisawat N, Wacharaplusadee S, Hemachudha T. Development of multiplex PCR for neglected infectious diseases. PLoS Negl Trop Dis 2019; 13:e0007440. [PMID: 31283768 PMCID: PMC6613674 DOI: 10.1371/journal.pntd.0007440] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/06/2019] [Indexed: 01/28/2023] Open
Abstract
Scrub typhus, murine typhus, and leptospirosis are widely neglected infectious diseases caused by Orientia tsutsugamushi, Rickettsia typhi, and pathogenic Leptospira spp., respectively. Patients usually present with non-specific symptoms and therefore are commonly diagnosed with acute undifferentiated febrile illness. Consequently, patients face delayed treatment and increased mortality. Antibody-based serological test currently used as gold standard has limitations due to insufficient antibody titers, especially in the early phase of infection. In this study, we aimed to develop multiplex PCR to combine 3 primer pairs that target specific genes encoding 56-kDa TSA of O. tsutsugamushi, 17-kDa antigen of R. typhi, and LipL32 of L. Interrogans and evaluate its performance in comparison to the standard serological tests. Using EDTA blood samples of known patients, the sensitivity and specificity of our multiplex PCR was 100% and 70%, respectively. In addition, the assay was able to diagnose the co-infection of scrub typhus and leptospirosis. The assay may be useful in identifying causative agents during the early phase of these diseases, enabling prompt and appropriate treatment. Scrub typhus, murine typhus, and leptospirosis are diagnosed as acute undifferentiated febrile illness. Diagnostic tests for these diseases depend on antibody detection. However, antibody detection is still limited by its tendency to return negative results during the early phase of aforementioned diseases. In this study, a novel multiplex PCR has been developed for detecting Orientia tsutsugamushi, Rickettsia typhi, and Leptospira interrogans that are simultaneously amplified in a single tube. The results have shown that multiplex PCR could be used as a diagnostic tool for detecting bacteria during the early phase of scrub typhus, murine typhus, and leptospirosis, allowing for administration of appropriate treatment.
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Affiliation(s)
- Nutchanart Sea-liang
- Nanomedicine Research Unit, Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Amornpun Sereemaspun
- Nanomedicine Research Unit, Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
| | - Kanitha Patarakul
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jariyanart Gaywee
- Armed Forces Research Institute of Medical Science, Royal Thai Army, Bangkok, Thailand
| | - Wuttikon Rodkvamtook
- Armed Forces Research Institute of Medical Science, Royal Thai Army, Bangkok, Thailand
| | - Nattachai Srisawat
- Nephrology Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supaporn Wacharaplusadee
- Thai Red Cross Emerging Infectious Diseases-Health Science Centre, World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thiravat Hemachudha
- Thai Red Cross Emerging Infectious Diseases-Health Science Centre, World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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19
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Xin HL, Yu JX, Hu MG, Jiang FC, Li XJ, Wang LP, Huang JL, Wang JF, Sun JL, Li ZJ. Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016. Infect Dis Poverty 2019; 8:59. [PMID: 31253202 PMCID: PMC6599364 DOI: 10.1186/s40249-019-0566-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/10/2019] [Indexed: 01/30/2023] Open
Abstract
Background Scrub typhus is a life-threatening disease caused by Orientia tsutsugamushi, and specific antimicrobial medicine is available. Early and accurate diagnosis is essential for reducing the risk of severe complications and death. In this study, we aimed to evaluate the case diagnosis situation among medical care institutions and geographical regions in China, and the results will benefit both clinical practice and the disease surveillance system. Methods We extracted individual scrub typhus case data 2006–2016 from a national disease surveillance system in China. The diagnosis category and interval time from illness onset to diagnosis were compared among three levels of medical care institutions and provinces. The descriptive analysis method was performed in our study. Results During the 11-year study period, 93 481 scrub typhus cases, including 57 deaths, were recorded in the nationwide surveillance system. The overall proportion of laboratory-confirmed cases was only 4.7%, and this proportion varied greatly among primary medical centres (2.8%), county level hospitals (4.2%), and city level hospitals (6.3%). Notably, the proportion of laboratory-confirmed cases has consistently decreased from 16.3% in 2006 to 2.6% in 2016, and the same decreasing trend was found among all three levels of medical care institutions. The interval from illness onset to case diagnosis (Tdiag) for all cases was 5 days (interquartile range [IQR]: 2–9 days) and decreased from 7 days (IQR: 3–11 days) in 2006 to 5 days (IQR: 2–8 days) in 2016. The risk of death for patients with a Tdiag of > 7 days was 2.2 times higher (OR = 2.21, 95% CI: 1.05–5.21) than that of patients with a Tdiag of < 2 days. Conclusions The interval time from illness onset to diagnosis for scrub typhus cases decreased greatly in China; however, the diagnosis rate of cases with laboratory-confirmed results must be increased among all levels of medical care institutions to reduce both the risk of death and the misuse of antibiotics associated with scrub typhus. Electronic supplementary material The online version of this article (10.1186/s40249-019-0566-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hua-Lei Xin
- Qingdao City Center for Disease Control and Prevention, Qingdao, 266033, Shandong, China.,Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Jian-Xing Yu
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.,Ministry of Health Key Laboratory of Systems Biology of Pathogens and Dr. Christophe Mérieux Laboratory, CAMS-Fondation Mérieux, Institute of Pathogen Biology, Academy of Medical Sciences of China and Peking Union Medical College, Beijing, 100000, China
| | - Mao-Gui Hu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100000, China
| | - Fa-Chun Jiang
- Qingdao City Center for Disease Control and Prevention, Qingdao, 266033, Shandong, China
| | - Xiao-Jing Li
- Qingdao City Center for Disease Control and Prevention, Qingdao, 266033, Shandong, China
| | - Li-Ping Wang
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Ji-Lei Huang
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.,National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China
| | - Jin-Feng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100000, China
| | - Jun-Ling Sun
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
| | - Zhong-Jie Li
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
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20
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Evans SM, Adcox HE, VieBrock L, Green RS, Luce-Fedrow A, Chattopadhyay S, Jiang J, Marconi RT, Paris D, Richards AL, Carlyon JA. Outer Membrane Protein A Conservation among Orientia tsutsugamushi Isolates Suggests Its Potential as a Protective Antigen and Diagnostic Target. Trop Med Infect Dis 2018; 3:E63. [PMID: 30274459 PMCID: PMC6073748 DOI: 10.3390/tropicalmed3020063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 01/28/2023] Open
Abstract
Scrub typhus threatens one billion people in the Asia-Pacific area and cases have emerged outside this region. It is caused by infection with any of the multitude of strains of the bacterium Orientia tsutsugamushi. A vaccine that affords heterologous protection and a commercially-available molecular diagnostic assay are lacking. Herein, we determined that the nucleotide and translated amino acid sequences of outer membrane protein A (OmpA) are highly conserved among 51 O. tsutsugamushi isolates. Molecular modeling revealed the predicted tertiary structure of O. tsutsugamushi OmpA to be very similar to that of the phylogenetically-related pathogen, Anaplasma phagocytophilum, including the location of a helix that contains residues functionally essential for A. phagocytophilum infection. PCR primers were developed that amplified ompA DNA from all O. tsutsugamushi strains, but not from negative control bacteria. Using these primers in quantitative PCR enabled sensitive detection and quantitation of O. tsutsugamushi ompA DNA from organs and blood of mice that had been experimentally infected with the Karp or Gilliam strains. The high degree of OmpA conservation among O. tsutsugamushi strains evidences its potential to serve as a molecular diagnostic target and justifies its consideration as a candidate for developing a broadly-protective scrub typhus vaccine.
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Affiliation(s)
- Sean M Evans
- Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, School of Medicine, Richmond, VA 23298, USA.
| | - Haley E Adcox
- Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, School of Medicine, Richmond, VA 23298, USA.
| | - Lauren VieBrock
- Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, School of Medicine, Richmond, VA 23298, USA.
| | - Ryan S Green
- Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, School of Medicine, Richmond, VA 23298, USA.
| | - Alison Luce-Fedrow
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA.
- Department of Biology, Shippensburg University, Shippensburg, PA 17257, USA.
| | - Suschsmita Chattopadhyay
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA.
| | - Ju Jiang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA.
| | - Richard T Marconi
- Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, School of Medicine, Richmond, VA 23298, USA.
| | - Daniel Paris
- Department of Medicine, Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.
| | - Allen L Richards
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA.
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Jason A Carlyon
- Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, School of Medicine, Richmond, VA 23298, USA.
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21
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Varghese GM, Rajagopal VM, Trowbridge P, Purushothaman D, Martin SJ. Kinetics of IgM and IgG antibodies after scrub typhus infection and the clinical implications. Int J Infect Dis 2018; 71:53-55. [PMID: 29653201 PMCID: PMC5985369 DOI: 10.1016/j.ijid.2018.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 03/23/2018] [Accepted: 03/30/2018] [Indexed: 11/18/2022] Open
Abstract
The kinetics of IgM and IgG post scrub typhus infection remain elusive. Scrub typhus patients were followed up to study antibody kinetics. IgM remained above the threshold for 12 months. IgG reached a peak at 10 months and remained above the threshold for 36 months. Paired IgM samples are required for accurate diagnosis.
Objectives The serological detection of IgM antibodies is the most widely used test to diagnose scrub typhus infection. However, the kinetics of IgM and IgG antibodies post-infection remain elusive, which could contribute to false positivity. The objective of this study was to document the nature of the evolution of these antibody titres after infection. Methods Adult patients previously confirmed to have scrub typhus by IgM ELISA, positive PCR, or both, were included in this cross-sectional study. The levels of IgM and IgG antibodies in serum samples were tested using an ELISA and the distribution curve was plotted. Results Two hundred and three patients were included in this study. Post-infection serum sampling was done between 1 month and 46 months after documented infection. IgM levels declined gradually but remained elevated above the diagnostic cut-off for up to 12 months post-infection. However, IgG levels continued to rise reaching a peak at 10 months, followed by a gradual decline over several months. In the majority of cases, the IgG levels remained above the cut-off threshold for more than 36 months. Conclusions Clinicians need to be cautious in using a single serum sample for the detection of IgM to diagnose scrub typhus, as it remains elevated for up to 12 months after the infection, whereas the serum IgG level could be used as an indicator of past infection.
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Affiliation(s)
- George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore 632004, Tamil Nadu, India.
| | | | - Paul Trowbridge
- Department of Infectious Diseases, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Divya Purushothaman
- Department of Infectious Diseases, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Sherry Joseph Martin
- Department of Infectious Diseases, Christian Medical College, Vellore 632004, Tamil Nadu, India
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22
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Qi Y, Yin Q, Shao Y, Cao M, Li S, Chen H, Shen W, Rao J, Li J, Li X, Sun Y, Lin Y, Deng Y, Zeng W, Zheng S, Liu S, Li Y. Development of a rapid and visual nucleotide detection method for a Chinese epidemic strain of Orientia tsutsugamushi based on recombinase polymerase amplification assay and lateral flow test. Int J Infect Dis 2018; 70:42-50. [PMID: 29548879 DOI: 10.1016/j.ijid.2018.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/19/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES Orientia tsutsugamushi is an obligate intracellular pathogen that causes scrub typhus. Diagnosing scrub typhus remains a challenge, and a sensitive, specific, simple, and rapid diagnostic test is still needed. METHODS A recombinase polymerase amplification (RPA) assay combined with a lateral flow (LF) test targeting the 56-kDa gene of a Karp-like strain of O. tsutsugamushi was developed and optimized. The detection limits, sensitivity, specificity, and simulative clinical performance were evaluated. RESULTS Primers and probe were screened to establish the RPA assay, and the reaction conditions were optimized. The detection limit was 10 copies/reaction in detecting plasmid DNA and 12 copies/reaction in detecting genomic DNA. The RPA-LF method could differentiate O. tsutsugamushi from other phylogenetically related bacteria. The sensitivity was 100% and specificity was over 90%, when evaluated using infected animal samples or simulative clinical samples. Furthermore, the method was completed in 20min at 37°C followed by a 3-5min incubation at room temperature for the development of an immunochromatographic strip, and the results could be determined visually. CONCLUSIONS This method is promising for wide-ranging use in basic medical units considering that it requires minimal instruments and infrastructure and is highly time-efficient, sensitive, and specific for diagnosing scrub typhus.
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Affiliation(s)
- Yong Qi
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu, China
| | - Qiong Yin
- China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yinxiu Shao
- China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Min Cao
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu, China
| | - Suqin Li
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu, China
| | - Hongxia Chen
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu, China
| | - Wanpeng Shen
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu, China
| | - Jixian Rao
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu, China
| | - Jiameng Li
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu, China
| | - Xiaoling Li
- China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yu Sun
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu Lin
- China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yi Deng
- China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Wenwen Zeng
- China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Shulong Zheng
- China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Suyun Liu
- China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yuexi Li
- Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu, China; China Pharmaceutical University, Nanjing, Jiangsu, China; Nanjing Medical University, Nanjing, Jiangsu, China.
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23
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Park EC, Lee SY, Yun SH, Choi CW, Lee H, Song HS, Jun S, Kim GH, Lee CS, Kim SI. Clinical proteomic analysis of scrub typhus infection. Clin Proteomics 2018; 15:6. [PMID: 29449793 PMCID: PMC5812041 DOI: 10.1186/s12014-018-9181-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/23/2018] [Indexed: 12/14/2022] Open
Abstract
Background
Scrub typhus is an acute and febrile infectious disease caused by the Gram-negative α-proteobacterium Orientia tsutsugamushi from the family Rickettsiaceae that is widely distributed in Northern, Southern and Eastern Asia. In the present study, we analysed the serum proteome of scrub typhus patients to investigate specific clinical protein patterns in an attempt to explain pathophysiology and discover potential biomarkers of infection. Methods Serum samples were collected from three patients (before and after treatment with antibiotics) and three healthy subjects. One-dimensional sodium dodecyl sulphate–polyacrylamide gel electrophoresis followed by liquid chromatography-tandem mass spectrometry was performed to identify differentially abundant proteins using quantitative proteomic approaches. Bioinformatic analysis was then performed using Ingenuity Pathway Analysis. Results Proteomic analysis identified 236 serum proteins, of which 32 were differentially expressed in normal subjects, naive scrub typhus patients and patients treated with antibiotics. Comparative bioinformatic analysis of the identified proteins revealed up-regulation of proteins involved in immune responses, especially complement system, following infection with O. tsutsugamushi, and normal expression was largely rescued by antibiotic treatment. Conclusions This is the first proteomic study of clinical serum samples from scrub typhus patients. Proteomic analysis identified changes in protein expression upon infection with O. tsutsugamushi and following antibiotic treatment. Our results provide valuable information for further investigation of scrub typhus therapy and diagnosis. Electronic supplementary material The online version of this article (10.1186/s12014-018-9181-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edmond Changkyun Park
- 1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea.,2Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology (KRICT), Daejeon, 34114 Republic of Korea.,3Department of Bio-Analytical Science, University of Science and Technology (UST), Daejeon, 34113 Republic of Korea
| | - Sang-Yeop Lee
- 1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea.,2Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology (KRICT), Daejeon, 34114 Republic of Korea
| | - Sung Ho Yun
- 1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea
| | - Chi-Won Choi
- 1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea.,4Division of Life Science, Tunneling Nanotube Research Center, Korea University, Seoul, 02841 Republic of Korea
| | - Hayoung Lee
- 1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea.,3Department of Bio-Analytical Science, University of Science and Technology (UST), Daejeon, 34113 Republic of Korea
| | - Hyun Seok Song
- 1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea.,2Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology (KRICT), Daejeon, 34114 Republic of Korea.,3Department of Bio-Analytical Science, University of Science and Technology (UST), Daejeon, 34113 Republic of Korea
| | - Sangmi Jun
- 1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea.,2Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology (KRICT), Daejeon, 34114 Republic of Korea.,3Department of Bio-Analytical Science, University of Science and Technology (UST), Daejeon, 34113 Republic of Korea
| | - Gun-Hwa Kim
- 1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea.,3Department of Bio-Analytical Science, University of Science and Technology (UST), Daejeon, 34113 Republic of Korea.,4Division of Life Science, Tunneling Nanotube Research Center, Korea University, Seoul, 02841 Republic of Korea
| | - Chang-Seop Lee
- 5Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, 54986 Republic of Korea.,6Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, 54907 Republic of Korea
| | - Seung Il Kim
- 1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea.,2Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology (KRICT), Daejeon, 34114 Republic of Korea.,3Department of Bio-Analytical Science, University of Science and Technology (UST), Daejeon, 34113 Republic of Korea
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24
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Lee HS, Sunwoo JS, Ahn SJ, Moon J, Lim JA, Jun JS, Lee WJ, Lee ST, Jung KH, Park KI, Jung KY, Lee SK, Chu K. Central Nervous System Infection Associated with Orientia tsutsugamushi in South Korea. Am J Trop Med Hyg 2017; 97:1094-1098. [PMID: 28820719 DOI: 10.4269/ajtmh.17-0077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Orientia tsutsugamushi is a major cause of vector-borne infection in Asia. Prompt recognition and appropriate treatment are crucial because of its potentially fatal complications and lack of response to beta-lactam antibiotics. The present study retrospectively evaluated the clinical characteristics and laboratory findings of 16 patients with scrub typhus-related central nervous system (CNS) infections. Single titers ≥ 1:40 of total serum antibodies against O. tsutsugamushi detected by an indirect immunofluorescent assay were considered as positive results. The median age was 35.5 (range, 14-72) years, and 10 (62.5%) patients were female. The most common symptoms were headache (81.3%) and fever (81.3%). Eschar formation was found in three (18.8%) patients. Among patients with encephalitis, seizures and altered consciousness occurred in five (83.3%) and four (66.7%) patients, respectively. An abnormal liver function was noted in seven (43.8%) patients. The median antibody titer was 1:120 (range, 1:40-1:2,560). Typical cerebrospinal fluid profiles were lymphocytic pleocytosis, mild protein elevations, and normal glucose levels. All patients received an empirical treatment with doxycycline and most (93.8%) of them recovered without neurological sequelae. None of the patients reported side effects of the doxycycline treatment. An empirical treatment with doxycycline is needed in patients with CNS infections in scrub typhus endemic areas.
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Affiliation(s)
- Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Seon-Jae Ahn
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, National Center for Mental Health, An affiliate of the Ministry for Health & Welfare, Seoul, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
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25
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Abstract
Scrub typhus is an acute febrile illness in the “tsutsugamushi triangle”, transmitted by chiggers that can be treated effectively if detected early. Laboratory testing, including molecular and serological assays, is needed for confirming the diagnosis, especially in the absence of the pathognomonic eschar. In this review, factors that play a role in disease occurrence and clinical clues for diagnosis, in addition to risk factors contributing to disease severity, including mortality, are discussed in detail. Moreover, issues related to diagnostic assays, treatment, and mixed infections are also enumerated and described.
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26
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Zhao D, Zhang Y, Yin Z, Zhao J, Yang D, Zhou Q. Clinical Predictors of Multiple Organ Dysfunction Syndromes in Pediatric patients with Scrub Typhus. J Trop Pediatr 2017; 63:167-173. [PMID: 27697827 DOI: 10.1093/tropej/fmw066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Scrub typhus can produce multiple organ dysfunction syndrome (MODS). Early recognition of the patients at risk of MODS would be helpful in providing timely management and reducing the mortality. In all, 449 children with scrub typhus were enrolled at three hospitals in Yunnan, China from January 2010 to January 2015. The patients' clinical status of organ system dysfunction was evaluated on the day of discharge from hospital by using standard criteria. The patients were classified into MODS present (64 cases, 14.3%) or MODS absent (385 cases, 85.7%). Multivariate logistic regression analyses revealed that the prognostic factors for MODS included skin rash (odds ratio, OR = 3.3, p = 0.037), time interval form treatment to defervescence (OR = 1.2, p = 0.035), hemoglobin (OR = 0.54, p = 0.041), platelet counts (OR = 0.06, p < 0.001), aspartate-aminotransferase (OR = 4.7, p = 0.011) and total bilirubin (OR = 2.3, p = 0.013). By describing risk factors resulting in MODS in pediatric scrub typhus, our study provides clinicians with important information to improve the clinical monitoring and prognostication of MODS.
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Affiliation(s)
- Dongying Zhao
- Xin Hua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
| | - Yongjun Zhang
- Xin Hua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China.,MOE and Shanghai Key Laboratory of Children's Environmental Health, Shanghai, 200092, China
| | | | - Jing Zhao
- Longling People's Hospital, Yunnan, 678300, China
| | - Defeng Yang
- Longling People's Hospital, Yunnan, 678300, China
| | - Qun Zhou
- Baoshan People's Hospital, Yunnan, 678000, China
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27
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Theunissen C, Cnops L, Van Esbroeck M, Huits R, Bottieau E. Acute-phase diagnosis of murine and scrub typhus in Belgian travelers by polymerase chain reaction: a case report. BMC Infect Dis 2017; 17:273. [PMID: 28407761 PMCID: PMC5390359 DOI: 10.1186/s12879-017-2385-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/06/2017] [Indexed: 12/03/2022] Open
Affiliation(s)
- Caroline Theunissen
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium.
| | - Lieselotte Cnops
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium
| | - Ralph Huits
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium
| | - Emmanuel Bottieau
- Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium
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28
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Weitzel T, Dittrich S, López J, Phuklia W, Martinez-Valdebenito C, Velásquez K, Blacksell SD, Paris DH, Abarca K. Endemic Scrub Typhus in South America. N Engl J Med 2016; 375:954-61. [PMID: 27602667 DOI: 10.1056/nejmoa1603657] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Scrub typhus is a life-threatening zoonosis caused by Orientia tsutsugamushi organisms that are transmitted by the larvae of trombiculid mites. Endemic scrub typhus was originally thought to be confined to the so called "tsutsugamushi triangle" within the Asia-Pacific region. In 2006, however, two individual cases were detected in the Middle East and South America, which suggested that the pathogen was present farther afield. Here, we report three autochthonous cases of scrub typhus caused by O. tsutsugamushi acquired on Chiloé Island in southern Chile, which suggests the existence of an endemic focus in South America. (Funded by the Chilean Comisión Nacional de Investigación Científica y Tecnológica and the Wellcome Trust.).
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Affiliation(s)
- Thomas Weitzel
- From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.)
| | - Sabine Dittrich
- From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.)
| | - Javier López
- From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.)
| | - Weerawat Phuklia
- From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.)
| | - Constanza Martinez-Valdebenito
- From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.)
| | - Katia Velásquez
- From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.)
| | - Stuart D Blacksell
- From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.)
| | - Daniel H Paris
- From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.)
| | - Katia Abarca
- From Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo (T.W.), Veterinary Hospital Puente Alto (J.L.), and Departamento de Enfermedades Infecciosas e Inmunología Pediátrica (C.M.-V., K.A.) and Millennium Institute on Immunology and Immunotherapy (K.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, and Hospital de Ancud, Ancud (K.V.) - all in Chile; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos (S.D., W.P.); Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (S.D., S.D.B., D.H.P.); and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (S.D.B., D.H.P.)
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Roopa KS, Karthika K, Sugumar M, Bammigatti C, Shamanna SB, Harish BN. Serodiagnosis of Scrub Typhus at a Tertiary Care Hospital from Southern India. J Clin Diagn Res 2015; 9:DC05-7. [PMID: 26675629 DOI: 10.7860/jcdr/2015/15871.6759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/28/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Scrub typhus, a zoonotic disease is one of the most covert emerging and re-emerging Rickettsial infections. There is an upsurge in the incidence of the disease worldwide with ever-changing habitat. Clinical diagnosis of scrub typhus is challenging as the signs and symptoms of scrub typhus are similar to other febrile illnesses. In developing countries, among the various laboratory tests to diagnose scrub typhus, Weil-Felix test is commonly performed despite its low sensitivity. The Immunofluorescence antibody (IFA) test has its limitations in terms of cost and expertise required. The present study was conducted to determine the seropositivity of IgM ELISA for scrub typhus in clinically suspected cases. MATERIALS AND METHODS Weil-Felix test and IgM ELISA were performed using clinically suspected cases of scrub typhus using commercially available kits. RESULTS Out of 482 samples tested, 109 were positive by both Weil-Felix test and IgM ELISA. One hundred and sixteen samples which were negative by Weil-Felix test reacted positive by IgM ELISA. Fourteen samples which were positive by Weil-Felix test were negative by ELISA. CONCLUSION Owing to the limitations of the Weil-Felix test and IFA, commercially available recombinant IgM ELISA which has a good sensitivity and specificity may be an alternative in laboratories with moderate set up.
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Affiliation(s)
- K S Roopa
- PhD scholar, Department of Microbiology, Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry, India
| | - K Karthika
- Senior Research Fellow, Department of Microbiology, Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry, India
| | - Madhan Sugumar
- Senior Research Fellow, Department of Microbiology, Jawaharlal Institute of Post Graduate, Medical Education and Research , Puducherry, India
| | - Chanaveerappa Bammigatti
- Associate Professor, Department of Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry, India
| | - Suryanarayana Bettadpura Shamanna
- Associate Professor, Departmentof Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry, India
| | - Belgode Narasimha Harish
- Senior Professor and Head, Department of Microbiology, Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry, India
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