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Cui H, Shen S, Chen L, Fan Z, Wen Q, Xing Y, Wang Z, Zhang J, Chen J, La B, Fang Y, Yang Z, Yang S, Yan X, Pei S, Li T, Cui X, Jia Z, Cao W. Global epidemiology of severe fever with thrombocytopenia syndrome virus in human and animals: a systematic review and meta-analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101133. [PMID: 39040038 PMCID: PMC11261768 DOI: 10.1016/j.lanwpc.2024.101133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024]
Abstract
Background Since the initial identification of the Severe Fever with Thrombocytopenia Syndrome (SFTS) in ticks in rural areas of China in 2009, the virus has been increasingly isolated from a diverse array of hosts globally, exhibiting a rising trend in incidence. This study aims to conduct a systematic analysis of the temporal and spatial distribution of SFTS cases, alongside an examination of the infection rates across various hosts, with the objective of addressing public concerns regarding the spread and impact of the disease. Methods In this systematic review and meta-analysis, an exhaustive search was conducted across multiple databases, including PubMed, Web of Science, Embase, and Medline, CNKI, WanFang, and CQVIP. The literature search was confined to publications released between January 1, 2009, and May 29, 2023. The study focused on collating data pertaining to animal infections under natural conditions and human infection cases reported. Additionally, species names were unified using the National Center for Biotechnology Information (NCBI) database. The notification rate, notification death rate, case fatality rate, and infection rates (or MIR) were assessed for each study with available data. The proportions were pooled using a generalized linear mixed-effects model (GLMM). Meta-regressions were conducted for subgroup analysis. This research has been duly registered with PROSPERO, bearing the registration number CRD42023431010. Findings We identified 5492 studies from database searches and assessed 238 full-text studies for eligibility, of which 234 studies were included in the meta-analysis. For human infection data, the overall pooled notification rate was 18.93 (95% CI 17.02-21.05) per ten million people, the overall pooled notification deaths rate was 3.49 (95% CI 2.97-4.10) per ten million people, and the overall pooled case fatality rate was 7.80% (95% CI 7.01%-8.69%). There was an increasing trend in notification rate and deaths rate, while the case fatality rate showed a significant decrease globally. Regarding animal infection data, among 94 species tested, 48 species were found to carry positive nucleic acid or antibodies. Out of these, 14 species were classified under Arthropoda, while 34 species fell under Chordata, comprising 27 Mammalia and 7 Aves. Interpretation This systematic review and meta-analysis present the latest global report on SFTS. In terms of human infections, notification rates and notification deaths rates are on the rise, while the case fatality rate has significantly decreased. More SFTSV animal hosts have been discovered than before, particularly among birds, indicating a potentially broader transmission range for SFTSV. These findings provide crucial insights for the prevention and control of SFTS on a global scale. Funding None.
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Affiliation(s)
- Haoliang Cui
- School of Public Health, Peking University, Beijing 100191, China
| | - Shijing Shen
- Institute of EcoHealth, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lin Chen
- School of Public Health, Peking University, Beijing 100191, China
| | - Zhiyu Fan
- School of Public Health, Peking University, Beijing 100191, China
| | - Qian Wen
- School of Public Health, Peking University, Beijing 100191, China
| | - Yiwen Xing
- School of Public Health, Peking University, Beijing 100191, China
| | - Zekun Wang
- School of Public Health, Peking University, Beijing 100191, China
| | - Jianyi Zhang
- School of Public Health, Peking University, Beijing 100191, China
| | - Jingyuan Chen
- School of Public Health, Peking University, Beijing 100191, China
| | - Bin La
- School of Public Health, Peking University, Beijing 100191, China
| | - Yujie Fang
- School of Public Health, Peking University, Beijing 100191, China
| | - Zeping Yang
- School of Public Health, Peking University, Beijing 100191, China
| | - Shuhan Yang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Xiangyu Yan
- Institute of Disaster and Emergency Medicine, Medical School, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Shaojun Pei
- School of Public Health, Peking University, Beijing 100191, China
| | - Tao Li
- School of Public Health, Peking University, Beijing 100191, China
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoming Cui
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Zhongwei Jia
- School of Public Health, Peking University, Beijing 100191, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
- Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
| | - Wuchun Cao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
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2
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Xu AL, Xue H, Li Y, Wang X, Zheng JX, Shi FY, Cui QX, Lu Y, Cun DJ, Li LH. Comprehensive meta-analysis of severe fever with thrombocytopenia syndrome virus infections in humans, vertebrate hosts and questing ticks. Parasit Vectors 2024; 17:265. [PMID: 38902842 PMCID: PMC11191292 DOI: 10.1186/s13071-024-06341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/01/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne zoonosis caused by the SFTS virus (SFTSV). Understanding the prevalence of SFTSV RNA in humans, vertebrate hosts and ticks is crucial for SFTS control. METHODS A systematic review and meta-analysis were conducted to determine the prevalence of SFTSV RNA in humans, vertebrate hosts and questing ticks. Nine electronic databases were searched for relevant publications, and data on SFTSV RNA prevalence were extracted. Pooled prevalence was estimated using a random effects model. Subgroup analysis and multivariable meta-regression were performed to investigate sources of heterogeneity. RESULTS The pooled prevalence of SFTSV RNA in humans was 5.59% (95% confidence interval [CI] 2.78-9.15%) in those in close contact (close contacts) with infected individuals (infected cases) and 0.05% (95% CI 0.00-0.65%) in healthy individuals in endemic areas. The SFTSV infection rates in artiodactyls (5.60%; 95% CI 2.95-8.96%) and carnivores (6.34%; 95% CI 3.27-10.23%) were higher than those in rodents (0.45%; 95% CI 0.00-1.50%). Other animals, such as rabbits, hedgehogs and birds, also played significant roles in SFTSV transmission. The genus Haemaphysalis was the primary transmission vector, with members of Ixodes, Dermacentor, and Amblyomma also identified as potential vectors. The highest pooled prevalence was observed in adult ticks (1.03%; 95% CI 0.35-1.96%), followed by nymphs (0.66%; 95% CI 0.11-1.50%) and larvae (0.01%; 95% CI 0.00-0.46%). The pooled prevalence in ticks collected from endemic areas (1.86%; 95% CI 0.86-3.14%) was higher than that in ticks collected in other regions (0.41%; 95% CI 0.12-0.81%). CONCLUSIONS Latent SFTSV infections are present in healthy individuals residing in endemic areas, and close contacts with SFTS cases are at a significantly higher risk of infection. The type of animal is linked to infection rates in vertebrate hosts, while infection rates in ticks are associated with the developmental stage. Further research is needed to investigate the impact of various environmental factors on SFTSV prevalence in vertebrate hosts and ticks.
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Affiliation(s)
- Ao-Long Xu
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, 261053, People's Republic of China
| | - Han Xue
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, 261053, People's Republic of China
| | - Yi Li
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, 261053, People's Republic of China
| | - Xu Wang
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, 261053, People's Republic of China
| | - Jin-Xin Zheng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases; Key Laboratory on Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, 200025, People's Republic of China
| | - Fu-Yan Shi
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, 261053, People's Republic of China
| | - Qing-Xia Cui
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, 261053, People's Republic of China
| | - Yan Lu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases; Key Laboratory on Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, 200025, People's Republic of China.
| | - De-Jiao Cun
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, 261053, People's Republic of China.
- Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, 650022, People's Republic of China.
| | - Lan-Hua Li
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, 261053, People's Republic of China.
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3
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Ogawa T, Tsuzuki S, Ohbe H, Matsui H, Fushimi K, Yasunaga H, Kutsuna S. Analysis of Differences in Characteristics of High-Risk Endemic Areas for Contracting Japanese Spotted Fever, Tsutsugamushi Disease, and Severe Fever With Thrombocytopenia Syndrome. Open Forum Infect Dis 2024; 11:ofae025. [PMID: 38312217 PMCID: PMC10836194 DOI: 10.1093/ofid/ofae025] [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: 09/16/2023] [Accepted: 01/13/2024] [Indexed: 02/06/2024] Open
Abstract
Background Tick-borne infections, including tsutsugamushi disease, Japanese spotted fever, and severe fever with thrombocytopenia syndrome (SFTS), are prevalent in East Asia with varying geographic distribution and seasonality. This study aimed to investigate the differences in the characteristics among endemic areas for contracting each infection. Methods We conducted an ecologic study in Japan, using data from a nationwide inpatient database and publicly available geospatial data. We identified 4493 patients who were hospitalized for tick-borne infections between July 2010 and March 2021. Mixed-effects modified Poisson regression analysis was used to identify factors associated with a higher risk of contracting each tick-borne disease (Tsutsugamushi, Japanese spotted fever, and SFTS). Results Mixed-effects modified Poisson regression analysis revealed that environmental factors, such as temperature, sunlight duration, elevation, precipitation, and vegetation, were associated with the risk of contracting these diseases. Tsutsugamushi disease was positively associated with higher temperatures, farms, and forests, whereas Japanese spotted fever and SFTS were positively associated with higher solar radiation and forests. Conclusions Our findings from this ecologic study indicate that different environmental factors play a significant role in the risk of transmission of tick-borne infections. Understanding the differences can aid in identifying high-risk areas and developing public health strategies for infection prevention. Further research is needed to address causal relationships.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopedic, Saku General Hospital Saku Medical Center, Nagano, Japan
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinya Tsuzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Satoshi Kutsuna
- Department of Infection Control and Prevention, Graduate School of Medicine, Faculty of Medicine, Osaka University, Osaka, Japan
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4
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Chatterjee S, Kim CM, Kim DM, Seo JW, Kim DY, Yun NR, Jung SI, Kim UJ, Kim SE, Kim HA, Kim ES, Hur J, Kim YK, Jeong HW, Heo JY, Jung DS, Lee H, Park SH, Kwak YG, Lee S, Chatterjee RP. Coinfection With Severe Fever With Thrombocytopenia Syndrome and Scrub Typhus in Korea. Open Forum Infect Dis 2023; 10:ofad377. [PMID: 37854108 PMCID: PMC10580145 DOI: 10.1093/ofid/ofad377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Indexed: 10/20/2023] Open
Abstract
Background Scrub typhus and severe fever with thrombocytopenia syndrome (SFTS) are the 2 most common tick-borne infectious diseases in Korea. Every year, an increasing number of cases are reported, which is a public health concern. Therefore, we aimed to investigate the prevalence of SFTS-scrub typhus coinfection in patients with SFTS. Methods Clinical samples were collected from 129 patients with SFTS. One-step reverse-transcription polymerase chain reaction (PCR) was performed to identify the SFTS virus (SFTSV), and real-time PCR followed by nested PCR was performed to detect the Orientia tsutsugamushi gene for scrub typhus. Phylogenetic analysis was conducted to confirm the evolutionary relationships among different species. Results Among 129 SFTS cases, 2 patients with SFTSV were positive for O. tsutsugamushi with a prevalence of coinfection of 1.6% (95% confidence interval, .001-.06). Phylogenetic analysis confirmed these as O. tsutsugamushi strain Boryong. Conclusions Our study found that 1.6% of patients were coinfected with SFTS and scrub typhus infection. We believe that this information will add a new dimension to clinical diagnosis, which should be considered for better public health management. Further research is needed to better understand the ecological transmission dynamics and geographical distribution of SFTSV and O. tsutsugamushi in endemic countries.
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Affiliation(s)
- Shilpa Chatterjee
- Department of Biomedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Choon-Me Kim
- Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Jun-Won Seo
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Da Young Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Na-Ra Yun
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Sook In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Uh Jin Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong Eun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyun ah Kim
- Division of Infectious Diseases, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Young Keun Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Hye Won Jeong
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jung Yeon Heo
- Department of Infectious Diseases, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Dong Sik Jung
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Hyungdon Lee
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Sujin Lee
- Department of Internal Medicine, College of Medicine, Pusan National University, Yangsan, Republic of Korea
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5
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Rattanakomol P, Khongwichit S, Linsuwanon P, Lee KH, Vongpunsawad S, Poovorawan Y. Severe Fever with Thrombocytopenia Syndrome Virus Infection, Thailand, 2019-2020. Emerg Infect Dis 2022; 28:2572-2574. [PMID: 36418010 PMCID: PMC9707585 DOI: 10.3201/eid2812.221183] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Infection with severe fever with thrombocytopenia syndrome (SFTS) virus, which can cause hemorrhagic febrile illness, is often transmitted by ticks. We identified 3 patients with SFTS in or near Bangkok, Thailand. Our results underscore a need for heightened awareness by clinicians of possible SFTS virus, even in urban centers.
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Gu XL, Su WQ, Zhou CM, Fang LZ, Zhu K, Ma DQ, Jiang FC, Li ZM, Li D, Duan SH, Peng QM, Wang R, Jiang Y, Han HJ, Yu XJ. SFTSV infection in rodents and their ectoparasitic chiggers. PLoS Negl Trop Dis 2022; 16:e0010698. [PMID: 36037170 PMCID: PMC9423666 DOI: 10.1371/journal.pntd.0010698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/25/2022] [Indexed: 11/19/2022] Open
Abstract
SFTSV, a tick-borne bunyavirus causing a severe hemorrhagic fever termed as severe fever with thrombocytopenia syndrome (SFTS). To evaluate the potential role of rodents and its ectoparasitic chiggers in the transmission of SFTSV, we collected wild rodents and chiggers on their bodies from a rural area in Qingdao City, Shandong Province, China in September 2020. PCR amplification of the M and L segments of SFTSV showed that 32.3% (10/31) of rodents and 0.2% (1/564) of chiggers (Leptotrombidium deliense) from the rodents were positive to SFTSV. Our results suggested that rodents and chiggers may play an important role in the transmission of SFTSV, although the efficiency of chiggers to transmit SFTSV needs to be further investigated experimentally.
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Affiliation(s)
- Xiao-Lan Gu
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Wen-Qing Su
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Chuan-Min Zhou
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Li-Zhu Fang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Ke Zhu
- Qingdao West Coast New District Center for Disease Control and Prevention, Qingdao, China
| | - Dong-Qiang Ma
- Qingdao West Coast New District Center for Disease Control and Prevention, Qingdao, China
| | - Fa-Chun Jiang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Ze-Min Li
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Dan Li
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Shu-Hui Duan
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Qiu-Ming Peng
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Rui Wang
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Yuan Jiang
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
| | - Hui-Ju Han
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji’nan, China
- * E-mail: (H-JH); (X-JY)
| | - Xue-Jie Yu
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan, China
- * E-mail: (H-JH); (X-JY)
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7
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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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Kirino Y, Yamamoto S, Nomachi T, Mai TN, Sato Y, Sudaryatma PE, Norimine J, Fujii Y, Ando S, Okabayashi T. Serological and molecular survey of tick-borne zoonotic pathogens including severe fever with thrombocytopenia syndrome virus in wild boars in Miyazaki Prefecture, Japan. Vet Med Sci 2021; 8:877-885. [PMID: 34953052 PMCID: PMC8959263 DOI: 10.1002/vms3.696] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Miyazaki Prefecture is one of the hotspots of severe fever with thrombocytopenia syndrome (SFTS) cases and related deaths in Japan since 2013 and other pathogens of tick‐borne diseases (TBDs). Japanese spotted fever and scrub typhus are also endemic in this region. Objectives A total of 105 wild boars, hunted in 2009, were serologically examined as sentinels for TBDs to indirectly demonstrate the potential hazard of ticks transmitting pathogens to humans in the studied area. Methods The collected blood and spleens of the wild boars underwent serological and molecular tests for SFTSV, Rickettsia japonica (Rj) [antibody to spotted fever group rickettsiae (SFGR) were tested by using species‐common antigen], and Orientia tsutsugamushi (Ot). Results Seroprevalences of SFTSV, SFGR, and Ot were 41.9%, 29.5%, and 33.3%, respectively. SFTS viral RNA was identified in 7.6% of the sera, whereas DNA of Rj or Ot was not detected in any sample. In total, 43.8% of the boars possessed an infection history with SFTSV (viral gene and/or antibody). Of these, 23.8% had multiple‐infection history with SFGR and/or Ot. Conclusions The high prevalence of SFTSV in wild boars might reflect the high risk of exposure to the virus in the studied areas. In addition, SFTSV infection was significantly correlated with Ot infection, and so were SFGR infection and Ot infection, indicating that these pathogens have common factors for infection or transmission. These data caution of the higher risk of SFTSV infection in areas with reported cases of other TBDs.
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Affiliation(s)
- Yumi Kirino
- Department of Veterinary Science, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan.,Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan
| | - Seigo Yamamoto
- Department of Microbiology, Miyazaki Prefectural Institute for Public Health and Environment, Miyazaki, Japan
| | - Taro Nomachi
- Department of Microbiology, Miyazaki Prefectural Institute for Public Health and Environment, Miyazaki, Japan
| | - Thi Ngan Mai
- Department of Veterinary Science, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan.,Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yukiko Sato
- Department of Veterinary Science, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Putu Eka Sudaryatma
- Department of Veterinary Science, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan.,Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
| | - Junzo Norimine
- Department of Veterinary Science, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan.,Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan.,Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yoshinori Fujii
- Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan.,Faculty of Education, University of Miyazaki, Miyazaki, Japan
| | - Shuji Ando
- Department of Virology I, National Institute of Infectious Diseases (NIID), Tokyo, Japan
| | - Tamaki Okabayashi
- Department of Veterinary Science, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan.,Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan.,Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
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9
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Ra SH, Kim JY, Cha HH, Kwon JS, Lee HJ, Jeon NY, Kim MJ, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH. Coinfection of Severe Fever with Thrombocytopenia Syndrome and Scrub Typhus in Patients with Tick-Borne Illness. Am J Trop Med Hyg 2020; 101:1259-1262. [PMID: 31549609 DOI: 10.4269/ajtmh.19-0242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) and scrub typhus are the most common tick-borne diseases in South Korea. However, few studies have systematically examined the simultaneous presence of the two diseases. We found that two (4.9%) of 41 patients with suspected and confirmed SFTS had evidence of coinfection with scrub typhus. In addition, two (3.6%) of 55 suspected and confirmed scrub typhus patients were identified to have coinfection with SFTS. Our data suggest that diagnostic evaluation for coinfection in patients with tick-borne illness and empirical doxycycline treatment in patients with SFTS may be warranted in areas endemic for both diseases until coinfection with scrub typhus is ruled out.
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Affiliation(s)
- Sang Hyun Ra
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Yeun Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye Hee Cha
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Soo Kwon
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Na Young Jeon
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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10
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Heo DH, Kang YM, Song KH, Seo JW, Kim JH, Chun JY, Jun KI, Kang CK, Moon SM, Choe PG, Park WB, Bang JH, Kim ES, Kim HB, Park SW, Oh WS, Kim NJ, Oh MD. Clinical Score System to Differentiate Severe Fever with Thrombocytopenia Syndrome Patients from Patients with Scrub Typhus or Hemorrhagic Fever with Renal Syndrome in Korea. J Korean Med Sci 2020; 35:e77. [PMID: 32193903 PMCID: PMC7086083 DOI: 10.3346/jkms.2020.35.e77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/21/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high mortality in East Asia. This study aimed to develop, for primary care providers, a prediction score using initial symptoms and basic laboratory blood tests to differentiate between SFTS and other endemic zoonoses in Korea. METHODS Patients aged ≥ 18 years diagnosed with endemic zoonoses during a 3-year period (between January 2015 and December 2017) were retrospectively enrolled from 4 tertiary university hospitals. A prediction score was built based on multivariate logistic regression analyses. RESULTS Of 84 patients, 35 with SFTS and 49 with other endemic zoonoses were enrolled. In multivariate logistic regression analysis, independent predictors of SFTS included neurologic symptoms (odds ratio [OR], 12.915; 95% confidence interval [CI], 2.173-76.747), diarrhea (OR, 10.306; 95% CI, 1.588-66.895), leukopenia (< 4,000/mm³) (OR, 19.400; 95% CI, 3.290-114.408), and normal C-reactive protein (< 0.5 mg/dL) (OR, 24.739; 95% CI, 1.812-337.742). We set up a prediction score by assigning one point to each of these four predictors. A score of ≥ 2 had 82.9% sensitivity (95% CI, 71.7%-87.5%) and 95.9% specificity (95% CI, 88.0%-99.2%). The area under the curve of the clinical prediction score was 0.950 (95% CI, 0.903-0.997). CONCLUSION This study finding suggests a simple and useful scoring system to predict SFTS in patients with endemic zoonoses. We expect this strategic approach to facilitate early differentiation of SFTS from other endemic zoonoses, especially by primary care providers, and to improve the clinical outcomes.
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Affiliation(s)
- Dae Hyuk Heo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yu Min Kang
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyoung Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Jun Won Seo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Han Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - June Young Chun
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kang Il Jun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Song Mi Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Won Sup Oh
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Myoung Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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11
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Thi Hai Yen N, Kim C, Jeong S, Jeon K, Choi H, Ro HJ, Kim HI, Kim Y, Kang JG, Park D, Choi MS, Lee KH, Cho NH. Severe Fever with Thrombocytopenia Syndrome Virus Infection or Mixed Infection with Scrub Typhus in South Korea in 2000-2003. Am J Trop Med Hyg 2020; 101:1096-1099. [PMID: 31482787 DOI: 10.4269/ajtmh.19-0392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome is a tick-borne viral disease, with a high mortality rate that was first reported in China in 2009. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, a bacterium transmitted to humans through chigger mite bites. Severe fever with thrombocytopenia syndrome and scrub typhus are endemic to South Korea. To investigate evidence of severe fever with thrombocytopenia syndrome virus (SFTSV) infection or mixed infection with scrub typhus in South Korea, we examined 2,329 sera samples collected from patients presenting from November 1, 2000, to November 1, 2003, for the diagnosis of rickettisal diseases at Seoul National University, Seoul, South Korea. We found retrospective evidence of SFTSV infection or mixed infection with scrub typhus in South Korea in 2000-2003. Severe fever with thrombocytopenia syndrome virus infections in South Korea occurred before previously reported cases and were more concurrent with those in China. It is important to consider SFTSV infection in patients with scrub typhus.
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Affiliation(s)
- Nguyen Thi Hai Yen
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Chaewon Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Seonyoung Jeong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyeongseok Jeon
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Hooncheol Choi
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Jin Ro
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Hong-Il Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Yuri Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Endemic Disease, Seoul National University Medical Research Center and Bundang Hospital, Seoul, South Korea
| | - Jun-Gu Kang
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Endemic Disease, Seoul National University Medical Research Center and Bundang Hospital, Seoul, South Korea
| | - Dahee Park
- Department of Microbiology and Immunology, College of Medicine, Jeju National University, Jeju, South Korea
| | - Myung-Sik Choi
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun Hwa Lee
- Department of Microbiology and Immunology, College of Medicine, Jeju National University, Jeju, South Korea
| | - Nam-Hyuk Cho
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Endemic Disease, Seoul National University Medical Research Center and Bundang Hospital, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
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12
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Kim JH, Lee CS, Moon C, Kwak YG, Kim BN, Kim ES, Kang JM, Park WB, Oh MD, Park SW. Co-Infection of Scrub Typhus and Human Granulocytic Anaplasmosis in Korea, 2006. J Korean Med Sci 2019; 34:e257. [PMID: 31602827 PMCID: PMC6786965 DOI: 10.3346/jkms.2019.34.e257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/22/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Scrub typhus, severe fever with thrombocytopenia syndrome (SFTS) and human granulocytic anaplasmosis (HGA) are important arthropod-borne infectious diseases in Korea and share a common point that they are transmitted by arthropod bites mostly during outdoor activities and there are considerable overlaps of epidemiologic and clinical features at presentation. We investigated the co-infection of these infections. METHODS The study subjects were patients with laboratory-confirmed scrub typhus who were enrolled retrospectively in 2006. SFTS virus (SFTSV) infection was confirmed by a reverse transcriptase polymerase chain reaction (PCR) to amplify partial L segment of SFTSV for molecular diagnosis. HGA was confirmed by a nested PCR to amplify 16S rRNA gene of Anaplasma phagocytophilum. Direct sequencing of the positive PCR products was performed. Clinical features of co-infected subjects were described. RESULTS One-hundred sixty-seven patients with scrub typhus were included in the analysis. Co-infection of A. phagocytophilum was identified in 4.2% of scrub typhus patients (7/167). The route of co-infection was uncertain. The co-infected patients had not different clinical manifestations compared to the patients with scrub typhus only. All the study subjects were negative for SFTSV. CONCLUSION We found retrospective molecular evidence of the co-infection of scrub typhus and HGA in Korea. HGA may be more prevalent than expected and need to be considered as an important differential diagnosis of febrile patients in Korea.
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Affiliation(s)
- Jeong Han Kim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Seop Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Chisook Moon
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Baek Nam Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Myung Kang
- Department of Internal Medicine, Pohang St. Mary's Hospital, Pohang, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Won Park
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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13
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Kim MC, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH. Differentiation of Severe Fever With Thrombocytopenia Syndrome From Scrub Typhus. Clin Infect Dis 2019; 66:1621-1624. [PMID: 29293899 DOI: 10.1093/cid/cix1119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
We developed a scoring system to differentiate severe fever with thrombocytopenia syndrome (SFTS) in 21 patients with SFTS and 91 with scrub typhus; it provided 100% sensitivity and 97% specificity (score > 1). Criteria included altered mental status, leukopenia, prolonged activated partial thromboplastin time, and normal C-reactive protein (1-point each).
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Affiliation(s)
- Min-Chul Kim
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan.,Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, College of Medicine, University of Ulsan
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14
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Trung NV, Hoi LT, Cuong DD, Ha DT, Hoa TM, Lien VN, Hoa NT, Hoa LNM, Huong DT, Bich VTN, van Doorn HR, Nadjm B, Richards AL. Analysis of the 56-kDa type specific antigen gene of Orientia tsutsugamushi from northern Vietnam. PLoS One 2019; 14:e0221588. [PMID: 31469878 PMCID: PMC6716651 DOI: 10.1371/journal.pone.0221588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022] Open
Abstract
Scrub typhus has been documented since 1932 in Vietnam, however, the disease burden of scrub typhus remains poorly understood in the country. We conducted this study to describe the phylogenetic analysis of the 56-kDa type-specific antigen (TSA) gene of Orientia tsutsugamushi associated with PCR positive cases of scrub typhus. Of 116 positive samples, 65 type-specific antigen gene sequences were obtained and classified into 3 genogroups: Karp, Kato and Gilliam. The Karp genogroup was the most frequently detected phylogenetic cluster in the study with 30 samples (46%), followed by Kato and Gilliam with 20 (31%) and 15 (23%), respectively. All sequences showed 94–100% nucleotide similarity to reference sequences collected in the central part of Vietnam in 2017. Patients infected with Karp genogroup were more likely to have significant thrombocytopenia than the other genogroups. These results suggest that any scrub typhus vaccine considered for use in Vietnam should provide protection against each of these 3 genogroups.
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Affiliation(s)
- Nguyen Vu Trung
- National Hospital for Tropical Diseases, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | - Le Thi Hoi
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | | | - Tran Mai Hoa
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Vu Ngoc Lien
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | | | | | - Vu Thi Ngoc Bich
- Oxford University Clinical Research Unit, Wellcome Trust Asia Program, Hanoi, Vietnam
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Wellcome Trust Asia Program, Hanoi, Vietnam
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Wellcome Trust Asia Program, Hanoi, Vietnam
| | - Allen L. Richards
- Naval Medical Research Center, Silver Spring, Maryland, United States of America
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- * E-mail:
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15
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Kim YR, Yun Y, Bae SG, Park D, Kim S, Lee JM, Cho NH, Kim YS, Lee KH. Severe Fever with Thrombocytopenia Syndrome Virus Infection, South Korea, 2010. Emerg Infect Dis 2019; 24:2103-2105. [PMID: 30334706 PMCID: PMC6199997 DOI: 10.3201/eid2411.170756] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) was reported in China in 2009 and in South Korea in 2012. We found retrospective evidence of SFTS virus infection in South Korea in 2010, suggesting that infections in South Korea occurred before previously reported and were more concurrent with those in China.
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16
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Mahdi AS, Al-Khalili SM, Chung CC, Molai M, Ibrahim H, Eskild P, Khamis F, Nenad P. Scrub Typhus Complicated by ARDS, Myocarditis, and Encephalitis Imported to Oman from Nepal. Oman Med J 2019; 34:254-256. [PMID: 31110635 PMCID: PMC6505338 DOI: 10.5001/omj.2019.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Scrub typhus is a potentially fatal rickettsial infection caused by Orientia tsutsugamushi. It is an obligate intracellular Gram-negative bacterium transmitted by the bite of infected chigger larva. The disease is distributed from Asia to the Pacific islands, and this region is known as the Tsutsugamushi Triangle. A 28-year-old man was admitted to the Royal Hospital with a four-day history of fever, headache, rigors, anorexia, and a nonspecific macular rash. Clinical presentation, laboratory results as well as epidemiological data indicated that this might be a case of scrub typhus. Additional serology tests confirmed the presumed diagnosis, and the patient was successfully treated with empirical therapy. Untreated scrub typhus has high mortality and early diagnosis and adequate treatment can prevent the potentially fatal outcome of the disease.
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Affiliation(s)
- Asmaa Sabr Mahdi
- Infectious Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman
| | | | - Chao Chien Chung
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland, United States
| | - Mariya Molai
- Infectious Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman
| | - Hashim Ibrahim
- Infectious Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman
| | - Petersen Eskild
- Infectious Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman
| | - Faryal Khamis
- Infectious Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman
| | - Pandak Nenad
- Infectious Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman
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17
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Park SW, Lee CS, Kim JH, Bae IG, Moon C, Kwak YG, Kim BN, Lee JH, Ryu SY, Jang HC, Hur J, Jun JB, Jung Y, Chang HH, Kim YK, Hwang JH, Kim YS, Jeong HW, Song KH, Park WB, Kim ES, Oh MD. Severe fever with thrombocytopenia syndrome: comparison with scrub typhus and clinical diagnostic prediction. BMC Infect Dis 2019; 19:174. [PMID: 30782137 PMCID: PMC6381645 DOI: 10.1186/s12879-019-3773-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/01/2019] [Indexed: 01/21/2023] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes. Methods Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus. Results The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm3; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm3; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1% (95% confidence interval [CI], 87.9–96.4%) and a specificity of 96.1% (95% CI, 93.8–97.6%) for SFTS. Conclusion This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings.
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Affiliation(s)
- Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea.,Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jeong-Han Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea
| | - In-Gyu Bae
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Chisook Moon
- Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - Baek-Nam Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - Jae Hoon Lee
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jae-Bum Jun
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Younghee Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Yeon-Sook Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, the Republic of Korea.
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18
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Yoo JR, Heo ST, Kang JH, Park D, Kim JS, Bae JH, Woo JJ, Kim S, Lee KH. Mixed Infection with Severe Fever with Thrombocytopenia Syndrome Virus and Two Genotypes of Scrub Typhus in a Patient, South Korea, 2017. Am J Trop Med Hyg 2018; 99:287-290. [PMID: 29943715 DOI: 10.4269/ajtmh.18-0088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne viral disease with a high mortality rate. Infection can also occur through close contact with an infected patient. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, a bacterium transmitted to humans through chigger mite bites. South Korea is an endemic region of SFTS and scrub typhus. In this study, we confirmed that a patient was coinfected with SFTS virus and two (Boryong and Taguchi) genotypes of O. tsutsugamushi.
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Affiliation(s)
- Jeong Rae Yoo
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
| | - Sang Taek Heo
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
| | - Ji-Hoon Kang
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
| | - Dahee Park
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
| | - Jeong Soon Kim
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
| | - Jeong Hoon Bae
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
| | - Jong Jin Woo
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
| | - Suhyun Kim
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
| | - Keun Hwa Lee
- Department of Microbiology and Immunology, Jeju National University College of Medicine, Jeju, South Korea
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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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