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Kumaraswamy J, Govindasamy P, Nagarajan LS, Gunasekaran K, Abhilash KPP, Prakash JAJ. Genotyping of Orientia tsutsugamushi circulating in and around Vellore (South India) using TSA 56 gene. Indian J Med Microbiol 2024; 47:100483. [PMID: 37890413 DOI: 10.1016/j.ijmmb.2023.100483] [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: 05/11/2023] [Revised: 08/05/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE The immunodominant TSA 56 gene of Orientia tsutsugamushi, (scrub typhus agent) has four variable regions (VD-I to VD-IV) making it useful for genotyping. This study was undertaken to determine Orientia tsutsugamushi genotypes circulating in and around Vellore using complete and partial TSA 56 gene. METHODS Of the 162 patients positive by 47 kDa qPCR, on 21 samples PCR to amplify the complete TSA 56 gene (≈1605 bp: Long protocol) and the partial gene sequence using the Horinouchi (≈650bp) and the Furuya (≈480 bp) protocol was performed. Sanger and Nanopore sequencing was performed to obtain sequence data for assigning genotype. For 13 amplicons partial and complete gene data was obtained. RESULTS Phylogenetic analysis of the complete gene (Long protocol) which includes VD-I to VD-IV region and partial gene (Horinouchi) which amplifies the VD-I to VD-III regions showed identical genotypes. Twelve belonged to TA763 genotype and one belongs to Karp genotype. The Furuya sequence (in silico) correctly identified the Karp genotype and 10 of the TA763 genotypes. Two TA763 genotypes (identified by complete and 650 bp partial gene analysis) were misidentified by Furuya sequence analysis as Karp genotype. CONCLUSIONS Analysis of the 13 complete 56 kDa gene sequences suggests that TA763 is the commonest genotype in Vellore. Sanger sequencing of the 650 bp fragment gives similar results. However, these results need to be validated by larger prospective multi-centric studies.
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Affiliation(s)
- Janaki Kumaraswamy
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Punitha Govindasamy
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Lakshmi Surya Nagarajan
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - Karthik Gunasekaran
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
| | - K P P Abhilash
- Emergency Medicine, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
| | - John Antony Jude Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
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Bhardwaj P, Behera SP, Nanaware N, Zaman K, Deval H, Kant R, Kulkarni S, Kumar R, Dwivedi GR, Singh R. Phylogenetic and immunological investigations of complete TSA56 ORF of Orientia tsutsugamushi present in acute encephalitis syndrome cases from eastern Uttar Pradesh, India. Arch Microbiol 2023; 205:178. [PMID: 37029825 PMCID: PMC10082565 DOI: 10.1007/s00203-023-03492-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
Scrub typhus (ST) caused by Orientia tsutsugamushi (OT), has long been known to cause acute encephalitis syndrome (AES) and acute febrile illness (AFI). The immunodominant 56 kDa protein of OT, which is encoded by the 56 kDa gene (1600 bp encoding 516-541 amino acids) is a commonly studied antigen for genotype and serotype assignment. Previous studies from India have utilized partial type specific antigen (TSA) 56 kDa sequences for OT strain characterisation. On the other hand, understanding the antigenic diversity of current OT strains, is critical for developing specific diagnostic tests and vaccines against ST. As a result, the current study analyses antigenic variants using the entire TSA56 ORF of OT from AES cases. Phylogenetic investigation using complete TSA56 ORF sequences revealed Karp and Gilliam were the circulating predominant strains of OT. Furthermore, Immuno-informatical analysis demonstrated that the majority of high-binding affinity CD4 TCEs against the most prevalent Indian human leukocyte antigen alleles were present in the S-VDIII/IV and S-VDIV spacer regions of TSA56 ORF. TSA56 conserved spacer is crucial for OT immunological response investigations. Further, the pathophysiological effects of spacer domains in ST require further investigation. Furthermore, the characterization of the TSA56 spacer region of the OT from different parts of India is critical for developing region-specific ST diagnostic assays and vaccines.
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Affiliation(s)
- Pooja Bhardwaj
- ICMR-Regional Medical Research Centre, BRD Medical College Campus, Gorakhpur, 273013, India
| | - Sthita Pragnya Behera
- ICMR-Regional Medical Research Centre, BRD Medical College Campus, Gorakhpur, 273013, India
| | - Nikita Nanaware
- ICMR-National AIDS Research Institute, Bhosari, Pune, 411026, India
| | - Kamran Zaman
- ICMR-Regional Medical Research Centre, BRD Medical College Campus, Gorakhpur, 273013, India
- ICMR-National Institute of Traditional Medicine, Belagavi, Karnatka, India
| | - Hirawati Deval
- ICMR-Regional Medical Research Centre, BRD Medical College Campus, Gorakhpur, 273013, India
| | - Rajni Kant
- ICMR-Regional Medical Research Centre, BRD Medical College Campus, Gorakhpur, 273013, India
| | - Smita Kulkarni
- ICMR-National AIDS Research Institute, Bhosari, Pune, 411026, India
| | - Rajesh Kumar
- RGSC, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India
| | - Gaurav Raj Dwivedi
- ICMR-Regional Medical Research Centre, BRD Medical College Campus, Gorakhpur, 273013, India
| | - Rajeev Singh
- ICMR-Regional Medical Research Centre, BRD Medical College Campus, Gorakhpur, 273013, India.
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Chen HF, Peng SH, Tsai KH, Yang CF, Chang MC, Hsueh YL, Su CL, Wang RY, Shu PY, Yang SL. Molecular epidemiology of scrub typhus in Taiwan during 2006-2016. PLoS Negl Trop Dis 2022; 16:e0010369. [PMID: 35486655 PMCID: PMC9094550 DOI: 10.1371/journal.pntd.0010369] [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: 11/07/2021] [Revised: 05/11/2022] [Accepted: 03/29/2022] [Indexed: 12/31/2022] Open
Abstract
Scrub typhus is the most common endemic vector-borne disease in Taiwan. We identified a total of 4,857 laboratory-confirmed cases during 2006-2016 with hyperendemic foci on offshore islands, including Penghu (778 cases, 16.0%) and Kinmen (716 cases, 14.7%), and eastern Taiwan, including Taitung (628 cases, 12.9%) and Hualien (508 cases, 10.5%). Scrub typhus cases occur year-round throughout Taiwan, with a summer peak in June and July. A total of 545 O. tsutsugamushi isolates were successfully obtained from patients infected in diverse geographic areas, including Taiwan and three offshore islands, and the complete open reading frame of the 56 kDa type-specific antigen gene (tsa56) sequence of these isolates was examined. High phylogenetic diversity was found in these isolates, which could be grouped into 36 distinct sequence types. Most isolates belonged to the Karp (49.9%; 272/545), followed by the TW-22 (17.8%; 97/454) and Kawasaki (14.7%; 80/545) genotypes. In conclusion, our data indicate the widespread presence of tsa56 genotypes closely related to Thailand and Korean strains and the presence of the unique endemic strains TW-12, TW-22, TW-29, and TW-36 in Taiwan.
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Affiliation(s)
- Hsiang-Fei Chen
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Shih-Huan Peng
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Kun-Hsien Tsai
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Republic of China
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Republic of China
| | - Cheng-Fen Yang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Mei-Chun Chang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Yeou-Lin Hsueh
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Chien-Ling Su
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Ruo-Yu Wang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
| | - Pei-Yun Shu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
- * E-mail: (P-YS); (S-LY)
| | - Su-Lin Yang
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan, Republic of China
- * E-mail: (P-YS); (S-LY)
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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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Heo JY, Choi YW, Kim EJ, Lee SH, Lim SK, Hwang SD, Lee JY, Jeong HW. Clinical characteristics of acute Q fever patients in South Korea and time from symptom onset to serologic diagnosis. BMC Infect Dis 2019; 19:903. [PMID: 31660875 PMCID: PMC6819606 DOI: 10.1186/s12879-019-4479-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 09/13/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Acute Q fever usually presents as a nonspecific febrile illness, and its occurrence is rapidly increasing in South Korea. This study investigated the clinical characteristics of acute Q fever patients in South Korea and the time from symptom onset to serologic diagnosis. The clinical courses were examined according to antibiotic treatment. METHODS Data of patients diagnosed with acute Q fever at Chungbuk National University Hospital between January 2015 and February 2018 were retrospectively collected. Demographic and epidemiologic data were reviewed. The time from symptom onset to serologic diagnosis by an immunofluorescence assay (IFA) was analyzed. Clinical courses and the percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) were compared between patients administered antibiotics with anti-Coxiella burnetii activity and patients not administered such antibiotics. RESULTS Forty-eight patients (median age: 51.5 years) were included. Most were male (95.8%) and had no history of animal contact (91.7%). The median time from illness onset to serologic diagnosis was 21 days. Thirty-nine patients received antibiotics with anti-C. burnetii activity. The length of hospital stay and fever duration did not significantly differ between patients who received antibiotics with anti-C. burnetii activity (7 and 15 days) and those who did not (5 and 8 days) (P = 0.110 and P = 0.137, respectively). The percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) did not significantly differ between patients who received antibiotics with anti-C. burnetii activity and those who did not (P = 0.340). CONCLUSIONS Most acute Q fever patients had a nonspecific febrile illness with mild elevation of transaminases and no history of animal contact or occupational risk. The time from symptom onset to a positive IFA test was longer than the fever duration in most acute Q fever patients. Consequently, it may be difficult for clinicians to serologically diagnose acute Q fever. However, inappropriate antibiotic treatment was not associated with prolongation of symptoms or progression to chronic Q fever.
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Affiliation(s)
- Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Wha Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eun Jin Kim
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seung Hun Lee
- Division of Bacterial Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Republic of Korea.,Yeosu National Quarantine Office, Korea Centers for Disease Control and Prevention, Yeosu, Republic of Korea
| | - Seung Kwan Lim
- Department of Internal Medicine, Gyeonggi Provincial Medical Center Ansung Hospital, Ansung, Republic of Korea
| | - Seon Do Hwang
- Division of Bacterial Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea
| | - Ju Young Lee
- Department of Internal Medicine, Sam Anyang Hospital, Anyang, Republic of Korea
| | - Hye Won Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea. .,Department of Internal Medicine, Chungbuk National University College of Medicine, Chungdae-Ro 1, Seowon-Gu, Cheongju, Chungbuk, 28644, Republic of Korea.
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Weitzel T, Aylwin M, Martínez-Valdebenito C, Jiang J, Munita JM, Thompson L, Abarca K, Richards AL. Imported scrub typhus: first case in South America and review of the literature. Trop Dis Travel Med Vaccines 2018; 4:10. [PMID: 30140442 PMCID: PMC6097283 DOI: 10.1186/s40794-018-0070-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scrub typhus is a neglected vector-borne zoonosis causing life-threatening illnesses, endemic in the Asian-Pacific region and, as recently discovered, in southern Chile. Scrub typhus is rarely reported in travelers, most probably due to the lack of clinical experience and diagnostic tests in non-endemic countries. We report the first case of imported scrub typhus in South America. CASE PRESENTATION A 62-year-old tourist from South Korea presented severely ill with fever, rash, and eschar in Santiago, Chile. Laboratory exams showed thrombocytopenia and elevated inflammation parameters, hepatic enzymes, and LDH. With the clinical suspicion of scrub typhus, empirical treatment with doxycycline was initiated and the patient recovered rapidly and without complications. The diagnosis was confirmed by IgM serology and by real-time PCR, which demonstrated infection with Orientia tsutsugamushi (Kawasaki clade). CONCLUSIONS Only due to the emerging clinical experience with endemic South American scrub typhus and the recent implementation of appropriate diagnostic techniques in Chile, were we able to firstly identify and adequately manage a severe case of imported scrub typhus in South America. Physicians attending febrile travelers need to be aware of this rickettsiosis, since it requires prompt treatment with doxycycline to avoid complications.
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Affiliation(s)
- Thomas Weitzel
- Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av. Vitacura, 5951 Santiago, Chile
- Servicio de Infectología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Mabel Aylwin
- Servicio de Infectología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Constanza Martínez-Valdebenito
- Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ju Jiang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD USA
| | - Jose Manuel Munita
- Servicio de Infectología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Luis Thompson
- Servicio de Infectología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Katia Abarca
- Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Allen L. Richards
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD USA
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA
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Luce-Fedrow A, Lehman ML, Kelly DJ, Mullins K, Maina AN, Stewart RL, Ge H, John HS, Jiang J, Richards AL. A Review of Scrub Typhus (Orientia tsutsugamushi and Related Organisms): Then, Now, and Tomorrow. Trop Med Infect Dis 2018; 3:E8. [PMID: 30274407 PMCID: PMC6136631 DOI: 10.3390/tropicalmed3010008] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 12/26/2022] Open
Abstract
Scrub typhus and the rickettsial diseases represent some of the oldest recognized vector-transmitted diseases, fraught with a rich historical aspect, particularly as applied to military/wartime situations. The vectors of Orientia tsutsugamushi were once thought to be confined to an area designated as the Tsutsugamushi Triangle. However, recent reports of scrub typhus caused by Orientia species other than O. tsutsugamushi well beyond the limits of the Tsutsugamushi Triangle have triggered concerns about the worldwide presence of scrub typhus. It is not known whether the vectors of O. tsutsugamushi will be the same for the new Orientia species, and this should be a consideration during outbreak/surveillance investigations. Additionally, concerns surrounding the antibiotic resistance of O. tsutsugamushi have led to considerations for the amendment of treatment protocols, and the need for enhanced public health awareness in both the civilian and medical professional communities. In this review, we discuss the history, outbreaks, antibiotic resistance, and burgeoning genomic advances associated with one of the world's oldest recognized vector-borne pathogens, O. tsutsugamushi.
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Affiliation(s)
- Alison Luce-Fedrow
- Department of Biology, Shippensburg University, Shippensburg, PA 17202, USA.
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA.
| | - Marcie L Lehman
- Department of Biology, Shippensburg University, Shippensburg, PA 17202, USA.
| | - Daryl J Kelly
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA.
- Department of Evolution, Ecology and Organismal Biology, The Ohio State University, Columbus, OH 43210, USA.
| | - Kristin Mullins
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA.
| | - Alice N Maina
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA.
| | - Richard L Stewart
- Department of Biology, Shippensburg University, Shippensburg, PA 17202, USA.
| | - Hong Ge
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA.
| | - Heidi St John
- 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.
| | - 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.
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Park JW, Kim SH, Park DW, Jung SH, Park HJ, Seo MH, Song HJ, Lee JY, Kim DM, Kim CM, Gill BC, Jeong HJ, Lee JM, Ha DR, Kim ES, Chung JK. Molecular Epidemiology of an Orientia tsutsugamushi Gene Encoding a 56-kDa Type-Specific Antigen in Chiggers, Small Mammals, and Patients from the Southwest Region of Korea. Am J Trop Med Hyg 2018; 98:616-624. [PMID: 29313468 DOI: 10.4269/ajtmh.17-0070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A phylogenetic analysis of Orientia tsutsugamushi was performed to elucidate its antigenic diversity in chiggers, small mammals, and patients. Between September 2014 and December 2016, a total of 3,816 chiggers were identified within nine species of four genera in the southwest region of Korea: Leptotrombidium scutellare (49.9%; 1,907/3,816), Leptotrombidium orientale (21.1%; 804/3,816), Leptotrombidium pallidum (12.4%; 474/3,816), Euchoengastia koreaensis (7.2%; 273/3,816), Leptotrombidium palpale (6.7%; 256/3,816), Neotrombicular gardellai (1.3%; 50/3,816), Leptotrombidium zetum (0.8%; 32/3,816), Walchia fragilis (0.5%; 18/3,816), and Neotrombicular japonica (> 0.1%; 2/3,816). Twelve chiggers (11 L. scutellare and one L. palpale) tested positive for O. tsutsugamushi by polymerase chain reaction and, except for 1 chigger (KY266830), were part of the Boryong strain cluster. Of the 413 small mammals that were analyzed for O. tsutsugamushi, Apodemus agrarius was the most common rodent species (89.5%; 370/413), followed by Crocidura lasiura (6.8%; 28/413) and Myodes regulus (3.6%; 15/413). The sequence identity of an O. tsutsugamushi sample obtained from the A. agrarius sample population belonged to the Saitama strain cluster. Furthermore, a phylogenetic analysis in 125 patients revealed four clusters (Boryong cluster: 82.4% [103/125], Karp: 13.6% [17/125], Kawasaki: 3.2% [4/125], and Saitama: 0.8% [1/125]). This study clarified the phylogenetic relationship for O. tsutsugamushi in chiggers, small mammals, and patients. The Boryong strain was the most common strain in chiggers and patients. In addition, various strains were identified, except for the Boryong strain, in the southwest region of Korea. Overall, the data presented here will be helpful for the establishment of prevention strategies for scrub typhus.
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Affiliation(s)
- Jung Wook Park
- Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea
| | - Sun Hee Kim
- Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea
| | - Duck Woong Park
- Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea
| | - So Hyang Jung
- Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea
| | - Hye Jung Park
- Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea
| | - Mi Hee Seo
- Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea
| | - Hyeon Je Song
- Clinical Pathology, Gwangju Health University, Gwangju, Korea
| | - Jung Yoon Lee
- Clinical Pathology, Gwangju Health University, Gwangju, Korea
| | - Dong Min Kim
- Departments of Internal Medicine, School of Medicine, Chosun University, Gwangju, Korea
| | - Choon-Mee Kim
- Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Byong Chul Gill
- Division of Zoonoses, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Hang Jin Jeong
- Division of Zoonoses, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Jeong Min Lee
- Division of Zoonoses, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Dong Ryong Ha
- Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea
| | - Eun Sun Kim
- Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea
| | - Jae Keun Chung
- Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea
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Premaratna R, Blanton LS, Samaraweera DN, de Silva GNN, Chandrasena NTGA, Walker DH, de Silva HJ. Genotypic characterization of Orientia tsutsugamushi from patients in two geographical locations in Sri Lanka. BMC Infect Dis 2017; 17:67. [PMID: 28086810 PMCID: PMC5237229 DOI: 10.1186/s12879-016-2165-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To date more than 20 antigenically distinct strains of Orientia tsutsugamushi (OT) reported within the tsutsugamushi triangle that cause an undifferentiated acute febrile illness in humans. Genotypic characterization of OT in different geographic regions or within the same country, is important in order to establish effective diagnostics, clinical management and to develop effective vaccines. Genetic and antigenic characterization of OT causing human disease in OT-endemic regions is not known for Sri Lanka. METHODS Adult patients and children who were admitted with an acute febrile illness and presumed to having acute scrub typhus based on presence of an eschar and other supporting clinical features were recruited. Eschar biopsies and buffy coat samples collected from patients who were confirmed having OT by IFA were further studied by real time PCR (Orientia 47 kD) and nested PCR (Orientia 56 kD) amplification. DNA sequences were obtained for 56 kD gene amplicons and phylogenetic comparisons were analyzed using currently available data in GenBank [Neucleotide substitution per 100 residues, 1000 Bootstrap Trials]. RESULTS Twenty eschar biopsies (Location1,19, Location 2,1) and eight buffy coat samples (Location1,6, Location2,2) examined by real time PCR revealed Orientia amplicons in 16 samples. DNA sequences were obtained for the 56 kD gene amplicons in 12 eschars and 4 buffy coat samples. The genotypes of the Location1 samples revealed that, 7 exhibiting close homology with JP1 [distantly related to UT177 Thai (Karp related)], five had close homology with Kato strain, two had close homology with JGv and JG AF [Distantly related to Kawasaki M63383] and one had close homology with Gilliam strain. The Location 2 strain was closely related to Kuroki-Boryong L04956, the genotype which is distributed in far eastern Asia. Similar to other patients in the cohort this patient also had never travelled out of Sri Lanka. CONCLUSIONS We observed all three main OT genotypes in Sri Lanka, and the majority fell into Thai Karp related clade. These results demonstrate great antigenic diversity of OT in the studied areas of Sri Lanka.
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Affiliation(s)
- Ranjan Premaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, PO Box 6, Ragama, Sri Lanka.
| | - Lucas S Blanton
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | | | | | - Nilmini T G A Chandrasena
- Department of Parasitology, Faculty of Medicine, Universityof Kelaniya, Thalagolla Road, PO Box 6, Ragama, Sri Lanka
| | - David H Walker
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - H J de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, PO Box 6, Ragama, Sri Lanka
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10
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Wei Y, Ma Y, Luo L, Wu X, Huang Y, Li X, Yang Z. Differences in Clinical and Laboratory Features for Different Genotypes of Orientia tsutsugamushi in Guangzhou, Southern China. Vector Borne Zoonotic Dis 2017; 17:260-267. [PMID: 28055333 DOI: 10.1089/vbz.2016.2045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To describe the genotypes distribution of Orientia tsutsugamushi, in Guangzhou, and explore differences in clinical and laboratory features among genotypes. METHOD We collected blood or eschar samples of all scrub typhus cases reported in 2013 from 10 district hospitals positive for PCR. We further tested the PCR-positive samples for DNA sequencing and phylogenetic analysis. We collected the demographic, clinical, and laboratory data by questionnaire and medical records. RESULT A total of 589 samples were tested and 40 were PCR positive. Four genotypes were identified: Karp (52.2%), Kato (22.5%), Gilliam (12.5%), and TA763 (7.5%). Two new strains (ZCX90 and CHX5 strain) were previously unidentified in Guangzhou. Gilliam type cases were more likely to have continuous fever (60.0%). Only Kato genotype cases presented with splenomegaly. For laboratory features, Kato group had higher level of white blood cell count (16.44 × 1012/L) than normal range and other groups. Total bilirubin and direct bilirubin in Gilliam group (10.10 μM and 3.05 μM, respectively) were both lower than other groups and normal value. CONCLUSION Continuous fever and splenomegaly may be the distinctive symptom of Gilliam and Kato genotype cases, respectively. Karp genotype remained dominant in Guangzhou, but attention should be paid to the emergence of new types or variation of existing genotypes.
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Affiliation(s)
- Yuehong Wei
- Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Yu Ma
- Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Lei Luo
- Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Xinwei Wu
- Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Yong Huang
- Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Xiaoning Li
- Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention , Guangzhou, China
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11
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Yoo JR, Heo ST, Koh YS, Kim S, Kim S. Unusual genotypic distribution of Orientia tsutsugamushi strains causing human infections on Jeju Island. Am J Trop Med Hyg 2014; 90:507-10. [PMID: 24445200 DOI: 10.4269/ajtmh.13-0511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We investigated the clinical characteristics and serologic types of tsutsugamushi disease on the largest island of South Korea. There were 141 patients with tsutsugamushi disease at Jeju National University Hospital and Seogwipo Medical Center between November of 2003 and December of 2012. Median age of patients was 61 years, and 59% were women. The major clinical manifestations were fever (80.5%) and skin rash (55.7%), with eschars evident in 75.8% of the patients. Genotype analysis of Orientia tsutsugamushi was conducted in 33 specimens. The genotype was identified as Boryong type in 17 of 33 patients and Taguchi type in 15 of 33 patients. In our study, although the Taguchi genotype is rarely reported in the endemic area, it was common on Jeju Island. This genotype may be associated with mild and moderate forms of tsutsugamushi disease.
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Affiliation(s)
- Jeong Rae Yoo
- Division of Infectious Disease, Samsung Medical Center, Sungkynkwan University School of Medicine, Seoul, Republic of Korea; Departments of Internal Medicine, Microbiology, and Immunology, Jeju National University School of Medicine, Jeju, Republic of Korea; Department of Internal Medicine, Seogwipo Medical Center, Jeju, Republic of Korea
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12
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Kim MS, Baek JH, Lee JS, Chung MH, Lee SM, Kang JS. High In Vitro Infectivity of a Doxycycline-Insensitive Strain of Orientia tsutsugamushi. Infect Chemother 2013; 45:431-4. [PMID: 24475357 PMCID: PMC3902816 DOI: 10.3947/ic.2013.45.4.431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/11/2013] [Accepted: 08/14/2013] [Indexed: 11/24/2022] Open
Abstract
We compared the infectivity and growth rates of 12 strains of Orientia tsutsugamushi in a cell culture system. ECV304 cells were infected with O. tsutsugamushi strains for 4 hr, and the culture was maintained for 72 hr. Immunofluorescence (IF) staining was performed at 4, 24, 48, and 72 hr after inoculation (hpi), and IF-positive foci were enumerated. The AFSC-4 strain, which is known to be insensitive to doxycycline, showed higher numbers of IF-positive foci than the other 11 strains at 4, 24, 48, and 72 hpi, which may explain its apparent insensitivity to antibiotics.
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Affiliation(s)
- Min Su Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sun Myoung Lee
- Translation Research Center, Inha University School of Medicine, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University School of Medicine, Incheon, Korea
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13
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Varghese GM, Janardhanan J, Trowbridge P, Peter JV, Prakash JAJ, Sathyendra S, Thomas K, David TS, Kavitha ML, Abraham OC, Mathai D. Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome. Int J Infect Dis 2013; 17:e981-7. [PMID: 23891643 DOI: 10.1016/j.ijid.2013.05.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/20/2013] [Accepted: 05/20/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES This study sought to document the clinical and laboratory manifestations, genetic variability, and outcomes of scrub typhus, an often severe infection caused by Orientia tsutsugamushi, in South India. METHODS Patients admitted to a large teaching hospital with IgM ELISA-confirmed scrub typhus were evaluated. Clinical examination with a thorough search for an eschar, laboratory testing, chest X-ray, and outcome were documented and analyzed. Additionally, a 410-bp region of the 56-kDa type-specific antigen gene of O. tsutsugamushi was sequenced and compared with isolates from other regions of Asia. RESULTS Most of the 154 patients evaluated presented with fever and non-specific symptoms. An eschar was found in 86 (55%) patients. Mild hepatic involvement was seen in most, with other organ involvement including respiratory, cardiovascular, and renal. Multi-organ dysfunction was noted in 59 (38.3%), and the fatality rate was 7.8%. Hypotension requiring vasoactive agents was found to be an independent predictor of mortality (p<0.001). The phylogeny of 26 samples showed 17 (65%) clustering with the Kato-like group and eight (31%) with the Karp-like group. CONCLUSIONS The presentation of scrub typhus can be variable, often non-specific, but with potentially severe multi-organ dysfunction. Prompt recognition is key to specific treatment and good outcomes. Further study of the circulating strains is essential for the development of a successful vaccine and sensitive point-of-care testing.
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Affiliation(s)
- George M Varghese
- Medicine Unit I and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India.
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14
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Jang HC, Choi SM, Jang MO, Ahn JH, Kim UJ, Kang SJ, Shin JH, Choy HE, Jung SI, Park KH. Inappropriateness of quinolone in scrub typhus treatment due to gyrA mutation in Orientia tsutsugamushi Boryong strain. J Korean Med Sci 2013; 28:667-71. [PMID: 23678256 PMCID: PMC3653077 DOI: 10.3346/jkms.2013.28.5.667] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 02/27/2013] [Indexed: 12/25/2022] Open
Abstract
The use of quinolone for treatment of rickettsial diseases remains controversial. Recent clinical studies suggest that quinolone is not as effective as others in patients with rickettsial diseases including scrub typhus, although the mechanism is not well understood. In this study, we evaluated the mutation in gyrA associated with quinolone resistance. We prospectively enrolled scrub typhus patients, collected blood samples and clinical data from October, 2010 to November, 2011. Among the 21 patients enrolled, one initially received ciprofloxacin for 3 days but was switched to doxycycline due to clinical deterioration. We obtained the gyrA gene of Orientia tsutsugamushi from 21 samples (20 Boryong strain, 1 Kato strain) and sequenced the quinolone resistance-determining region. All of 21 samples had the Ser83Leu mutation in the gyrA gene, which is known to be associated with quinolone resistance. This suggests that quinolones may be avoided for the treatment of serious scrub typhus.
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Affiliation(s)
- Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Su-Mi Choi
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
- Research Institute of Medical Sciences, Chonnam National University, Gwangju, Korea
| | - Mi-Ok Jang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Joon-Hwan Ahn
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Uh-Jin Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Seung-Ji Kang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyon E Choy
- Department of Microbiology, Chonnam National University Medical School, Gwangju, Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
- Research Institute of Medical Sciences, Chonnam National University, Gwangju, Korea
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