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Qin H, Fu Y, Deng C, Chen Y, Huang K, Ruan Y, Liu K. The role of gut microbiota and the gut-lung axis in sepsis: A case study of a pregnant woman with severe rickettsial pneumonia and septic shock complicated by MODS. Clin Case Rep 2024; 12:e8815. [PMID: 38840756 PMCID: PMC11150134 DOI: 10.1002/ccr3.8815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/11/2024] [Accepted: 03/23/2024] [Indexed: 06/07/2024] Open
Abstract
Key Clinical Message In this case report, we describe the successful management of severe scrub typhus with pneumonia, sepsis, and multiple organ dysfunction in a pregnant woman. Despite initial challenges, the patient responded favorably to fecal microbiota transplantation and oral fecal microbiota capsule therapy. Abstract Scrub typhus, caused by Orientia tsutsugamushi, can lead to severe multiorgan dysfunction and carries a mortality rate of up to 70% if not treated properly. In this report, we present the case of a 27-year-old pregnant woman at 18 + 6 weeks gestation whose symptoms worsened 15 days after onset and progressed to severe pneumonia with sepsis and multiple organ dysfunction syndrome. After the pathogen was confirmed by next-generation sequencing analysis of bronchoalveolar-lavage fluid and blood samples, the patient's treatment was switched to antiinfective chloramphenicol. The patient also underwent uterine evacuation due to a miscarriage. Extracorporeal membrane oxygenation was discontinued once the pulmonary infection significantly improved. Subsequently, the patient had recurrent diarrhea, abdominal distension, and difficulty eating. The antibiotic regimen was adjusted according to the drug sensitivity, but the diarrhea and abdominal distension still did not improve. Following a comprehensive multidisciplinary risk assessment, we initiated fecal microbiota transplantation and oral fecal microbiota capsule therapy. As a result, the patient's condition was effectively managed, and they were gradually discharged. Fecal microbiota transplantation may be a safe and effective treatment for severe pneumonia and shock in pregnant women. This has significant implications for maternal health. However, further clinical cases are required to observe its long-term effectiveness.
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Affiliation(s)
- Hongmei Qin
- Department of Critical Care MedicineThe First People's Hospital of YulinYulinChina
| | - Yaoqing Fu
- Department of Critical Care MedicineThe First People's Hospital of YulinYulinChina
| | - Caixia Deng
- Department of Critical Care MedicineThe First People's Hospital of YulinYulinChina
| | - Yanxing Chen
- Department of Critical Care MedicineThe First People's Hospital of YulinYulinChina
| | - Keming Huang
- Department of Critical Care MedicineThe First People's Hospital of YulinYulinChina
| | - Yiyang Ruan
- Department of Critical Care MedicineThe First People's Hospital of YulinYulinChina
| | - Ke Liu
- Department of Critical Care MedicineThe First People's Hospital of YulinYulinChina
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Kim D, Cho YH, Bong JB, Kim YS, Shin BS, Kang HG. Acute ischemic stroke in Tsutsugamushi: understanding the underlying mechanisms and risk factors. BMC Neurol 2024; 24:42. [PMID: 38267851 PMCID: PMC10807141 DOI: 10.1186/s12883-024-03534-1] [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: 08/14/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Tsutsugamushi (scrub typhus) is an acute infectious febrile disease common in the Asia-Pacific region. Common symptoms of tsutsugamushi include lymphadenopathy, fever, and myalgia, and it rarely causes acute ischemic stroke (AIS). However, we hypothesized that tsutsugamushi infection could trigger AIS. METHOD We retrospectively examined patients diagnosed with AIS within 2 weeks of tsutsugamushi diagnosis at three hospitals over a 15-year period. We categorized patients who developed AIS while being treated for tsutsugamushi as the case group and those (of similar age and sex) who did not develop AIS as the control group. The case and control groups consisted of 22 and 66 participants, respectively. When a scattered pattern was observed or lesions were found in two or more vascular territories on diffusion-weighted imaging, the pattern was defined as embolic. Other patterns were defined as nonembolic. RESULTS Among the 19 patients, excluding three with transient ischemic stroke, 15 (78.9%) showed an embolic pattern. Although fever was common in the control group, it was less common in the case group. A higher D-dimer level at the time of hospitalization was associated with the development of AIS in patients with tsutsugamushi. CONCLUSIONS AIS in patients with tsutsugamushi showed an embolic rather than a non-embolic pattern on brain magnetic resonance imaging. It was more likely to occur in patients with risk factors for stroke. Tsutsugamushi patients with AIS were likely to have no fever or high D-dimer levels. We hypothesized that D-dimers play an important role in the pathophysiology, where tsutsugamushi infection increases the likelihood of AIS.
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Affiliation(s)
- Dain Kim
- Medical School, Jeonbuk National University, Jeonju, 54907, South Korea
| | - Yeon Hee Cho
- Medical School, Jeonbuk National University, Jeonju, 54907, South Korea
| | - Jeong Bin Bong
- Department of Neurology, Chosun University School of Medicine, Gwangju, 64153, South Korea
| | - Young Seo Kim
- Department of Neurology, Wonkwang University School of Medicine, Iksan, 54538, South Korea
| | - Byoung-Soo Shin
- Department of Neurology, Research Institute of Clinical Medicine of Jeonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju-si, 54907, Jeonbuk-do, South Korea
- Biomedical Research Institute, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonju, South Korea
| | - Hyun Goo Kang
- Department of Neurology, Research Institute of Clinical Medicine of Jeonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju-si, 54907, Jeonbuk-do, South Korea.
- Biomedical Research Institute, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonju, South Korea.
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Byeon JY, Kim H, Lee DW, Choi HJ. A CARE-compliant article: A case report of unusual eschar and extensive soft tissue necrosis in Tsutsugamushi disease. Medicine (Baltimore) 2023; 102:e36009. [PMID: 37960796 PMCID: PMC10637407 DOI: 10.1097/md.0000000000036009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
RATIONALE Tsutsugamushi disease is a common infectious disease in the Northern Hemisphere. A patient infected with tsutsugamushi disease will show a characteristic clinical course with eschar formation, which is mostly small and self-limited in nature without causing major problems. We report a rare case of unusually extensive necrosis started from a small eschar. PATIENT CONCERNS In this report, a 65-year-old female patient with a history of diabetes mellitus present an 8 × 6 cm-sized huge eschar and extensive soft tissue necrosis aggravated from a small eschar. Also, there were 3 other small eschars in the scalp and left flank area. In early July, she was farming in a field in Hongseong-gun, South Korea. She had been treated at another hospital for 2 weeks. However, the eschar became bigger and worse. DIAGNOSES After admission, escharectomy was performed and extensive soft tissue necrosis was identified. Orientia tsutsugamushi antibody tests were positive from blood test. Providencia rettgeri and Enterococcus faecalis were detected in a tissue bacterial culture test. INTERVENTION While using oral azithromycin and intravenous imipenem/cilastatin, the necrosis of the thigh was excised and covered by lateral femoral circumflex artery based myocutaneous Keystone flap. OUTCOMES The remaining small eschars recovered spontaneously, the large eschars that had caused necrosis were successfully treated, and all other clinical symptoms improved without complications. LESSONS For unusual eschar of an unknown cause, especially in patients with uncontrolled diabetes or immunocompromised, the possibility of Tsutsugamushi should be considered. Careful physical examination and proper management should be performed as soon as possible.
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Affiliation(s)
- Je Yeon Byeon
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Hyun Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Da Woon Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
- Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan, South Korea
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Vanramliana, Pautu L, Lalmalsawma P, Rosangkima G, Sarma DK, Chinzah H, Malvi Y, Kodali NK, Amarthaluri C, Balasubramani K, Balabaskaran Nina P. Epidemiology of scrub typhus and other rickettsial infections (2018-22) in the hyper-endemic setting of Mizoram, North-East India. PLoS Negl Trop Dis 2023; 17:e0011688. [PMID: 37910591 PMCID: PMC10642901 DOI: 10.1371/journal.pntd.0011688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/13/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND In the past decade, scrub typhus cases have been reported across India, even in regions that had no previous history of the disease. In the North-East Indian state of Mizoram, scrub typhus cases were first recorded only in 2012. However, in the last five years, the state has seen a substantial increase in the scrub typhus and other rickettsial infections. As part of the public health response, the Mizoram Government has integrated screening and line listing of scrub typhus and other rickettsial infections across all its health settings, a first in India. Here we detail the epidemiology of scrub typhus and other rickettsial infections from 2018-2022, systematically recorded across the state of Mizoram. METHODOLOGY/PRINCIPAL FINDINGS The line-listed data positive for scrub typhus and other rickettsial infections identified by rapid immunochromatographic test and/or Weil-Felix test from 2018-22 was used for the analysis. During this period, 22,914 cases of rickettsial infections were recorded, out of which 19,651 were scrub typhus cases. Aizawl is the worst affected, with 10,580 cases (46.17%). The average incidence of rickettsial infections is 3.54 cases per 1000 persons-year, and the case fatality rate is 0.35. Only ∼2% of the reported scrub typhus cases had eschar. Multivariate logistic regression analysis indicate patients with eschar (aOR = 2.5, p<0.05), occupational workers [farmers (aOR:3.9), businessmen (aOR:1.8), construction workers (aOR:17.9); p<0.05], and children (≤10 years) (aOR = 5.4, p<0.05) have higher odds of death due to rickettsial infections. CONCLUSION The integration of systematic surveillance and recording of rickettsial diseases across Mizoram has shed important insights into their prevalence, morbidity, and mortality. This study underscores the importance of active surveillance of rickettsial infections across India, as the burden could be substantially higher, and is probably going undetected.
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Affiliation(s)
- Vanramliana
- Department of Life Sciences, Pachhunga University College, Mizoram University, Mizoram, India
| | - Lalfakzuala Pautu
- Department of Life Sciences, Pachhunga University College, Mizoram University, Mizoram, India
- Integrated Disease Surveillance Programme, Health & Family Welfare Department, Mizoram, India
| | - Pachuau Lalmalsawma
- Integrated Disease Surveillance Programme, Health & Family Welfare Department, Mizoram, India
| | - Gabriel Rosangkima
- Department of Life Sciences, Pachhunga University College, Mizoram University, Mizoram, India
| | - Devojit Kumar Sarma
- ICMR- National Institute for Research in Environmental Health, Bhopal Bypass Road, Bhauri, Bhopal, Madhya Pradesh, India
| | - Hunropuia Chinzah
- Department of Life Sciences, Pachhunga University College, Mizoram University, Mizoram, India
| | - Yogesh Malvi
- Integrated Disease Surveillance Programme, Health & Family Welfare Department, Mizoram, India
| | - Naveen Kumar Kodali
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Christiana Amarthaluri
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | | | - Praveen Balabaskaran Nina
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
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Sapkota A, Devkota R, Dongol A, Pandey A, Bhattarai T. Acute Pancreatitis, Shock, and Multiple Organ Dysfunction Syndrome in Scrub Typhus. Cureus 2022; 14:e28233. [PMID: 36158374 PMCID: PMC9488657 DOI: 10.7759/cureus.28233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/19/2022] Open
Abstract
Scrub typhus is an endemic disease caused by the bites of infected chiggers (larval mites) harboring causative bacteria Orientia tsutsugamushi. Acute pancreatitis is a rare but occasionally fatal complication of scrub typhus infection caused by vascular and perivascular inflammation of the pancreas.A 34-year-old female presented with severe epigastric pain and multiple episodes of vomiting. Extensive evaluation of the patient revealed acute pancreatitis secondary to scrub typhus. The patient also had septic shock and multiple organ dysfunction syndrome. The patient was mechanically ventilated and treated with doxycycline, and pancreatitis was managed conservatively.
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Clinical usefulness of 16S ribosomal RNA real-time PCR for the diagnosis of scrub typhus. Sci Rep 2021; 11:14299. [PMID: 34253778 PMCID: PMC8275794 DOI: 10.1038/s41598-021-93541-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
Scrub typhus is a major acute febrile disease in the Asia–Pacific region. The purpose of the present study is to investigate the clinical usefulness of real-time PCR (Q-PCR) of 16S rRNA for the diagnosis of scrub typhus. We examined blood specimens from 148 adult patients who were confirmed to have scrub typhus from September 2008 to December 2009. Among the 148 scrub typhus patients, 36 patients were treated with antibiotics before admission. To evaluate the clinical usefulness of 16S rRNA Q-PCR, we compared its diagnostic accuracy to the accuracy of the following methods: nested PCR (N-PCR) targeting the gene encoding the 56-kDa protein, Q-PCR targeting the gene encoding the 47-kDa protein, and conventional PCR (C-PCR), targeting the 16S rRNA gene. According to 16S rRNA Q-PCR and 47-kDa Q-PCR, the mild group had copy numbers of 234.4 ± 261.9 and 130.5 ± 128.3, whereas the severe group had copy numbers of 584.4 ± 911.4 and 244.7 ± 210.9, respectively. In both tests, the mean copy numbers were significantly greater in the severe group (P = 0.037 and P = 0.035). 16S rRNA Q-PCR detected Orientia tsutsugamushi infections with a sensitivity of 91.9% (95% CI 86.3–95.7), and 56-kDa N-PCR, 47-kDa Q-PCR, and 16S rRNA C-PCR exhibited lower sensitivities of 81.1% (95% CI 73.8–87.0), 74.3% (95% CI 66.5–81.1), and 87.8% (95% CI 81.5–92.6), respectively, for all 148 patients. In addition, 16S rRNA Q-PCR exhibited a sensitivity of 99.1% (95% CI 95.1–100.0) in the 112 patients who were not treated with antibiotics before admission. 16S rRNA Q-PCR is clinically useful for the rapid diagnosis of scrub typhus and is more accurate than the 56-kDa N-PCR, 47-kDa Q-PCR, and 16S C-PCR methods.
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Xiang R, Guo XG. Research Advances of Leptotrombidium scutellare in China. THE KOREAN JOURNAL OF PARASITOLOGY 2021; 59:1-8. [PMID: 33684981 PMCID: PMC7939960 DOI: 10.3347/kjp.2021.59.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/27/2020] [Indexed: 12/27/2022]
Abstract
Leptotrombidium scutellare is one of the 6 main vectors of scrub typhus in China. It has been found in more than 15 provinces of China. Especially in Yunnan, it was found to be mainly distributed in some mountainous areas with high altitude, low temperature and low precipitation. Rodents and some other small mammals were the most common hosts of L. scutellare. To date, more than 40 host species of L. scutellare have been recorded with very low host specificity, and the main hosts varied in different geographical regions. L. scutellare had a strong resistance against the cold environment, and the temperature and humidity were 2 important factors affecting its growth and development. Among different individuals of their rodent hosts, L. scutellare mites often showed an aggregated distribution pattern, which reflected the interspecific cooperation of the mites. The chromosome karyotype of L. scutellare was 2n=16 and all the 8 pairs of chromosomes were short rod-shaped with metacentric or sub-metacentric types. The isozyme spectrum supported that L. scutellare, L. deliense and L. rubellum were in the same species group. Based on the natural infection, experimental transmission and epidemiological evidence, L. scutellare has been eventually confirmed as the second major vector of scrub typhus in China, which is second only to L. deliense.
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Affiliation(s)
- Rong Xiang
- Vector Laboratory, Institute of Pathogens and Vectors, Yunnan Provincial Key Laboratory for Zoonosis Control and Prevention, Dali University, Dali, Yunnan Province 671000, China
| | - Xian-Guo Guo
- Vector Laboratory, Institute of Pathogens and Vectors, Yunnan Provincial Key Laboratory for Zoonosis Control and Prevention, Dali University, Dali, Yunnan Province 671000, China
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Lee Y, Kim SI, Yi YS, Lee H, Hwang JH, Park EC, Jun S, Lee CS. Transmission Electron Microscopy Confirmation of Orientia tsutsugamushi in Human Bile. Emerg Infect Dis 2020; 26:3101-3103. [PMID: 33219812 PMCID: PMC7706943 DOI: 10.3201/eid2612.202188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Scrub typhus, the third most frequently reported infectious disease in South Korea, causes serious public health problems. In 2019, we collected a bile specimen from a patient with scrub typhus through percutaneous transhepatic gallbladder drainage and performed transmission electron microscopy to confirm the ultrastructure of Orientiatsutsugamushi.
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Lee KH, Heo ST, Jeong SU, Kim MY, Jeong WS, Hyun CL, Kim YK, Yoo JR. Acute Cholangitis Caused by Boryong Strain of Orientia tsutsugamushi. Infect Chemother 2020; 52:621-625. [PMID: 32869554 PMCID: PMC7779989 DOI: 10.3947/ic.2020.52.4.621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022] Open
Abstract
Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.
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Affiliation(s)
- Keun Hwa Lee
- Department of Microbiology, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Mi Yeon Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Woo Seong Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Chang Lim Hyun
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - Young Kyu Kim
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Jeong Rae Yoo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
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Seo CW. Analysis of Factors Related to Regional Occurrence Distribution of Scrub Typhus: 2012∼2016. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2019. [DOI: 10.15324/kjcls.2019.51.4.420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Choong Won Seo
- Division of Control for Zoonotic and Vector Borne Disease, Korea Centers for Disease Control and Prevention, Cheongju, Korea
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Kim HL, Park HR, Kim CM, Cha YJ, Yun NR, Kim DM. Indicators of severe prognosis of scrub typhus: prognostic factors of scrub typhus severity. BMC Infect Dis 2019; 19:283. [PMID: 30909868 PMCID: PMC6434784 DOI: 10.1186/s12879-019-3903-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 03/13/2019] [Indexed: 12/29/2022] Open
Abstract
Background Scrub typhus is an acute disease, characterized by symptoms of fever, which occurs due to infection by Orientia tsutsugamushi. In most cases, patients recover from the disease with appropriate treatment, but serious and fatal complications may occur. The present study examined laboratory findings and tumor necrosis factor-alpha (TNF-α) levels of scrub typhus patients to identify the prognostic predictors of disease severity. Method Patients whose scrub typhus diagnosis was confirmed by elevated indirect fluorescent antibody (IFA) levels and positive polymerase chain reaction (PCR) results were classified according to disease severity into one of three groups; i.e., deceased (n = 7), severe (n = 15), and mild (n = 15) retrospectively registered. Additionally, the usefulness of modified Acute Physiology and Chronic Health Evaluation II (APACHE II) score, C-reactive protein (CRP) level, white blood cell (WBC) count, and TNF-α level as prognostic predictors were examined. Result The mean TNF-α levels of the deceased, severe, and mild groups were 53.5 (range: 7.8–147.8), 26.0 (1.7–64.4), and 8.8 pg/mL (4.6–16.0), respectively. The results of Kruskal-Wallis tests showed statistically significant differences between the deceased and severe groups versus the mild group (p = 0.005). CRP level and Modified APACHE II score also differed significantly among the groups (p = 0.046 and 0.007, respectively); however, WBC count did not (p = 0.196). Conclusion An elevated serum TNF-α level in patients with scrub typhus could predict a severe condition or death and may be useful in predicting patient prognosis.
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Affiliation(s)
- Hyun Lee Kim
- Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Hye Rim Park
- Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Choon-Mee Kim
- Premedical sciences, College of Medicine, Chosun University, Gwang-ju, South Korea
| | - Youn Jung Cha
- Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Na Ra Yun
- Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, 501-717, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, 501-717, Republic of Korea.
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Ultrastructural visualization of Orientia tsutsugamushi in biopsied eschars and monocytes from scrub typhus patients in South Korea. Sci Rep 2018; 8:17373. [PMID: 30478364 PMCID: PMC6255831 DOI: 10.1038/s41598-018-35775-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/09/2018] [Indexed: 12/03/2022] Open
Abstract
Scrub typhus, which is caused by Orientia tsutsugamushi, is a public health problem in the Asian-Pacific region and is the third most frequently reported infectious disease in South Korea. While ultrastructural studies have been performed on O. tsutsugamushi in murine fibroblasts, its variable locations in patients have hampered similar studies in humans. Two patients with scrub typhus agreed to provide an eschar biopsy and peripheral blood, respectively. Transmission electron microscopy was performed separately on the necrotic crust and perifocal skin of the eschar, the peripheral blood, and the infected murine L cells. O. tsutsugamushi was located within or adjacent to the outermost layer of the perifocal inflamed skin of the eschar but not in the necrotic centre. O. tsutsugamushi in peripheral blood monocytes exhibited the characteristic features of O. tsutsugamushi in L cells, namely, nearly round shaped bacteria with a size of 1–2 µm and a double membrane bearing a clear halo-like outer layer. The findings confirmed that the bacterium was predominantly located in the inflamed skin around the eschar and that the bacterium had the same ultrastructural features in human monocytes as in L cells. These findings suggest that the perifocal area, not the necrotic centre, should be sampled for diagnosis.
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Choi YJ, Choi SY, Choi JH, Choi KD. Opsoclonus-Myoclonus Syndrome Associated with Scrub Typhus. ACTA ACUST UNITED AC 2017. [DOI: 10.21790/rvs.2017.16.1.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- J H Park
- Department of Preventive Medicine, Dongguk University, College of Medicine, Geyongju, South Korea
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15
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Jang MS, Kim CM, Kim DM, Yoon NR, Han MA, Kim HK, Oh WS, Yoon HJ, Wie SH, Hur J. Comparison of Preferred Bite Sites Between Mites and Ticks on Humans in Korea. Am J Trop Med Hyg 2016; 95:1021-1025. [PMID: 27645781 DOI: 10.4269/ajtmh.16-0186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/16/2016] [Indexed: 11/07/2022] Open
Abstract
Identification of mite and tick bite sites provides important clinical information. The predominant mite species in Korea associated with scrub typhus are Leptotrombidium pallidum and Leptotrombidium scutellare The most abundant tick species is Haemaphysalis longicornis To date, there has been no comparative study on preferred bite sites between mites and ticks in humans. This study included a review of medical records and a field study. For mite bite sites, eschars were checked on 506 patients with scrub typhus, confirmed by indirect immunofluorescence assay or nested polymerase chain reaction on the 56-kDa type-specific antigen gene of Orientia tsutsugamushi Tick bite sites were identified and marked on a diagram for 91 patients who experienced tick bites within the previous year through a field epidemiological investigation. The mite and tick bite sites in Koreans were compared. The most frequently observed mite bite sites were the anterior chest, including the axillae (29.1%) and the abdominal region, including the inguinal area (26.1%). Tick bite sites were most frequent on the lower extremities (33.0%), followed by the abdominal region, including the inguinal area (26.4%), and upper extremities (26.4%). The distribution was significantly different between mite and tick bite sites (P < 0.001). There was a statistically significant difference in the mite bite (P = 0.001), but not tick bite sites (P = 0.985), between men and women. This is the first report on the differences between tick and mite bite sites, and may help clinicians reach a rapid diagnosis of mite- or tick-borne infection.
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Affiliation(s)
- Mi-Sun Jang
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, South Korea
| | - Choon-Mee Kim
- Premedical Science, College of Medicine, Chosun University, Gwangju, South Korea
| | - Dong-Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, South Korea.
| | - Na Ra Yoon
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, South Korea
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, South Korea
| | - Hyun-Kuk Kim
- Department of Pulmonary and Critical Care Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Won Sup Oh
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hee-Jung Yoon
- Department of Infectious Diseases, Seoul Metropolitan Government Seobuk Hospital, Seoul, Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University, College of Medicine, Daegu, South Korea
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16
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Lee JH, Song HY, Lee JM, Cho JH. Optimal cutoff value of serum adenosine deaminase activity for diagnosing acute scrub typhus. Jpn J Infect Dis 2013; 66:232-4. [PMID: 23698485 DOI: 10.7883/yoken.66.232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to determine the optimal cutoff value of serum adenosine deaminase (ADA) activity for diagnosing scrub typhus in acute febrile patients, especially in the autumn. A total of 715 febrile patients were included; 286 of them were diagnosed with acute scrub typhus. The mean serum ADA activities in patients with and without scrub typhus were 42.8 ± 13.4 IU/L and 17.2 ± 11.5 IU/L, respectively. The optimal cutoff value for serum ADA activity was determined to be 25.0 IU/L with a sensitivity of 92.3%, specificity of 86.6%, and area under the curve of 89.4% using a receiver-operating characteristic curve analysis. The possibility of scrub typhus must be considered when acute febrile patients present with high ADA activity (>25 IU/L), especially in the autumn. Determining the optimal serum ADA activity cutoff value may help clinicians diagnose acute scrub typhus prior to serological confirmation.
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Affiliation(s)
- Jae Hoon Lee
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea.
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17
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Kim DY, Park HS, Han DJ, Kang HC, Lee JH, Jang WJ, Gil HW, Yang JO, Lee EY, Hong SY. A case of scrub typhus requiring maintenance hemodialysis. Kidney Res Clin Pract 2013; 32:190-3. [PMID: 26877941 PMCID: PMC4714168 DOI: 10.1016/j.krcp.2013.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/28/2013] [Accepted: 08/15/2013] [Indexed: 11/05/2022] Open
Abstract
Renal failure caused by scrub typhus is known to be reversible. In most cases, renal function is almost fully restored after appropriate antibiotic treatment. A 71-year-old man was diagnosed with scrub typhus complicated by renal failure. A renal biopsy revealed histopathologic findings consistent with acute tubulointerstitial nephritis. Renal function did not improve 18 months after discharge and the patient required continuous hemodialysis. Although severe renal failure requiring dialysis is a rare complication of scrub typhus, we describe a case of scrub typhus requiring maintenance hemodialysis. To the best of our knowledge, this is the first such report.
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Affiliation(s)
- Dae-Yeon Kim
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hee-Soon Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Dong-Jae Han
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyo-Chul Kang
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ji-Hye Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Won-Jong Jang
- Institute of Glocal Disease Control and Department of Microbiology, College of Medicine, Konkuk University, Seoul, Korea
| | - Hyo-Wook Gil
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jong-Oh Yang
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Eun-Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sae-Yong Hong
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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18
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Affiliation(s)
- Mee Soo Chang
- Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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19
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Kim KH, Jung DS, Kim SY, Kim B, Han SH, Jung EH, Kim DM, Lee H. Severe Scrub Typhus with Enterocolitis by the Ikeda Strain of Orientia tsutsugamushi. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.6.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyung Han Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Dong Sik Jung
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Su Young Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Bosung Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Seung-Hee Han
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Eui Han Jung
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Dong-Min Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Hyuck Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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20
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Ahn Y, Hwang JY, Kim YS, Kim JH, Cho OH, Lim CM, Woo JH. A Case of Coinfection with Pandemic (H1N1) 2009 Influenza and Scrub Typhus with Abnormal Liver Function Test. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.3.247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yongchel Ahn
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jenie Yoonoo Hwang
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Seok Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hui Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Oh Hyun Cho
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae Man Lim
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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