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Chang T, Min KD, Cho SI, Kim Y. Associations of meteorological factors and dynamics of scrub typhus incidence in South Korea: A nationwide time-series study. ENVIRONMENTAL RESEARCH 2024; 245:117994. [PMID: 38151145 DOI: 10.1016/j.envres.2023.117994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
Scrub typhus, also known as Tsutsugamushi disease, is a climate-sensitive vector-borne disease that poses a growing public health threat. However, studies on the association between scrub typhus epidemics and meteorological factors in South Korea need to be complemented. Therefore, we aimed to analyze the association among ambient temperature, precipitation, and the incidence of scrub typhus in South Korea. First, we obtained data on the weekly number of scrub typhus cases and concurrent meteorological variables at the city-county level (Si-Gun) in South Korea between 2001 and 2019. Subsequently, a two-stage meta-regression analysis was conducted. In the first stage, we conducted time-series regression analyses using a distributed lag nonlinear model (DLNM) to investigate the association between temperature, precipitation, and scrub typhus incidence at each location. In the second stage, we employed a multivariate meta-regression model to combine the association estimates from all municipalities, considering regional indicators, such as mite species distribution, Normalized Difference Vegetation Index (NDVI), and urban-rural classification. Weekly mean temperature and weekly total precipitation exhibited a reversed U-shaped nonlinear association with the incidence of scrub typhus. The overall cumulative association with scrub typhus incidence peaked at 18.7 C° (with RRs of 9.73, 95% CI: 5.54-17.10) of ambient temperature (reference 9.7 C°) and 162.0 mm (with RRs of 1.87, 95% CI: 1.02-3.83) of precipitation (reference 2.8 mm), respectively. These findings suggest that meteorological factors contribute to scrub typhus epidemics by interacting with vectors, reservoir hosts, and human behaviors. This information serves as a reference for future public health policies and epidemiological research aimed at controlling scrub typhus infections.
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Affiliation(s)
- Taehee Chang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, 08826, Republic of Korea
| | - Kyung-Duk Min
- College of Veterinary Medicine, Chungbuk National University, 28644, Republic of Korea
| | - Sung-Il Cho
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, 08826, Republic of Korea; Institute of Health and Environment, Seoul National University, Seoul, 08826, Republic of Korea.
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, University of Tokyo, Tokyo, 113-0033, Japan.
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Yoon BA, Kim SY, Kim J, Seok JI, Seok JM, Lee S, Kim JK, Oh SI. Clinical and laboratory findings in scrub typhus associated Guillain-Barré syndrome in South Korea. J Peripher Nerv Syst 2024; 29:82-87. [PMID: 38286033 DOI: 10.1111/jns.12614] [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: 04/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND AIMS Scrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain-Barré syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus. METHODS Patients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS-associated clinical and electrophysiological characteristics, outcomes, and scrub typhus-associated features were collected. RESULTS Of the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2-14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1-4) points. INTERPRETATION Patients with scrub typhus-associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS.
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Affiliation(s)
- Byeol-A Yoon
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, South Korea
- Department of Neurology, Dong-A University Medical Center, Busan, South Korea
| | - Sun-Young Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Juhyeon Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, South Korea
| | - Jung Im Seok
- Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, South Korea
| | - Jin Myoung Seok
- Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Sukyoon Lee
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Jong Kuk Kim
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, South Korea
- Department of Neurology, Dong-A University Medical Center, Busan, South Korea
| | - Seong-Il Oh
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
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Kim S, Lee IY, Monoldorova S, Kim J, Seo JH, Yong TS, Jeon BY. Prevalence of chigger mites and Orientia tsutsugamushi strains in northern regions of Gangwon-do, Korea. PARASITES, HOSTS AND DISEASES 2023; 61:263-271. [PMID: 37648231 PMCID: PMC10471477 DOI: 10.3347/phd.22148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/22/2023] [Indexed: 09/01/2023]
Abstract
The present study aimed to survey the prevalence of chigger mites and Orientia tsutsugamushi (O. tsutsugamushi) infection in the northern regions of Gangwon-do, Korea. From early February to early June 2015, a total of 17,050 chiggers were collected from striped field mice, Apodemus agrarius, in Cheorwon-gun, Hwacheon-gun, Yanggu-gun, and Goseong-gun, which are well-known endemic areas of scrub typhus in Korea. The chiggers were analyzed using molecular genomic methods, as previously described. Among the 7,964 identified chiggers, the predominant species was Leptotrombidium pallidum (76.9%), followed by L. zetum (16.4%), L. orientale (4.3%), L. palpale (0.3%), L. tectum (0.2%), and Neotrombicula tamiyai (1.8%). The chigger index (CI) was highest in Hwacheon (115.58), followed by Cheorwon (97.02), Yanggu (76.88), and Goseong (54.68). Out of the 79 O. tsutsugamushi-positive chigger pools, 67 (84.8%) were identified as the Boryong strain, 10 (12.7%) as the Youngworl strain, and only 2 were the Jecheon strain. Based on the high infestation of chiggers in striped field rodents and the high rate of O. tsutsugamushi infection in chigger mites, Hwacheon-gun and Cheorwon-gun are presumed to be high-risk areas for scrub typhus. Furthermore, L. pallidum, a major vector of scrub typhus, and the dominant O. tsutsugamushi serotype, the Boryong strain, were found in the northern regions of Gangwon-do, Korea.
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Affiliation(s)
- Soojin Kim
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493,
Korea
| | - In Yong Lee
- Department of Tropical Medicine and Institute of Tropical Medicine, Yonsei University College of Medicine, Seoul 03722,
Korea
| | - Sezim Monoldorova
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493,
Korea
| | - Jiro Kim
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493,
Korea
- Department of Clinical Laboratory Science, Cheju Halla University, Jeju 63092,
Korea
| | - Jang Hoon Seo
- Department of Biomedical Laboratory Science, Shinhan University, Uijeongbu 11644,
Korea
| | - Tai-Soon Yong
- Department of Tropical Medicine and Institute of Tropical Medicine, Yonsei University College of Medicine, Seoul 03722,
Korea
| | - Bo Young Jeon
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493,
Korea
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Kim J, Seok H, Jeon JH, Choi WS, Seo GH, Park DW. Association of scrub typhus with incidence of dementia: a nationwide population-based cohort study in Korea. BMC Infect Dis 2023; 23:127. [PMID: 36859244 PMCID: PMC9976677 DOI: 10.1186/s12879-023-08107-0] [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: 09/07/2022] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Scrub typhus is a mite-borne infectious rickettsial disease that can occur in rural and urban areas, with an especially high prevalence in older populations. This disease causes systemic vasculitis that can invade the central nervous system. Considering these characteristics, here we examined whether scrub typhus was associated with the occurrence of dementia, using large population-based cohort data. METHOD This population-based cohort study enrolled patients aged 60-89 years using data from the Health Insurance Review and Assessment database of South Korea between 2009 and 2018. We defined scrub typhus and dementia using International Classification of Diseases, Tenth Edition diagnostic codes. The control group was stratified according to age and sex at a ratio of 1:5 to the case group in the study population. The index date was set after 90 days beyond the date of the scrub typhus diagnosis, while the observation period was from the time of the index appointment to December 31, 2020. The primary outcome was newly diagnosed dementia. The secondary outcome was dementia classification, such as Alzheimer's disease, vascular dementia, and other. All analyses were conducted by matching age, gender, and comorbidity. RESULTS During the observation period, 10,460 of 71,047 (14.7%) people who had a history of scrub typhus versus 42,965 of 355,235 (12.1%) people in the control group, that is, with no history of scrub typhus, were diagnosed with dementia (adjusted hazard ratio, 1.12; 95% confidence interval, 1.10-1.15, p < 0.001). The Kaplan-Meier curves for time to cumulative incidence of dementia showed that the dementia incidence in both groups increased over time, while individuals with a past history of scrub typhus had a higher incidence of dementia than the control group. Second, the risk of Alzheimer's disease was significantly higher among patients with a history of scrub typhus (adjusted hazard ratio, 1.15; 95% confidence interval 1.13-1.18, p < 0.001). CONCLUSION In conclusion, a history of scrub typhus infection in old age is significantly associated with an increase in dementia, especially Alzheimer's disease. Our results suggest that prevention and appropriate treatment of scrub typhus should be emphasized as a dementia prevention measure.
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Affiliation(s)
- Jooyun Kim
- grid.222754.40000 0001 0840 2678Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355 Republic of Korea
| | - Hyeri Seok
- grid.222754.40000 0001 0840 2678Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355 Republic of Korea
| | - Ji Hoon Jeon
- grid.222754.40000 0001 0840 2678Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355 Republic of Korea
| | - Won Suk Choi
- grid.222754.40000 0001 0840 2678Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355 Republic of Korea
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, 60 Hyeoksin-ro, Wonju-si, Gangwon-do, 26465, Republic of Korea.
| | - Dae Won Park
- Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeukgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea.
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Lai SW, Chen GL, Liu WT, Yu TY, Lin GM, Dai YH. Diagnostic utility of procalcitonin in scrub typhus. JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/jmedsci.jmedsci_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nationwide Incidence of Chigger Mite Populations and Molecular Detection of Orientia tsutsugamushi in the Republic of Korea, 2020. Microorganisms 2021; 9:microorganisms9081563. [PMID: 34442642 PMCID: PMC8400602 DOI: 10.3390/microorganisms9081563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/02/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
The Korea Disease Control and Prevention Agency has established regional centers at 16 locations to monitor vectors and pathogens. We investigated the geographical and temporal distribution of chigger mite populations to understand tsutsugamushi disease epidemiology in 2020. To monitor weekly chigger mite populations, 3637 chigger mites were collected from sticky chigger mite traps in autumn. Chigger mites appeared from the first week of October to the third week of December, peaking in the fourth week of October. The predominant species were Leptotrombidium scutellare, Leptotrombidium palpale, Neotrombicula kwangneungensis, Neotrombicula tamiyai, and Leptotrombidium pallidum. To monitor Orientia tsutsugamushi infection in chigger mites, 50,153 chigger mites were collected from 499 trapped wild rodents in spring and autumn, with a chigger index of 100.5. Approximately 50% of chigger mites were pooled into 998 pools, and the minimum infection rate (MIR) of O. tsutsugamushi was 0.1%. Jeongeup had the highest MIR for O. tsutsugamushi (0.7%). The Kato-related genotype was the most common (52.2%), followed by the Karp-related (17.4%), Boryong (13.0%), JG-related (8.7%), Shimokoshi (4.3%), and Kawasaki (4.3%) genotypes. Ecological and geographical studies focusing on the basic ecology and pathology of mites will improve our understanding of tsutsugamushi disease risks in the Republic of Korea.
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Das A, Kim K, Park SG, Choi N, Choo J. SERS-based serodiagnosis of acute febrile diseases using plasmonic nanopopcorn microarray platforms. Biosens Bioelectron 2021; 192:113525. [PMID: 34325318 DOI: 10.1016/j.bios.2021.113525] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
We report a surface-enhanced Raman scattering (SERS)-based immunoassay platform for the rapid diagnosis of scrub typhus and murine typhus, which are the most common acute febrile diseases in South Korea. A microarray device, composed of multiple gold nanopopcorn substrates capable of detecting ultra-sensitive biomarkers, was used as a multiplex SERS-based assay platform. Sequentially diluted titers of Orientia tsutsugamushi and Rickettsia typhi specific human IgG/IgM antibodies, which are biomarkers of two typhus diseases, were analyzed by Raman spectroscopy, and the peak intensity was plotted against the different titer concentration range (0-2048 and 0-1024 for O. tsutsugamushi IgG/IgM and 0-8192 and 0-256 for R. typhi IgG/IgM) to generate calibration curves. The sensitivities and limits of detection (LODs) determined for four different IgG/IgM antibodies were significantly lower than those for the ELISA method. The LODs of titer concentrations for O. tsutsugamushi IgG/IgM and R. typhi IgG/IgM are determined to be 20.4, 7.03, 16.8 and 12.5, respectively. The LOD values were all lower than the cut-off values (256, 16, 128, and 64) used for clinical diagnosis, which means that this assay platform can diagnose two typhus diseases with high sensitivity. When the microarray sensors are combined with portable Raman spectrophotometers, which are commercially available worldwide, it is also possible to directly diagnose a patient in the field without sending their blood sample to a hospital.
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Affiliation(s)
- Anupam Das
- Department of Chemistry, Chung-Ang University, Seoul, 06974, South Korea
| | - Kihyun Kim
- Department of Chemistry, Chung-Ang University, Seoul, 06974, South Korea
| | - Sung-Gyu Park
- Advanced Nano-Surface Department, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea
| | - Namhyun Choi
- Department of Chemistry, Chung-Ang University, Seoul, 06974, South Korea.
| | - Jaebum Choo
- Department of Chemistry, Chung-Ang University, Seoul, 06974, South Korea.
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Bahk YY, Ahn SK, Lee J, Kwon HW, Hong SJ, Kim TS. Monitoring Chigger Mites for Orientia tsutsugamushi in Field Small Mammals in Hwaseong-si, Gyeonggi-do, Korea, 2019-2020. THE KOREAN JOURNAL OF PARASITOLOGY 2021; 59:319-324. [PMID: 34218605 PMCID: PMC8255491 DOI: 10.3347/kjp.2021.59.3.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/03/2021] [Indexed: 12/02/2022]
Abstract
Incidence of tsutsugamushi disease (scrub typhus) caused by Orientia tsutsugamushi, is steadily increasing. It is a mite-borne disease transmitted by chigger mites. In this study, the chigger mites were collected from field small mammals in Hwaseong-si (city), Gyeonggi-do (province), Korea, 2019 and 2020. The field small mammals captured were 56 Apodemus agrarius (94.9%) and 3 Crocidura lasiura (5.1%). A total of 7,531 chigger mites were collected from the captured small mammals. Using PCR test, 153 chigger mite pools were examined and 17 pools were reported positive for O. tsutsugamushi. The O. tsutsugamushi were identified to 5 strains; Jecheon strain was most prevalent, followed by Boryong strain. The other strains were OI011, Taguchi, and Shimokoshi. Collectively, these results provide essential regional information on mite-borne tsutsugamushi disease in the Hwaseong-si, and further contribute to bring awareness and rapid diagnosis for the tsutsugamushi disease.
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Affiliation(s)
- Young Yil Bahk
- Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju 27478, Korea
| | - Seong Kyu Ahn
- Infectious Diseases Investigation Division, Jeonnam Institute of Public Health and Environment, Muan 58568, Korea
| | - Jinyoung Lee
- Department of Parasitology and Tropical Medicine & Global Resource Bank of Parasitic Protozoa Pathogens, Inha University School of Medicine, Incheon 22212, Korea
| | - Hyung Wook Kwon
- Department of Life Sciences, Incheon National University, Incheon 22012, Korea.,Convergence Research Center for Insect Vectors, Incheon National University, Incheon 22012, Korea
| | - Sung Jong Hong
- Convergence Research Center for Insect Vectors, Incheon National University, Incheon 22012, Korea.,Department of Medical Environmental Biology, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Tong-Soo Kim
- Department of Parasitology and Tropical Medicine & Global Resource Bank of Parasitic Protozoa Pathogens, Inha University School of Medicine, Incheon 22212, Korea.,Convergence Research Center for Insect Vectors, Incheon National University, Incheon 22012, Korea
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Um J, Nam Y, Lim JN, Kim M, An Y, Hwang SH, Park JS. Seroprevalence of scrub typhus, murine typhus and spotted fever groups in North Korean refugees. Int J Infect Dis 2021; 106:23-28. [DOI: 10.1016/j.ijid.2021.02.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/31/2022] Open
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Bahk YY, Jun H, Park SH, Jung H, Jegal S, Kim-Jeon MD, Roh JY, Lee WG, Ahn SK, Lee J, Joo K, Gong YW, Kwon MJ, Kim TS. Surveillance of Chigger Mite Vectors for Tsutsugamushi Disease in the Hwaseong Area, Gyeonggi-do, Republic of Korea, 2015. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:301-308. [PMID: 32615743 PMCID: PMC7338901 DOI: 10.3347/kjp.2020.58.3.301] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
Abstract
Owing to global climate change, the global resurgence of vector-borne infectious diseases and their potential to inflict widespread casualties among human populations has emerged as a pivotal burden on public health systems. Tsutsugamushi disease (scrub typhus) in the Republic of Korea is steadily increasing and was designated as a legal communicable disease in 1994. The disease is a mite-borne acute febrile disease most commonly contracted from October to December. In this study, we tried to determine the prevalence of tsutsugamushi disease transmitted by chigger mites living on rodents and investigated their target vector diversity, abundance, and distribution to enable the mapping of hotspots for this disease in 2015. A total of 5 species belonging to 4 genera (109 mites): Leptotrombidium scutellare 60.6%, L. pallidum 28.4% Neotrombicula tamiyai 9.2%, Euschoengastia koreaensis/0.9%), and Neoschoengastia asakawa 0.9% were collected using chigger mite collecting traps mimicking human skin odor and sticky chigger traps from April to November 2015. Chigger mites causing tsutsugamushi disease in wild rodents were also collected in Hwaseong for the zoonotic surveillance of the vector. A total of 77 rodents belonging to 3 genera: Apodemus agrarius (93.5%), Crocidura lasiura (5.2%), and Micromys minutus (1.3%) were collected in April, October, and November 2015. The most common mite was L. pallidum (46.9%), followed by L. scutellare (18.6%), and L. orientale (18.0%). However, any of the chigger mite pools collected from rodent hosts was tested positive for Orientia tsutsugamushi, the pathogen of tsutsugamushi disease, in this survey.
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Affiliation(s)
- Young Yil Bahk
- Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju 27478, Korea
| | - Hojong Jun
- Department of Tropical Medicine, Inha University College of Medicine, Incheon 22212, Korea
| | - Seo Hye Park
- Department of Tropical Medicine, Inha University College of Medicine, Incheon 22212, Korea
| | - Haneul Jung
- Department of Tropical Medicine, Inha University College of Medicine, Incheon 22212, Korea
| | - Seung Jegal
- Department of Infectious Diseases Diagnosis, Incheon Metropolitan City Institute of Public Health and Environment, Incheon 22320, Korea
| | - Myung-Deok Kim-Jeon
- Department of Infectious Diseases Diagnosis, Incheon Metropolitan City Institute of Public Health and Environment, Incheon 22320, Korea
| | - Jong Yul Roh
- Division of Vectors and Parasitic Diseases, Korea Centers for Disease Control and Prevention, Osong 28159, Korea
| | - Wook-Gyo Lee
- Division of Vectors and Parasitic Diseases, Korea Centers for Disease Control and Prevention, Osong 28159, Korea
| | - Seong Kyu Ahn
- Department of Tropical Medicine, Inha University College of Medicine, Incheon 22212, Korea
| | - Jinyoung Lee
- Department of Tropical Medicine, Inha University College of Medicine, Incheon 22212, Korea
| | - Kwangsig Joo
- Department of Infectious Diseases Diagnosis, Incheon Metropolitan City Institute of Public Health and Environment, Incheon 22320, Korea
| | - Young Woo Gong
- Department of Infectious Diseases Diagnosis, Incheon Metropolitan City Institute of Public Health and Environment, Incheon 22320, Korea
| | - Mun Ju Kwon
- Department of Infectious Diseases Diagnosis, Incheon Metropolitan City Institute of Public Health and Environment, Incheon 22320, Korea
| | - Tong-Soo Kim
- Department of Tropical Medicine, Inha University College of Medicine, Incheon 22212, Korea
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Richards AL, Jiang J. Scrub Typhus: Historic Perspective and Current Status of the Worldwide Presence of Orientia Species. Trop Med Infect Dis 2020; 5:E49. [PMID: 32244598 PMCID: PMC7344502 DOI: 10.3390/tropicalmed5020049] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022] Open
Abstract
Scrub typhus and its etiological agents, Orientia species, have been around for a very long time. Historical reference to the rickettsial disease scrub typhus was first described in China (313 AD) by Hong Ge in a clinical manual (Zhouhofang) and in Japan (1810 AD) when Hakuju Hashimoto described tsutsuga, a noxious harmful disease in the Niigata prefecture. Other clinicians and scientists in Indonesia, Philippines, Taiwan, Australia, Vietnam, Malaysia, and India reported on diseases most likely to have been scrub typhus in the early 1900s. All of these initial reports about scrub typhus were from an area later designated as the Tsutsugamushi Triangle-an area encompassing Pakistan to the northwest, Japan to the northeast and northern Australia to the south. It was not until the 21st century that endemic scrub typhus occurring outside of the Tsutsugamushi Triangle was considered acceptable. This report describes the early history of scrub typhus, its distribution in and outside the Tsutsugamushi Triangle, and current knowledge of the causative agents, Orientia species.
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Affiliation(s)
- Allen L. Richards
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ju Jiang
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA;
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Kim YH, Hyun W, Kim DP, Chung MH, Im JH, Baek JH, Lee JS, Kang JS. The Eschar Size and Early Inoculation Lesion of Tsutsugamushi Disease on Jeju Island, Korea. Infect Chemother 2019; 51:345-354. [PMID: 31782274 PMCID: PMC6940375 DOI: 10.3947/ic.2019.51.4.345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/07/2019] [Indexed: 01/31/2023] Open
Abstract
Background Tsutsugamushi disease, or scrub typhus, is an acute febrile illness caused by Orientia tsutsugamushi, which is followed by chronic latent infection. People who reside in areas endemic of tsutsugamushi disease may be frequently reinfected with this organism. Volunteers who are experimentally reinfected with O. tsutsugamushi manifest various systemic and local reactions, including the presence of small-sized eschar. The present study recorded the morphology and size of eschars in patients with tsutsugamushi disease on Jeju Island, Korea. Materials and Methods From March 2018 to February 2019, 23 patients manifesting clinical characteristics and epidemiologic features of tsutsugamushi disease on Jeju Island were investigated. For comparison of eschar sizes between the two regions, 12 patients with tsutsugamushi disease in Incheon were similarly examined. Results Three patients, two on the first day and one on the fourth day of fever, presented with papules of 2 – 5 mm in diameter. Another three patients, one on the second day and two on the fourth day, presented with ruptured vesicles of 5 – 8 mm in diameter. Thirteen patients presented with eschars covered with dark scabs, with a median diameter of 5 (95% confidence interval [CI], 5 – 7.5) × 4 (95% CI, 3 – 5) mm. The medians of the eschar sizes did not differ between the two cities (P = 0.46 by Mann-Whitney U test), but eschars ≥10 mm in diameter were more frequent in Incheon than in Seogwipo-si (4 of 12 vs. 0 of 13 patients, P = 0.04 by Fisher's exact test). One patient presented with multiple eschars, and no eschar was detected in the remaining three patients. Among 11 Jeju Island patients with positive IgG and IgM antibodies, seven patients revealed higher IgG than IgM antibody titers during the acute phase of the illness, i.e., the IgG antibody response, two patients had equal IgG and IgM titers, and two patients presented the IgM antibody response. Life-threatening complications and death were not observed in this study. Conclusion The patients in Seogwipo-si had small-sized eschars and occasionally exhibited non-necrotic lesions. Many patients had serologically reinfected tsutsugamushi disease. Further studies are needed to investigate the association between these findings.
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Affiliation(s)
- Young Hoon Kim
- Department of Internal Medicine, Seogwipo Medical Center, Seogwipo, Korea
| | - Woojin Hyun
- Department of Internal Medicine, Seogwipo Medical Center, Seogwipo, Korea
| | - Dong Pil Kim
- Department of Internal Medicine, Seogwipo Medical Center, Seogwipo, Korea
| | - Moon Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Seogwipo, Korea.
| | - Jae Hyoung Im
- Department of Internal Medicine, Inha University, Incheon, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University, Incheon, Korea
| | - Jin Soo Lee
- Department of Internal Medicine, Inha University, Incheon, Korea
| | - Jae Seung Kang
- Department of Microbiology, Inha University, Incheon, Korea
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