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Wang YC, Li JH, Qin Y, Qin SY, Chen C, Yang XB, Ma N, Dong MX, Lei CC, Yang X, Sun HT, Sun ZY, Jiang J. The Prevalence of Rodents Orientia tsutsugamushi in China During Two Decades: A Systematic Review and Meta-Analysis. Vector Borne Zoonotic Dis 2023; 23:619-633. [PMID: 37625029 DOI: 10.1089/vbz.2023.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Background: Orientia tsutsugamushi is a zoonotic intracellular pathogen that requires parasitism in eukaryotic cells to reproduce. In recent years, tsutsugamushi disease reported in many places nationwide has crossed the Yangtze River, continuously, spreading to the North China. Now this phenomenon has aroused people's attention. Materials and Methods: In this study, meta-analysis was used to analyze the infection of rodents (vectors) in China, to clarify the transmission rule of O. tsutsugamushi. Results: This study included literature from six databases (PubMed, Web of Science, Science Direct, Wanfang, CNKI, and VIP). A total of 55 articles were included in the study from 610 retrieved articles. The total infection rate of O. tsutsugamushi in rodents was 5.5% (1206/20,620, 95% confidence interval [CI]: 0.0553-0.0617). The prevalence of O. tsutsugamushi in rodents before 2013 (7.73%, 95% CI: 4.11-12.37) was higher than after 2013 (2.11%, 95% CI: 0.64-4.41). O. tsutsugamushi spread among a variety of rodents, among which Rattus losea (13.3%, 95% CI: 4.33-26.26), Rattus tanezumi (5.69%, 95% CI: 1.37-12.72), and Apodemus agrarius (5.32%, 95% CI: 2.26-9.58) infection rate was higher. Kawasaki (8.32%, 95% CI: 1.42-20.17), Karp (7.36%, 95% CI: 2.62-14.22), Kato (2.54%, 95% CI: 0.08-8.28), and Gilliam (2.13%, 95% CI: 0.42-5.09) were the main prevalent genotypes in China. The prevalence of O. tsutsugamushi in rodents was seasonal, increasing gradually in summer (2.39%, 95% CI: 0.46-5.77), peaking in autumn (4.59%, 95% CI: 1.15-10.16), and then declining. The positive rate of immunofluorescence assay (25.07%, 95% CI: 8.44-46.88) was the highest among the detection methods, and it was statistically significant (p < 0.05). Based on the subgroup of geographical factors and climatic factors, the probability of O. tsutsugamushi infection in rodents was the highest when the temperature >19℃ (8.20%, 95% CI: 1.22-20.52), the altitude <100 millimeters (7.23%, 95% CI: 3.45-12.26), the precipitation >700 millimeters (12.22%, 95% CI: 6.45-19.50), and the humidity 60-70% (7.80%, 95% CI: 4.17-12.44). Conclusions: Studies have shown that rodents carrying O. tsutsugamushi are common. People should prevent and control rodents in life and monitor rodents carrying O. tsutsugamushi for a long time.
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Affiliation(s)
- Yan-Chun Wang
- School of Pharmacy, Qingdao University, Qingdao, PR China
- Changchun Sci-Tech University, Shuangyang, PR China
- Department of Technology, Ningbo Sansheng Biotechnology Co., Ltd, Ningbo, PR China
| | - Jing-Hao Li
- Center for Biological Disaster Prevention and Control, National Forestry and Grassland Administration, Shenyang, PR China
| | - Ya Qin
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, PR China
| | - Si-Yuan Qin
- Center for Biological Disaster Prevention and Control, National Forestry and Grassland Administration, Shenyang, PR China
| | - Chao Chen
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, PR China
| | - Xin-Bo Yang
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, PR China
| | - Ning Ma
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, PR China
| | - Ming-Xin Dong
- School of Pharmacy, Qingdao University, Qingdao, PR China
- Department of Technology, Ningbo Sansheng Biotechnology Co., Ltd, Ningbo, PR China
| | - Cong-Cong Lei
- Center for Biological Disaster Prevention and Control, National Forestry and Grassland Administration, Shenyang, PR China
| | - Xing Yang
- Department of Medical Microbiology and Immunology, School of Basic Medicine, Dali University, Dali, PR China
| | - He-Ting Sun
- Center for Biological Disaster Prevention and Control, National Forestry and Grassland Administration, Shenyang, PR China
| | - Zhi-Yong Sun
- Department of Technology, Ningbo Sansheng Biotechnology Co., Ltd, Ningbo, PR China
| | - Jing Jiang
- Changchun Sci-Tech University, Shuangyang, PR China
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Shrestha S, Karn M, Regmi SM, Pradhan S, Nagila A, Prajapati R. Clinical profile and biochemical abnormalities in Scrub Typhus: A cross-sectional study. Ann Med Surg (Lond) 2022; 84:104903. [DOI: 10.1016/j.amsu.2022.104903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/30/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022] Open
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Hong K, Shu Z, Li L, Zhong Y, Chen W, Nong C, Kong J. Diagnostic Value of CD4/CD8 in Scrub Typhus. Am J Trop Med Hyg 2022; 106:792-797. [PMID: 34902835 PMCID: PMC8922489 DOI: 10.4269/ajtmh.21-0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/20/2021] [Indexed: 11/07/2022] Open
Abstract
Scrub typhus is often misdiagnosed in febrile patients, leading to antibiotic abuse and multiple complications. We conducted a retrospective record review at the Fourth Affiliated Hospital of Guangxi Medical University in China. Data were collected on 52 patients with a confirmed diagnosis of scrub typhus and complete clinical data. In addition, data were collected on 52 patients with bloodstream infection, 25 patients with HIV infection, 112 patients with common community-acquired pneumonia (CCAP), and 36 patients with severe community-acquired pneumonia (SCAP) to serve as control groups. The peripheral blood CD4 and CD8 counts, CD4/CD8 ratio, C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, and β2 microglobulin levels; and the white blood cell count and neutrophil percentage were compared between the scrub typhus and the control groups. The value of these biomarkers in the diagnosis of scrub typhus was assessed using receiver-operating characteristic curve analysis. The scrub typhus group had a significantly lower CD4 count and CD4/CD8 ratio than the bloodstream infection, CCAP, and SCAP groups, and a significantly greater CD4 count and CD4/CD8 ratio than the HIV infection group. In contrast, the scrub typhus group had a significantly greater CD8 count than the bloodstream infection and CCAP and SCAP groups, and it had a lower level of CD8 than the HIV infection group. The areas under the curve of CD4/CD8 were more than 0.93 in the receiver-operating characteristic curve analysis. These findings suggest that the CD4/CD8 ratio is a useful ancillary test for diagnosing scrub typhus.
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Affiliation(s)
- Kangkang Hong
- Pulmonary and Critical Care Medicine Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China;,Department of Geriatric Medicine, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Ziping Shu
- Pulmonary and Critical Care Medicine Ward, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Laodong Li
- Pulmonary and Critical Care Medicine Ward, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Yu Zhong
- Department of Emergency, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Weiqian Chen
- Department of Geriatric Medicine, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Cunli Nong
- Department of Infectious Diseases, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Jinliang Kong
- Pulmonary and Critical Care Medicine Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China;,Address correspondence to Jinliang Kong, The First Affiliated Hospital of Guangzi Medical University, Shuangyong Rd., Nanning, China 540000. E-mail:
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Guccione C, Rubino R, Colomba C, Anastasia A, Caputo V, Iaria C, Cascio A. Rickettsiosis with Pleural Effusion: A Systematic Review with a Focus on Rickettsiosis in Italy. Trop Med Infect Dis 2022; 7:tropicalmed7010011. [PMID: 35051127 PMCID: PMC8777742 DOI: 10.3390/tropicalmed7010011] [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: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Motivated by a case finding of Mediterranean spotted fever (MSF) associated with atypical pneumonia and pleural effusion in which Rickettsia conorii subsp. israelensis was identified by molecular methods in the pleural fluid, we wanted to summarize the clinical presentations of rickettsiosis in Italy by systematic research and to make a systematic review of all the global cases of rickettsiosis associated with pleural effusion. Methods: For the literature search, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. We chose to select only the studies published in last 25 years and confirmed both with serological and molecular assays. Results: Human cases of rickettsiosis in Italy were reported in 48 papers describing 2831 patients with very different clinical presentations; the majority was MSF accounted to R. conorii and was reported in Sicily. Pleural effusion associated with infection with microorganisms belonging to Rickettsiales was described in 487 patients. It was rarely associated with microorganisms different from O. tsutsugamushi; also rarely, cases of scrub typhus were reported outside Southeast Asia and in the largest majority, the diagnosis was achieved with serology. Conclusions: MSF, especially when caused by R. conorii subsp. israelensis, may be a severe disease. A high index of suspicion is required to promptly start life-saving therapy. Pleural effusion and interstitial pneumonia may be part of the clinical picture of severe rickettsial disease and should not lead the physician away from this diagnosis
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Affiliation(s)
- Cristoforo Guccione
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (C.G.); (C.C.); (A.A.); (V.C.)
| | - Raffaella Rubino
- Infectious and Tropical Disease Unit, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy;
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (C.G.); (C.C.); (A.A.); (V.C.)
| | - Antonio Anastasia
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (C.G.); (C.C.); (A.A.); (V.C.)
| | - Valentina Caputo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (C.G.); (C.C.); (A.A.); (V.C.)
| | - Chiara Iaria
- Infectious and Tropical Disease Unit—ARNAS Civico, 90127 Palermo, Italy;
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (C.G.); (C.C.); (A.A.); (V.C.)
- Infectious and Tropical Disease Unit, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy;
- Correspondence: ; Tel.: +39-091-2389-0632
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Jesrani G, Gupta S, Gaba S, Gupta M. Scrub typhus manifesting as electrocardiographic disturbance: A case report and review of literature. Turk J Emerg Med 2022; 22:47-50. [PMID: 35284697 PMCID: PMC8862795 DOI: 10.4103/2452-2473.336103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022] Open
Abstract
Scrub typhus (ST) has wide organ system involvement, but cardiac involvement is paramount in this spectrum due to early hemodynamic compromise. Various forms of cardiac involvement have been described in the literature, but we are describing rare electrocardiographic changes in the ST infection. A young male presented in our emergency department with complaints of restlessness and vomiting of 2 days’ duration. The patient was having stable vitals on presentation, but his electrocardiogram (ECG) demonstrated second-degree atrioventricular block type 1 (also known Mobitz 1) and Osborn wave in the precordial leads. Further, he was having thrombocytopenia and eventually diagnosed with ST. For this, appropriate antibiotic treatment was given, which led to considerable symptomatic improvement and reversal of the ECG changes.
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Zhou XL, Ye QL, Chen JQ, Li W, Dong HJ. Manifestation of acute peritonitis and pneumonedema in scrub typhus without eschar: A case report. World J Clin Cases 2021; 9:6900-6906. [PMID: 34447840 PMCID: PMC8362526 DOI: 10.12998/wjcc.v9.i23.6900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Scrub typhus is an acute infectious disease caused by rickettsia infection. The diagnosis is based on eschar, and clinical manifestations can range from asymptomatic to multiorgan dysfunction.
CASE SUMMARY We report the case of a 35-year-old man living in Zhuhai, Guangdong, China, who had repeated high fever with a maximum body temperature of 40.2 °C and elevated white blood cells and procalcitonin levels. After 7 d of persistent high fever, the patient developed rash, abdominal pain, and symptoms of peritonitis. Within 24 h after admission, the patient developed diffuse peritonitis and pneumonedema, requiring ventilator support in the intensive care unit. However, there was no eschar on the body, and the first Weil-Felix test was negative. Taking into account that the patient had a history of jungle activities, doxycycline combined with meropenem was selected. The patient improved, healed, and was discharged after a week. The diagnosis of scrub typhus was confirmed by a repeat Weil-Felix test (Oxk 1:640), and pathology of the appendix resected by laparotomy suggests vasculitis.
CONCLUSION This rare presentation of peritonitis, pulmonary edema, and pancreatitis caused by scrub typhus reminds physicians to be alert to the possibility of scrub typhus.
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Affiliation(s)
- Xiu-Ling Zhou
- Department of Internal Medicine, Guangdong Provincial People’s Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai 519000, Guangdong Province, China
| | - Qing-Long Ye
- Department of Internal Medicine, Guangdong Provincial People’s Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai 519000, Guangdong Province, China
| | - Jia-Qian Chen
- Department of Internal Medicine, Guangdong Provincial People’s Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai 519000, Guangdong Province, China
| | - Wei Li
- Department of Internal Medicine, Guangdong Provincial People’s Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai 519000, Guangdong Province, China
| | - Hao-Jian Dong
- Department of Internal Medicine, Guangdong Provincial People’s Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai 519000, Guangdong Province, China
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Musa TH, Ahmad T, Wana MN, Li W, Musa HH, Sharun K, Tiwari R, Dhama K, Chaicumpa W, Campbell MC, Wei P. The epidemiology, diagnosis and management of scrub typhus disease in China. Hum Vaccin Immunother 2021; 17:3795-3805. [PMID: 34124995 DOI: 10.1080/21645515.2021.1934355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Thirty-nine years ago, scrub typhus (ST), a disease, was not among the China's notifiable diseases. However, ST has reemerged to become a growing public health issue in the southwest part of China. The major factors contributing to an increased incidence and prevalence of this disease include rapid globalization, urbanization, expansion of humans into previously uninhabited areas, and climate change. The clinical manifestation of ST also consists of high fever, headache, weakness, myalgia, rash, and an eschar. In severe cases, complications (e.g. multi-organ failure, jaundice, acute renal failure, pneumonitis, myocarditis, and even death) can occur. The diagnosis of ST is mainly based on serological identification by indirect immunofluorescence assay and other molecular methods. Furthermore, several groups of antibiotics (e.g. tetracycline, chloramphenicol, macrolides, and rifampicin) are currently effective in treating this disease. This fact suggests the need for robust early diagnostic techniques, increased surveillance, and prompt treatment, and develop future vaccine.
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Affiliation(s)
- Taha Hussein Musa
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Biomedical Research Institute (BRI), Darfur College, Nyala, Sudan
| | - Tauseef Ahmad
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Mohammed Nasiru Wana
- Department of Biological Sciences, Faculty of Science, Abubakar Tafawa Balewa University, Bauchi, Nigeria
| | - Wei Li
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Hassan Hussein Musa
- Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Bareilly, India
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, UP Deen Dayal Upadhayaya Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU), Mathura, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, India
| | - Wanpen Chaicumpa
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pingmin Wei
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
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Verma SK, Gupta KK, Arya RK, Kumar V, Reddy DH, Chaudhary SC, Sonkar SK, Kumar S, Verma N, Sharma D. Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India. J Family Med Prim Care 2021; 10:1459-1465. [PMID: 34041194 PMCID: PMC8140274 DOI: 10.4103/jfmpc.jfmpc_1162_20] [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: 06/12/2020] [Revised: 09/08/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022] Open
Abstract
Background Scrub typhus is a neglected rickettsial disease in India. Every year, we are facing outbreaks of Scrub typhus after Monsoon season. Patients present with a wide clinical spectrum ranging from pyrexia of unknown origin to multiple organ dysfunction. Some of these clinical features overlap with presentation of other tropical infections prevalent in Indian subcontinent, which leads to diagnostic dilemma and delay in diagnosis. Hence, we planned this study to know the demographic, clinical and biochemical profile of scrub typhus patients. Methods This was an observational study conducted in department of Medicine, King George's Medical University Lucknow, India a leading tertiary care hospital of Northern India. All scrub typhus patients were evaluated by detailed history, examination and laboratory tests. Results We enrolled 52 patients in our study. The mean age of the patients was 35.17 ± 16.90 years with majority (82.7%) of patients from rural background. All the patients had fever with an average duration of 9.6 ± 2 days. Most of the patients developed hepatitis (69.2%) followed by acute encephalitis syndrome (47%), acute kidney injury (23.1%) and acute respiratory failure (19.2%). Eschar was found in 11 patients (21.2%). Conclusion Scrub typhus is often misdiagnosed or diagnosed late due to its wide clinical spectrum overlapping with clinical presentation of other commonly prevalent tropical diseases. One should always consider the differential diagnosis of scrub typhus while evaluating a young febrile patient of rural background, with features of single or multiple organ dysfunction and laboratory findings of leucocytosis, thrombocytopenia and elevation of transaminases.
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Affiliation(s)
- Sudhir K Verma
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kamlesh K Gupta
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh K Arya
- Department of Medicine, Government Medical College, Orai, Jalaun, Uttar Pradesh, India
| | - Vivek Kumar
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D Himanshu Reddy
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shyam C Chaudhary
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satyendra K Sonkar
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satish Kumar
- Department of Endocrinology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neeraj Verma
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deepak Sharma
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Panthawong A, Grieco JP, Ngoen-Klan R, Chao CC, Chareonviriyaphap T. Detection of Anaplasma spp. and Bartonella spp. from wild-caught rodents and their ectoparasites in Nakhon Ratchasima Province, Thailand. JOURNAL OF VECTOR ECOLOGY : JOURNAL OF THE SOCIETY FOR VECTOR ECOLOGY 2020; 45:241-253. [PMID: 33207059 DOI: 10.1111/jvec.12395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
The objective of this study was to investigate evidence of emerging anaplasmosis and bartonellosis in rodents from endemic areas of Nakhon Ratchasima, Thailand. Rodent trapping was undertaken in 13 sub-districts of Muang District. The live-capture traps were set up in three locations of selected scrub typhus patient houses for three consecutive nights. Wild-caught rodent whole blood samples and associated ticks and fleas were collected and tested for Anaplasma spp. and Bartonella spp. In addition, heat maps using GIS software were used to determine the density of infection of positive wild-caught rodents. A total of 347 wild-caught rodents of nine species was captured. Rattus rattus (38.6%) was the dominant species. A total of 1,518 Heamaphysalis bandicota ticks and 57 Xenopsylla cheopis fleas was removed. Twenty-two of the 347 tested blood samples (6.3%) were Anaplasma bovis-positive and 121 blood samples and five out of 27 pools of X. cheopis fleas were Bartonella queenslandensis-positive. Of these infected rodents, dual-infections between A. bovis and B. queenslandensis were found in three B. indica rodents. Our results offer new information concerning the infections of A. bovis and B. queenslandensis in both rodents and their ectoparasites collected in high-risk areas of rodent-borne diseases in Thailand.
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Affiliation(s)
- Amonrat Panthawong
- Department of Entomology, Faculty of Agriculture, Kasetsart University, angkok, 10900, Thailand
| | - John Paul Grieco
- Department of Biological Sciences, University of Notre Dame, IN, 46556, U.S.A
| | - Ratchadawan Ngoen-Klan
- Department of Entomology, Faculty of Agriculture, Kasetsart University, angkok, 10900, Thailand
| | - Chien-Chung Chao
- Viral and Rickettsial Diseases Department, Naval Medical Research Center Silver Spring, MD, 20910, U.S.A
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Luo L, Guo Z, Lei Z, Hu Q, Chen M, Chen F, Zhao Z, Rui J, Liu X, Zhu Y, Wang Y, Yang M, Chen T. Epidemiology of tsutsugamushi disease and its relationship with meteorological factors in Xiamen city, China. PLoS Negl Trop Dis 2020; 14:e0008772. [PMID: 33057334 PMCID: PMC7591240 DOI: 10.1371/journal.pntd.0008772] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/27/2020] [Accepted: 09/03/2020] [Indexed: 12/31/2022] Open
Abstract
Tsutsugamushi disease (TD) is an acute infectious disease caused by Orientia tsutsugamushi. This study aimed to analyze the epidemiological features of TD, investigate chigger mites and their hosts, and investigate the meteorological factors affecting TD incidence and the host of O. tsutsugamushi in Xiamen city, China. Data on reported TD cases were collected from 2006 to 2018. Spearman’s correlation test were used for identifying the relationship between meteorological factors and TD incidence and whether meteorological factors affect the host of O. tsutsugamushi. The incidence of reported TD increased gradually from 2006, reached a peak of 4.59 per 100,000 persons in 2014, and then decreased gradually. The TD incidence was seasonal, with epidemic periods occurred mainly in summer and autumn. Patients aged 40–60 years had the highest proportion of cases, accounting for 44.44% of the total cases. Farmers had the largest number of cases among all occupational groups. Rattus Norvegicus was the most common host, accounting for the largest proportion of rats (73.00%), and the highest rat density was observed in March and October every year. There were significant positive correlations between the number of reported cases and average temperature, sunshine duration, and rainfall as well as between rat density and average temperature. On phylogenetic analysis, 7 sequences of hosts and human TD cases obtained from health records demonstrated the highest similarities to the Kato, Karp, and Gilliam strains. No correlations were observed between rat density, and sunshine duration and rainfall. The transmission of TD in Xiamen city, China, was seasonal, and its incidence was affected by several meteorological factors including average temperature, sunshine duration, and rainfall. However, the host of O. tsutsugamushi was only affected by average temperature. Tsutsugamushi disease (TD) is a natural focal disease caused by Orientia tsutsugamushi, which is widespread in some areas. The incidence of TD is greatly influenced by meteorological factors. Therefore, it is essential to analyze the epidemiological features of TD, investigate chigger mites and their hosts, and explore the relationship between meteorological factors and TD incidence and whether meteorological factors affect the host of O. tsutsugamushi in Xiamen city, China. The results showed significant positive correlations between the number of reported cases and average temperature, sunshine duration, and rainfall. A positive correlation between rat density and average temperature. No correlations were observed between the rat density and sunshine duration and rainfall. We believe our findings may provide scientific basis for studies or health strategies conducted in areas that are meteorologically similar in characteristics with Xiamen city, China.
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Affiliation(s)
- Li Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Zhinan Guo
- Xiamen Center for Disease Control and Prevention, Xiamen city, Fujian Province, People’s Republic of China
| | - Zhao Lei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Qingqing Hu
- Division of Public Health, School of Medicine, University of Utah, Presidents Circle, Salt Lake City, Utah, United States of America
| | - Min Chen
- Xiamen Center for Disease Control and Prevention, Xiamen city, Fujian Province, People’s Republic of China
| | - Fanghua Chen
- Xiamen Center for Disease Control and Prevention, Xiamen city, Fujian Province, People’s Republic of China
| | - Zeyu Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Xingchun Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Yuanzhao Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Yao Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Meng Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
- * E-mail:
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Li W, Huang L, Zhang W. Scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia: a case report and review of the literature. J Med Case Rep 2019; 13:358. [PMID: 31810465 PMCID: PMC6898947 DOI: 10.1186/s13256-019-2299-x] [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: 03/24/2019] [Accepted: 10/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scrub typhus is an acute infectious zoonotic disease caused by Orientia tsutsugamushi. Multi-organ dysfunction secondary to scrub typhus is hard to diagnose and has a high mortality rate. Only one case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia has been reported thus far. In this study, we report a second case of scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia, and we summarize its diagnosis and treatment. CASE PRESENTATION A 43-year-old Han Chinese woman, a sanitation worker, was admitted to our hospital after 7 days of a skin infection and 5 days of a sore throat with fever and dizziness. A physical examination revealed the presence of an eschar on the right side of her neck. She had a history of insect bites during her sanitation work. A diagnostic evaluation identified scrub typhus as the primary illness, which was associated with multi-organ dysfunction syndrome and immune thrombocytopenia. She recovered completely after 15 days of treatment and extensive symptomatic supportive care. CONCLUSION We report a second case of tsutsugamushi disease with multi-organ dysfunction syndrome and immune thrombocytopenia, which resolved after treatment and extensive care.
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Affiliation(s)
- Weijia Li
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
| | - Lei Huang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
| | - Weixing Zhang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
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Acute Severe Calculous Cholecystitis with Multiorgan Failure Complicated by Scrub Typhus. Case Rep Surg 2019; 2019:7505108. [PMID: 31341695 PMCID: PMC6612987 DOI: 10.1155/2019/7505108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/27/2019] [Accepted: 06/17/2019] [Indexed: 12/07/2022] Open
Abstract
Scrub typhus is a febrile illness and can present with manifestations ranging from subclinical symptoms to multiorgan failure and death. Scrub typhus is a rare etiology of acute cholecystitis. A patient presenting with the features of acute cholecystitis who does not respond to standard treatment should be screened for scrub typhus in a typhus endemic region. We report a case of a 70-year-old female with acute severe calculous cholecystitis with multiorgan failure complicated by scrub typhus. She improved remarkably after starting doxycycline for scrub typhus. Scrub typhus should be considered as a trigger in a patient presenting with cholecystitis in a typhus endemic region.
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Pathania M, Amisha, Malik P, Rathaur VK. Scrub typhus: Overview of demographic variables, clinical profile, and diagnostic issues in the sub-Himalayan region of India and its comparison to other Indian and Asian studies. J Family Med Prim Care 2019; 8:1189-1195. [PMID: 31041272 PMCID: PMC6482722 DOI: 10.4103/jfmpc.jfmpc_124_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: India is a tropical country with a high burden of febrile zoonotic/infectious illnesses, scrub typhus being such a cause with multiple epidemics reported from different regions of the country. Objective: This study was plotted to document the clinical and diagnostic manifestations, treatment, and outcomes of scrub typhus in the sub-Himalayan region of India and to compare the results with other Indian and Asian studies. Materials and Methods: This was a retrospective observational study involving collection of data for 54 IgM ELISA-confirmed in-patient cases of scrub typhus at a tertiary care institute in Uttarakhand, India, from their case records. Results: The majority of patients were from rural background. Housewives constituted 28 (51.85%) patients. The most common symptoms were due to involvement of gastrointestinal tract in the form of abdominal pain in 39 (72.22%) and vomiting in 29 (53.7%) patients. Central nervous system involvement in the form of altered sensorium in 14 (25.9%) patients and pulmonary involvement as cough in 28 (51.85%) patients was observed. An eschar was found in 7 (12.96%) patients and upper eyelid edema in 40 (74.07%) patients. The most common laboratory abnormality documented was elevation of liver transaminases (aspartate aminotransferase > alanine aminotransferase), 40 (74.07%), and blood urea levels, 47 (87.03%). There was no difference in the clinical presentation, severity, or mortality in pregnant females when compared with nonpregnant females. One (1.45% mortality) died in our study. Conclusion: Scrub typhus is an important cause of acute febrile illness with variable, often nonspecific and multisystem involvement. Early recognition and antibiotic administration are the key to reduce complications and mortality, especially for a primary care physician.
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Affiliation(s)
- Monika Pathania
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Amisha
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Paras Malik
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Vyas Kumar Rathaur
- Department of Paediatrics, Government Doon Medical College, Dehradun, Uttarakhand, India
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Lim HK, Wang JM. Scrub Typhus: Seven-Year Experience and Literature Review. J Acute Med 2018; 8:99-108. [PMID: 32995211 PMCID: PMC7517964 DOI: 10.6705/j.jacme.201809_8(3).0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/24/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Scrub typhus, an emerging rickettsial disease caused by Orientia tsutsugamushi, is a clinically important endemic disease on Taiwan. METHODS From January 1, 2007, to December 31, 2013, 156 patients diagnosed with scrub typhus were admitted to Taitung MacKay Memorial Hospital. Demographic data, clinical features, laboratory results, and outcomes of patients were retrospectively analyzed. RESULTS Among 156 cases, 150 survived (96%) and six died (4%). There were 111 males (71%) and 45 females (29%) with a mean age of 47.8 years. The most common clinical features were fever (100%), general malaise (77%), chill (74%), headache (59%), and eschar (55%). No seasonal pattern was observed, with peaks in November and January. The average time to defervescence after appropriate antibiotics for the 150 surviving patients was 2.45 days. The significant risk factors were a delay of initial appropriate antibiotics use within 24 hrs, increased C-reactive protein (CRP), and liver cirrhosis. CONCLUSION Scrub typhus, a growing and emerging disease, is considered in the differential diagnosis of fever of unknown origin, and its diagnosis may be missed if it is not considered owing to its nonspecific clinical presentation. It is important to have a high index of suspicion and to increase awareness in endemic areas. Prompt diagnosis and early treatment with appropriate antibiotics are vital.
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Affiliation(s)
- Hwee-Kheng Lim
- Taitung MacKay Memorial Hospital Division of Infectious Diseases, Department of Medicine Taitung Taiwan
| | - Jinn-Ming Wang
- Taitung MacKay Memorial Hospital Division of Urology, Department of Surgery Taitung Taiwan
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15
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van Eekeren LE, de Vries SG, Wagenaar JFP, Spijker R, Grobusch MP, Goorhuis A. Under-diagnosis of rickettsial disease in clinical practice: A systematic review. Travel Med Infect Dis 2018; 26:7-15. [PMID: 29486240 DOI: 10.1016/j.tmaid.2018.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rickettsial diseases present as acute febrile illnesses, sometimes with inoculation eschars. METHODS We performed a systematic review of studies published between 1997 and 2017 to assess the underestimation of non-eschar rickettsial disease (NERD) relative to eschar rickettsial disease (ERD), as a cause of acute fever in patients with rickettsial diseases that commonly present with eschar(s): scrub typhus (ST), Mediterranean spotted fever (MSF), and African tick-bite fever. We compared ERD/NERD ratios according to study design: 'complete approach' studies, with testing performed in all patients with 'unspecified febrile illness'; versus 'clinical judgement' studies, with testing performed if patients presented with specific symptoms. RESULTS In 'complete approach' studies, ERD/NERD ratios were significantly lower, suggesting a considerable under-diagnosis of NERD in 'clinical judgement' studies. Based on these results, we estimate that the diagnosis of rickettsial disease was missed in 66.5% of patients with ST, and in 57.9% of patients with MSF. CONCLUSIONS Study design influences the reported eschar rates in ST and MSF significantly. NERD is likely to be a vastly underdiagnosed entity, and clinicians should consider and test for the disease more often. PROSPERO REGISTRATION NUMBER CRD 42016053348.
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Affiliation(s)
- Louise E van Eekeren
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Sophia G de Vries
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Jiri F P Wagenaar
- Leptospirosis Reference Center, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - René Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands.
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16
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Balasubramanian P, Sharma N, Biswal M, Bhalla A, Kumar S, Kumar V. Critical Illness Scoring Systems: Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II, and Quick Sequential Organ Failure Assessment to Predict the Clinical Outcomes in Scrub Typhus Patients with Organ Dysfunctions. Indian J Crit Care Med 2018; 22:706-710. [PMID: 30405280 PMCID: PMC6201639 DOI: 10.4103/ijccm.ijccm_254_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Aim Scrub typhus (ST) is an acute infectious disease of variable severity caused by Orientia (formerly Rickettsia) tsutsugamushi. The disease can be complicated by organ dysfunctions and the case fatality rate (CFR) is approximately 15%, which further rises with the development of severe complications. We studied the clinical features of the ST and the performance of critical illness scoring systems (CISSs) - Acute Physiology and Chronic Health Evaluation (APACHE) II, sequential organ failure assessment (SOFA), and quick SOFA (qSOFA) in predicting the clinical outcomes in complicated ST (cST) patients admitted to the emergency department. Study Design and Methods A prospective observational study was done in 50 patients diagnosed to have cST with one or more organ dysfunctions. Clinical features and laboratory parameters were recorded and the patients were followed up until the end of their stay in the hospital. APACHE II, SOFA, and qSOFA scores at admission were calculated and were analyzed in predicting the clinical outcomes. Results The median SOFA, APACHE II, and qSOFA scores of the cohort were 7 (interquartile range [IQR] = 13-22), 8 (IQR = 5-11), and 2 (IQR = 1-3), respectively. The median duration of in-hospital stay was 9 (IQR 5-11) days and overall CFR was 8%. On bivariate analysis, both SOFA (P = 0.031) and qSOFA (P = 0.001) predicted mortality. However, only SOFA score correlated with the in-hospital stay duration (Pearson's correlation = 0.311, P = 0.028). Conclusion Among the three CISSs studied, the SOFA score correlated with in-hospital stay duration and mortality, whereas the qSOFA score formed a simple as well as a convenient tool in predicting the mortality in patients of cST with organ dysfunction.
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Affiliation(s)
| | - Navneet Sharma
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Susheel Kumar
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Vivek Kumar
- Department of Nephrology, PGIMER, Chandigarh, India
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Sedhain A, Bhattarai GR. Renal Manifestation in Scrub Typhus during a Major Outbreak in Central Nepal. Indian J Nephrol 2017; 27:440-445. [PMID: 29217880 PMCID: PMC5704408 DOI: 10.4103/ijn.ijn_133_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal involvement and acute kidney injury (AKI) are common clinical manifestations seen in scrub typhus, a vector-borne tropical disease. There are no data on renal manifestation in scrub typhus in Nepal. We conducted a prospective study to analyze the incidence, urinary abnormalities, course, severity, outcome, and the predictors of AKI in patients with scrub typhus during a major outbreak in Central Nepal. Total 1398 patients admitted with acute febrile illness were subjected for Scrub Typhus Detect™ Immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) test, of which 502 (35.90%) patients tested positive and were included in the study. Mean age of the patients was 30.37 ± 18.81 years (range, 1-79 years) with 26.29% in the pediatric age group. Female-to-male ratio was 1.26:1. Mean duration of fever was 6.8 ± 3.1 days. Mean IgM ELISA value for scrub typhus was 2.17 ± 1.70 without difference in AKI and non-AKI groups (2.17 ± 1.76 vs. 2.16 ± 1.62; P = 0.94). Urinary abnormalities were seen in 42.3% of patients. Mean serum creatinine was 1.37 ± 0.69 mg/dl with significant difference in two groups (1.85 ± 0.87 vs. 1.03 ± 0.17; P = 0.003). AKI was seen in 35.8% of patients with majority having Stage 1 AKI (68.3%) followed by Stage 2 (34.1%) and Stage 3 (1.2%). Hemodialysis was required for 3.94% of patients. In 54% of patients, AKI occurred in fifth and sixth day of fever. ICU admission was required for 18.73% of patients and 8.57% required ventilator support. Mortality rate was 1.79%, which was higher among patients with AKI (2.96% vs. 1.0%; P = 0.106). Multivariate analysis revealed that the presence of pneumonia, shock, and acute respiratory distress syndrome predicted the development of AKI.
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Affiliation(s)
- A. Sedhain
- Department of Medicine, Nephrology Unit, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - G. R. Bhattarai
- Health Services Research, United Health Group, OptumInsight, CT, USA
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Huang XD, Cheng P, Zhao YQ, Li WJ, Zhao JX, Liu HM, Kou JX, Gong MQ. Chigger Mite (Acari: Trombiculidae) Survey of Rodents in Shandong Province, Northern China. THE KOREAN JOURNAL OF PARASITOLOGY 2017; 55:555-559. [PMID: 29103271 PMCID: PMC5678473 DOI: 10.3347/kjp.2017.55.5.555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 09/08/2017] [Accepted: 10/11/2017] [Indexed: 11/23/2022]
Abstract
Chigger mites are parasites of rodents and other vertebrates, invertebrates, and other arthropods, and are the only vectors of scrub typhus, in addition to other zoonoses. Therefore, investigating their distribution, diversity, and seasonal abundance is important for public health. Rodent surveillance was conducted at 6 districts in Shandong Province, northern China (114–112°E, 34–38°N), from January to December 2011. Overall, 225/286 (78.7%) rodents captured were infested with chigger mites. A total of 451 chigger mites were identified as belonging to 5 most commonly collected species and 3 genera in 1 family. Leptotrombidium scutellare and Leptotrombidium intermedia were the most commonly collected chigger mites. L. scutellare (66.2%, 36.7%, and 49.0%) was the most frequently collected chigger mite from Apodemus agrarius, Rattus norvegicus, and Microtus fortis, respectively, whereas L. intermedia (61.5% and 63.2%) was the most frequently collected chigger mite from Cricetulus triton and Mus musculus, respectively. This study demonstrated a relatively high prevalence of chigger mites that varied seasonally in Shandong Province, China.
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Affiliation(s)
- Xiao-Dan Huang
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Peng Cheng
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Yu-Qiang Zhao
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Wen-Juan Li
- Institute of Forensic Medicine and Laboratory Medicine, Jining Medical University, Jining, Shandong Province 272067, People's Republic of China
| | - Jiu-Xu Zhao
- Jining Health School, Jining, Shandong Province 272031, People's Republic of China
| | - Hong-Mei Liu
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Jing-Xuan Kou
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
| | - Mao-Qing Gong
- Shandong Academy of Medicine Sciences, Shandong Institute of Parasitic Diseases, Jining, Shandong Province 272033, People's Republic of China
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Chen H, Ning Z, Qiu Y, Liao Y, Chang H, Ai Y, Wei Y, Deng Y, Shen Y. Elevated levels of von Willebrand factor and high mobility group box 1 (HMGB1) are associated with disease severity and clinical outcome of scrub typhus. Int J Infect Dis 2017; 61:114-120. [PMID: 28652214 DOI: 10.1016/j.ijid.2017.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/11/2017] [Accepted: 06/16/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES This study aimed to investigate whether von Willebrand factor (vWF) and high mobility group box 1 (HMGB1) are associated with the severity and clinical outcome of scrub typhus and to seek novel biomarkers for surveillance and prediction of the prognosis of this infection. METHODS Serum concentrations of vWF and HMGB1 were measured twice by ELISA for scrub typhus patients (n=103), once prior to doxycycline therapy and then on day 7 of doxycycline therapy; concentrations were measured once for healthy controls (n=32). RESULTS Among the total 103 patients enrolled, 38 had disease complicated by multiple organ dysfunction syndrome (MODS). Serum concentrations of vWF and HMGB1 were significantly higher in all the patients than in the healthy controls, both prior to doxycycline treatment and on day 7 of doxycycline treatment (p<0.01). Furthermore, serum levels of vWF, HMGB1, and creatinine (SCr) in the patients with MODS increased distinctly, while the platelet (PLT) count diminished markedly compared to the levels in patients without MODS (p<0.01). The concentration of vWF was positively correlated with that of HMGB1 (r=0.764, p<0.001) and SCr (r=0.528, p<0.001), but negatively correlated with the PLT count (r=-0.632, p<0.001). Both HMGB1 and vWF were significantly associated with mortality in scrub typhus (area under the curve (AUC)=0.864, p=0.001, and AUC=0.862, p=0.001, respectively). CONCLUSIONS Elevated levels of vWF and HMGB1 are associated with the severity and clinical outcome of scrub typhus. These represent possible new biomarkers for use in the assessment and prognostic prediction of this infection.
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Affiliation(s)
- Hongliu Chen
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Zong Ning
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Ying Qiu
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yuanli Liao
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Haihua Chang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yuanyuan Ai
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yinghua Wei
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Yiming Deng
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, 530021, China
| | - Ying Shen
- General Practice School of Guangxi Medical University, Nanning, Guangxi Province, 530021, China.
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Mendell NL, Bouyer DH, Walker DH. Murine models of scrub typhus associated with host control of Orientia tsutsugamushi infection. PLoS Negl Trop Dis 2017; 11:e0005453. [PMID: 28282373 PMCID: PMC5362142 DOI: 10.1371/journal.pntd.0005453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/22/2017] [Accepted: 03/03/2017] [Indexed: 01/19/2023] Open
Abstract
Background Scrub typhus, a febrile illness of substantial incidence and mortality, is caused by infection with the obligately intracellular bacterium Orientia tsutsugamushi. It is estimated that there are more than one million cases annually transmitted by the parasitic larval stage of trombiculid mites in the Asia-Pacific region. The antigenic and genetic diversity of the multiple strains of O. tsutsugamushi hinders the advancement of laboratory diagnosis, development of long-lasting vaccine-induced protection, and interpretation of clinical infection. Despite the life-threatening severity of the illness in hundreds of thousands of cases annually, 85–93% of patients survive, often without anti-rickettsial treatment. To more completely understand the disease caused by Orientia infection, animal models which closely correlate with the clinical manifestations, target cells, organ involvement, and histopathologic lesions of human cases of scrub typhus should be employed. Previously, our laboratory has extensively characterized two relevant C57BL/6 mouse models using O. tsutsugamushi Karp strain: a route-specific intradermal model of infection and persistence and a hematogenously disseminated dose-dependent lethal model. Principal findings To complement the lethal model, here we illustrate a sublethal model in the same mouse strain using the O. tsutsugamushi Gilliam strain, which resulted in dose-dependent severity of illness, weight loss, and systemic dissemination to endothelial cells of the microcirculation and mononuclear phagocytic cells. Histopathologic lesions included expansion of the pulmonary interstitium by inflammatory cell infiltrates and multifocal hepatic lesions with mononuclear cellular infiltrates, renal interstitial lymphohistiocytic inflammation, mild meningoencephalitis, and characteristic typhus nodules. Significance These models parallel characteristics of human cases of scrub typhus, and will be used in concert to understand differences in severity which lead to lethality or host control of the infection and to address the explanation for short duration of heterologous immunity in Orientia infection. Scrub typhus is an acute febrile illness with considerable mortality, and no available vaccine, caused by the obligately intracellular bacterium, Orientia tsutsugamushi. Despite the life-threatening severity of the illness in approximately one million cases annually, 85–93% of patients survive. The lack of appropriate animal models of scrub typhus has left a void in the fundamental knowledge necessary to develop a vaccine, such as mechanisms which contribute to disease severity and immunity. Here, we report a sublethal inbred murine model for scrub typhus using the intradermal and intravenous routes of inoculation, which are comparable to the natural route of chigger-bite transmission and subsequent hematogenous spread. This model, infection of mice with O. tsutsugamushi Gilliam strain, can be employed in conjunction with the lethal model of O. tsutsugamushi Karp strain to perform in-depth mechanistic studies related to strain cross-protection, lethality, pathogenesis and specific immunological investigations of the host immune response.
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Affiliation(s)
- Nicole L. Mendell
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Donald H. Bouyer
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - David H. Walker
- Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
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Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India. Infect Dis Poverty 2016; 5:91. [PMID: 27716337 PMCID: PMC5051022 DOI: 10.1186/s40249-016-0186-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 08/22/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND India is an integral component of "tsutsugamushi triangle" which depicts a part of the globe endemic to scrub typhus. Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is described as a re-emerging infectious disease in India. The present study aimed to study the clinical and paraclinical profile, complications and predictors of outcome among 90 cases of scrub typhus diagnosed in a hospital of north-eastern India from Sept 2011 to Aug 2012. METHODS A longitudinal study was conducted in a hospital of Meghalaya, India between Sept 2011 and Aug 2012. Diagnosis of scrub typhus was arrived by SD BIOLINE tsutsugamushi (solid phase immunochromatographic assay) rapid diagnostic test for antibodies (IgM, IgG or IgA). Descriptive analyses of age, gender, geographic area, symptoms and signs, treatment, laboratory findings, complications, and outcome were conducted. Relative risk (RR) with 95 % confidence interval (CI) was computed for Multiple Organ Dysfunction Syndrome (MODS) and mortality. Binary logistic regression was applied to the significant correlates (P < 0.05) on univariate analysis to identify the predictors of MODS and mortality in scrub typhus. RESULTS As many as 662 clinically suspected scrub typhus patients were tested and 90 (13.6 %) were diagnosed to have scrub typhus. Out of 90 patients, 52.2 % (n = 47) were males and their mean (SD) age was 36.29 (13.38) years. Fever of <7 days (n = 75, 83.3 %), myalgia (n = 56, 62.2 %), pain abdomen (n = 24, 26.7 %), headache (n = 24, 26.7 %), nausea/vomiting (n = 21, 23.3 %), dry cough (n = 21, 23.3 %), hepatomegaly (n = 24, 26.7 %), splenomegaly (n = 22, 24.4 %), and lymphadenopathy (n = 20, 22.2 %) were the predominant clinical features. Eschar was seen in 10 patients (11.1 %). One third (n = 30) of the patients developed at least one systemic complication. Acute hepatitis (n = 15, 16.7 %), pneumonitis (n = 14, 15.6 %), and acute kidney injury (n = 11, 12.2 %) were the common complications. MODS was seen in 14.4 % (n = 13) and 38.5 % (n = 5) of the patients with MODS died. Overall, case fatality rate was 5.15 % (n = 5). On univariate analysis, platelets <100 000/mm3, serum creatinine >1.5 mg/dl, and transaminase (AST, ALT or both) >500 U/L were associated with MODS (P < 0.001) and mortality (P < 0.05). In addition, serum bilirubin >3 mg/dl was also associated with MODS (P < 0.001). On applying binary logistic regression, serum creatinine >1.5 mg/dl was a predictor of MODS (OR: 76.1, 95 % CI: 4.9-1175.6) and mortality (OR: 18.03, 95 % CI: 1.38-235.1). CONCLUSION In this study setting, approximately one-seventh (13.6 %) of the acute undifferentiated febrile illness were due to scrub typhus. Systemic complications were common (33.3 %). Serum creatinine >1.5 mg/dl was a predictor of MODS and mortality.
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Abstract
The obligate intracellular bacterium Orientia tsutsugamushi is responsible for more than one million cases of scrub typhus annually throughout the Asia-Pacific region. Human infection occurs via the bite of the larval form (chigger) of several species of trombiculid mites. While in some patients the result of infection is a mild, febrile illness, others experience severe complications, which may even be fatal. This review discusses the genome and biology of the causative agent, the changing epidemiology of scrub typhus, the challenges of its diagnosis, and current treatment recommendations.
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Affiliation(s)
- Sunil Thomas
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania USA
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Zheng L, Bi Z, Kou Z, Yang H, Zhang L, Zhao Z. Genotype diversity and distribution of Orientia tsutsugamushi in scrub typhus patients and rodents in Shandong, northern China. INFECTION GENETICS AND EVOLUTION 2015; 36:126-130. [PMID: 26371067 DOI: 10.1016/j.meegid.2015.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/13/2015] [Accepted: 09/10/2015] [Indexed: 11/18/2022]
Abstract
Orientia tsutsugamushi, the etiologic agent of scrub typhus, is transmitted to humans through the bites of infected chiggers. To identify the genotypes of O.tsutsugamushi and their geographical distribution in Shandong, 236 patient's samples and 1606 captured rodents were collected in major-endemic regions of Shandong Province from June 2013 to December 2014. Sequences were determined for the 56-kDa TSA gene, and the relationship between these sequences and those previously determined was assessed. Two genotypes out of 5 previously reported in Shandong were identified, i.e. Kawasaki-related and STA-07. The Kawasaki-related genotype was predominant (82.1% (23/28) in human and 50% (5/10) in rodents), with wide distribution through the endemic areas of Shandong Province. The STA-07 was confined to Tai'an, Linyi and Qingdao districts. The Fuji-related, Shimikoshi-related and Karp-related genotypes were not found, while identified in previous studies. For prevention and control of scrub typhus in Shandong, more attention should be paid to surveillance of Kawasaki-related and STA-07 genotypes.
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Affiliation(s)
- Li Zheng
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China
| | - Zhenwang Bi
- Institute for Bacterial Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250012, China
| | - Zengqiang Kou
- Institute for Bacterial Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250012, China
| | - Hui Yang
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China
| | - Luyan Zhang
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China
| | - Zhongtang Zhao
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
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Taylor AJ, Paris DH, Newton PN. A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi). PLoS Negl Trop Dis 2015; 9:e0003971. [PMID: 26274584 PMCID: PMC4537241 DOI: 10.1371/journal.pntd.0003971] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/10/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Scrub typhus, a bacterial infection caused by Orientia tsutsugamushi, is increasingly recognized as an important cause of fever in Asia, with an estimated one million infections occurring each year. Limited access to health care and the disease's non-specific symptoms mean that many patients are undiagnosed and untreated, but the mortality from untreated scrub typhus is unknown. This review systematically summarizes the literature on the untreated mortality from scrub typhus and disease outcomes. METHODOLOGY/PRINCIPAL FINDINGS A literature search was performed to identify patient series containing untreated patients. Patients were included if they were symptomatic and had a clinical or laboratory diagnosis of scrub typhus and excluded if they were treated with antibiotics. The primary outcome was mortality from untreated scrub typhus and secondary outcomes were total days of fever, clinical symptoms, and laboratory results. A total of 76 studies containing 89 patient series and 19,644 patients were included in the final analysis. The median mortality of all patient series was 6.0% with a wide range (min-max) of 0-70%. Many studies used clinical diagnosis alone and had incomplete data on secondary outcomes. Mortality varied by location and increased with age and in patients with myocarditis, delirium, pneumonitis, or signs of hemorrhage, but not according to sex or the presence of an eschar or meningitis. Duration of fever was shown to be long (median 14.4 days Range (9-19)). CONCLUSIONS Results show that the untreated mortality from scrub typhus appears lower than previously reported estimates. More data are required to clarify mortality according to location and host factors, clinical syndromes including myocarditis and central nervous system disease, and in vulnerable mother-child populations. Increased surveillance and improved access to diagnostic tests are required to accurately estimate the untreated mortality of scrub typhus. This information would facilitate reliable quantification of DALYs and guide empirical treatment strategies.
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Affiliation(s)
- Andrew J. Taylor
- Lao Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Daniel H. Paris
- Lao Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
- Mahidol–Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul N. Newton
- Lao Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
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Clinical characteristics and risk factors of an outbreak with scrub typhus in previously unrecognized areas, Jiangsu province, China 2013. PLoS One 2015; 10:e0125999. [PMID: PMID: 25954814 PMCID: PMC4425678 DOI: 10.1371/journal.pone.0125999] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/27/2015] [Indexed: 11/19/2022] Open
Abstract
Scrub typhus, caused by Orientia tsutsugamushi, has emerged recently in Jingjiang City, China where the disease had not been known to exist. We analyzed epidemiological data, clinical characteristics and risk factors of scrub typhus outbreak in Jingjiang City, 2013. The 271 clinically diagnosed patients were predominantly farmers 50 to 69 years old and the peak of onset was early to mid-November. For the 187 laboratory-confirmed cases, the major clinical manifestations of the patients were fever (100%), eschar (88.2%), rash (87.7%), chills (87.7%), and headache (66.8%). A community-based case-control study was carried out to investigate the risk factors of the scrub typhus outbreak. Bundling or moving waste straw (OR=9.0, 95%CI 4.6-17.8) and living at the edge of village (OR=0.6, 95%CI 0.4-0.9) posed the highest risks through single- and multi-variable conditional logistic regression. Phylogenetic analysis of the 56-kDa TSA gene showed that the new cluster (GB-C2) and the previously reported cluster (GB-C1) of O. tsutsugamushi were associated with this outbreak. These findings are useful for the establishment of a detailed control strategy for scrub typhus infection in previously unrecognized areas of Jiangsu Province, China.
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Zhang L, Bi Z, Kou Z, Yang H, Zhang A, Zhang S, Meng X, Zheng L, Zhang M, Yang H, Zhao Z. Scrub typhus caused by Orientia tsutsugamushi Kawasaki-related genotypes in Shandong Province, northern China. INFECTION GENETICS AND EVOLUTION 2015; 30:238-243. [DOI: 10.1016/j.meegid.2014.12.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/20/2014] [Accepted: 12/30/2014] [Indexed: 11/29/2022]
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De W, Jing K, Huan Z, Qiong ZH, Monagin C, Min ZJ, Ping H, Wen KC, Yan LJ. Scrub typhus, a disease with increasing threat in Guangdong, China. PLoS One 2015; 10:e0113968. [PMID: 25689778 PMCID: PMC4331496 DOI: 10.1371/journal.pone.0113968] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022] Open
Abstract
There has been a rapid increase in the number of scrub typhus cases in Guangdong Province, China. For this reason, an epidemiologic study was conducted to understand the characteristics of scrub typhus epidemics in Guangdong. From 2006 to 2013, the incidence of human cases increased from 0.4321 to 3.5917 per 100,000 with a bimodal peak in human cases typically occurring between May and November. To detect the prevalence of Orientia tsutsugamushi among suspected human cases and rodents, we performed ELISA tests of IgM/IgG and nested PCR tests on 59 whole blood samples from the suspected cases and 112 spleen samples from the rodents. Suspected cases tested positive for anti-O. tsutsugamushi IgM and IgG 66.1% (39/59) and 50.8% (30/59) of the time, respectively. Additionally, 20.3% (12/59) of blood samples and 13.4% (15/112) of spleen samples were positive for PCR. Phylogenetic analysis revealed that there were four definable clusters among the 27 nucleotide sequences of the 56-kDa antigen genes: 44.4% Karp (12/27), 25.9% Kato (7/27), 22.2% Gilliam (6/27) and 7.4% TA763 (2/27). We concluded many suspected cases may result in diagnostic errors; therefore, it is necessary to perform laboratory tests on suspected cases in hospitals. The high infection rate of O. tsutsugamushi among the limited rodents tested suggested that further rodent sampling throughout the province is necessary to further define high-risk areas. Furthermore, the multiple co-circulating genotypes of O. tsutsugamushi play a key role in the pervasiveness of scrub typhus in the Guangdong area.
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Affiliation(s)
- Wu De
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
- * E-mail:
| | - Kou Jing
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Zhang Huan
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Zhou Hui Qiong
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Corina Monagin
- Metabiota, Inc., San Francisco, California, United States of America
| | - Zhong Jian Min
- Department of Biological Sciences, Humboldt State University, Arcata, California 95521, United States of America
| | - Huang Ping
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Ke Chang Wen
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Lin Jin Yan
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
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Epidemic characteristics and spatio-temporal patterns of scrub typhus during 2006–2013 in Tai'an, Northern China. Epidemiol Infect 2014; 143:2451-8. [DOI: 10.1017/s0950268814003598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYTai'an, a famous cultural tourist district, is a new endemic foci of scrub typhus in northern China. Frequent reports of travel-acquired cases and absence of effective vaccine indicated a significant health problem of scrub typhus in Tai'an. Thus, descriptive epidemiological methods and spatial-temporal scan statistics were used to describe the epidemic characteristics and detect the significant clusters of the high incidence of scrub typhus at the town level in Tai'an. Results of descriptive epidemiological analysis showed a total of 490 cases were reported in Tai'an with the annual average incidence ranging from 0·48 to 2·27/100 000 during 2006–2013. Females, the elderly and farmers are the high-risk groups. Monthly changes of scrub typhus cases indicated an obvious epidemic period in autumn. Spatial-temporal distribution analysis, showed significant clusters of high incidence mainly located in eastern and northern Tai'an. Our study suggests that more effective, targeted measures for local residents should be implemented in the eastern and northern areas of Tai'an in autumn. Meanwhile, it may prove beneficial for health policy makers to advise travellers to take preventive measures in order to minimize the risk of infection of scrub typhus in Tai'an.
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Zhang L, Zhao Z, Bi Z, Kou Z, Zhang M, Yang L, Zheng L. Risk factors associated with severe scrub typhus in Shandong, northern China. Int J Infect Dis 2014; 29:203-7. [DOI: 10.1016/j.ijid.2014.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/17/2014] [Accepted: 09/25/2014] [Indexed: 11/17/2022] Open
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Agarwal VK, Reddy GKM, Krishna MR, Ramareddy G, Saroj P, Bandaru VCSS. Predictors of scrub typhus: a study from a tertiary care center. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60704-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wei Y, Huang Y, Luo L, Xiao X, Liu L, Yang Z. Rapid increase of scrub typhus: an epidemiology and spatial-temporal cluster analysis in Guangzhou City, Southern China, 2006-2012. PLoS One 2014; 9:e101976. [PMID: 25006820 PMCID: PMC4090214 DOI: 10.1371/journal.pone.0101976] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 06/13/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Scrub typhus has been increasingly reported in Southern China, and public health authorities are concerned about its increased incidence. Additionally, little evidence is available on the epidemiology of scrub typhus in Southern China. This study aims to analyze the epidemiological and geographic features of ST in Guangzhou City, Southern China, to guide the future prevention efforts. METHODS Scrub typhus surveillance data in Guangzhou City during 2006-2012 were obtained from the Chinese National Communicable Disease Surveillance Network. We first conducted a descriptive analysis to analyze the epidemiological features of scrub typhus. Then we used space-time scan statistic based on a discrete Poisson model to detect and evaluate high-risk spatial-temporal clusters of scrub typhus. RESULTS There were 4,001 cases of scrub typhus in Guangzhou City during the study period. The incidence of scrub typhus increased from 3.29 per 100,000 in 2006 to 9.85 per 100,000 in 2012. A summer peak was observed in June and July with a second peak in September and October except year 2009 and 2011. The majority of the cases (71.4%) were among persons aged ≥40 years, and female incidence was higher than male incidence in persons ≥50 years. In the space-time analysis, high-risk clusters were concentrated in rural areas in Guangzhou City. Over the past 7 years, Haizhu District, an urban area, was found to be a high-risk cluster for the first time in 2012. CONCLUSION The resurgence of scrub typhus epidemics in Guangzhou population in 2012 necessitates more effective measures for minimizing future epidemics. Consideration of high-risk population and historical spatial-temporal clusters may help prevent scrub typhus. The risk of scrub typhus in urban areas should not be neglected and needs more attention from public health authorities.
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Affiliation(s)
- Yuehong Wei
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Yong Huang
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Lei Luo
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Xincai Xiao
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Lan Liu
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, China
- * E-mail:
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Li T, Yang Z, Dong Z, Wang M. Meteorological factors and risk of scrub typhus in Guangzhou, southern China, 2006-2012. BMC Infect Dis 2014; 14:139. [PMID: 24620733 PMCID: PMC3995673 DOI: 10.1186/1471-2334-14-139] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 03/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scrub typhus is becoming the most common vector born disease in Guangzhou, southern China. In this study, we aimed to examine the effect of weather patterns on the incidence of Scrub typhus in the subtropical city of Guangzhou for the period 2006-2012, and assist public health prevention and control measures. METHODS Scrub typhus reported cases during the period of 2006-2012 in Guangzhou were obtained from National Notifiable Disease Report System (NNDRS). Simultaneous meteorological data including temperature, relative humidity, atmospheric pressure, sunshine, and rainfall were obtained from the documentation of the Guangzhou Meteorological Bureau. A negative binomial regression was used to identify the relationship between meteorological variables and scrub typhus. RESULTS Annual incidence rates of scrub typhus from 2006 to 2012 were 3.25, 2.67, 3.81, 4.22, 4.41, 5.12, and 9.75 (per 100 000) respectively. Each 1°C rise in temperature corresponded to an increase of 14.98% (95% CI 13.65% to 16.33%) in the monthly number of scrub typhus cases, while a 1 hPa rise in atmospheric pressure corresponded to a decrease in the number of cases by 8.03% (95% CI -8.75% to -7.31%). Similarly, a 1 hour rise in sunshine corresponded to an increase of 0.17% or 0.54%, and a 1 millimeter rise in rainfall corresponded to an increase of 0.05% or 0.10%, in the monthly number of scrub typhus cases, depending on the variables considered in the model. CONCLUSION Our study provided evidence that climatic factors were associated with occurrence of scrub typhus in Guangzhou city, China. Temperature, duration of sunshine, and rainfall were positively associated with scrub typhus incidence, while atmospheric pressure was inversely associated with scrub typhus incidence. These findings should be considered in the prediction of future patterns of scrub typhus transmission.
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Affiliation(s)
- Tiegang Li
- Guangzhou Center for Disease Control and Prevention, No 1, Qide Rd, Jiahe, Baiyun District, Guangzhou, Guangdong Province 510440, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, No 1, Qide Rd, Jiahe, Baiyun District, Guangzhou, Guangdong Province 510440, China
| | - Zhiqiang Dong
- Guangzhou Center for Disease Control and Prevention, No 1, Qide Rd, Jiahe, Baiyun District, Guangzhou, Guangdong Province 510440, China
| | - Ming Wang
- Guangzhou Center for Disease Control and Prevention, No 1, Qide Rd, Jiahe, Baiyun District, Guangzhou, Guangdong Province 510440, China
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Paris DH, Shelite TR, Day NP, Walker DH. Unresolved problems related to scrub typhus: a seriously neglected life-threatening disease. Am J Trop Med Hyg 2013; 89:301-7. [PMID: 23926142 DOI: 10.4269/ajtmh.13-0064] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Daniel H Paris
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Zhang M, Zhao ZT, Yang HL, Zhang AH, Xu XQ, Meng XP, Zhang HY, Wang XJ, Li Z, Ding SJ, Yang L, Zhang LY. Molecular epidemiology of Orientia tsutsugamushi in chiggers and ticks from domestic rodents in Shandong, northern China. Parasit Vectors 2013; 6:312. [PMID: 24499627 PMCID: PMC3843596 DOI: 10.1186/1756-3305-6-312] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/20/2013] [Indexed: 12/02/2022] Open
Abstract
Background Scrub typhus is endemic to a 13,000,000-km2 area of the Asia-Pacific region, and causes an annual incidence of 1 million people. The mortality rate of scrub typhus ranges from 6.1% to 25% in Southeast Asia. Natural infection of Orientia tsutsugamushi has been identified in domestic rodents in Shandong Province. However, infestation of chiggers and ticks on the domestic rodents and prevalence and genotypes of O. tsutsugamushi in these Acarina remain unclear. Methods During September 2010 to March 2012, 3134 chiggers and 89 ticks were collected from domestic rodents captured in three counties of Shandong Province. We amplified and sequenced the 56-kDa type-specific antigen gene of O. tsutsugamushi from DNA samples of these Acarina and designated to genotype according to sequence analysis. Results Overall, the infestation rate of chiggers on domestic rodents was 17.0%, and the chigger index was 5.38. The infestation rate of ticks on rodents was 3.1%. Natural infection of O. tsutsugamushi was found in Leptotrombidium taishanicum, L. linhuaikongense, L. intermedium, L. scutellare, L. palpale, and Ixodes spp., the minimum positive rates of which were 5.9%, 3.2%, 1.2%, 0.8%, 0.8%, and 2.2%, respectively. Kawasaki-like genotypes were predominant in chiggers and ticks on domestic rodents, which were detected from L. taishanicum, L. intermedium, L. scutellare, L. palpale, and Ixodes spp. Shimokoshi-like genotype was detected from L. palpale. Conclusions In the present study we investigated the infestation of chiggers and ticks on domestic rodents in Shandong Province, and identified the prevalence and genotypes of O. tsutsugamushi in the Acarina. Infestation of vector chiggers in domestic rodents, prevalence of O. tsutsugamushi in infested chiggers, and high nucleotide homologies among the O. tsutsugamushi sequences from the Acarina, their animal hosts and scrub typhus patients, implied that domestic rodents may play an important role in the transmission of scrub typhus in Shandong, China. Further studies are needed to verify the vector significance of chiggers and ticks that tested positive for O. tsutsugamushi, and to assess the risk of human exposure to chiggers and ticks on domestic rodents.
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Affiliation(s)
| | - Zhong-Tang Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China.
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