Three cases of scrub typhus with hemorrhage: a case report and literature review

Scrub typhus (ST) is an acute focal infectious disease that is caused by Orientia tsutsugamushi. The Asia-Pacific region is an area of relatively high incidence. There is a high incidence in China, principally owing to the disease being endemic in the south of the country. The main source of ST infection is rats, which act as reservoirs of infection after being bitten by the chigger mite, and the human population is generally susceptible to the disease. ST can be controlled and treated successfully if antibiotics are administered in a timely manner. However, because it does not have a specific clinical manifestation, it is difficult to distinguish ST from other febrile diseases in clinical practice. Therefore, rapid diagnostic methods are still needed to help clinicians make a timely diagnosis. Here, we share three cases of patients with ST who experienced hemorrhage, but did not have typical skin lesions, such as eschar and ulcer, early in the course of their disease, and review the relevant literature regarding ST. We conclude that clinicians should pay attention to the risk of hemorrhage associated with this disease, and emphasize the importance of making an early diagnosis.

Disease vector occurrence and ecological characteristics of chiggers on the chestnut white-bellied rat Niviventer fulvescens in Southwest China between 2001 and 2019

Chigger mites are the vector of scrub typhus. This study estimates the infestation status and ecological characteristics of chiggers on the chestnut white-bellied rat Niviventer fulvescens in Southwest China between 2001 and 2019. Chiggers were identified under the microscope, and infestation indices were calculated. The Preston's log-normal model was used to fit the curve of species abundance distribution. A total of 6,557 chiggers were collected in 136 of 342 N. fulvescens rats, showing high overall infestation indices (prevalence=39.8%, mean abundance=19.2, mean intensity=48.2) and high species diversity (S=100, H'=3.0). Leptotrombidium cangjiangense, Neotrombicula japonica, and Ascoschoengastia sifanga were the three dominant chigger species (constituent ratio=42.9%; 2,736/6,384) and exhibited an aggregated distribution among different rat individuals. We identified 100 chigger species, with 3 of them (Leptotrombidium scutellare, Leptotrombidium wenense, and Leptotrombidium deliense) as the main vectors of scrub typhus in China and nine species as potential vectors of this disease. Disease vector occurrence on N. fulvescens may increase the risk of spreading scrub typhus from rats to humans. Chigger infestation on N. fulvescens varied significantly in different environments. The species abundance distribution showed a log-normal distribution pattern. The estimated number of chigger species on N. fulvescens was 126 species.

Infestation of Oriental House Rat (Rattus tanezumi) with Chigger Mites Varies along Environmental Gradients across Five Provincial Regions of Southwest China

Chigger mites are the exclusive vector of scrub typhus. Based on field investigations of 91 survey sites in 5 provincial regions of Southwest China, this paper reported variations of chigger infestation on the oriental house rat (Rattus tanezumi) along various environmental gradients. A total of 149 chigger species were identified from 2919 R. tanezumi in the 5 provincial regions, and Leptotrombidium deliense (a major vector of scrub typhus in China) was the first dominant chigger species, followed by Ascoschoengastia indica and Walchia ewingi. Rattus tanezumi had a stable overall prevalence (PM = 21.10%), mean abundance (MA = 7.01), and mean intensity (MI = 33.20) of chiggers with the same dominant mites in the whole Southwest China in comparison with a previous report in Yunnan Province, but chigger infestations on R. tanezumi varied along different environmental gradients. Rattus tanezumi in mountainous landscape had a higher infestation load of chiggers with higher species diversity than in flatland landscape. The infestation was higher at lower altitudes and latitudes. A high intensity of vegetation coverage was associated with high infestations. The results reflect the environmental heterogeneity of chiggers on the same host species. Warm climate and high relative humidity are beneficial to chigger infestation on R. tanezumi.

Emerging trends of scrub typhus disease in southern Rajasthan, India: A neglected public health problem

Scrub typhus is the oldest known vector-borne zoonotic infectious disease in the world which is life-threatening for all age groups as it presents acute febrile illness along with multi-organ involvements and spread with the biting of infectious 'Trombiculid mite' (chigger mite). The pathogen of this disease is an obligatory coccobacillus gram-negative rickettsial bacteria Orientia tsutsugamushi. Scrub typhus disease was previously confined geographically only to the Asia Pacific region (tsutsugamushi triangle), but in recent years it has crossed its limit and has spread in other countries beyond the tsutsugamushi triangle and has become more hazardous for the community. The objective of this study is to explore the scrub typhus disease outbreak trends with existing information in southern Rajasthan state, India. This study concluded that scrub typhus disease is being re-emerged again and again in various Indian geographical regions with new species of vectors. The disease has been raised in tremendous amounts in Rajasthan within the last five years especially in the hilly zone and has led to major public health problems with other zoonotic diseases.

Vector and rodent surveillance for Orientia tsutsugamushi in north India

BACKGROUND & OBJECTIVES

Scrub typhus or chigger borne typhus, caused by Orientia tsutsugamushi is an emerging vector-borne disease as large numbers of cases have been reported in various tropical countries. It is transmitted to humans through bites of infected chiggers (larval mites). The knowledge about the vector, its distribution, density and habitat are important so as to understand the epidemiology of scrub typhus in a given area. To control rickettsial infections, regular rodent-vector surveillance should be planned in areas where the disease transmission is occurring and it will also help to strengthen the existing entomological data related to the vector of scrub typhus in northern India.

METHODS

In the present study, rodent-vector surveillance was planned for one whole year, covering both mite active and non-active seasons (October 2019-December 2020) in selected areas of Chandigarh and Punjab in north India. Rodent tissues and mites were also examined for the presence of O. tsutsugamushi by nested PCR for 56 kDa gene and real-time PCR for 47 kDa outer membrane protein gene. 18S gene PCR was performed for molecular identification of mites.

RESULTS

In the surveillance, three types of ectoparasite, viz. mites, fleas and ticks were obtained in rodents. All mites found were of Laelapidae family. None of the pooled rodent tissue samples as well as mite samples were found positive for O. tsutsugamushi by nested PCR for rickettsial DNA.

INTERPRETATION & CONCLUSION

In the present study, we did not get any evidence of carriage of O. tsutsugamushi in either mites or rodents collected and sampled in selected regions in Chandigarh and Punjab. We need to strengthen the entomological surveillance over a broader region and increase the frequency of trapping rodents to increase clarity on vector-reservoir dynamics in this geographical region.

Infestation and Related Ecology of Chigger Mites on the Asian House Rat (Rattus tanezumi) in Yunnan Province, Southwest China

This paper is to illustrate the infestation and related ecological characteristics of chigger mites on the Asian house rat (Rattus tanezumi). A total of 17,221 chigger mites were collected from 2,761 R. tanezumi rats, and then identified as 131 species and 19 genera in 2 families. Leptotrombidium deliense, the most powerful vector of scrub typhus in China, was the first major dominant species on R. tanezumi. All the dominant mite species were of an aggregated distribution among different individuals of R. tanezumi. The species composition and infestations of chiggers on R. tanezumi varied along different geographical regions, habitats and altitudes. The species-abundance distribution of the chigger mite community was successfully fitted and the theoretical curve equation was Ŝ (R)=37e^−(0.28R)². The total chigger species on R. tanezumi were estimated to be 199 species or 234 species, and this further suggested that R. tanezumi has a great potential to harbor abundant species of chigger mites. The results of the species-plot relationship indicated that the chigger mite community on R. tanezumi in Yunnan was an uneven community with very high heterogeneity. Wide geographical regions with large host samples are recommended in the investigations of chigger mites.

Monitoring Chigger Mites for Orientia tsutsugamushi in Field Small Mammals in Hwaseong-si, Gyeonggi-do, Korea, 2019-2020

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.

A New Genus and Species of Chiggers (Trombidiformes: Leeuwenhoekiidae) From Peru

South American chiggers have historically been poorly studied, and this has continued into present times. Of the 33 genera in the family Leeuwenhoekiidae Womersley, only Odontacarus Ewing and Sasacarus Brennan & Jones have been reported in Peru. Here, we describe a new genus, Peruacarus n. gen., and a new species, Peruacarus anthurium n. sp., parasitizing Koford's grass mouse, Akodon kofordi Myers & Patton, in Peru.

Research Advances of Leptotrombidium scutellare in China

Leptotrombidium scutellare is one of the 6 main vectors of scrub typhus in China. It has been found in more than 15 provinces of China. Especially in Yunnan, it was found to be mainly distributed in some mountainous areas with high altitude, low temperature and low precipitation. Rodents and some other small mammals were the most common hosts of L. scutellare. To date, more than 40 host species of L. scutellare have been recorded with very low host specificity, and the main hosts varied in different geographical regions. L. scutellare had a strong resistance against the cold environment, and the temperature and humidity were 2 important factors affecting its growth and development. Among different individuals of their rodent hosts, L. scutellare mites often showed an aggregated distribution pattern, which reflected the interspecific cooperation of the mites. The chromosome karyotype of L. scutellare was 2n=16 and all the 8 pairs of chromosomes were short rod-shaped with metacentric or sub-metacentric types. The isozyme spectrum supported that L. scutellare, L. deliense and L. rubellum were in the same species group. Based on the natural infection, experimental transmission and epidemiological evidence, L. scutellare has been eventually confirmed as the second major vector of scrub typhus in China, which is second only to L. deliense.

Redescription of Brennanacarus annereauxi (Trombidiformes: Trombiculidae) With New Records for Uruguay

Brennanacarus annereauxi (Brennan and Yunker, 1969) was described from Venezuela parasitizing the greater spear-nosed bat. The monotypic genus Brennanacarus Goff, Yunker and Wheeler, 1987 is a replacement name for Nasicola Brennan and Yunker, 1969, which was preoccupied by Nasicola Yamaguti, 1968. Here, we redescribe the genus Brennanacarus and the type species B. annereauxi. Also, this is the first record of this species, as well as the second record of any chigger, for Uruguay.

New Species of Chiggers (Trombidiformes: Trombiculidae and Leeuwenhoekiidae) From the Conservation Unit Parque Nacional da Serra das Confusões, Brazil

The Piauí State, Brazil, has never had its chigger fauna recorded. In this study, we examined chiggers collected on marsupials, rodents, and lizards from the conservation unit Parque Nacional da Serra das Confusões (PNSC). Herein we describe four new species, Paraguacarus klompenin. sp., Neoschoengastia ochoain. sp., Quadraseta welbournin. sp., and Susa bauchanin. sp. Furthermore, an additional seven species are reported: Eutrombicula alfreddugesi (Oudemans, 1910), Microtrombicula brachytrichiaBrennan, 1971, Microtrombicula rhipidomysiGoff, Whitaker and Dietz, 1983, Parascoschoengastia aemulata (Brennan and Jones, 1964), Parasecia validaBrennan, 1969, Pseudochoengastia petrolinensis Jacinavicius, Bassini-Silva and Barros-Battesti 2019, and Quadraseta flochi (Brennan and Jones, 1960). This is the first report of chiggers in Piauí State, which includes one of the most biodiverse areas in the Caatinga biome and is of particular importance to conservation. The genera Paraguacarus Goff and Whitaker, 1984 and Susa Audy and Nadcharam, 1960 are reported here for the first time to Brazil.

Identification of Trombiculid Chigger Mites Collected on Rodents from Southern Vietnam and Molecular Detection of Rickettsiaceae Pathogen

Trombiculid “chigger” mites (Acari) are ectoparasites that feed blood on rodents and another animals. A cross-sectional survey was conducted in 7 ecosystems of southern Vietnam from 2015 to 2016. Chigger mites were identified with morphological characteristics and assayed by polymerase chain reaction for detection of rickettsiaceae. Overall chigger infestation among rodents was 23.38%. The chigger index among infested rodents was 19.37 and a mean abundance of 4.61. A total of 2,770 chigger mites were identified belonging to 6 species, 3 genera, and 1 family, and pooled into 141 pools (10–20 chiggers per pool). Two pools (1.4%) of the chiggers were positive for Orientia tsutsugamushi. Ricketsia spp. was not detected in any pools of chiggers. Further studies are needed including a larger number and diverse hosts, and environmental factors to assess scrub typhus.

Surveillance of Chigger Mite Vectors for Tsutsugamushi Disease in the Hwaseong Area, Gyeonggi-do, Republic of Korea, 2015

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.

Relative Abundance of a Vector of Scrub Typhus, Leptotrombidium sialkotense, in Southern Yunnan Province, China

The chigger mite Leptotrombidium sialkotense is one of the 6 main vectors of scrub typhus in China. Before present study, L. sialkotense was found in some parts of Hunan province, China with a narrow geographical distribution. During field investigation 2016–2017, we found L. sialkotense in Jingha, southern Yunnan, China. Of 15 small mammal host species, L. sialkotense were collected from 6 species of the hosts. Rattus brunneusculus was a dominant host of L. sialkotense, from which 98.3% of the mites were collected. The chigger mite showed a relatively high infestation prevalence (P_M=11.7%) and mean abundance (MA=0.5) in comparison with the rest 5 host species. These results reveal a certain host specificity of L. sialkotense to a rat R. brunneusculus. The mite L. sialkotense showed an aggregated distribution on the host (P<0.05). A positive correlation observed between L. sialkotense and the body length of hosts. There was a positive interspecific association between L. sialkotense and 2 other dominant vectors, L. deliense and L. scutellare.

Severe Trombiculiasis in Hunting Dogs Infested With Neotrombicula inopinata (Acari: Trombiculidae)

This study records the clinical findings in nine hunting dogs showing systemic illness associated with trombiculids and identifies the mite species involved. In fall, coinciding with the seasonality of mites, all dogs were infested with mites and had been in the risk area (Sierra Cebollera Natural Park, La Rioja, Spain) a few hours before the onset of symptoms. The symptoms included vomiting, anorexia, weakness and lethargy, diarrhea, and even stupor. The clinical picture was fast-acting and potentially fatal. The infestations varied from low to severe. Molecular analysis of mites that fed on the dogs confirmed that they were larvae of Neotrombicula inopinata (Oudemans, Acari, Trombiculidae). This is the first time that N. inopinata has been identified as feeding on dogs and implicated in canine systemic illness associated with trombiculids. In contrast to other chiggers, N. inopinata does not seem to cause dermatitis. Likewise, the clinical and epidemiological similarity between the clinical symptoms we describe herein and the occurrence of seasonal canine illness (SCI) led us to suspect that this illness may be caused by infestation with these mites. The condition could be the consequence of severe infestation from large numbers of feeding mites, especially N. inopinata. Whether or not the cases were due to a severe allergic host response to salivary proteins or the result of the transmission of a new or emerging trombiculid-borne pathogen is not known.

New Record of the Scrub Typhus Vector, Leptotrombidium rubellum, in Southwest China

There are several main vectors of scrub typhus in China, and Leptotrombidium rubellum Wang et Liao, 1984 is one of them, which was previously considered to be restricted to the coastal regions of Changle to Xiamen, Fujian province of east China. Ecological investigation of chigger mites in recent years demonstrated the presence of L. rubellum also in Yunnan province. Chigger mites were collected from 34 counties, in which 127,460 larval mites were collected from 14,381 small mammal hosts. A total of 277 species belonging to 26 genera and three subfamilies were identified. A total of 705/127,460 (0.55%) L. rubellum were collected from eight counties. Leptotrombidium rubellum was collected mainly at low elevations in southern Yunnan. A total of 663/705 (94.04%) of L. rubellum were collected from Rattus flavipectus (Milne-Edwards, 1871) found in outdoor habitats with relatively high infestation prevalence and mean intensity. Although it was collected from several hosts, the primary host was Rattus tanezumi. This represents a new distribution record of L. rubellum for Yunnan province.

Chigger Mite (Acari: Trombiculidae) Survey of Rodents in Shandong Province, Northern China

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.

Description of Blankaartia shatrovi n. sp. (Acari: Trombiculidae) From Brazil

The chigger mite genus Blankaartia includes 28 known species, of which 10 are distributed in the Nearctic and Neotropical regions. These species preferentially parasitize birds, but occasionally they can also be found on rodents, bats, and reptiles, showing low host selectivity. In the present study, we report the presence of this genus in Brazil for the first time, including the first report of Blankaartia sinnamaryi (Floch and Fauran) and the description of a new species of Blankaartia collected from birds (Order Passeriformes).

Host-Seeking Behavior of Trombiculid Mites on Vegetation in Relation to Sika Deer

We collected larval trombiculid mites on vegetation monthly from October 1997 to February 2000, and from the heads of sika deer culled in March 2003 in Boso Peninsula, central Japan. Two species of trombiculid mites, Neotrombicula nogamii Takahashi, Takano, Misumi, and Kikuchi and Leptotrombidium scutellare Nagayo, Miyagawa, Mitamura, and Tamiya, occurred on vegetation. Peak numbers of N. nogamii were found in January, and L. scutellare numbers peaked in November. Both species were collected predominantly on the top of Sasa bamboo stems, where they formed clusters, though N. nogamii preferred heights of 40-50 cm. Furthermore, N. nogamii and Walchia masoni (Asanuma and Saito) were collected from deer. These findings indicate that vegetation is an important substrate for some trombiculid mites awaiting hosts.

Larval chigger mites collected from small mammals in 3 provinces, Korea

A total of 9,281 larval chigger mites were collected from small mammals captured at Hwaseong-gun, Gyeonggi-do (Province) (2,754 mites from 30 small mammals), Asan city, Chungcheongnam-do (3,358 mites from 48 mammals), and Jangseong-gun, Jeollanam-do (3,169 for 62 mammals) from April-November 2009 in the Republic of Korea (= Korea) and were identified to species. Leptotrombidium pallidum was the predominant species in Hwaseong (95.8%) and Asan (61.2%), while Leptotrombidium scutellare was the predominant species collected from Jangseong (80.1%). Overall, larval chigger mite indices decreased from April (27.3) to June (4.9), then increased in September (95.2) and to a high level in November (169.3). These data suggest that L. pallidum and L. scutellare are the primary vectors of scrub typhus throughout their range in Korea. While other species of larval chigger mites were also collected with some implications in the transmission of Orientia tsutsugamushi, they only accounted for 11.2% of all larval chigger mites collected from small mammals.

A new species of chigger mite (acari: trombiculidae) from rodents in southwest China

This paper describes a new species of chigger mite (Acari: Trombiculidae), Gahrliepia cangshanensis n. sp., from rodents in southwest China. The specimens were collected from Yunnan red-backed voles, Eothenomys miletus (Thomas, 1914), and a Chinese white-bellied rat, Niviventer confucianus (Milne-Edwards, 1871) in Yunnan Province. The new species is unique mainly in its number of dorsal setae (n=21), and it has the following features: fT (formula of palpotarsus)=4B (B=branched), fp (formula of palpal seta)=B/N/N/N/B (N=naked), a broad tongue-shaped scutum with an almost straight posterior margin, and 17 PPLs (posterior posterolateral seta) with a length of 36-43 µm. This chigger mite may also infect other rodent hosts and may be distributed in other localities.