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Yu Y, He G. Disseminated central nervous system tuberculoma in a patient with scrub typhus: A case report. Exp Ther Med 2024; 27:260. [PMID: 38756901 PMCID: PMC11097286 DOI: 10.3892/etm.2024.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/20/2024] [Indexed: 05/18/2024] Open
Abstract
Central nervous system (CNS) tuberculosis mainly manifests as tuberculous meningitis and intracranial tuberculosis; intramedullary tuberculosis is uncommon. Scrub typhus is an acute naturally occurring infectious disease caused by Orientia tsutsugamushi. CNS tuberculoma following typhus is rare. The present study described a 60-year-old man with high fever, muscle soreness, yellowish skin and sclera and hepatosplenomegaly. At first, the patient was diagnosed with scrub typhus, after treatment with doxycycline he recovered completely. However, half a month after discharge, the patient experienced headache, night sweats and anorexia. Tuberculosis-specific enzyme-linked immunospot assay showed positive Mycobacterium tuberculosis antibody in cerebrospinal fluid (CSF). Metagenomic next-generation sequencing detected the presence of Mycobacterium tuberculosis in CSF. Magnetic resonance imaging of the brain and spinal cord showed multiple rings enhancing lesions in the cerebral hemispheres, cerebellum, brainstem and spinal cords. After the diagnosis of CNS tuberculoma, the patient was started on conventional anti-tuberculosis therapy resulting in a good prognosis.
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Affiliation(s)
- Yachun Yu
- Department of Neurology, The Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan 410000, P.R. China
| | - Guohua He
- Department of Neurology, The Affiliated Changsha Central Hospital, University of South China, Changsha, Hunan 410000, P.R. China
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2
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Samanta A, Poddar U, Sen Sarma M, Srivastava A, Yachha SK, Mishra P. Persistent fever in acute hepatitis: think beyond acute viral hepatitis. Infect Dis (Lond) 2024; 56:476-483. [PMID: 38465663 DOI: 10.1080/23744235.2024.2325568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Acute hepatitis due to various tropical infections can mimic the clinical picture of acute viral hepatitis(AVH), leading to increased morbidity and mortality. We aimed to identify clinical and laboratory parameters that could help to distinguish acute hepatitis due to tropical infections from AVH. METHODS We retrospectively analyzed our database of 150 children (107 boys) with AVH and 50 children(34 boys)with acute hepatitis due to tropical infections between January 2013 and March 2023. Clinical features, investigations, complications and outcomes were compared. RESULTS Hepatitis A (75%) was the commonest etiology of AVH while enteric fever (34%), dengue (26%), scrub typhus (20%) and leptospirosis (16%) constituted the majority of tropical infections. Persistent fever and skin rashes were found in 88% and 16% of patients respectively in the tropical infection group and none in the AVH group (p < 0.001). On univariate analysis, prodromal symptoms, clinically detectable jaundice, cholestatic pattern, total and direct bilirubin and liver enzymes were significantly higher in AVH while headache, myalgia, leukopoenia, thrombocytopenia, hyponatremia were significantly higher in tropical infections group (all p < 0.05). Multivariate analysis identified thrombocytopenia (Odds ratio [OR] 4.237) as an independent positive predictive factor and markedly elevated total bilirubin (OR 0.575), direct bilirubin (OR 0.498), aspartate aminotransferase (OR 0.841) and alanine aminotransferase (OR 0.863) as independent negative predictive factors for acute hepatitis due to tropical infections. CONCLUSION High index of suspicion for tropical infections is warranted in patients with persistent fever after the onset of jaundice, especially in the presence of skin rash and thrombocytopenia.SUMMARYAcute viral hepatitis and acute hepatitis due to tropical infections can have similar clinical and biochemical parameters. Milder degree of jaundice, lower elevation of serum transaminases and thrombocytopenia can be useful predictors for acute hepatitis due to tropical infections.
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Affiliation(s)
- Arghya Samanta
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Eikenbary B, Devaraju P, Chakkravarthi A, Sihag KK, Nathan T, Thangaraj G, Srinivasan L, Kumar A. A molecular survey of zoonotic pathogens of public health importance in rodents/shrews and their ectoparasites trapped in Puducherry, India. Trans R Soc Trop Med Hyg 2024:trae033. [PMID: 38768316 DOI: 10.1093/trstmh/trae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/18/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Globally, India has a high zoonotic disease burden and lacks surveillance data in humans and animals. Rodents are known reservoirs for many zoonotic diseases and their synanthropic behavior poses a great public health threat. METHODS In this study, trapped rodents/shrews from randomly selected villages within Puducherry, India, and their ectoparasites were screened for zoonotic pathogens, namely, Orientia tsutsugamushi, other pathogenic rickettsiae, Leptospira spp., Cryptosporidium spp., Coxiella burnetii and methicillin-resistant Staphylococcus aureus (MRSA) using conventional PCR. A total of 58 rodents/shrews were trapped from 11 villages. The species trapped were Suncus murinus (49/58, 84.48%), Rattus rattus (8/58, 13.79%) and Rattus norvegicus (1/58, 1.72%). All ectoparasites collected were identified as mites and its infestation rate was 46.55% (27/58). RESULTS Real-time PCR targeting the 47 kDa gene of O. tsutsugamushi revealed positivity in one rodent and one shrew (3.45%) and two mite pools (7.41%). Conventional PCR targeting the 56 kDa gene revealed positivity in one shrew and two mite pools and the phylogenetic analysis of all three amplicons indicated the circulation of the Gilliam-related serotype. MRSA was detected in the alimentary tract of a shrew (1/32, 3.13%). Leptospira spp., Rickettsia, Cryptosporidium spp. and Co. burnetii tested negative. CONCLUSIONS The detection of zoonotic pathogens within reservoir hosts and vectors poses a risk of transmission to humans. This study signifies the need for zoonotic pathogen surveillance in synanthropic rodents/shrews.
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Affiliation(s)
- Brenna Eikenbary
- Department of Global Health, Georgetown University, Washington DC, 20057, USA
| | - Panneer Devaraju
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | | | - Krishan Kumar Sihag
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | - Terence Nathan
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | - Gowdham Thangaraj
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | - Lakshmy Srinivasan
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | - Ashwani Kumar
- ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
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Perrone C, Kanthawang N, Cheah PY, Intralawan D, Lee SJ, Nedsuwan S, Fuwongsitt B, Wangrangsimakul T, Greer RC. Community engagement around scrub typhus in northern Thailand: a pilot project. Trans R Soc Trop Med Hyg 2024:trae028. [PMID: 38708716 DOI: 10.1093/trstmh/trae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/08/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Scrub typhus is highly endemic in northern Thailand yet awareness and knowledge are low. We developed a community engagement project to improve awareness in communities at risk of contracting scrub typhus. METHODS We conducted a series of engagement sessions with healthcare workers and community health volunteers so they would, in turn, engage with their communities. We evaluated our activities by assessing the increase in scrub typhus knowledge, using a series of Likert-scale items and open-ended questions. Three to 6 months after the sessions, participants were followed up to collect their experiences training community members. RESULTS Of 134 participants who took part in eight sessions, 87.3% were community health volunteers. Disease knowledge increased substantially after the sessions and was well maintained for up to 5 mo. Satisfaction was high and, through participant feedback, engagement materials were improved to be more useful to the communities. People with higher education had higher scores and retention. CONCLUSIONS Community engagement was shown to be an effective tool to develop and carry out health-promoting activities in a culturally and context-appropriate manner.
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Affiliation(s)
- Carlo Perrone
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Nipaphan Kanthawang
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Daranee Intralawan
- Social and Preventive Medicine Department, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand
| | - Sue J Lee
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Supalert Nedsuwan
- Social and Preventive Medicine Department, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand
| | - Benjarat Fuwongsitt
- Social and Preventive Medicine Department, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand
| | - Tri Wangrangsimakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Rachel C Greer
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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Maharshi S, Gupta PK, Sharma KK, Pokharna R, Nijhawan S, Sharma SS. Scrub Typhus: An Acute Precipitant for Acute on Chronic Liver Failure. J Clin Exp Hepatol 2024; 14:101344. [PMID: 38322816 PMCID: PMC10840006 DOI: 10.1016/j.jceh.2024.101344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
Acute-on-chronic liver failure (ACLF) is a clinical syndrome with high mortality. Many acute precipitating factors have been implicated in triggering the acute event of ACLF, with bacterial infections being a common precipitant. However, many other precipitants can cause ACLF; therefore, identification of these factors early in the golden window and their treatment can result in improved prognosis. Scrub typhus usually presents as uncomplicated acute febrile illness but rarely as complicated. Few case reports of scrub-typhus-induced acute liver failure have been reported but none with scrub-typhus-precipitating ACLF so far. Therefore, we are reporting a case of scrub-typhus-precipitating ACLF, where timely intervention with antibiotics results in improved outcome.
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Affiliation(s)
- Sudhir Maharshi
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Pankaj K. Gupta
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Kamlesh K. Sharma
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Rupesh Pokharna
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Shyam S. Sharma
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
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Saraswati K, Tanganuchitcharnchai A, Ongchaikupt S, Mukaka M, Day NPJ, Baird JK, Antonjaya U, Myint KSA, Dewi YP, Yudhaputri FA, Haryanto S, Witari NPD, Blacksell SD. Scrub typhus in Indonesia: A cross-sectional analysis of archived fever studies samples. Trans R Soc Trop Med Hyg 2024; 118:321-327. [PMID: 38205975 PMCID: PMC11062201 DOI: 10.1093/trstmh/trad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/06/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Scrub typhus is an understudied vector-borne bacterial infection. METHODS We tested archived fever samples for scrub typhus seropositivity to begin charting its geographic distribution in Indonesia. We analysed 1033 serum samples from three sites. IgM and IgG enzyme-linked immunosorbent assay (ELISA) against Orientia tsutsugamushi was performed using Karp, Kato, Gilliam, TA 716 antigens. To determine the cutoff in the absence of a presumed unexposed population and gold standard tests, we identified the visual inflection point, performed change point analysis, and used finite mixture models. RESULTS The optical density cutoff values used for IgM and IgG were 0.49 and 0.13, respectively. Across all sites, IgM seropositivity was 4.6% (95% CI: 3.4 to 6.0%) while IgG seropositivity was 4.4% (95% CI: 3.3 to 5.8%). The overall seropositivity across sites was 8.8% (95% CI: 8.1 to 11.7%). The overall seropositivity for Jambi, Denpasar, Tabanan were 9.7% (95% CI: 7.0 to 13.3%), 8.0% (95% CI: 5.7 to 11.0%), 9.0% (95% CI: 6.1 to 13.0%), respectively. CONCLUSIONS We conclude that O. tsutsugamushi exposure in humans occurred at all sites analysed and could be the cause of illness in some cases. Though it was not the main cause of acute fever in these locations, it is still important to consider scrub typhus in cases not responding to beta-lactam antibiotics. Future seroprevalence surveys and testing for scrub typhus in acute febrile illness studies will be essential to understand its distribution and burden in Indonesia.
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Affiliation(s)
- Kartika Saraswati
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, 10430 Jakarta, Indonesia
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 10400 Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LG Oxford, UK
| | - Ampai Tanganuchitcharnchai
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 10400 Bangkok, Thailand
| | - Sirada Ongchaikupt
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 10400 Bangkok, Thailand
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 10400 Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LG Oxford, UK
| | - Nicholas P J Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 10400 Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LG Oxford, UK
| | - J Kevin Baird
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, 10430 Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LG Oxford, UK
| | - Ungke Antonjaya
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, 10430 Jakarta, Indonesia
| | | | - Yora P Dewi
- Exeins Health Initiative, 12870 Jakarta, Indonesia
| | | | - Sotianingsih Haryanto
- Raden Mattaher Hospital, 36122 Jambi, Indonesia
- Faculty of Medicine and Health Sciences, Universitas Jambi, 36361 Jambi, Indonesia
| | - N P Diah Witari
- Faculty of Medicine and Health Sciences, Warmadewa University, 80235 Denpasar, Bali, Indonesia
| | - Stuart D Blacksell
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 10400 Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LG Oxford, UK
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Jitvaropas R, Sawaswong V, Poovorawan Y, Auysawasdi N, Vuthitanachot V, Wongwairot S, Rodkvamtook W, Lindroth E, Payungporn S, Linsuwanon P. Identification of Bacteria and Viruses Associated with Patients with Acute Febrile Illness in Khon Kaen Province, Thailand. Viruses 2024; 16:630. [PMID: 38675971 PMCID: PMC11054472 DOI: 10.3390/v16040630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The majority of cases of undifferentiated acute febrile illness (AFI) in the tropics have an undefined etiology. In Thailand, AFI accounts for two-thirds of illnesses reported to the Ministry of Public Health. To characterize the bacterial and viral causes of these AFIs, we conducted molecular pathogen screening and serological analyses in patients who sought treatment in Chum Phae Hospital, Khon Kaen province, during the period from 2015 to 2016. Through integrated approaches, we successfully identified the etiology in 25.5% of cases, with dengue virus infection being the most common cause, noted in 17% of the study population, followed by scrub typhus in 3.8% and rickettsioses in 6.8%. Further investigations targeting viruses in patients revealed the presence of Guadeloupe mosquito virus (GMV) in four patients without other pathogen co-infections. The characterization of four complete genome sequences of GMV amplified from AFI patients showed a 93-97% nucleotide sequence identity with GMV previously reported in mosquitoes. Nucleotide substitutions resulted in amino acid differences between GMV amplified from AFI patients and mosquitoes, observed in 37 positions. However, these changes had undergone purifying selection pressure and potentially had a minimal impact on protein function. Our study suggests that the GMV strains identified in the AFI patients are relatively similar to those previously reported in mosquitoes, highlighting their potential role associated with febrile illness.
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Affiliation(s)
- Rungrat Jitvaropas
- Division of Biochemistry, Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
| | - Vorthon Sawaswong
- Center of Excellence in Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Nutthanun Auysawasdi
- Department of Entomology, US Medical Directorate-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand; (N.A.); (S.W.); (E.L.)
| | | | - Sirima Wongwairot
- Department of Entomology, US Medical Directorate-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand; (N.A.); (S.W.); (E.L.)
| | - Wuttikon Rodkvamtook
- Analytic Division, Royal Thai Army Component-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand;
| | - Erica Lindroth
- Department of Entomology, US Medical Directorate-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand; (N.A.); (S.W.); (E.L.)
| | - Sunchai Payungporn
- Center of Excellence in Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Piyada Linsuwanon
- Department of Entomology, US Medical Directorate-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand; (N.A.); (S.W.); (E.L.)
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Jain HK, Das A, Dixit S, Kaur H, Pati S, Ranjit M, Dutta A, Bal M. Development and implementation of a strategy for early diagnosis and management of scrub typhus: an emerging public health threat. Front Public Health 2024; 12:1347183. [PMID: 38660358 PMCID: PMC11039949 DOI: 10.3389/fpubh.2024.1347183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging zoonotic disease in the tropics with considerable morbidity and mortality rates. This disease, which is mostly prevalent in rural areas, remains underdiagnosed and underreported because of the low index of suspicion and non-specific clinical presentation. Limited access to healthcare, diagnostics, and treatment in rural settings further makes it challenging to distinguish it from other febrile illnesses. While easily treatable, improper treatment leads to severe forms of the disease and even death. As there is no existing public health program to address scrub typhus in India, there is an urgent need to design a program and test its effectiveness for control and management of the disease. With this backdrop, this implementation research protocol has been developed for a trial in few of the endemic "pockets" of Odisha, an eastern Indian state that can be scalable to other endemic areas of the country, if found effective. The main goal of the proposed project is to include scrub typhus as a differential diagnosis of fever cases in every tier of the public health system, starting from the community level to the health system, for the early diagnosis among suspected cases and to ensure that individuals receive complete treatment. The current study aimed to describe the protocol of the proposed Scrub Typhus Control Program (STCP) in detail so that it can receive valuable views from peers which can further strengthen the attempt.
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Affiliation(s)
- Hitesh Kumar Jain
- Department of Molecular Epidemiology, Indian Council of Medical Research, Regional Medical Research Centre, Bhubaneswar, India
| | - Arundhuti Das
- Department of Molecular Epidemiology, Indian Council of Medical Research, Regional Medical Research Centre, Bhubaneswar, India
| | - Sujata Dixit
- Department of Molecular Epidemiology, Indian Council of Medical Research, Regional Medical Research Centre, Bhubaneswar, India
| | - Harpreet Kaur
- Department of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Sanghamitra Pati
- Department of Public Health, Indian Council of Medical Research, Regional Medical Research Centre, Bhubaneswar, India
| | - Manoranjan Ranjit
- Department of Molecular Epidemiology, Indian Council of Medical Research, Regional Medical Research Centre, Bhubaneswar, India
| | - Ambarish Dutta
- Department of Epidemiology, Public Health Foundation of India, Indian Institute of Public Health, Bhubaneswar, India
| | - Madhusmita Bal
- Department of Molecular Epidemiology, Indian Council of Medical Research, Regional Medical Research Centre, Bhubaneswar, India
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Balasubramanian T, Sambath U, Radja RD, Thangaraj G, Devaraju P, Srinivasan L, Srinivasan P, Nair MG, Raja K, Lakkawar AW, Soong L. Pathological Responses in Asian House Shrews ( Suncus murinus) to the Naturally Acquired Orientia tsutsugamushi Infection. Microorganisms 2024; 12:748. [PMID: 38674692 PMCID: PMC11051718 DOI: 10.3390/microorganisms12040748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Scrub typhus is a re-emerging disease caused by Orientia tsutsugamushi, transmitted by mites belonging to the family Trombiculidae. Humans and rodents acquire the infection by the bite of larval mites/chiggers. Suncus murinus, the Asian house shrew, has been reported to harbor the vector mites and has been naturally infected with O. tsutsugamushi. The present study aimed to localize and record O. tsutsugamushi in the tissues and the host response in shrews naturally infected with O. tsutsugamushi. Sheehan's modified May-Grunwald Giemsa staining was carried out in 365 tissues from 87 animals, and rickettsiae were documented in 87 tissues from 20 animals. Immunohistochemical (IHC) staining, using polyclonal antibodies raised against selected epitopes of the 56-kDa antigen, was carried out, and 81/87 tissue sections were tested positive for O. tsutsugamushi. By IHC, in addition to the endothelium, the pathogen was also demonstrated by IHC in cardiomyocytes, the bronchiolar epithelium, stroma of the lungs, hepatocytes, the bile duct epithelium, the epithelium and goblet cells of intestine, the tubular epithelium of the kidney, and splenic macrophages. Furthermore, the pathogen was confirmed by real-time PCR using blood (n = 20) and tissues (n = 81) of the IHC-positive animals. None of the blood samples and only 22 out of 81 IHC-positive tissues were tested positive by PCR. By nucleotide sequencing of the 56-kDa gene, Gilliam and Karp strains were found circulating among these animals. Although these bacterial strains are highly virulent and cause a wide range of pathological alterations, hence exploring their adaptive mechanisms of survival in shrews will be of significance. Given that the pathogen localizes in various organs following a transient bacteremia, we recommend the inclusion of tissues from the heart, lung, intestine, and kidney of reservoir animals, in addition to blood samples, for future molecular surveillance of scrub typhus.
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Affiliation(s)
- Tharani Balasubramanian
- Department of Veterinary Pathology, Rajiv Gandhi Institute of Veterinary Education and Research, Kurumbapet, Puducherry 605009, India; (T.B.); (U.S.); (M.G.N.); (K.R.); (A.W.L.)
| | - Uma Sambath
- Department of Veterinary Pathology, Rajiv Gandhi Institute of Veterinary Education and Research, Kurumbapet, Puducherry 605009, India; (T.B.); (U.S.); (M.G.N.); (K.R.); (A.W.L.)
| | - Ranjana Devi Radja
- Unit of One Health, ICMR—Vector Control Research Centre, Indira Nagar, Puducherry 605006, India; (R.D.R.); (G.T.); (L.S.); (P.S.)
| | - Gowdham Thangaraj
- Unit of One Health, ICMR—Vector Control Research Centre, Indira Nagar, Puducherry 605006, India; (R.D.R.); (G.T.); (L.S.); (P.S.)
| | - Panneer Devaraju
- Unit of One Health, ICMR—Vector Control Research Centre, Indira Nagar, Puducherry 605006, India; (R.D.R.); (G.T.); (L.S.); (P.S.)
| | - Lakshmy Srinivasan
- Unit of One Health, ICMR—Vector Control Research Centre, Indira Nagar, Puducherry 605006, India; (R.D.R.); (G.T.); (L.S.); (P.S.)
| | - Pushpa Srinivasan
- Unit of One Health, ICMR—Vector Control Research Centre, Indira Nagar, Puducherry 605006, India; (R.D.R.); (G.T.); (L.S.); (P.S.)
| | - Madhavan Gopalakrishnan Nair
- Department of Veterinary Pathology, Rajiv Gandhi Institute of Veterinary Education and Research, Kurumbapet, Puducherry 605009, India; (T.B.); (U.S.); (M.G.N.); (K.R.); (A.W.L.)
| | - Kumar Raja
- Department of Veterinary Pathology, Rajiv Gandhi Institute of Veterinary Education and Research, Kurumbapet, Puducherry 605009, India; (T.B.); (U.S.); (M.G.N.); (K.R.); (A.W.L.)
| | - Avinash Warundeo Lakkawar
- Department of Veterinary Pathology, Rajiv Gandhi Institute of Veterinary Education and Research, Kurumbapet, Puducherry 605009, India; (T.B.); (U.S.); (M.G.N.); (K.R.); (A.W.L.)
| | - Lynn Soong
- Department of Microbiology and Immunology, Institute for Human Infections & Immunity, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
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Minahan NT, Yen TY, Guo YLL, Shu PY, Tsai KH. Concatenated ScaA and TSA56 Surface Antigen Sequences Reflect Genome-Scale Phylogeny of Orientia tsutsugamushi: An Analysis Including Two Genomes from Taiwan. Pathogens 2024; 13:299. [PMID: 38668254 PMCID: PMC11054523 DOI: 10.3390/pathogens13040299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/29/2024] Open
Abstract
Orientia tsutsugamushi is an obligate intracellular bacterium associated with trombiculid mites and is the causative agent of scrub typhus, a life-threatening febrile disease. Strain typing of O. tsutsugamushi is based on its immunodominant surface antigen, 56-kDa type-specific antigen (TSA56). However, TSA56 gene sequence-based phylogenetic analysis is only partially congruent with core genome-based phylogenetic analysis. Thus, this study investigated whether concatenated surface antigen sequences, including surface cell antigen (Sca) proteins, can reflect the genome-scale phylogeny of O. tsutsugamushi. Complete genomes were obtained for two common O. tsutsugamushi strains in Taiwan, TW-1 and TW-22, and the core genome/proteome was identified for 11 O. tsutsugamushi strains. Phylogenetic analysis was performed using maximum likelihood (ML) and neighbor-joining (NJ) methods, and the congruence between trees was assessed using a quartet similarity measure. Phylogenetic analysis based on 691 concatenated core protein sequences produced identical tree topologies with ML and NJ methods. Among TSA56 and core Sca proteins (ScaA, ScaC, ScaD, and ScaE), TSA56 trees were most similar to the core protein tree, and ScaA trees were the least similar. However, concatenated ScaA and TSA56 sequences produced trees that were highly similar to the core protein tree, the NJ tree being more similar. Strain-level characterization of O. tsutsugamushi may be improved by coanalyzing ScaA and TSA56 sequences, which are also important targets for their combined immunogenicity.
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Affiliation(s)
- Nicholas T. Minahan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100025, Taiwan; (N.T.M.); (Y.-L.L.G.)
| | - Tsai-Ying Yen
- Centers for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei 115210, Taiwan; (T.-Y.Y.); (P.-Y.S.)
| | - Yue-Liang Leon Guo
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100025, Taiwan; (N.T.M.); (Y.-L.L.G.)
- Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei 100025, Taiwan
| | - Pei-Yun Shu
- Centers for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei 115210, Taiwan; (T.-Y.Y.); (P.-Y.S.)
| | - Kun-Hsien Tsai
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100025, Taiwan; (N.T.M.); (Y.-L.L.G.)
- Global Health Program, College of Public Health, National Taiwan University, Taipei 100025, Taiwan
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11
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Konyak BM, Soni M, Saikia S, Chang T, Gogoi I, Khongstid I, Chang CM, Sharma M, Pandey RP. Scrub typhus in Northeast India: epidemiology, clinical presentations, and diagnostic approaches. Trans R Soc Trop Med Hyg 2024; 118:206-222. [PMID: 37972992 DOI: 10.1093/trstmh/trad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
Scrub typhus is one of the most neglected tropical diseases, a leading cause of acute undifferentiated febrile illness in areas of the 'tsutsugamushi triangle', diagnosed frequently in South Asian countries. The bacteria Orientia tsutsugamushi is the causative agent of the disease, which enters the human body through the bite of trombiculid mites (also known as chiggers) of the genus Leptotrombidium deliense. Diagnosis of the disease is challenging, as its early symptoms mimic other febrile illnesses like dengue, influenza and corona viruses. Lack of rapid, reliable and cost-effective diagnostic methods further complicates the identification process. Northeast India, a mountainous region with a predominantly rural tribal population, has witnessed a resurgence of scrub typhus cases in recent years. Various ecological factors, including rodent populations, habitat characteristics and climatic conditions, influence its prevalence. Entomological investigations have confirmed the abundance of vector mites, highlighting the importance of understanding their distribution and the probability of transmission of scrub typhus in the region. Proper diagnosis, awareness campaigns and behavioural interventions are essential for controlling scrub typhus outbreaks and reducing its impact on public health in Northeast India. Further research and community-based studies are necessary to accurately assess the disease burden and implement effective prevention strategies.
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Affiliation(s)
- Beyau M Konyak
- Integrated Molecular Diagnostic and Research Laboratory (BSL-2), District Hospital Tuensang, Tuensang-798612, Nagaland, India
- Department of Biosciences, Assam Don Bosco University, Tapesia Garden, Sonapur, Guwahati-782402, Assam, India
| | - Monika Soni
- Department of Biosciences, Assam Don Bosco University, Tapesia Garden, Sonapur, Guwahati-782402, Assam, India
| | - Shyamalima Saikia
- Department of Life Sciences, Dibrugarh University, Dibrugarh-786004, Assam, India
| | - Tochi Chang
- Integrated Molecular Diagnostic and Research Laboratory (BSL-2), District Hospital Tuensang, Tuensang-798612, Nagaland, India
| | - Indrani Gogoi
- Department of Life Sciences, Dibrugarh University, Dibrugarh-786004, Assam, India
| | - Ibakmensi Khongstid
- Department of Biosciences, Assam Don Bosco University, Tapesia Garden, Sonapur, Guwahati-782402, Assam, India
| | - Chung-Ming Chang
- Master's and PhD Program in Biotechnology Industry, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan District, Taoyuan City-33302, Taiwan (ROC)
- Graduate Institute of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan District, Taoyuan City-33302, Taiwan (ROC)
| | - Mohan Sharma
- Integrated Molecular Diagnostic and Research Laboratory (BSL-2), District Hospital Tuensang, Tuensang-798612, Nagaland, India
| | - Ramendra Pati Pandey
- School of Health Sciences and Technology, UPES, Dehradun-248007, Uttarakhand, India
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12
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Selvan AT, Agarwal I, Behera B, Singh S. Scrub typhus in pregnancy: A report of two cases. Obstet Med 2024; 17:58-60. [PMID: 38660322 PMCID: PMC11037195 DOI: 10.1177/1753495x221122593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/27/2022] [Indexed: 04/26/2024] Open
Abstract
Scrub typhus shows a high prevalence in South-East Asia. In pregnant females, it can cause both maternal and fetal adverse outcomes. We report a case series of two women with scrub typhus and their varied outcomes. A 25-year-old primigravida treated for scrub typhus at 23 weeks' gestation presented at 34 weeks with stage three fetal growth restriction (FGR). Caesarean delivery was performed. The neonate had biliary atresia. A 24-year-old primigravida at 31 weeks' gestation was referred from a local hospital due to scrub typhus induced multi-organ dysfunction. She had FGR stage 1 with oligohydramnios. Emergency caesarean delivery was performed in view of acute fetal bradycardia. There is an emerging need for research to reassess what is already known about scrub typhus in pregnancy and to develop techniques for its treatment inorder to achieve a positive maternal and neonatal outcome in these cases.
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Affiliation(s)
- Advika Thamarai Selvan
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ishita Agarwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sweta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, India
- Trialect Fellow (High Risk Pregnancy), King’s College Hospital, London, UK
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13
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Sahoo DP, Pradhan SR, War G, Gupta A, Tara RK. Acute Pyelonephritis by Scrub Typhus: A Rare Condition. Cureus 2024; 16:e55752. [PMID: 38463407 PMCID: PMC10920403 DOI: 10.7759/cureus.55752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
Scrub typhus is prevalent in tropical countries and can have a varied spectrum of presentations from pneumonia, gastroenteritis, lymphadenitis, meningitis, encephalitis, and acute kidney injury to multi-organ dysfunction syndrome. Urinary tract infections like cystitis and pyelonephritis are rarely reported. Here we present an atypical presentation of a 53-year-old female with diabetes mellitus who came to the outpatient department with complaints of high-grade fever, burning micturition, and left flank pain for three days and was initially treated outpatient basis with oral antibiotics. However, her deteriorating condition landed her in an emergency in a state of septic shock. She was initially treated with broad-spectrum conventional antibiotics with other supportive medications. Even after confirmation of the diagnosis of left acute pyelonephritis with septic shock, with appropriate antibiotics, her condition was deteriorating. A sterile urine culture raised suspicion of atypical organisms causing the infection. Proper analysis of her history and readily available investigations of IgM against scrub typhus antigen led to a diagnosis of scrub typhus-related left acute pyelonephritis with septic shock. She was treated adequately with an injection of doxycycline, followed by oral tablets of the same, after which she showed drastic improvement in her symptoms, and then she was discharged. Thus, atypical organisms causing urinary tract infections should be kept always in mind, which can be treated easily and if untreated, can lead to life-threatening consequences.
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Affiliation(s)
| | | | - Gwenette War
- General Medicine, All India Institute of Medical Sciences, Guwahati, IND
| | - Annu Gupta
- General Medicine, All India Institute of Medical Sciences, Guwahati, IND
| | - Ruth K Tara
- General Medicine, All India Institute of Medical Sciences, Guwahati, IND
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Yoon BA, Kim SY, Kim J, Seok JI, Seok JM, Lee S, Kim JK, Oh SI. Clinical and laboratory findings in scrub typhus associated Guillain-Barré syndrome in South Korea. J Peripher Nerv Syst 2024; 29:82-87. [PMID: 38286033 DOI: 10.1111/jns.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND AIMS Scrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain-Barré syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus. METHODS Patients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS-associated clinical and electrophysiological characteristics, outcomes, and scrub typhus-associated features were collected. RESULTS Of the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2-14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1-4) points. INTERPRETATION Patients with scrub typhus-associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS.
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Affiliation(s)
- Byeol-A Yoon
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, South Korea
- Department of Neurology, Dong-A University Medical Center, Busan, South Korea
| | - Sun-Young Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Juhyeon Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, South Korea
| | - Jung Im Seok
- Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, South Korea
| | - Jin Myoung Seok
- Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Sukyoon Lee
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Jong Kuk Kim
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, South Korea
- Department of Neurology, Dong-A University Medical Center, Busan, South Korea
| | - Seong-Il Oh
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
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15
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Han S, Yang S, Wang Y, Xu Y. Case Report: Encephalitis with Initial Manifestation of Orientia Tsutsugamushi Infection Detected by Metagenomic Next-Generation Sequencing. Infect Drug Resist 2024; 17:749-760. [PMID: 38433784 PMCID: PMC10906725 DOI: 10.2147/idr.s450693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Scrub typhus, caused by Orientia tsutsugamushi, is characterized by fever, eschars, lymphadenopathy, and rash. The absence of eschars in some cases makes it difficult to distinguish it from other diseases, complicating the diagnosis process. Atypical Scrub typhus is difficult to diagnose and often leads to delayed treatment. Therefore, early diagnosis and treatment through effective detection methods have high clinical value. Here, a case of scrub typhus with encephalitis symptoms is reported. Patients and Methods A 64-year-old man and mNGS testing. Results A 64-year-old man developed cough, headache, and fever, dismissing it as a respiratory tract infection. Initial treatment with cephalosporin antibiotics had minimal effect. Admission to the respiratory department showed inflammation in blood tests. Subsequent CT and further treatment provided no improvement. Multidisciplinary discussions and neurology department guidance were conducted to consider the suspected diagnosis of encephalitis in the patient. After improving the mNGS detection, the patient was diagnosed with "Orientia tsutsugamushi encephalitis". After treatment with doxycycline, the patient's symptoms were alleviated. He remained afebrile in follow-up and adhered well to medical advice. Conclusion Our case demonstrates that it is difficult to distinguish Orientia tsutsugamushi encephalitis from central nervous system infectious diseases such as meningitis and encephalitis using conventional diagnostic methods, which may affect the treatment plan for the disease. mNGS is a useful and valuable method for early diagnosis of scrub typhus.
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Affiliation(s)
- Song Han
- The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People’s Republic of China
| | - Suge Yang
- The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People’s Republic of China
| | - Yun Wang
- Department of Neurology Medicine, The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People’s Republic of China
| | - Yingying Xu
- Department of Neurology Medicine, The Second Hospital of Shandong University, Cheeloo College of Medicine of Shandong University, Shandong University, Jinan, 250033, People’s Republic of China
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16
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Bahadur A, Mundhra R, Pathak A, Kumar M, Rundla SR, Suresh G. Scrub typhus in pregnancy - A threat to maternal and fetal outcome. J Family Med Prim Care 2024; 13:764-767. [PMID: 38605756 PMCID: PMC11006060 DOI: 10.4103/jfmpc.jfmpc_1347_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 04/13/2024] Open
Abstract
Background and Objectives Scrub typhus is an acute febrile illness transmitted by the bite of trombiculid mite in the larval stage. Scrub typhus is rare in pregnancy and there is paucity of data on the clinical outcome of scrub typhus during pregnancy. Material and Methods We present five cases of scrub typhus complicating pregnancy who were admitted in the obstetric ward at AIIMS Rishikesh, India during the antenatal period for management. Results The first patient presented at term pregnancy in semiconscious state while the rest were preterm between 31 and 34 weeks period of gestation. The age at presentation was 21-31 years. All five had febrile illness of >5 days' duration along with cough. Fever investigations like blood culture, peripheral smear for malarial parasite, dengue serology, widal test, and urine culture were negative. Serology for scrub typhus was positive in all. Once diagnosis was confirmed for scrub typhus, patients were given the drug of choice azithromycin 500 mg twice daily for five days. Scrub typhus complicating pregnancy led to maternal mortality in one patient. It resulted in one preterm delivery, one intrauterine fetal death, and rest three were delivered at term with good perinatal outcome. Conclusion Scrub typhus is common in endemic areas like Uttarakhand, India. It has a poor fetal outcome. If diagnosed early and treatment started, maternal and fetal prognosis can be favorable. As large case series are unavailable in literature, it is difficult to predict the course of disease which at times may be fulminant.
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Affiliation(s)
- Anupama Bahadur
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajlaxmi Mundhra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anjali Pathak
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mukesh Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shri Ram Rundla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Gayatri Suresh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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17
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Govindarajan R, Sankar SG, Kumar MS, Rajamannar V, Krishnamoorthi R, Anand AAP, Kumar A, Samuel PP. Molecular detection of Orientia tsutsugamushi in ectoparasites & their small mammal hosts captured from scrub typhus endemic areas in Madurai district, India. Indian J Med Res 2024; 159:180-192. [PMID: 38494626 PMCID: PMC11050748 DOI: 10.4103/ijmr.ijmr_3530_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND OBJECTIVES Scrub typhus, caused by Orientia tsutsugamushi present in small mammals harbouring the ectoparasites. A study was undertaken to detect the pathogen present in small mammals and its ectoparasites in the scrub typhus-reported areas. METHODS The small mammals (rodents/shrews) and its ectoparasites were screened for O. tsutsugamushi using nested PCR amplification of the groEL gene. Small mammals were collected by trapping and screened for ectoparasites (mites, ticks and fleas) by combing method. RESULTS All the chigger mites collected were tested negative for O. tsutsugamushi . Interestingly, adult non-trombiculid mites ( Oribatida sp., Dermanyssus gallinae ), fleas ( Xenopsylla astia, X. cheopis, Ctenophalides felis and Ctenophalides sp.) and ticks ( Rhipicephalus sanguineus , R. haemaphysaloides ) screened were found to be positive for O. tsutsugamushi , which the authors believe is the first report on these species globally. Bandicota bengalensis with O. tsutsugamushi infection is reported for the first time in India. The O. tsutsugamushi groEL sequences from the positive samples were similar to the reference strains, Karp and Ikeda and phylogenetically clustered in clade IV with less evolutionary divergence. The blood samples of Rattus rattus , Suncus murinus and B. bengalensis collected from this area were tested positive for O. tsutsugamushi ; interestingly, the sequence similarity was much pronounced with their ectoparasites indicating the transmission of the pathogen to host or vice versa . INTERPRETATION CONCLUSIONS The outcome of the present investigations widened our scope on the pathogens present in ectoparasites and rodents/shrews from this area. This will help to formulate the required vector control methods to combat zoonotic diseases.
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Affiliation(s)
- R. Govindarajan
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - S. Gowri Sankar
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - M. Senthil Kumar
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - V. Rajamannar
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | | | | | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Puducherry, India
| | - P. Philip Samuel
- Division of Vector Borne Zoonotic Diseases, ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
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Du Q, Zeng H, Pang X, Cao J, Xie B, Long C, Liang L, Deng F, Huang M, Li L, Huang F, Liu X, Hu Y, Lv J. CagA-positive Helicobacter pylori may promote and aggravate scrub typhus. Front Microbiol 2024; 15:1351784. [PMID: 38298891 PMCID: PMC10828044 DOI: 10.3389/fmicb.2024.1351784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
Helicobacter pylori (H. pylori) infection may alter the host's resistance to tsutsugamushi disease pathogens through the Th1 immune response, leading to potential synergistic pathogenic effects. A total of 117 scrub typhus cases at Beihai People's Hospital and affiliated hospitals of Youjiang University for Nationalities and Medical Sciences were studied from January to December 2022, alongside 130 healthy individuals forming the control group. All participants underwent serum H. pylori antibody testing. The prevalence of H. pylori infection was significantly higher among scrub typhus patients (89.7%) compared to healthy individuals (54.6%) (p < 0.05). Moreover, type I H. pylori infection was notably more prevalent in scrub typhus cases (67.5%) compared to healthy individuals (30%) (p < 0.05). Multifactorial analysis demonstrated type I H. pylori infection as an independent risk factor for scrub typhus (adjusted odds ratio: 2.407, 95% confidence interval: 1.249-4.64, p = 0.009). Among scrub typhus patients with multiple organ damage, the prevalence of type I H. pylori infection was significantly higher (50.6%) than type II H. pylori infection (15.4%) (χ2 = 4.735, p = 0.030). These results highlight a higher incidence of H. pylori infection in scrub typhus patients compared to the healthy population. Additionally, type I H. pylori strain emerged as an independent risk factor for scrub typhus development. Moreover, individuals infected with type I H. pylori are more susceptible to multiple organ damage. These findings suggest a potential role of H. pylori carrying the CagA gene in promoting and exacerbating scrub typhus.
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Affiliation(s)
- Qiuying Du
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Houyang Zeng
- Department of Infectious Diseases, Beihai People's Hospital, Beihai, Guangxi, China
| | - Xianwu Pang
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Jianyu Cao
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Bo Xie
- Institute of Life Sciences, Guangxi Medical University, Nanning, Guangxi, China
| | - Chunyi Long
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Liudan Liang
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Fenglian Deng
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Meijin Huang
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Li Li
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Fengyan Huang
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Xinli Liu
- Center for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Yanling Hu
- Institute of Life Sciences, Guangxi Medical University, Nanning, Guangxi, China
- Center for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiannan Lv
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
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Ritu GP, Arif W, Sihag KK, Chakravarthi A, Anthony TN, Srinivasan L, Balakrishnan V, Kumar A, Ayanar E, Devaraju P. Comparative Evaluation of Different Tissues and Molecular Techniques for the Zoonotic Surveillance of Scrub Typhus. Vector Borne Zoonotic Dis 2024. [PMID: 38181193 DOI: 10.1089/vbz.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Background and Objectives: Scrub typhus (ST) is detected in one-fourth of patients with acute febrile illnesses, confirming its nationwide re-emergence. The disease, if not diagnosed, can lead to multiple organ dysfunction and mortality. Being a vector-borne zoonotic disease, the molecular survey for pathogens in animal hosts is essential to predict the risk of its transmission to humans. Hence, this study aimed at identifying the effective animal tissue and molecular technique for zoonotic surveillance of ST infection in small animal hosts. Methods: Rodents/shrews were trapped from seventeen randomly selected villages in Puducherry between July and September, 2022. The presence of Orientia tsutsugamushi in ectoparasites and tissues including blood, lung, liver, spleen, kidney, heart, brain, and intestine retrieved from the animals was screened by nested PCR targeting 56 kDa, real-time PCR (qPCR) targeting 47 kDa and traD, and conventional PCR targeting groEL. The Weil-Felix test was carried out to detect antibodies against O. tsutsugamushi in rodent/shrew serum samples. Diagnostic accuracy measures of the molecular tests were calculated for each of the tissues by latent class modeling. Results: O. tsutsugamushi detected in the rodents/shrews were identified to be Karp-like and Kawasaki-like strains. Upon statistical analysis, qPCR targeting 47 kDa exhibited the highest accuracy measures in most of the tissues analyzed, with perfect sensitivity and specificity of 100% and 97% for intestine and lung samples for the epidemiological surveillance, respectively. Interpretation and Conclusion: The study recommends qPCR targeting 47 kDa gene and analysis of intestine and lung along with blood for the zoonotic surveillance of ST infection.
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Affiliation(s)
- Georgina Parren Ritu
- MSc. Public Health Entomology Student, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | - Waseema Arif
- Unit of One Health, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | - Krishan Kumar Sihag
- Unit of One Health, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | | | | | - Lakshmy Srinivasan
- Unit of One Health, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | | | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | - Elango Ayanar
- Unit of Vector Biology and Control, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | - Panneer Devaraju
- Unit of One Health, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
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20
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Goonetilleke A, Silva S. Case report of scrub typhus with bilateral acute sensorineural hearing loss and cerebral salt-wasting disease. Trop Doct 2024; 54:69-71. [PMID: 37671547 DOI: 10.1177/00494755231195933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Scrub typhus is a re-emerging and endemic disease in the Asia Pacific region caused by Orientia tsutsugamushi. We present a 65-year-old male from Sri Lanka who presented with fever, bilateral acute sensorineural hearing loss, and confusion. On examination, he was dehydrated. Significant orthostatic hypotension and an eschar were noted. Investigations revealed hyponatraemia with elevated urine sodium, reduced serum osmolality, and normal urine osmolality suggestive of cerebral salt wasting. After initial hydration with 0.9% NaCl, hyponatraemia was corrected with 3% NaCl. Oral doxycycline was prescribed, and he showed dramatic clinical improvement. A diagnosis of typhus must be considered in a patient presenting with a febrile illness and acute hearing loss. Cerebral salt-wasting disease should be considered in a patient with typhus who develops hyponatraemia with dehydration. Furthermore, acute sensorineural hearing loss in both ears is an important manifestation of the disease.
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Affiliation(s)
- Asitha Goonetilleke
- Registrar, University Medical Unit, Colombo South Teaching Hospital, Kalubowila-Dehiwala, Sri Lanka
| | - Shehan Silva
- Registrar, University Medical Unit, Colombo South Teaching Hospital, Kalubowila-Dehiwala, Sri Lanka
- Consultant Physician & Senior Lecturer, Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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21
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Chauhan R, Ahmad S, Goyal C, Tewatia P. Hepatopathy in Scrub Typhus: Clinical Presentation, Association With Morbidity and Impact on Outcome. Cureus 2024; 16:e52316. [PMID: 38357080 PMCID: PMC10866566 DOI: 10.7759/cureus.52316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Acute liver injury accompanies tropical fevers like scrub typhus. This study was undertaken to evaluate liver injury in scrub typhus and its association with the disease severity. METHODS This was a single-centre prospective, observational study on in-patients of scrub typhus from north India. All patients were categorized on basis of elevation of transaminases as having normal or abnormal liver function. Those with hepatopathy were sub-categorized as having mild, moderate, severe or very severe liver injury. RESULTS Liver dysfunction was present in 76/109 of the patients and was significantly associated with eschar, clinically discernible hepatomegaly and splenomegaly. Shock, renal and respiratory insufficiency, need for intensive care and oxygen supplementation were also significantly associated with hepatopathy. Duration of hospitalization and mortality were comparable in patients with/without liver injury; however delayed defervescence (6.2+3.8 vs. 4.5+2.5 days; p=0.025) was observed with hepatopathy. Icterus (p=0.001), hepatomegaly (p=0.015), thrombocytopenia (p<0.001) and raised erythrocyte sedimentation rate (ESR) (p=0.003) were significantly observed with increasing grade of liver injury. Conclusion: Liver dysfunction and its increased severity in scrub typhus did not translate into increased morbidity and/or poor outcomes.
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Affiliation(s)
- Rishabh Chauhan
- Internal Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Sohaib Ahmad
- Internal Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Chandan Goyal
- Internal Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Pavit Tewatia
- Internal Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
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22
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Bhardwaj P, Nanaware NS, Behera SP, Kulkarni S, Deval H, Kumar R, Dwivedi GR, Kant R, Singh R. CRISPR/Cas12a-Based Detection Platform for Early and Rapid Diagnosis of Scrub Typhus. Biosensors (Basel) 2023; 13:1021. [PMID: 38131781 PMCID: PMC10742217 DOI: 10.3390/bios13121021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023]
Abstract
Orientia tsutsugamushi is responsible for causing scrub typhus (ST) and is the leading cause of acute encephalitis syndrome (AES) in AES patients. A rapid and sensitive method to detect scrub typhus on-site is essential for the timely deployment of control measures. In the current study, we developed a rapid, sensitive, and instrument-free lateral flow assay (LFA) detection method based on CRISPR/Cas12a technology for diagnosing ST (named LoCIST). The method is completed in three steps: first, harnessing the ability of recombinase polymerase for isothermal amplification of the target gene; second, CRISPR/Cas12a-based recognition of the target; and third, end-point detection by LFA. The detection limit of LoCIST was found to be one gene copy of ST genomic DNA per reaction, and the process was complete within an hour. In 81 clinical samples, the assay showed no cross-reactivity with other rickettsial DNA and was 100% consistent with PCR detection of ST. LoCIST demonstrated 97.6% sensitivity and 100% specificity. Overall, the LoCIST offers a novel alternative for the portable, simple, sensitive, and specific detection of ST, and it may help prevent and control AES outbreaks due to ST. In conclusion, LoCIST does not require specialized equipment and poses a potential for future applications as a point-of-care diagnostic.
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Affiliation(s)
- Pooja Bhardwaj
- ICMR-Regional Medical Research Centre Gorakhpur, BRD Medical College Campus, Gorakhpur 273013, India; (P.B.); (S.P.B.); (H.D.); (G.R.D.); (R.K.)
| | | | - Sthita Pragnya Behera
- ICMR-Regional Medical Research Centre Gorakhpur, BRD Medical College Campus, Gorakhpur 273013, India; (P.B.); (S.P.B.); (H.D.); (G.R.D.); (R.K.)
| | - Smita Kulkarni
- ICMR-National AIDS Research Institute, Bhosari, Pune 411026, India; (N.S.N.); (S.K.)
| | - Hirawati Deval
- ICMR-Regional Medical Research Centre Gorakhpur, BRD Medical College Campus, Gorakhpur 273013, India; (P.B.); (S.P.B.); (H.D.); (G.R.D.); (R.K.)
| | - Rajesh Kumar
- RGSC, Department of Genetics and Plant Breeding, Banaras Hindu University, Varanasi 221005, India;
| | - Gaurav Raj Dwivedi
- ICMR-Regional Medical Research Centre Gorakhpur, BRD Medical College Campus, Gorakhpur 273013, India; (P.B.); (S.P.B.); (H.D.); (G.R.D.); (R.K.)
| | - Rajni Kant
- ICMR-Regional Medical Research Centre Gorakhpur, BRD Medical College Campus, Gorakhpur 273013, India; (P.B.); (S.P.B.); (H.D.); (G.R.D.); (R.K.)
| | - Rajeev Singh
- ICMR-Regional Medical Research Centre Gorakhpur, BRD Medical College Campus, Gorakhpur 273013, India; (P.B.); (S.P.B.); (H.D.); (G.R.D.); (R.K.)
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23
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Senvanpan N, Phimolsarnnousith V, Rattanavong S, Mayxay M, Reinharz D, Fine AE, Horwood PF, Dussart P, Blacksell SD, Pruvot M, Newton PN, Robinson MT. Longitudinal comparison of bacterial pathogen seropositivity among wet market vendors in the Lao People's Democratic Republic. One Health 2023; 17:100618. [PMID: 37811399 PMCID: PMC7615163 DOI: 10.1016/j.onehlt.2023.100618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/10/2023] Open
Abstract
Wild animal trade for human consumption is a global issue, involving complex interactions between economics, culture, food security and conservation. Whilst being a biodiversity issue, it is also a major public health concern, with recent epidemics and pandemics of zoonotic pathogens linked to interactions with wildlife. At three time points, between March 2017 and June 2018, a longitudinal sero-survey of 150 market vendors from three wet markets in Laos (selling vegetables, domestic animal meat and/or wildlife meat) was conducted to determine if vendors had been differentially exposed to three endemic bacterial pathogens - Orientia tsutsugamushi, Rickettsia typhi, and Leptospira spp. A total of 367 serum samples were tested by IgG enzyme-linked immunosorbent assay (ELISA) and immunofluorescence assay (IFA, for scrub typhus group (STG) and typhus group (TG) only). Among vendors, 32.7% were IgG-positive for at least one pathogen, 13.3% sero-converted during the study. Multi-season occupancy modelling for STG indicated a significantly higher prevalence of STG IgG in vegetable vendors (27.3%) and wildlife vendors (28.4%) than in domestic animal meat vendors (6.9 %, p=0.05), and higher in Phonsavanh market (OR=9.6, p=0.03) compared to Lak Sao and Salavan markets. Estimated mean incidence was 57 cases per 10,000 per 7.5-month period. For TG, vendor age had a significant effect on prevalence (OR=1.04, p=0.006), estimated mean incidence was 64 cases per 10,000 per season (7.5-month period). Despite individuals selling domestic meat having a higher prevalence of Leptospira infections than those that did not (11.6% versus 4.5%), the difference was not significant. Whilst this study has a number of limitations, including vendors changing what food types they sold and no investigation of exposure outside of markets, the finding that the risk of exposure of vendors to zoonotic pathogens may be associated with types of food sold for human consumption warrants further investigation.
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Affiliation(s)
- Nilandone Senvanpan
- Institute de la Francophonie pour la Médecine Tropicale (IFMT)/Lao Tropical & Public Health Institute, Vientiane, Laos
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Vilayouth Phimolsarnnousith
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Mayfong Mayxay
- 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 Medicine, University of Oxford, Oxford, UK
- Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Laos
| | - Daniel Reinharz
- Institute de la Francophonie pour la Médecine Tropicale (IFMT)/Lao Tropical & Public Health Institute, Vientiane, Laos
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
| | - Amanda E. Fine
- Wildlife Conservation Society, Health Program, 2300 Southern Blvd, Bronx, NY 10460, USA
| | - Paul F. Horwood
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
| | - Stuart D. Blacksell
- 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 Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mathieu Pruvot
- Wildlife Conservation Society, Health Program, 2300 Southern Blvd, Bronx, NY 10460, USA
- University of Calgary, Faculty of Veterinary Medicine, Calgary, AB, Canada
| | - 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 Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Matthew T. Robinson
- 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 Medicine, University of Oxford, Oxford, UK
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Park J, Zhang Z, Belinskaya T, Tsoras AN, Chao CC, Jiang L, Champion JA. Dual-Antigen Subunit Vaccine Nanoparticles for Scrub Typhus. Pathogens 2023; 12:1390. [PMID: 38133275 PMCID: PMC10745692 DOI: 10.3390/pathogens12121390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Orientia tsutsugamushi is the causative pathogen of scrub typhus, an acute febrile disease prevalent in the Asia-Pacific region that is spread to people through chigger bites. Despite the emerging threat, there is no currently available vaccine against O. tsutsugamushi. Here, we developed dual-antigen subunit vaccine nanoparticles using recombinant 47 kD and 56 kD proteins, which are immunogenic outer membrane antigens of O. tsutsugamushi. The biocompatible protein vaccine nanoparticles were formed via desolvation of r56 or r47E antigens with acetone, coating with an additional layer of the 56 kD protein, and stabilization with reducible homobifunctional DTSSP and heterobifunctional SDAD crosslinkers. The dual-antigen subunit vaccine nanoparticles significantly improved antigen-specific antibody responses in vaccinated mice. Most importantly, the dual-antigen nanoparticles coated with an additional layer of the 56 kD protein were markedly more immunogenic than soluble antigens or single-antigen nanoparticles in the context of cellular immune responses. Given the significance of cellular immune responses for protection against O. tsutsugamushi, these results demonstrate the potent immunogenicity of dual-layered antigen nanoparticles and their potential as a promising strategy for developing vaccines against scrub typhus.
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Affiliation(s)
- Jaeyoung Park
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 950 Atlantic Dr. NW, Atlanta, GA 30332, USA; (J.P.); (A.N.T.)
| | - Zhiwen Zhang
- Henry Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Dr, Bethesda, MD 20817, USA; (Z.Z.); (T.B.)
- Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910, USA;
| | - Tatyana Belinskaya
- Henry Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Dr, Bethesda, MD 20817, USA; (Z.Z.); (T.B.)
- Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910, USA;
| | - Alexandra N. Tsoras
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 950 Atlantic Dr. NW, Atlanta, GA 30332, USA; (J.P.); (A.N.T.)
| | - Chien-Chung Chao
- Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910, USA;
| | - Le Jiang
- Henry Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Dr, Bethesda, MD 20817, USA; (Z.Z.); (T.B.)
- Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910, USA;
| | - Julie A. Champion
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 950 Atlantic Dr. NW, Atlanta, GA 30332, USA; (J.P.); (A.N.T.)
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25
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Teramoto K, Tamura S, Yoshida K, Inada Y, Yamashita Y, Morimoto M, Mushino T, Koreeda D, Miyamoto K, Komiya N, Nakano Y, Takagaki Y, Koizumi Y. Clinical Characteristics and Diagnostic Prediction of Severe Fever with Thrombocytopenia Syndrome and Rickettsiosis in the Co-Endemic Wakayama Prefecture, Japan. Medicina (Kaunas) 2023; 59:2024. [PMID: 38004073 PMCID: PMC10672843 DOI: 10.3390/medicina59112024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: The Wakayama prefecture is endemic for two types of tick-borne rickettsioses: Japanese spotted fever (JFS) and scrub typhus (ST). Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne hemorrhagic viral disease with a high mortality rate and is often difficult to differentiate from such rickettsioses. SFTS cases have recently increased in Wakayama prefecture. For early diagnosis, this study aimed to evaluate the clinical characterization of such tick-borne infections in the co-endemic area. Materials and Methods: The study included 64 febrile patients diagnosed with tick-borne infection in Wakayama prefecture between January 2013 and May 2022. Medical records of 19 patients with SFTS and 45 with rickettsiosis (JSF, n = 26; ST, n = 19) were retrospectively examined. The receiver operating curve (ROC) and area under the curve (AUC) were calculated to evaluate potential factors for differentiating SFTS from rickettsiosis. Results: Adults aged ≥70 years were most vulnerable to tick-borne infections (median, 75.5 years; interquartile range, 68.5-84 years). SFTS and rickettsiosis occurred mostly between summer and autumn. However, no significant between-group differences were found in age, sex, and comorbidities; 17 (89%) patients with SFTS, but none of those with rickettsiosis, experienced gastrointestinal symptoms such as vomiting, abdominal pain, and diarrhea. Meanwhile, 43 (96%) patients with rickettsiosis, but none of those with SFTS, developed a skin rash. The AUCs of white blood cells (0.97) and C-reactive protein (CRP) levels (0.98) were very high. Furthermore, the differential diagnosis of SFTS was significantly associated with the presence of gastrointestinal symptoms (AUC 0.95), the absence of a skin rash (AUC 0.98), leukopenia <3.7 × 109/L (AUC 0.95), and low CRP levels < 1.66 mg/dL (AUC 0.98) (p < 0.001 for each factor). Conclusions: Clinical characteristics and standard laboratory parameters can verify the early diagnosis of SFTS in areas where tick-borne infections are endemic.
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Affiliation(s)
- Kan Teramoto
- Department of Internal Medicine, National Health Insurance Susami Hospital, Wakayama 649-2621, Japan
- Department of Hematology, Kinan Hospital, Wakayama 641-8509, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Shinobu Tamura
- Department of Hematology, Kinan Hospital, Wakayama 641-8509, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
- Department of Infection Control and Prevention, Wakayama Medical University, Wakayama 641-8509, Japan
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Kikuaki Yoshida
- Department of Hematology, Kinan Hospital, Wakayama 641-8509, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Yukari Inada
- Department of Infection Control and Prevention, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Yusuke Yamashita
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Masaya Morimoto
- Department of Hematology, Kinan Hospital, Wakayama 641-8509, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
- Department of Infection Control and Prevention, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Toshiki Mushino
- Department of Hematology, Kinan Hospital, Wakayama 641-8509, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Daisuke Koreeda
- Department of Emergency and Intensive Care Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Japan
| | - Kyohei Miyamoto
- Department of Infection Control and Prevention, Wakayama Medical University, Wakayama 641-8509, Japan
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Nobuhiro Komiya
- Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Japan
| | - Yoshio Nakano
- Department of Internal Medicine, Kinan Hospital, Wakayama 646-8588, Japan
| | - Yusaku Takagaki
- Department of Internal Medicine, National Health Insurance Susami Hospital, Wakayama 649-2621, Japan
| | - Yusuke Koizumi
- Department of Infection Control and Prevention, Wakayama Medical University, Wakayama 641-8509, Japan
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Nepal TN, Drukpa S. Scrub typhus in a febrile patient and challenges faced in a diagnosis-constrained health centre: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231209684. [PMID: 37941980 PMCID: PMC10629319 DOI: 10.1177/2050313x231209684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Scrub typhus is an acute febrile bacterial illness and has a high mortality if left untreated. It is caused by bacterium called Orientia tsutsugamushi which is transmitted to humans as zoonosis by bite of chigger mites that are infected by the bacterium. The diagnosis is based on clinical features and specific laboratory tests. Treatment of Scrub typhus is done with antibiotics and symptoms management. This report is a case of a 24-year-old female febrile patient who presented with complications of Scrub typhus due to missed diagnosis at Primary Health Centre and managed at district hospital. This case report highlights the challenges faced by health workers in management of acute febrile illness in a diagnosis-constrained setting.
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Sun H, Lei L, Li J, Niu H, Yang J, Chen M. Clinical treatment of patients with scrub typhus-induced liver injury and intracranial infection. J Int Med Res 2023; 51:3000605231214503. [PMID: 38008898 PMCID: PMC10683569 DOI: 10.1177/03000605231214503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/27/2023] [Indexed: 11/28/2023] Open
Abstract
Scrub typhus is an infectious disease caused by Orientia tsutsugamushi, a bacterium within the family Rickettsiaceae. The clinical symptoms are usually acute and are characterized by fever, eschar formation or ulceration, local or generalized lymphadenopathy, and rash. Because of the extensive damage to small blood vessels throughout the body, scrub typhus can involve multiple systems and organs, causing damage to the respiratory, digestive, and nervous systems and inducing kidney and liver dysfunction. Death can occur in severe cases. We herein report two cases of scrub typhus with liver damage and intracranial infection. Among patients with scrub typhus, the risk of death is significantly higher in those who develop liver injury and intracranial infection. However, there are few reports on the treatment of patients with liver injury and intracranial infection caused by scrub typhus, and relevant treatment experience is thus lacking. Our clinical case report helps to fill the knowledge gap in this area.
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Affiliation(s)
- HongKui Sun
- Critical Care Department, Zhongshan City People’s Hospital, China
| | - Li Lei
- Department of Respiratory Medicine, Zhongshan City People’s Hospital, China
| | - JianWei Li
- Critical Care Department, Zhongshan City People’s Hospital, China
| | - Haiming Niu
- Critical Care Department, Zhongshan City People’s Hospital, China
| | - Jiezhang Yang
- Critical Care Department, Zhongshan City People’s Hospital, China
| | - MiaoLian Chen
- Critical Care Department, Zhongshan City People’s Hospital, China
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28
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Khairkar M, Vagha S, Deotale V. Review on Scrub Typhus: An Important Etiology of Acute Undifferentiated Fever Illness. Cureus 2023; 15:e47290. [PMID: 38021775 PMCID: PMC10656281 DOI: 10.7759/cureus.47290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
One of India's predominant public health issues is acute undifferentiated fever illness (AUFI), a typical response to an infectious agent. Diagnosis becomes challenging when the disease has been reported with fever as the primary symptom. Among the cases presenting at a tertiary care hospital in central India, 88% had an acute undifferentiated fever, the most common being dengue infection. In India, rural communities are at more risk from AUFI than cities. Most of those in danger are those who reside in remote areas, and one of the most significant risks is for those who reside close to forests. AUFI is a complex condition for physicians to deal with and is one of the most frequent clinical conditions for which empirical treatment is required. Nowadays, AUFI can be managed by a syndromic approach with the judicial use of antibiotics. Symptoms of AUFI, along with myalgia, headache, and anorexia, can be caused by various illnesses. Patients are recommended to undertake a battery of investigations, which may delay the therapy and increase expenses because many diseases may present with the same symptoms. In the developed world, viral illness is the primary cause of AUFI. However, in developing countries like India, it can also be brought on by potentially curable but life-threatening conditions such as malaria, leptospirosis, hantavirus infection, and Japanese encephalitis. Lack of knowledge of the locally prevalent illnesses, which might be the cause of AUFI, and lack of preliminary screening and diagnostics at the point of care to identify the etiologies make it difficult to control these generally curable causes of the burden of AUFI, especially in tropical and subtropical countries. A deeper understanding of AUFI is required to develop better diagnostics and cures for various etiologies, especially scrub typhus.
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Affiliation(s)
- Mihika Khairkar
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sunita Vagha
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Vijayshri Deotale
- Microbiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
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Abstract
Scrub typhus, which is prevalent in the Asia Pacific region is most feared owing to its life-threatening neurological complications. We present four cases of scrub typhus with acute encephalitis, including one with multiorgan failure and another serologically proven co-infection with Hepatitis C. Treatment of scrub typhus is not, however, so difficult, so its early diagnosis is paramount.
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Affiliation(s)
- Uneza Husain
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Arpita
- Department of Paediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Raj Kumar Kalyan
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Lamichhane P, Pokhrel KM, Alghalyini B, Zaidi ARZ, Alshehery MZ, Khanal K, Bhattarai M, Yadav A. Epidemiology, clinical characteristics, diagnosis, and complications of scrub typhus infection in Nepal: a systematic review. Ann Med Surg (Lond) 2023; 85:5022-5030. [PMID: 37811079 PMCID: PMC10553080 DOI: 10.1097/ms9.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Scrub typhus (ST) is a neglected tropical disease of serious concern in Nepal. This systematic review aims to describe the burden of disease, clinical presentation, and complications of ST infection in Nepal. Methods A systematic search of PubMed, EMBASE, Google Scholar, and national databases was conducted for any literature published in English between January 2000 and January 2023. Any type of study design (observational studies, case series, and interventional studies) that reported laboratory-confirmed ST and was conducted in Nepal among patients of all age groups was included. The seroprevalence of ST among acute undifferentiated febrile illness (AUFI) cases, geographical distribution, monthly distribution, clinical presentations, complications, and treatment were assessed by the study. Result A total of 15 studies with 10, 977 participants were included in the review. The seroprevalence of ST among the AUFI cases in Nepal was 19.31%. Young people at or below 20 years of age were mostly affected. The maximum number of cases were reported from Bagmati province (59.46%) and in the month of August (26.33%). Fever, headache, cough, shortness of breath, nausea, and abdominal pain were the clinical characteristics in decreasing order of occurrence. The most common complication was acute kidney injury, followed by respiratory problems, cardiac issues, and neurological manifestations. The case fatality rate of ST in Nepal was 2.56%. Conclusion The authors findings showed a significant burden of ST among AUFI cases in Nepal. Improved surveillance, general public awareness, and early detection post-calamities could help reduce the disease burden and improve patient outcomes.
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Affiliation(s)
| | | | - Baraa Alghalyini
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdul Rehman Zia Zaidi
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Maied Z. Alshehery
- Department of Palliative Care, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Kapil Khanal
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Madhur Bhattarai
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Alisha Yadav
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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Fromm L, Mehl J, Keller C. Orientia tsutsugamushi: A life between escapes. Microbiologyopen 2023; 12:e1380. [PMID: 37877457 PMCID: PMC10493369 DOI: 10.1002/mbo3.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023] Open
Abstract
The life cycle of the mite-borne, obligate intracellular pathogen Orientia tsutsugamushi (Ot), the causative agent of human scrub typhus, differs in many aspects from that of other members of the Rickettsiales order. Particularly, the nonlytic cellular exit of individual Ot bacteria at the plasma membrane closely resembles the budding of enveloped viruses but has only been rudimentarily studied at the molecular level. This brief article is focused on the current state of knowledge of escape events in the life cycle of Ot and highlights differences in strategies of other rickettsiae.
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Affiliation(s)
- Lea Fromm
- Institute of VirologyPhilipps University MarburgMarburgGermany
| | - Jonas Mehl
- Institute of VirologyPhilipps University MarburgMarburgGermany
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Sarkar M, Roy A, Bhakta S, Chowdhoury SR, Mandal RK. Retrospective analysis of clinico-laboratory parameters, outcome and predictors of scrub typhus co- infection in covid-19 affected children. Trop Doct 2023; 53:448-454. [PMID: 37587858 DOI: 10.1177/00494755221076904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The objective of this study was to describe clinico-laboratory parameters, outcome and predictors of scrub typhus co- infection in COVID-19 affected children. Ours was a retrospective analysis done in a tertiary care pediatric COVID facility. COVID-19 positive children in the age group of 1 month to 12 years who were tested for scrub typhus co-infection between May to August 2020 were included in the study. In all positive cases, clinical, laboratory, treatment and outcome data were analyzed. Relevant data were compared between scrub typhus confirmed, and suspected but negative patients. All six patients with co-infection had fever for >5 days and four had features of cerebral involvement. These had lymphocytic pleocytosis in cerebrospinal fluid (CSF) analysis and two had eschar. Screening for scrub typhus in persistently febrile children residing in highly endemic areas is highly recommended.
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Affiliation(s)
- Mihir Sarkar
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal, India
| | - Aniket Roy
- Department of Pediatrics, Medical College, Kolkata, West Bengal, India
| | - Subhajit Bhakta
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Rakesh Kumar Mandal
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal, India
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Chatterjee S, Kim CM, Kim DM, Seo JW, Kim DY, Yun NR, Jung SI, Kim UJ, Kim SE, Kim HA, Kim ES, Hur J, Kim YK, Jeong HW, Heo JY, Jung DS, Lee H, Park SH, Kwak YG, Lee S, Chatterjee RP. Coinfection With Severe Fever With Thrombocytopenia Syndrome and Scrub Typhus in Korea. Open Forum Infect Dis 2023; 10:ofad377. [PMID: 37854108 PMCID: PMC10580145 DOI: 10.1093/ofid/ofad377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Indexed: 10/20/2023] Open
Abstract
Background Scrub typhus and severe fever with thrombocytopenia syndrome (SFTS) are the 2 most common tick-borne infectious diseases in Korea. Every year, an increasing number of cases are reported, which is a public health concern. Therefore, we aimed to investigate the prevalence of SFTS-scrub typhus coinfection in patients with SFTS. Methods Clinical samples were collected from 129 patients with SFTS. One-step reverse-transcription polymerase chain reaction (PCR) was performed to identify the SFTS virus (SFTSV), and real-time PCR followed by nested PCR was performed to detect the Orientia tsutsugamushi gene for scrub typhus. Phylogenetic analysis was conducted to confirm the evolutionary relationships among different species. Results Among 129 SFTS cases, 2 patients with SFTSV were positive for O. tsutsugamushi with a prevalence of coinfection of 1.6% (95% confidence interval, .001-.06). Phylogenetic analysis confirmed these as O. tsutsugamushi strain Boryong. Conclusions Our study found that 1.6% of patients were coinfected with SFTS and scrub typhus infection. We believe that this information will add a new dimension to clinical diagnosis, which should be considered for better public health management. Further research is needed to better understand the ecological transmission dynamics and geographical distribution of SFTSV and O. tsutsugamushi in endemic countries.
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Affiliation(s)
- Shilpa Chatterjee
- Department of Biomedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Choon-Me Kim
- Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Jun-Won Seo
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Da Young Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Na-Ra Yun
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Sook In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Uh Jin Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong Eun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyun ah Kim
- Division of Infectious Diseases, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jian Hur
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Young Keun Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Hye Won Jeong
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jung Yeon Heo
- Department of Infectious Diseases, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Dong Sik Jung
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Hyungdon Lee
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Sujin Lee
- Department of Internal Medicine, College of Medicine, Pusan National University, Yangsan, Republic of Korea
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Chen Y, Guo Z, Wang L, Cheng N, Wang C. The first case report of acute myocardial infarction in young adult caused by scrub typhus. Medicine (Baltimore) 2023; 102:e35271. [PMID: 37773827 PMCID: PMC10545295 DOI: 10.1097/md.0000000000035271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/28/2023] [Indexed: 10/01/2023] Open
Abstract
RATIONALE Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi, a gram-negative intracellular bacterium and endemic in Asia-Pacific area. Acute myocardial infarction after Oricntia tsutsugamushi infection was rarely reported, and young adult was not reported. PATIENT CONERNS A 33-year-old man came to the emergency complained with chest tightness and fever for 4 days. DIAGONOSES After Weil-Felix agglutination test (titer 1:160) twice, scrub typhus was diagnosed. INTERVENTIONS After treating with a hormonotherapy, antibiotic and ventilator-assisted ventilation, his chest tightness was mild lessened with normal breath and body temperature. However, an emergent coronary angiography performed unnormal, then a percutaneous coronary intervention was realized with the implantation of a stent. OUTCOMES After the surgeon, his chest tightness was totally released, and he was discharged. LESSONS Our case was the first report of young adult acute myocardial infarction after O tsutsugamushi infection and we tried to figure out the potential mechanism and how to deal with.
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Affiliation(s)
- Yan Chen
- Department of Respiratory, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenfeng Guo
- Department of Cardiovascular, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Li Wang
- Department of Respiratory, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Ningchang Cheng
- Department of Respiratory, Xinglong Community Health Center, Nanjing, China
| | - Cheng Wang
- Department of Respiratory, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
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Ling Y, Hu X, Zheng G, Ye W, Yuan K, Ye L, Huang W, Tian B, Gu B. Metagenomics as New Tool for Diagnosis of Scrub Typhus: Two Case Reports. Int Med Case Rep J 2023; 16:617-622. [PMID: 37789830 PMCID: PMC10544144 DOI: 10.2147/imcrj.s431864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
Scrub typhus is a vector-borne infectious disease caused by Orientia tsutsugamushi. Accurate and timely diagnosis at the early infection stage could save the patients' lives. Traditional technologies were limited to rapidly and successfully detecting Orientia tsutsugamushi due to poor specificity, especially in the condition of atypical symptoms. The technology of Metagenomic next-generation sequencing (mNGS) is amenable to finding the real pathogen because it holds potential as a diagnostic platform for unbiased pathogen identification and precision medicine. Herein, we reported two clinical case reports relative to the Orientia tsutsugamushi infection diagnosed by mNGS. We hope these two cases will improve clinical diagnosis.
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Affiliation(s)
- Yong Ling
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China
| | - Xuejiao Hu
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China
| | - Guansheng Zheng
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China
| | - Weitao Ye
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China
| | - Kaixuan Yuan
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China
| | - Long Ye
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China
| | - Weiye Huang
- Department of Pathology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China
| | - Benshun Tian
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China
| | - Bing Gu
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510000, People’s Republic of China
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Kamra N, Jagadeesan S, Singh R. Scrub Typhus Presenting As Acute Febrile Illness With Splenic Infarct: A Rare Manifestation. Cureus 2023; 15:e45622. [PMID: 37868404 PMCID: PMC10588906 DOI: 10.7759/cureus.45622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Scrub typhus is a mite-borne infectious disease endemic in India, Korea, China, Japan, Taiwan, Pakistan, Malaysia, Thailand, and Australia. It has a multitude of clinical manifestations ranging from mild symptoms like headache, myalgia, anorexia, fever, and rash to severe multiorgan failure. It can also lead to several complications, including pancreatitis, hepatitis, myocardial infarction, and cerebral infarction. A few cases of splenic infarction are also reported. We report a rare case of a 40-year-old female presenting with fever and left upper quadrant abdominal pain of acute onset. She is diagnosed serologically with scrub typhus using enzyme-linked immunosorbent assay (ELISA) after ruling out other infectious causes, including other tropical diseases. Abdominal computed tomography revealed splenic infarction attributed to scrub typhus after excluding other etiologies. She improved after a course of doxycycline and was advised to follow up. Hence, a splenic infarct should be suspected in a patient with scrub typhus complaining of acute left hypochondriac pain.
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Affiliation(s)
- Namita Kamra
- Internal Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Subramani Jagadeesan
- Internal Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Ramandeep Singh
- Internal Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Diaz JH. An Urge to Scratch. Wilderness Environ Med 2023; 34:397-401. [PMID: 37183075 DOI: 10.1016/j.wem.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 05/16/2023]
Affiliation(s)
- James H Diaz
- Professor of Public Health and Preventive Medicine, School of Public Health, Louisiana State University Health, New Orleans, LA.
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Ravikumar DB, Sivasubramanian BP, Shanmugam SN, Krishnaswamy V, Rabaan A, Al-Tawfiq JA, Tirupathi R. Multifaceted realities of scrub typhus: a case series from southern India. Infez Med 2023; 31:384-393. [PMID: 37701392 PMCID: PMC10495056 DOI: 10.53854/liim-3103-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/31/2023] [Indexed: 09/14/2023]
Abstract
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, a Gram-negative bacillus, commonly occurring in the Asia-Pacific region. It is transmitted to humans by the bite of an infected Leptotrombidium mite and the bacterium causes endothelial dysfunction resulting in widespread vasculitis and the possible development of thrombocytopenia, meningitis, acute respiratory distress syndrome, and infrequently, myocarditis. Early diagnosis and prompt treatment are crucial in managing scrub typhus. Here, we present four cases of scrub typhus with a comprehensive literature review. This study highlights the significance of considering scrub typhus as a possible diagnosis in patients of all ages from endemic regions who exhibit symptoms such as fever, thrombocytopenia, or transaminitis, even in the absence of typical clinical features. Two cases exhibited the characteristic lesion of eschar at the site of mite feeding. One case involved a middle-aged woman who was diagnosed with typhus-induced myocarditis with left ventricular dysfunction. Another case involved a 23-day-old neonate with poor feeding and seizures, who was diagnosed with late-onset sepsis with meningitis. Scrub typhus was confirmed in all cases using a positive qualitative IgM ELISA. However, it is preferred to use paired (ELISA before and after antibiotic therapy) or quantitative titers for confirmation. Healthcare providers must consider the patient's exposure history and clinical presentation to diagnose and treat scrub typhus promptly.
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Affiliation(s)
| | | | | | | | - Ali Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Infectious Diseases Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Kim S, Lee IY, Monoldorova S, Kim J, Seo JH, Yong TS, Jeon BY. Prevalence of chigger mites and Orientia tsutsugamushi strains in northern regions of Gangwon-do, Korea. Parasites Hosts Dis 2023; 61:263-271. [PMID: 37648231 PMCID: PMC10471477 DOI: 10.3347/phd.22148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/22/2023] [Indexed: 09/01/2023]
Abstract
The present study aimed to survey the prevalence of chigger mites and Orientia tsutsugamushi (O. tsutsugamushi) infection in the northern regions of Gangwon-do, Korea. From early February to early June 2015, a total of 17,050 chiggers were collected from striped field mice, Apodemus agrarius, in Cheorwon-gun, Hwacheon-gun, Yanggu-gun, and Goseong-gun, which are well-known endemic areas of scrub typhus in Korea. The chiggers were analyzed using molecular genomic methods, as previously described. Among the 7,964 identified chiggers, the predominant species was Leptotrombidium pallidum (76.9%), followed by L. zetum (16.4%), L. orientale (4.3%), L. palpale (0.3%), L. tectum (0.2%), and Neotrombicula tamiyai (1.8%). The chigger index (CI) was highest in Hwacheon (115.58), followed by Cheorwon (97.02), Yanggu (76.88), and Goseong (54.68). Out of the 79 O. tsutsugamushi-positive chigger pools, 67 (84.8%) were identified as the Boryong strain, 10 (12.7%) as the Youngworl strain, and only 2 were the Jecheon strain. Based on the high infestation of chiggers in striped field rodents and the high rate of O. tsutsugamushi infection in chigger mites, Hwacheon-gun and Cheorwon-gun are presumed to be high-risk areas for scrub typhus. Furthermore, L. pallidum, a major vector of scrub typhus, and the dominant O. tsutsugamushi serotype, the Boryong strain, were found in the northern regions of Gangwon-do, Korea.
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Affiliation(s)
- Soojin Kim
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493,
Korea
| | - In Yong Lee
- Department of Tropical Medicine and Institute of Tropical Medicine, Yonsei University College of Medicine, Seoul 03722,
Korea
| | - Sezim Monoldorova
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493,
Korea
| | - Jiro Kim
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493,
Korea
- Department of Clinical Laboratory Science, Cheju Halla University, Jeju 63092,
Korea
| | - Jang Hoon Seo
- Department of Biomedical Laboratory Science, Shinhan University, Uijeongbu 11644,
Korea
| | - Tai-Soon Yong
- Department of Tropical Medicine and Institute of Tropical Medicine, Yonsei University College of Medicine, Seoul 03722,
Korea
| | - Bo Young Jeon
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493,
Korea
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Chen K, Travanty NV, Garshong R, Crossley D, Wasserberg G, Apperson CS, Roe RM, Ponnusamy L. Detection of Orientia spp. Bacteria in Field-Collected Free-Living Eutrombicula Chigger Mites, United States. Emerg Infect Dis 2023; 29:1676-1679. [PMID: 37486323 PMCID: PMC10370866 DOI: 10.3201/eid2908.230528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Scrub typhus, a rickettsial disease caused by Orientia spp., is transmitted by infected larval trombiculid mites (chiggers). We report the molecular detection of Orientia species in free-living Eutrombicula chiggers collected in an area in North Carolina, USA, to which spotted fever group rickettsiae infections are endemic.
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Shanks GD. Historical epidemics of scrub typhus in Queensland and Papua New Guinea. Intern Med J 2023; 53:1501-1505. [PMID: 37599229 DOI: 10.1111/imj.16199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/30/2023] [Indexed: 08/22/2023]
Abstract
Undifferentiated febrile diseases (e.g., Mossman fever) from northern Queensland were eventually partially attributed to mite-transmitted rickettsial infections known as scrub typhus or tsutsugamushi fever. Scrub typhus became a major medical threat to military operations in Papua New Guinea during the Second World War and killed more Australian soldiers than malaria in the pre-antibiotic era. Further investigations showed scrub typhus to be an occupational disease of rural workers in north Queensland especially around Cairns and Innisfail. Occasional small epidemics of scrub typhus still occur during military exercises in Queensland, but as scrub typhus is not a reportable disease, its presence in the civilian community is largely unknown. Increased use of serological testing in patients with fever and rash illnesses after exposure in northern Queensland is likely to show that scrub typhus is a modern infection that remains treatable with antibiotics once it is identified.
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Affiliation(s)
- G D Shanks
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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Damalapati SSVY, Deshpande R, Moola NS, Jadav RH, Havannavar S. Rickettsial Cerebellitis: A Rare Neurological Manifestation. Cureus 2023; 15:e42901. [PMID: 37664253 PMCID: PMC10474878 DOI: 10.7759/cureus.42901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Scrub typhus is a vector-borne disease caused by gram-negative bacilli, Orientia tsutsugamushi. The vector of scrub typhus is the mite. The clinical manifestations often present with either a simple fever or life-threatening multi-organ dysfunction. Neurological manifestations also vary, and the incidence of neurological manifestations is unknown. Cerebellitis is one of the rare neurological manifestations associated with scrub typhus. In this case report, we present the case of a 35-year-old man who tested positive for scrub typhus (IgM enzyme-linked immunosorbent assay (ELISA) blood test) with a history of fever and cerebellar signs and symptoms. He was managed with antibacterial agents and made a good recovery.
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Rana A, Tewari J, Roy S, Batra P, Pant P, Sharma D, Atam V, Tripathi KM. Acute Pancreatitis as a Rare Complication of Scrub Typhus: A Case Report. Cureus 2023; 15:e42358. [PMID: 37621808 PMCID: PMC10445296 DOI: 10.7759/cureus.42358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Scrub typhus is transmitted by the bite of chiggers (larvae) of Leptotrombidium deliense and is caused by the bacteria Orientia tsutsugamushi. Common symptoms include fever, headache, lymphadenopathy, and black eschar formation, while acute pancreatitis is a rare complication. We present the case of a 27-year-old gentleman, who presented with epigastric pain and constipation for three weeks, fever for four days, and vomiting for two days. Serum lipase, C-reactive protein, and serum amylase were significantly raised. Enzyme-linked immunosorbent assay anti-scrub typhus IgM was positive at 0.605 optical density. An abdominal computed tomography scan revealed a bulky pancreas. Mild fluid collection (50 × 60 × 65 mm) was seen in the peripancreatic region, along with moderate to gross mesenteric fat stranding. The left anterior and lateral renal conal fascia were thickened and edematous. The patient was managed with intravenous fluids, antipyretics, and intravenous doxycycline.
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Affiliation(s)
- Anadika Rana
- Internal Medicine, King Geroge's Medical University, Lucknow, IND
| | - Jay Tewari
- Faculty of Medical Sciences, King George's Medical University, Lucknow, IND
| | - Shubhajeet Roy
- Faculty of Medical Sciences, King George's Medical University, Lucknow, IND
| | - Punyagam Batra
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Pratiksha Pant
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Deepak Sharma
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Virendra Atam
- Internal Medicine, King George's Medical University, Lucknow, IND
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Abstract
To elucidate the epidemiology of murine typhus, which is infrequently reported in Japan, we conducted a cross-sectional study involving 2,382 residents of rickettsiosis-endemic areas in Honshu Island during August-November 2020. Rickettsia typhi seroprevalence rate was higher than that of Orientia tsutsugamushi, indicating that murine typhus is a neglected disease.
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Suri V, Singh H, Ary KA, Biswal M, Ahuja CK, Kharbanda P, Sharma N. A Case Series of Scrub Meningoencephalitis from a Tertiary Care Center in North India. Ann Indian Acad Neurol 2023; 26:549-552. [PMID: 37970282 PMCID: PMC10645237 DOI: 10.4103/aian.aian_135_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 11/17/2023] Open
Abstract
Scrub typhus infection is reemerging leading cause of acute febrile illnesses in post-rainy or monsoon season in Southeast Asia. It is caused by Orientia tsutsugamushi and spread by the bite of chiggers, larval forms of trombiculid mites. The clinical picture can range from simple acute febrile illness to multiorgan dysfunction. Neurological manifestations also vary from aseptic meningitis, meningoencephalitis, cerebral infarction, acute disseminated encephalomyelitis, transverse myelitis, and psychiatric manifestations. Here, we present a case series of eight cases of scrub meningoencephalitis diagnosed based on clinical, laboratory, and radiological criteria.
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Affiliation(s)
- Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kunwer A. Ary
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag K. Ahuja
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parampreet Kharbanda
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kumar Jana J, Krishna Mandal A, Gayen S, Mahata D, Alam Mallick MS. Scrub Typhus in Children: A Prospective Observational Study in a Tertiary Care Hospital in Eastern India. Cureus 2023; 15:e41976. [PMID: 37593313 PMCID: PMC10427745 DOI: 10.7759/cureus.41976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
Background Scrub typhus is a reemerging, acute, undifferentiating febrile illness and one of the most neglected tropical diseases, calling for an in-depth investigation into its clinical diversity, complications, and mortality, which drives us to carry out this research work. Methods Over a year, prospective observational research was carried out after gaining parental consent and institutional ethical clearance, 206 children of either gender aged between one month and 12 years who had been hospitalized with a fever for at least five days and subsequently tested positive for Orientia tsutsugamushi were included in the study. Basic demographic information, clinical characteristics, laboratory findings, complications, related coinfections, and results were gathered and analyzed. A P-value of 0.05 was set as the statistical benchmark. Results The current study found that boys outnumbered girls. The ratio of boys to girls was 1.22:1, and the average age was 5.18 years. All had a fever (100%), and the other most frequently occurring clinical signs and symptoms were abdominal pain (16.99%), vomiting (22.33%), hepatosplenomegaly (49.51%), facial puffiness (39.32%), edema (27.18%), lymphadenopathy (19.90%), eschar (19.90%), macular-erythematous rash (17.96%), cough (21.84%), conjunctival congestion (25.24%), and headache (13.59%). Anemia (81.55%), leucocytosis (20.39%), leucopenia (6.8%), thrombocytopenia (49.51%), thrombocytosis (2.43%), and elevated serum levels of alanine aminotransferase (ALT, 57.28%) and aspartate aminotransferase (AST, 63.59%) were characteristic laboratory results. The coinfections were dengue, enteric fever, urinary tract infections, and malaria. Children who also had dengue were more likely to develop thrombocytopenia, which was statistically significant (P-value = 0.008). With doxycycline medication, early defervescence of fever occurred earlier than with azithromycin, and it was statistically significant (P-value = 0.000). The complications were hepatitis (63.59%), lower respiratory tract infections (LRTIs, 22.82%), scrub typhus meningoencephalitis (STME, 3.88%), acute kidney injury (AKI, 2.91%), myocarditis (1.46%), and acute disseminated encephalomyelitis (ADEM, 0.49%). Except for one who had ADEM, everyone was sent back home after receiving the best care possible. The average duration of hospital stay was 6.89 days. Conclusions Even in the absence of eschar, scrub typhus should be suspected in any febrile child who experiences clinical signs of meningoencephalitis syndrome, capillary leakage, skin rash, conjunctival congestion, LRTI, AKI, lymphadenopathy, hepatosplenomegaly, thrombocytopenia, and liver dysfunction in the post-monsoon season. Strong clinical suspicion and prompt anti-scrub drug administration go a long way in preventing or decreasing the morbidity and mortality of the same.
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Affiliation(s)
- Jadab Kumar Jana
- Pediatrics, Bankura Sammilani Medical College and Hospital, Bankura, IND
| | | | - Soumya Gayen
- Pediatrics, Bankura Sammilani Medical College and Hospital, Bankura, IND
| | - Dipti Mahata
- Pediatrics, Bankura Sammilani Medical College and Hospital, Bankura, IND
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Liang Y, Aditi, Onyoni F, Wang H, Gonzales C, Sunyakumthorn P, Wu P, Samir P, Soong L. Brain transcriptomics reveal the activation of neuroinflammation pathways during acute Orientia tsutsugamushi infection in mice. Front Immunol 2023; 14:1194881. [PMID: 37426673 PMCID: PMC10326051 DOI: 10.3389/fimmu.2023.1194881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 09/03/2023] Open
Abstract
Scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi (Ot), is prevalent in endemic areas with one million new cases annually. Clinical observations suggest central nervous system (CNS) involvement in severe scrub typhus cases. Acute encephalitis syndrome (AES) associated with Ot infection is a major public health problem; however, the underlying mechanisms of neurological disorder remain poorly understood. By using a well-established murine model of severe scrub typhus and brain RNA-seq, we studied the brain transcriptome dynamics and identified the activated neuroinflammation pathways. Our data indicated a strong enrichment of several immune signaling and inflammation-related pathways at the onset of disease and prior to host death. The strongest upregulation of expression included genes involved in interferon (IFN) responses, defense response to bacteria, immunoglobulin-mediated immunity, IL-6/JAK-STAT signaling, and TNF signaling via NF-κB. We also found a significant increase in the expression of core genes related to blood-brain barrier (BBB) disruption and dysregulation in severe Ot infection. Brain tissue immunostaining and in vitro infection of microglia revealed microglial activation and proinflammatory cytokine production, suggesting a crucial role of microglia in neuroinflammation during scrub typhus. This study provides new insights into neuroinflammation in scrub typhus, highlighting the impact of excessive IFN responses, microglial activation, and BBB dysregulation on disease pathogenesis.
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Affiliation(s)
- Yuejin Liang
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
| | - Aditi
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Florence Onyoni
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Hui Wang
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Casey Gonzales
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Piyanate Sunyakumthorn
- Department of Veterinary Medicine, United States Army Medical Directorate, Armed Forces Research Institute of Medical Sciences (United States MD-AFRIMS), Bangkok, Thailand
| | - Ping Wu
- Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, United States
| | - Parimal Samir
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, United States
| | - Lynn Soong
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
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Kannabiran RK, Banerjee A, Jyothi L, Reddy M, Narang R. Scrub Typhus and Dengue Co-infection in an Adolescent Girl: A Diagnostic Challenge. Cureus 2023; 15:e40810. [PMID: 37485123 PMCID: PMC10362927 DOI: 10.7759/cureus.40810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Scrub typhus and dengue fever are common infectious diseases in tropical regions, and both have overlapping clinico-epidemiological and laboratory features, which often pose a diagnostic challenge. This case report discusses a 15-year-old girl from the Indian subcontinent who presented with acute undifferentiated febrile illness (AUFI) without typical features of any of the common tropical infections. She was diagnosed with co-infection of scrub typhus and dengue fever using laboratory tests with good diagnostic accuracy. The patient was managed on an ambulatory basis, treated with oral doxycycline, and showed symptomatic improvement within 48 hours. Co-infections in endemic areas present a significant diagnostic and therapeutic challenge. This case report highlights the importance of considering co-infections in the differential diagnosis of AUFI, especially during the post-monsoon period, and the use of highly sensitive and specific tests for the diagnosis of co-infections.
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Affiliation(s)
- Rajesh Kanna Kannabiran
- Department of Microbiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Arjun Banerjee
- Department of Microbiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Lakshmi Jyothi
- Department of Microbiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Mounika Reddy
- Department of Pediatrics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Rahul Narang
- Department of Microbiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
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John KJ, George TK, Joy M, John B, Abraham O, Prasad J. Costs & outcomes of hospitalized scrub typhus infection in a tertiary hospital in south India. Indian J Med Res 2023; 157:559-567. [PMID: 37530311 PMCID: PMC10466492 DOI: 10.4103/ijmr.ijmr_3917_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 07/08/2023] Open
Abstract
Background & objectives Scrub typhus is a rickettsial infection seen along the Asian-Pacific rim and imposes a considerable burden on affected people in low- and middle-income countries. The present study was aimed to determine the direct cost of hospitalization of scrub typhus and its trend over six years. Methods This was a retrospective, observational, hospital based study of individuals admitted to the hospital, diagnosed with scrub typhus over six years, from January 2013 to December 2018. The potential out of pocket expenditure was evaluated. Results A total of 198 patients were included in the study. The median cost of admission (adjusted to INR 2020) for the six years (2013 to 2018) was found to be ₹ 37,026 (US $ 490) [interquartile range (IQR) 22,996-64,992]. The median cost for patients admitted to the intensive care unit (ICU) was ₹ 128,046 (US $ 1695) (IQR 71,575-201,171), while the cost for patients admitted to the ward-alone was ₹ 33,232 (US $ 440) (IQR 19,609-45,373). The multivariable analysis showed that ARDS and SOFA score were the independent predictors of ICU admission. Interpretation & conclusions Hospitalisation for scrub typhus is associated with a substantial healthcare expense. The predictors of increased cost were the presence of acute respiratory distress syndrome (ARDS), shock, increasing sequential organ failure assessment (SOFA) score and duration of hospital stay.
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Affiliation(s)
- Kevin John John
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tarun K. George
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Melvin Joy
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bimi John
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - O.C. Abraham
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jasmine Prasad
- Department of Community Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Lee NJ, Shih HI, Lin CH, Hsu HC. Scrub Typhus Complicated With Fulminant Perimyocarditis. J Acute Med 2023; 13:84-88. [PMID: 37465824 PMCID: PMC10351402 DOI: 10.6705/j.jacme.202306_13(2).0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/26/2022] [Accepted: 11/24/2022] [Indexed: 07/20/2023]
Abstract
A 62-year-old woman with no systemic disease presented to the emergency department (ED) with acute febrile illness for three days. During her ED course, she developed respiratory distress and refractory cardiogenic shock with ST-elevation on electrocardiography. No occluded coronary vessel was found in angiography, and perimyocarditis was impressed. The serum indirect immunofluorescence assay was positive for scrub typhus. Hemopericardium and subsequently intracranial hemorrhage occurred on the 4th hospital day even under intensive care, and the patient expired. Perimyocarditis is a rare but fatal complication of scrub typhus. Through this case report, we aim to convey the genuine possibility that a fulminant perimyocarditis may occur in a previously healthy adult as a potential complication of scrub typhus. By recognizing the risk factors of scrub typhus-related myocarditis, an ED physician can maintain a high index of suspicion for the cardiac complication and intervene in a timely manner.
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Affiliation(s)
- Nien-Jung Lee
- National Cheng Kung University Department of Emergency Medicine College of Medicine National Cheng Kung University Hospital Tainan Taiwan
| | - Hsin-I Shih
- National Cheng Kung University Department of Emergency Medicine College of Medicine National Cheng Kung University Hospital Tainan Taiwan
| | - Chih-Hao Lin
- National Cheng Kung University Department of Emergency Medicine College of Medicine National Cheng Kung University Hospital Tainan Taiwan
| | - Hsiang-Chin Hsu
- National Cheng Kung University Department of Emergency Medicine College of Medicine National Cheng Kung University Hospital Tainan Taiwan
- National Cheng Kung University Department of Emergency Medicine College of Medicine Tainan Taiwan
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