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Antonovskaia AA, Balakirev AE, Lopatina YV. New data on the distribution of chigger mites (Acariformes: Trombiculidae) associated with small mammals in Vietnam. Zootaxa 2023; 5346:271-306. [PMID: 38221339 DOI: 10.11646/zootaxa.5346.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Indexed: 01/16/2024]
Abstract
The study of chigger mites of Vietnam is based on the material collected during fieldworks in 20112019 and examination of small mammal samples deposited in museum collections. A total 59 small mammals species were examined (49 species of Rodentia, 8 species of Eulipotyphla, and 2 species of Scandentia). On them, 79 species of chigger mites were collected, of which 44 species are recorded in Vietnam for the first time. Thus, the list of chigger mite species reported in Vietnam has been extended to 122 species belonging to 16 genera and 3 subfamilies. Most recorded species belong to the genera Leptotrombidium and Walchia. New hosts have been recorded for 48 trombiculid species. The study showed that the diversity of trombiculids of various regions of Vietnam has been studied unevenly.
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Affiliation(s)
- A A Antonovskaia
- Department of Entomology; Lomonosov Moscow State University; Moscow; Russia.
| | - A E Balakirev
- Laboratory of Tropical Ecology; Severtsov Institute of Ecology and Evolution; Russian Academy of Sciences; Moscow; Russia; Russian-Vietnamese Tropical Research and Test Center; Hanoi; Vietnam.
| | - Y V Lopatina
- Department of Entomology; Lomonosov Moscow State University; Moscow; Russia.
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2
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Mohd-Azami SNI, Loong SK, Khoo JJ, Husin NA, Lim FS, Mahfodz NH, Ishak SN, Mohd-Taib FS, Makepeace BL, AbuBakar S. Molecular Surveillance for Vector-Borne Bacteria in Rodents and Tree Shrews of Peninsular Malaysia Oil Palm Plantations. Trop Med Infect Dis 2023; 8:tropicalmed8020074. [PMID: 36828490 PMCID: PMC9965954 DOI: 10.3390/tropicalmed8020074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Many human clinical cases attributed to vector-borne pathogens are underreported in Malaysia, especially in rural localities where healthcare infrastructures are lacking. Here, 217 small mammals, consisting of rodents and tree shrews, were trapped in oil palm plantations in the Peninsular Malaysia states of Johor and Perak. Species identification was performed using morphological and DNA barcoding analyses, and 203 small mammals were included in the detection of selected vector-borne bacteria. The DNA extracted from the spleens was examined for Orientia tsutsugamushi, Borrelia spp., Bartonella spp. and Rickettsia spp. using established PCR assays. The small mammals collected in this study included Rattus tanezumi R3 mitotype (n = 113), Rattus argentiventer (n = 24), Rattus tiomanicus (n = 22), Rattus exulans (n = 17), Rattus tanezumi sensu stricto (n = 1) and Tupaia glis (n = 40). Orientia tsutsugamushi, Borrelia spp. and Bartonella phoceensis were detected in the small mammals with the respective detection rates of 12.3%, 5.9% and 4.9%. Rickettsia spp., however, was not detected. This study encountered the presence of both Lyme disease and relapsing fever-related borreliae in small mammals collected from the oil palm plantation study sites. All three microorganisms (Orientia tsutsugamushi, Borrelia spp. and Bartonella phoceensis) were detected in the R. tanezumi R3 mitotype, suggesting that the species is a competent host for multiple microorganisms. Further investigations are warranted to elucidate the relationships between the ectoparasites, the small mammals and the respective pathogens.
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Affiliation(s)
- Siti Nurul Izzah Mohd-Azami
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Higher Institution Centre of Excellence, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Institute for Advanced Studies (IAS), Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Shih Keng Loong
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Higher Institution Centre of Excellence, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence:
| | - Jing Jing Khoo
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L3 5RF, UK
| | - Nurul Aini Husin
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Higher Institution Centre of Excellence, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Institute for Advanced Studies (IAS), Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Fang Shiang Lim
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Higher Institution Centre of Excellence, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Nur Hidayana Mahfodz
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Higher Institution Centre of Excellence, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Siti Nabilah Ishak
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
- Kuantan Fisheries Biosecurity Centre, Department of Fisheries Malaysia, Kuantan 25100, Malaysia
| | - Farah Shafawati Mohd-Taib
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
| | - Benjamin L. Makepeace
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L3 5RF, UK
| | - Sazaly AbuBakar
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Higher Institution Centre of Excellence, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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Swain SK, Sahu BP, Panda S, Sarangi R. Molecular characterization and evolutionary analysis of Orientia tsutsugamushi in eastern Indian population. Arch Microbiol 2022; 204:221. [PMID: 35338394 PMCID: PMC8956147 DOI: 10.1007/s00203-022-02823-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 01/13/2023]
Abstract
Scrub typhus is a bacterial zoonotic acute febrile illness (AFI) caused by the obligate intracellular bacterium Orientia tsutsugamushi, which is an antigenically diverse strain frequently observed in the tropical region of Southeast Asian countries. The recent investigation was conducted to delineate the genotype identification of Orientia tsutsugamushi predominating in the eastern zone of India such as Odisha to decipher its strain type, and evaluate its diversity as well as evolutionary pattern based on the nucleotide analysis of the immune dominant 56 KDa gene. During this study, we have investigated 100 clinical samples (2014-2018), out of which 28 were positive for scrub typhus followed by its molecular characterization and phylogenetic analysis utilizing 56 KDa partial genes. Population genetic parameters showed the presence of 287 polymorphic sites within the analyzed 56 KDa gene. The gene diversity (Hd) and sequence diversity (π) was estimated 0.638 and 0.280, respectively. Selection pressure analysis (θ = dN/dS) having the value 0.222 suggests that the gene lied under purifying selection. The present study suggested a high rate of genetic diversity within the isolates. This research study sheds light on the hereditary and evolutionary relationships of Orientia strains found in the eastern Indian population. Understanding regional genetic variation is critical for vaccine development and sero-diagnostics methods. A significant level of genetic variability was observed during this study. This information has a way to understand more about antigen diversity that leads to develop an effective vaccine candidate for this pathogen.
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Affiliation(s)
- Subrat Kumar Swain
- Department of Pediatrics, IMS and SUM Hospital, Siksha "O" Anusandhan Deemed to be University, Bhubaneswar, Odisha, 751003, India
| | - Basanta Pravas Sahu
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, 453552, India
| | - Subhasmita Panda
- Department of Pediatrics, IMS and SUM Hospital, Siksha "O" Anusandhan Deemed to be University, Bhubaneswar, Odisha, 751003, India
| | - Rachita Sarangi
- Department of Pediatrics, IMS and SUM Hospital, Siksha "O" Anusandhan Deemed to be University, Bhubaneswar, Odisha, 751003, India.
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Jiang J, Farris CM, Yeh KB, Richards AL. International Rickettsia Disease Surveillance: An Example of Cooperative Research to Increase Laboratory Capability and Capacity for Risk Assessment of Rickettsial Outbreaks Worldwide. Front Med (Lausanne) 2021; 8:622015. [PMID: 33738293 PMCID: PMC7960665 DOI: 10.3389/fmed.2021.622015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/20/2021] [Indexed: 01/30/2023] Open
Abstract
Cooperative research that addresses infectious disease surveillance and outbreak investigations relies heavily on availability and effective use of appropriate diagnostic tools, including serological and molecular assays, as exemplified by the current COVID-19 pandemic. In this paper, we stress the importance of using these assays to support collaborative epidemiological studies to assess risk of rickettsial disease outbreaks among international partner countries. Workforce development, mentorship, and training are important components in building laboratory capability and capacity to assess risk of and mitigate emerging disease outbreaks. International partnerships that fund cooperative research through mentoring and on-the-job training are successful examples for enhancing infectious disease surveillance. Cooperative research studies between the Naval Medical Research Center's Rickettsial Diseases Research Program (RDRP) and 17 institutes from nine countries among five continents were conducted to address the presence of and the risk for endemic rickettsial diseases. To establish serological and molecular assays in the collaborative institutes, initial training and continued material, and technical support were provided by RDRP. The laboratory methods used in the research studies to detect and identify the rickettsial infections included (1) group-specific IgM and IgG serological assays and (2) molecular assays. Twenty-six cooperative research projects performed between 2008 and 2020 enhanced the capability and capacity of 17 research institutes to estimate risk of rickettsial diseases. These international collaborative studies have led to the recognition and/or confirmation of rickettsial diseases within each of the partner countries. In addition, with the identification of specific pathogen and non-pathogen Rickettsia species, a more accurate risk assessment could be made in surveillance studies using environmental samples. The discoveries from these projects reinforced international cooperation benefiting not only the partner countries but also the scientific community at large through presentations (n = 40) at international scientific meetings and peer-reviewed publications (n = 18). The cooperative research studies conducted in multiple international institutes led to the incorporation of new SOPs and trainings for laboratory procedures; biosafety, biosurety, and biosecurity methods; performance of rickettsia-specific assays; and the identification of known and unknown rickettsial agents through the introduction of new serologic and molecular assays that complemented traditional microbiology methods.
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Affiliation(s)
- Ju Jiang
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Christina M. Farris
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States
| | | | - Allen L. Richards
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Kala D, Gupta S, Nagraik R, Verma V, Thakur A, Kaushal A. Diagnosis of scrub typhus: recent advancements and challenges. 3 Biotech 2020; 10:396. [PMID: 32834918 PMCID: PMC7431554 DOI: 10.1007/s13205-020-02389-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Scrub typhus is a mite-borne, acute febrile illness caused by the bacterium Orientia tsutsugamushi. It is a re-emerging infectious disease of the tsutsugamushi triangle. Scrub typhus is transmitted through bites of contaminated chiggers (larval stage). Diagnosis of scrub typhus is challenging as its symptoms mimic with other acute febrile illnesses. Several methods are effectual for diagnosis of scrub typhus that includes enzyme-linked immunosorbent assay (ELISA), immunofluorescence assay (IFA), immunochromatographic test (ICT), Weil-Felix, polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP). Weil-Felix test was initially used for the diagnosis of scrub typhus in underdeveloped countries but not preferred due to a lack of both specificity and sensitivity. Other immuno-based methods like IFA and ELISA are most outrank for detection of scrub typhus due to their higher sensitivity and specificity, but not vigorous to lay bare the infection at early stages and need the convalescent sampling for verification of positive samples. On another deed, PCR based methods becoming acceptable over era due to its dexterity of early-stage diagnosis with higher specificity and sensitivity but lack its applicability in circumstances of scrub typhus due to the variegated genetic makeup of Orientia tsutsugamushi among its serotypes. The present review focused on various detection methods along with their advantages and disadvantages used in the diagnosis of scrub typhus. A comparison between available methods of diagnosis with challenges in the detection of scrub typhus is also summarized.
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Affiliation(s)
- Deepak Kala
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
| | | | | | | | - Atul Thakur
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
| | - Ankur Kaushal
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
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Richards AL, Jiang J. Scrub Typhus: Historic Perspective and Current Status of the Worldwide Presence of Orientia Species. Trop Med Infect Dis 2020; 5:E49. [PMID: 32244598 PMCID: PMC7344502 DOI: 10.3390/tropicalmed5020049] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022] Open
Abstract
Scrub typhus and its etiological agents, Orientia species, have been around for a very long time. Historical reference to the rickettsial disease scrub typhus was first described in China (313 AD) by Hong Ge in a clinical manual (Zhouhofang) and in Japan (1810 AD) when Hakuju Hashimoto described tsutsuga, a noxious harmful disease in the Niigata prefecture. Other clinicians and scientists in Indonesia, Philippines, Taiwan, Australia, Vietnam, Malaysia, and India reported on diseases most likely to have been scrub typhus in the early 1900s. All of these initial reports about scrub typhus were from an area later designated as the Tsutsugamushi Triangle-an area encompassing Pakistan to the northwest, Japan to the northeast and northern Australia to the south. It was not until the 21st century that endemic scrub typhus occurring outside of the Tsutsugamushi Triangle was considered acceptable. This report describes the early history of scrub typhus, its distribution in and outside the Tsutsugamushi Triangle, and current knowledge of the causative agents, Orientia species.
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Affiliation(s)
- Allen L. Richards
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ju Jiang
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA;
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Low VL, Tan TK, Khoo JJ, Lim FS, AbuBakar S. An overview of rickettsiae in Southeast Asia: Vector-animal-human interface. Acta Trop 2020; 202:105282. [PMID: 31778642 DOI: 10.1016/j.actatropica.2019.105282] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/24/2019] [Accepted: 11/24/2019] [Indexed: 02/07/2023]
Abstract
Rickettsioses are emerging, and re-emerging diseases caused by obligate intracellular arthropod-borne bacteria that infect humans and animals worldwide. Various rickettsiae such as Orientia, Rickettsia, Anaplasma and Ehrlichia have been circulated in companion, domesticated and wild animals through bites of infected ticks, fleas, lice or mites. This review summarizes the infections of rickettsiae, including the newly discovered regional species Rickettsia thailandii, Candidatus Rickettsia sepangensis, Candidatus Rickettsia johorensis, Candidatus Rickettsia laoensis, Candidatus Rickettsia mahosotii, Candidatus Rickettsia khammouanensis, Candidatus Anaplasma pangolinii, and other novel genotypes in vectors, humans and animals in Southeast Asia. Issues on some unidentified rickettsiae that elicit immune responses and production of antibodies that are cross-reactive with the antigens used are discussed. Knowledge gaps which required attention are also identified in this review.
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Affiliation(s)
- Van Lun Low
- Higher Institution Centre of Excellence (HICoE), Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia.
| | - Tiong Kai Tan
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jing Jing Khoo
- Higher Institution Centre of Excellence (HICoE), Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia
| | - Fang Shiang Lim
- Higher Institution Centre of Excellence (HICoE), Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia
| | - Sazaly AbuBakar
- Higher Institution Centre of Excellence (HICoE), Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia; Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Trung NV, Hoi LT, Dien VM, Huong DT, Hoa TM, Lien VN, Van Luan P, Lewycka SO, Choisy M, Bryant JE, Nadjm B, Rogier van Doorn H, Richards AL, Van Kinh N. Clinical Manifestations and Molecular Diagnosis of Scrub Typhus and Murine Typhus, Vietnam, 2015-2017. Emerg Infect Dis 2019; 25. [PMID: 30882318 PMCID: PMC6433017 DOI: 10.3201/eid2504.180691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Scrub typhus was the predominant rickettsial disease diagnosed among hospitalized patients with acute undifferentiated fever in northern Vietnam. Rickettsioses are endemic to Vietnam; however, only a limited number of clinical studies have been performed on these vectorborne bacteria. We conducted a prospective hospital-based study at 2 national referral hospitals in Hanoi to describe the clinical characteristics of scrub typhus and murine typhus in northern Vietnam and to assess the diagnostic applicability of quantitative real-time PCR assays to diagnose rickettsial diseases. We enrolled 302 patients with acute undifferentiated fever and clinically suspected rickettsiosis during March 2015–March 2017. We used a standardized case report form to collect clinical information and laboratory results at the time of admission and during treatment. We confirmed scrub typhus in 103 (34.1%) patients and murine typhus in 12 (3.3%) patients. These results highlight the need for increased emphasis on training for healthcare providers for earlier recognition, prevention, and treatment of rickettsial diseases in Vietnam.
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Katoh S, Cuong NC, Hamaguchi S, Thuy PT, Cuong DD, Anh LK, Anh NTH, Anh DD, Sando E, Suzuki M, Fujita H, Yasunami M, Yoshihara K, Yoshida LM, Paris DH, Ariyoshi K. Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam. PLoS Negl Trop Dis 2019; 13:e0007928. [PMID: 31805053 PMCID: PMC6917290 DOI: 10.1371/journal.pntd.0007928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 12/17/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Scrub typhus (ST) is a leading cause of non-malarial febrile illness in Southeast Asia, but evidence of its true disease burden is limited because of difficulties of making the clinical diagnosis and lack of adequate diagnostic tests. To describe the epidemiology and clinical characteristics of ST, we conducted an observational study using multiple diagnostic assays at a national tertiary hospital in Hanoi, Vietnam. METHODOLOGY/PRINCIPAL FINDINGS We enrolled 1,127 patients hospitalized with documented fever between June 2012 and May 2013. Overall, 33 (2.9%) patients were diagnosed with ST by PCR and/or screening of ELISA for immunoglobulin M (IgM) with confirmatory tests: 14 (42.4%) were confirmed by indirect immunoperoxidase assay (IIP), and 19 (57.6%) were by IIP and PCR. Living by farming, conjunctival injection, eschar, aspartate aminotransferase elevation, and alanine aminotransferase elevation were significantly associated with ST cases (adjusted odds ratios (aORs): 2.8, 3.07, 48.8, 3.51, and 4.13, respectively), and having a comorbidity and neutrophilia were significantly less common in ST cases (aORs: 0.29 and 0.27, respectively). The majority of the ST cases were not clinically diagnosed with rickettsiosis (72.7%). Dominant IIP reactions against a single antigen were identified in 15 ST cases, whereas indistinguishably high reactions against multiple antigens were seen in 11 ST cases. The most frequently observed dominant IIP reaction was against Karp antigen (eight cases) followed by Gilliam (four cases). The highest diagnostic accuracy of IgM ELISA in acute samples was 78%. In a phylogenetic analysis of the 56-kDa type-specific antigen gene, the majority (14 cases) were located in the Karp-related branch followed by the Gilliam-related (two cases), Kato-related (two cases), and TA763-related clades (one case). CONCLUSIONS/SIGNIFICANCE Both the clinical and laboratory diagnoses of ST remain challenging at a tertiary hospital. Implementation of both serological and nucleic acid amplification assays covering endemic O. tsutsugamushi strains is essential.
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Affiliation(s)
- Shungo Katoh
- Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of General Internal Medicine, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Ngo Chi Cuong
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan
| | - Pham Thanh Thuy
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Do Duy Cuong
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Le Kim Anh
- Vietnam Research Station, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Hanoi, Vietnam
| | | | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Eiichiro Sando
- Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of General Internal Medicine, Kameda Medical Center, Chiba, Japan
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hiromi Fujita
- Mahara Institute of Medical Acarology, Tokushima, Japan
| | - Michio Yasunami
- Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Keisuke Yoshihara
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Daniel Henry Paris
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- * E-mail:
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Trung NV, Hoi LT, Cuong DD, Ha DT, Hoa TM, Lien VN, Hoa NT, Hoa LNM, Huong DT, Bich VTN, van Doorn HR, Nadjm B, Richards AL. Analysis of the 56-kDa type specific antigen gene of Orientia tsutsugamushi from northern Vietnam. PLoS One 2019; 14:e0221588. [PMID: 31469878 PMCID: PMC6716651 DOI: 10.1371/journal.pone.0221588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022] Open
Abstract
Scrub typhus has been documented since 1932 in Vietnam, however, the disease burden of scrub typhus remains poorly understood in the country. We conducted this study to describe the phylogenetic analysis of the 56-kDa type-specific antigen (TSA) gene of Orientia tsutsugamushi associated with PCR positive cases of scrub typhus. Of 116 positive samples, 65 type-specific antigen gene sequences were obtained and classified into 3 genogroups: Karp, Kato and Gilliam. The Karp genogroup was the most frequently detected phylogenetic cluster in the study with 30 samples (46%), followed by Kato and Gilliam with 20 (31%) and 15 (23%), respectively. All sequences showed 94–100% nucleotide similarity to reference sequences collected in the central part of Vietnam in 2017. Patients infected with Karp genogroup were more likely to have significant thrombocytopenia than the other genogroups. These results suggest that any scrub typhus vaccine considered for use in Vietnam should provide protection against each of these 3 genogroups.
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Affiliation(s)
- Nguyen Vu Trung
- National Hospital for Tropical Diseases, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | - Le Thi Hoi
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | | | - Tran Mai Hoa
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Vu Ngoc Lien
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | | | | | - Vu Thi Ngoc Bich
- Oxford University Clinical Research Unit, Wellcome Trust Asia Program, Hanoi, Vietnam
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Wellcome Trust Asia Program, Hanoi, Vietnam
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Wellcome Trust Asia Program, Hanoi, Vietnam
| | - Allen L. Richards
- Naval Medical Research Center, Silver Spring, Maryland, United States of America
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- * E-mail:
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Al Amin MM, Paul SK, Aung MS, Paul A, Aziz MA, Khan NA, Haque AKMF, Ahamed F, Melan A, Sarker SR, Hossain MA, Ahmed S, Nasreen SA, Haque N, Kobayashi N. Molecular characterization of Orientia tsutsugamushi causing scrub typhus among febrile patients in north-central Bangladesh. New Microbes New Infect 2019; 32:100595. [PMID: 31641512 PMCID: PMC6796758 DOI: 10.1016/j.nmni.2019.100595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 01/30/2023] Open
Abstract
Scrub typhus is a mite-borne rickettsial disease caused by Orientia tsutsugamushi, which is endemic in Asia Pacific region. In this study, infection rate and molecular epidemiologic traits of O. tsutsugamushi was investigated in Mymensingh, located in north-central Bangladesh. Among the blood samples from 453 febrile patients who visited Mymensingh medical college hospital in 2018, the 47 kDa protein gene of O. tsutsugamushi was detected in 78 samples (17.2%) by nested PCR. Phylogenetic analysis of the O. tsutsugamushi 56 kDa protein gene (18 samples) revealed a predominance of Karp-related genotype (89%), while the remaining belonged to Gilliam genotype. Samples of the Karp-related genotype mostly clustered with those of China, Taiwan, Thailand and India, etc., in emergent subgroups clades 2 and 4, which were distinct from clade 1, including prototype Karp strains. Among the 18 samples, three variable domains (VD) of 56 kDa type-specific antigen had different types of sequence diversity; VDI contained two or three repeats of eight amino acid units, while VDII and VDIII had amino acid substitution, deletion or insertion. The present study documented a potentially high prevalence of genetically diverse O. tsutsugamushi in north-central Bangladesh.
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Affiliation(s)
- M M Al Amin
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S K Paul
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - M S Aung
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - A Paul
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - M A Aziz
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - N A Khan
- Mymensingh Medical College, Mymensingh, Bangladesh
| | | | - F Ahamed
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - A Melan
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S R Sarker
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - M A Hossain
- National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh
| | - S Ahmed
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S A Nasreen
- Sheikh Hasina Medical College, Jamalpur, Bangladesh
| | - N Haque
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - N Kobayashi
- Sapporo Medical University School of Medicine, Sapporo, Japan
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12
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Kelly DJ, Fuerst PA, Richards AL. Origins, Importance and Genetic Stability of the Prototype Strains Gilliam, Karp and Kato of Orientia tsutsugamushi. Trop Med Infect Dis 2019; 4:E75. [PMID: 31052283 PMCID: PMC6631653 DOI: 10.3390/tropicalmed4020075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 11/16/2022] Open
Abstract
Scrub typhus, a chigger-borne febrile illness, occurs primarily in countries of the Asia-Pacific rim and islands of the Western Pacific. The etiologic agent is the obligate intracellular rickettsial bacterium Orientia tsutsugamushi. Research on O. tsutsugamushi has relied on the availability of several prototype strains, which were isolated from human cases of scrub typhus in the 1940s and 1950s. We review the history of the three original, and most important, prototype strains, Gilliam, Karp and Kato, including information on their isolation, their culture history, their clinical characteristics, their importance within the research literature on scrub typhus, and recent advances in elucidating their molecular genomics. The importance of these strains to the research and development of clinical tools related to scrub typhus is also considered. Finally, we examine whether the strains have been genetically stable since their isolation, and whether prototype strains maintained in separate laboratories are identical, based on pairwise comparisons of several sequences from four genes. By using genetic information archived in international DNA databases, we show that the prototype strains used by different laboratories are essentially identical, and that the strains have retained their genetic integrity at least since the 1950s. The three original prototype strains should remain a standard by which new diagnostic procedures are measured. Given their fundamental position in any comparative studies, they are likely to endure as a critical part of present and future research on scrub typhus and Orientia.
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Affiliation(s)
- Daryl J Kelly
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA, and Department of Evolution, Ecology and Organismal Biology, The Ohio State University, Columbus, OH 43210, USA.
| | - Paul A Fuerst
- Department of Evolution, Ecology and Organismal Biology, The Ohio State University, Columbus, OH 43210, USA.
| | - Allen L Richards
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA, and Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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13
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Le-Viet N, Phan DT, Le-Viet N, Trinh S, To M, Raoult D, Parola P. Dual Genotype Orientia tsutsugamushi Infection in Patient with Rash and Eschar, Vietnam, 2016. Emerg Infect Dis 2019; 24:1520-1523. [PMID: 30014833 PMCID: PMC6056126 DOI: 10.3201/eid2408.171622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We report a dual genotype Orientia tsutsugamushi infection in Vietnam in 2016. The patient had fever, rash, and an eschar. The Kawasaki genotype was identified in the eschar specimen and Karp genotype in the whole blood specimen. The genotype co-infection rate for scrub typhus is unknown and should be further evaluated.
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14
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Fleshman A, Mullins K, Sahl J, Hepp C, Nieto N, Wiggins K, Hornstra H, Kelly D, Chan TC, Phetsouvanh R, Dittrich S, Panyanivong P, Paris D, Newton P, Richards A, Pearson T. Comparative pan-genomic analyses of Orientia tsutsugamushi reveal an exceptional model of bacterial evolution driving genomic diversity. Microb Genom 2018; 4. [PMID: 30035711 PMCID: PMC6202447 DOI: 10.1099/mgen.0.000199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Orientia tsutsugamushi, formerly Rickettsia tsutsugamushi, is an obligate intracellular pathogen that causes scrub typhus, an underdiagnosed acute febrile disease with high morbidity. Scrub typhus is transmitted by the larval stage (chigger) of Leptotrombidium mites and is irregularly distributed across endemic regions of Asia, Australia and islands of the western Pacific Ocean. Previous work to understand population genetics in O. tsutsugamushi has been based on sub-genomic sampling methods and whole-genome characterization of two genomes. In this study, we compared 40 genomes from geographically dispersed areas and confirmed patterns of extensive homologous recombination likely driven by transposons, conjugative elements and repetitive sequences. High rates of lateral gene transfer (LGT) among O. tsutsugamushi genomes appear to have effectively eliminated a detectable clonal frame, but not our ability to infer evolutionary relationships and phylogeographical clustering. Pan-genomic comparisons using 31 082 high-quality bacterial genomes from 253 species suggests that genomic duplication in O. tsutsugamushi is almost unparalleled. Unlike other highly recombinant species where the uptake of exogenous DNA largely drives genomic diversity, the pan-genome of O. tsutsugamushi is driven by duplication and divergence. Extensive gene innovation by duplication is most commonly attributed to plants and animals and, in contrast with LGT, is thought to be only a minor evolutionary mechanism for bacteria. The near unprecedented evolutionary characteristics of O. tsutsugamushi, coupled with extensive intra-specific LGT, expand our present understanding of rapid bacterial evolutionary adaptive mechanisms.
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Affiliation(s)
- Amy Fleshman
- 1Northern Arizona University, Flagstaff, AZ, USA
| | | | - Jason Sahl
- 1Northern Arizona University, Flagstaff, AZ, USA
| | - Crystal Hepp
- 1Northern Arizona University, Flagstaff, AZ, USA
| | - Nathan Nieto
- 1Northern Arizona University, Flagstaff, AZ, USA
| | | | | | - Daryl Kelly
- 2Naval Medical Research Center, Silver Spring, MD, USA.,3The Ohio State University, Columbus, OH, USA
| | | | - Rattanaphone Phetsouvanh
- 4Lao-Oxford-Mahosot Hospital-Wellcome Trust, Research Unit, Mahosot Hospital, Vientiane, Vientiane, Lao People's Democratic Republic
| | - Sabine Dittrich
- 5University of Oxford, Centre for Tropical Medicine and Global Health, Oxford, UK.,6Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.,7Foundation of Innovative New Diagnostics, Geneva, Switzerland
| | - Phonepasith Panyanivong
- 6Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Daniel Paris
- 8Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,9Swiss Tropical and Public Health Institute, Basel, Switzerland.,10University of Basel, Basel, Switzerland
| | - Paul Newton
- 5University of Oxford, Centre for Tropical Medicine and Global Health, Oxford, UK.,6Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Allen Richards
- 2Naval Medical Research Center, Silver Spring, MD, USA.,11Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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15
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Nguyen HLK, Pham HTT, Nguyen TV, Hoang PV, Le MTQ, Takemura T, Hasebe F, Hayasaka D, Yamada A, Hotta K. The genotypes of Orientia tsutsugamushi, identified in scrub typhus patients in northern Vietnam. Trans R Soc Trop Med Hyg 2018; 111:137-139. [PMID: 28531311 DOI: 10.1093/trstmh/trx022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/08/2017] [Indexed: 11/12/2022] Open
Abstract
Background There are an estimated one million patients with scrub typhus in the Asia-Pacific region. There are few reports describing the incidence of scrub typhus in Vietnam. Methods Blood samples collected from 63 patients clinically diagnosed as having scrub typhus from July 2015 to September 2016 were subjected to genotyping of Orientia tsutsugamushi. Results and Conclusions Of these patients, 42 (67%) tested positive for O. tsutsugamushi, and the most common genotype was identified to be Karp (55%). Other genotypes, TA763, Gilliam type in Japan variant, and Kato were also found in 17%, 17% and 12% of patients, respectively. To better understand the epidemiological landscape of scrub typhus in Vietnam, a countrywide study is needed. Accession numbers LC110330-LC110333, LC110336-LC110351 and LC214804-LC214825.
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Affiliation(s)
- Hang L K Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Hang T T Pham
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Phuong Vm Hoang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Mai T Q Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Taichiro Takemura
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Futoshi Hasebe
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Daisuke Hayasaka
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Akio Yamada
- Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan
| | - Kozue Hotta
- Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan
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16
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Trung NV, Hoi LT, Thuong NTH, Toan TK, Huong TTK, Hoa TM, Fox A, Kinh NV, van Doorn HR, Wertheim HFL, Bryant JE, Nadjm B. Seroprevalence of Scrub Typhus, Typhus, and Spotted Fever Among Rural and Urban Populations of Northern Vietnam. Am J Trop Med Hyg 2017; 96:1084-1087. [PMID: 28500808 PMCID: PMC5417199 DOI: 10.4269/ajtmh.16-0399] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rickettsial infections are recognized as important causes of fever throughout southeast Asia. Herein, we determined the seroprevalence to rickettsioses within rural and urban populations of northern Vietnam. Prevalence of individuals with evidence of prior rickettsial infections (IgG positive) was surprisingly low, with 9.14% (83/908) testing positive to the three major rickettsial serogroups thought to circulate in the region. Prevalence of typhus group rickettsiae (TG)–specific antibodies (6.5%, 58/908) was significantly greater than scrub typhus group orientiae (STG)– or spotted fever group rickettsiae (SFG)–specific antibodies (P < 0.05). The majority of TG seropositives were observed among urban rather than rural residents (P < 0.05). In contrast, overall antibody prevalence to STG and SFG were both very low (1.1%, 10/908 for STG; 1.7%, 15/908 for SFG), with no significant differences between rural and urban residents. These results provide data on baseline population characteristics that may help inform development of Rickettsia serological testing criteria in future clinical studies.
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Affiliation(s)
| | - Le Thi Hoi
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Nguyen Thi Hong Thuong
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | | | - Tran Thi Kieu Huong
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - Tran Mai Hoa
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Annette Fox
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia.,Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | | | - H Rogier van Doorn
- Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - Heiman F L Wertheim
- Department of Medical Microbiology, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - Juliet E Bryant
- Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - Behzad Nadjm
- Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
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17
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Aetiology of acute meningoencephalitis in Cambodian children, 2010-2013. Emerg Microbes Infect 2017; 6:e35. [PMID: 28536430 PMCID: PMC5520480 DOI: 10.1038/emi.2017.15] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 01/09/2023]
Abstract
Acute meningoencephalitis (AME) is associated with considerable morbidity and mortality in children in developing countries. Clinical specimens were collected from children presenting with AME at two Cambodian paediatric hospitals to determine the major aetiologies associated with AME in the country. Cerebrospinal fluid (CSF) and blood samples were screened by molecular and cell culture methods for a range of pathogens previously associated with AME in the region. CSF and serum (acute and convalescent) were screened for antibodies to arboviruses such as Japanese encephalitis virus (JEV), dengue virus (DENV), and chikungunya virus (CHIKV). From July 2010 through December 2013, 1160 children (one month to 15 years of age) presenting with AME to two major paediatric hospitals were enroled into the study. Pathogens associated with AME were identified using molecular diagnostics, cell culture and serology. According to a diagnostic algorithm, a confirmed or highly probable aetiologic agent was detected in 35.0% (n=406) of AME cases, with a further 9.2% (total: 44.2%, n=513) aetiologies defined as suspected. JEV (24.4%, n=283) was the most commonly identified pathogen followed by Orientia tsutsugamushi (4.7%, n=55), DENV (4.6%, n=53), enteroviruses (3.5%, n=41), CHIKV (2.0%, n=23) and Streptococcus pneumoniae (1.6%, n=19). The majority of aetiologies identified for paediatric AME in Cambodia were vaccine preventable and/or treatable with appropriate antimicrobials.
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18
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Le Viet N, Laroche M, Thi Pham HL, Viet NL, Mediannikov O, Raoult D, Parola P. Use of eschar swabbing for the molecular diagnosis and genotyping of Orientia tsutsugamushi causing scrub typhus in Quang Nam province, Vietnam. PLoS Negl Trop Dis 2017; 11:e0005397. [PMID: 28241043 PMCID: PMC5344524 DOI: 10.1371/journal.pntd.0005397] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 03/09/2017] [Accepted: 02/07/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Scrub typhus is a rickettsiosis which is caused by Orientia tsutsugamushi and occurs throughout the Asia-Pacific region. Molecular diagnosis of rickettsioses using eschar swabs has recently emerged, and may be very useful for the diagnosis of these diseases in tropical settings. METHODOLOGY/PRINCIPAL FINDINGS Quantitative polymerase chain reaction (qPCR) was used to detect O. tsutsugamushi DNA in whole blood and eschar swab specimens of 67 patients who were clinically suspected of scrub typhus in Quang Nam province, Vietnam. Among the 20 patients for whom both eschar and whole blood were obtained, 17 (85%) of the eschar specimens and 5 (25%) of the whole blood specimens tested positive for O. tsutsugamushi. Genetic analysis of the 56-kDa TSA gene sequences demonstrated that the 14 sequences obtained in this study, including 12 eschar swabs and 2 whole blood specimens, were related to 4 groups: Karp, Kawasaki, Gilliam (JG-v and TG-v) and TA716. The majority (9/14; 64.4%) of contemporary O. tsutsugamushi genotypes in Quang Nam province were related to the Karp group. CONCLUSIONS These results suggest that polyclonal antigen pools used for serological testing in the future should contain at least Karp, Kawasaki, Gilliam and TA716 antigens for Vietnamese patients, as well as patients who have traveled to Vietnam. qPCR after eschar swabbing should be considered for molecular diagnosis of scrub typhus in endemic patients as well as in travelers, since it is easy to perform and appears very useful for the rapid detection of Orientia tsutsugamushi in the early phase of infection.
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Affiliation(s)
- Nhiem Le Viet
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France
- Department of Tropical Diseases, Quang Nam Central General Hospital, Quang Nam, Vietnam
| | - Maureen Laroche
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France
| | - Hoa L. Thi Pham
- Department of Infectious Diseases, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nho L. Viet
- Department of Internal Medicine, Quang Nam Central General Hospital, Quang Nam, Vietnam
| | - Oleg Mediannikov
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France
| | - Didier Raoult
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France
| | - Philippe Parola
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France
- * E-mail:
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19
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Hotta K, Pham HTT, Hoang HT, Trang TC, Vu TN, Ung TTH, Shimizu K, Arikawa J, Yamada A, Nguyen HT, Nguyen HLK, Le MTQ, Hayasaka D. Prevalence and Phylogenetic Analysis of Orientia tsutsugamushi in Small Mammals in Hanoi, Vietnam. Vector Borne Zoonotic Dis 2016; 16:96-102. [PMID: 26771283 DOI: 10.1089/vbz.2015.1831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rodents are important reservoirs of many human pathogens transmitted via arthropod vectors. Arthropod-borne bacteria belonging to the family Rickettsiaceae cause acute febrile diseases in humans worldwide, but the real burdens of rickettsial diseases appear to be underestimated in Hanoi, Vietnam, because differential diagnosis on the basis of clinical signs and symptoms is confounded by the presence of other tropical infectious diseases with similar signs and symptoms. To know the prevalence of bacteria of the family Rickettsiaceae among small mammals in Hanoi, 519 animals thriving in the public places were captured and examined for the presence of bacterial sequences using duplex PCR. Nucleotide sequences specific for Orientia tsutsugamushi were detected in seven samples (1.3%). Out of seven animals, two were captured in a market, whereas five were in hospitals. None of the captured small mammals tested positive for the genus Rickettsia. The nucleotide sequence analysis of the genes encoding the 47-kDa high-temperature requirement A (47-kDa HtrA) and 56-kDa type-specific antigen (TSA) showed that these seven isolates were indistinguishable from each other. O. tsutsugamushi isolated in this study was closely related phylogenetically to the Gilliam strain, which was originally isolated at the border of Assam and Burma, rather than to those isolated in the central to southern part of Vietnam. It should be emphasized that Vietnamese hospitals were heavily infested by small rodents and some of them harbored O. tsutsugamushi. Strict hygienic control should be implemented to mitigate the potential risk posed by O. tsutsugamushi in hospital settings.
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Affiliation(s)
- Kozue Hotta
- 1 Graduate School of Agricultural and Life Sciences, University of Tokyo , Tokyo, Japan
| | - Hang T T Pham
- 2 National Institute of Hygiene and Epidemiology , Hanoi, Vietnam
| | - Huong T Hoang
- 2 National Institute of Hygiene and Epidemiology , Hanoi, Vietnam
| | - Tu C Trang
- 2 National Institute of Hygiene and Epidemiology , Hanoi, Vietnam
| | - Thuy N Vu
- 2 National Institute of Hygiene and Epidemiology , Hanoi, Vietnam
| | - Trang T H Ung
- 3 Vietnam Research Station, Nagasaki University , c/o National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Kenta Shimizu
- 4 Graduate School of Medicine, Hokkiado University , Hokkaido, Japan
| | - Jiro Arikawa
- 4 Graduate School of Medicine, Hokkiado University , Hokkaido, Japan
| | - Akio Yamada
- 1 Graduate School of Agricultural and Life Sciences, University of Tokyo , Tokyo, Japan
| | - Hoa T Nguyen
- 2 National Institute of Hygiene and Epidemiology , Hanoi, Vietnam
| | - Hang L K Nguyen
- 2 National Institute of Hygiene and Epidemiology , Hanoi, Vietnam
| | - Mai T Q Le
- 2 National Institute of Hygiene and Epidemiology , Hanoi, Vietnam
| | - Daisuke Hayasaka
- 5 Institute of Tropical Medicine, Nagasaki University , Nagasaki, Japan
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20
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Varghese GM, Janardhanan J, Mahajan SK, Tariang D, Trowbridge P, Prakash JAJ, David T, Sathendra S, Abraham OC. Molecular epidemiology and genetic diversity of Orientia tsutsugamushi from patients with scrub typhus in 3 regions of India. Emerg Infect Dis 2015; 21:64-9. [PMID: 25530231 PMCID: PMC4285260 DOI: 10.3201/eid2101.140580] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Clarifying local antigenic diversity is critical for development of region-specific vaccines and diagnostics. Scrub typhus, an acute febrile illness that is widespread in the Asia-Pacific region, is caused by the bacterium Orientia tsutsugamushi, which displays high levels of antigenic variation. We conducted an investigation to identify the circulating genotypes of O. tsutsugamushi in 3 scrub typhus–endemic geographic regions of India: South India, Northern India, and Northeast India. Eschar samples collected during September 2010–August 2012 from patients with scrub typhus were subjected to 56-kDa type-specific PCR and sequencing to identify their genotypes. Kato-like strains predominated (61.5%), especially in the South and Northeast, followed by Karp-like strains (27.7%) and Gilliam and Ikeda strains (2.3% each). Neimeng-65 genotype strains were also observed in the Northeast. Clarifying the genotypic diversity of O. tsutsugamushi in India enhances knowledge of the regional diversity among circulating strains and provides potential resources for future region-specific diagnostic studies and vaccine development.
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21
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Morand S, Bordes F, Blasdell K, Pilosof S, Cornu JF, Chaisiri K, Chaval Y, Cosson JF, Claude J, Feyfant T, Herbreteau V, Dupuy S, Tran A. Assessing the distribution of disease-bearing rodents in human-modified tropical landscapes. J Appl Ecol 2015. [DOI: 10.1111/1365-2664.12414] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Serge Morand
- CNRS; Institut des Sciences de l'Evolution; CIRAD - AGIRs; Centre d'Infectiologie Christophe Mérieux du Laos; PO Box 3888 Samsenthai Road Vientiane Lao PDR
| | - Frédéric Bordes
- Institut des Sciences de l'Evolution; CNRS-IRD-UM2; Université de Montpellier 2; F-34093 Montpellier France
| | - Kim Blasdell
- CSIRO Animal, Biosecurity Flagship; Australian Animal Health Laboratory; 5 Portarlington Road Geelong Vic 3220 Australia
| | - Shai Pilosof
- Mitrani Department of Desert Ecology; Swiss Institute for Dryland Environmental and Energy Research; Albert Katz International School for Desert Studies; Jacob Blaustein Institutes for Desert Research; Ben-Gurion University of the Negev; Sede Boqer Campus 84990 Midreshet Ben-Gurion Israel
| | - Jean-François Cornu
- Institut des Sciences de l'Evolution; CNRS-IRD-UM2; Université de Montpellier 2; F-34093 Montpellier France
| | - Kittipong Chaisiri
- Department of Helminthology; Faculty of Tropical Medicine; Mahidol University; 420/6 Ratchavithi Rd Ratchathevi Bangkok 10400 Thailand
| | - Yannick Chaval
- Centre de Biologie et de Gestion des Population; INRA; Campus International de Baillarguet CS 30016 34988 Montferrier sur Lez France
| | - Jean-François Cosson
- Centre de Biologie et de Gestion des Population; INRA; Campus International de Baillarguet CS 30016 34988 Montferrier sur Lez France
| | - Julien Claude
- CNRS; Institut des Sciences de l'Evolution; CIRAD - AGIRs; Centre d'Infectiologie Christophe Mérieux du Laos; PO Box 3888 Samsenthai Road Vientiane Lao PDR
| | | | - Vincent Herbreteau
- ESPACE-DEV; IRD; Université des Antilles et de la Guyane; Université de Montpellier 2; Université de la Réunion; Station SEAS-OI F-97410 Saint-Pierre France
| | | | - Annelise Tran
- CIRAD; UMR TETIS; F-34093 Montpellier France
- CIRAD; UR AGIRs; F-34398 Montpellier France
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Hamaguchi S, Cuong NC, Tra DT, Doan YH, Shimizu K, Tuan NQ, Yoshida LM, Mai LQ, Duc-Anh D, Ando S, Arikawa J, Parry CM, Ariyoshi K, Thuy PT. Clinical and Epidemiological Characteristics of Scrub Typhus and Murine Typhus among Hospitalized Patients with Acute Undifferentiated Fever in Northern Vietnam. Am J Trop Med Hyg 2015; 92:972-978. [PMID: 25778504 PMCID: PMC4426587 DOI: 10.4269/ajtmh.14-0806] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/20/2015] [Indexed: 01/31/2023] Open
Abstract
A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non-scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Pham Thanh Thuy
- *Address correspondence to Pham Thanh Thuy, Infectious Disease Department, Bach Mai Hospital, 78 Giai Phong Road, Hanoi 84, Vietnam. E-mail:
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23
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De W, Jing K, Huan Z, Qiong ZH, Monagin C, Min ZJ, Ping H, Wen KC, Yan LJ. Scrub typhus, a disease with increasing threat in Guangdong, China. PLoS One 2015; 10:e0113968. [PMID: 25689778 PMCID: PMC4331496 DOI: 10.1371/journal.pone.0113968] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022] Open
Abstract
There has been a rapid increase in the number of scrub typhus cases in Guangdong Province, China. For this reason, an epidemiologic study was conducted to understand the characteristics of scrub typhus epidemics in Guangdong. From 2006 to 2013, the incidence of human cases increased from 0.4321 to 3.5917 per 100,000 with a bimodal peak in human cases typically occurring between May and November. To detect the prevalence of Orientia tsutsugamushi among suspected human cases and rodents, we performed ELISA tests of IgM/IgG and nested PCR tests on 59 whole blood samples from the suspected cases and 112 spleen samples from the rodents. Suspected cases tested positive for anti-O. tsutsugamushi IgM and IgG 66.1% (39/59) and 50.8% (30/59) of the time, respectively. Additionally, 20.3% (12/59) of blood samples and 13.4% (15/112) of spleen samples were positive for PCR. Phylogenetic analysis revealed that there were four definable clusters among the 27 nucleotide sequences of the 56-kDa antigen genes: 44.4% Karp (12/27), 25.9% Kato (7/27), 22.2% Gilliam (6/27) and 7.4% TA763 (2/27). We concluded many suspected cases may result in diagnostic errors; therefore, it is necessary to perform laboratory tests on suspected cases in hospitals. The high infection rate of O. tsutsugamushi among the limited rodents tested suggested that further rodent sampling throughout the province is necessary to further define high-risk areas. Furthermore, the multiple co-circulating genotypes of O. tsutsugamushi play a key role in the pervasiveness of scrub typhus in the Guangdong area.
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Affiliation(s)
- Wu De
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
- * E-mail:
| | - Kou Jing
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Zhang Huan
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Zhou Hui Qiong
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Corina Monagin
- Metabiota, Inc., San Francisco, California, United States of America
| | - Zhong Jian Min
- Department of Biological Sciences, Humboldt State University, Arcata, California 95521, United States of America
| | - Huang Ping
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Ke Chang Wen
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
| | - Lin Jin Yan
- Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People’s Republic of China
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24
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Wongprompitak P, Duong V, Anukool W, Sreyrath L, Mai TTX, Gavotte L, Moulia C, Cornillot E, Ekpo P, Suputtamongkol Y, Buchy P, Frutos R. Orientia tsutsugamushi, agent of scrub typhus, displays a single metapopulation with maintenance of ancestral haplotypes throughout continental South East Asia. INFECTION GENETICS AND EVOLUTION 2015; 31:1-8. [PMID: 25577986 DOI: 10.1016/j.meegid.2015.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/03/2015] [Accepted: 01/05/2015] [Indexed: 11/17/2022]
Abstract
Orientia tsutsugamushi is the causative agent of scrub typhus, a major cause of febrile illness in rural area of Asia-Pacific region. A multi-locus sequence typing (MLST) analysis was performed on strains isolated from human patients from 3 countries in Southeast Asia: Cambodia, Vietnam and Thailand. The phylogeny of the 56-kDa protein encoding gene was analyzed on the same strains and showed a structured topology with genetically distinct clusters. MLST analysis did not lead to the same conclusion. DNA polymorphism and phylogeny of individual gene loci indicated a significant level of recombination and genetic diversity whereas the ST distribution indicated the presence of isolated patches. No correlation was found with the geographic origin. This work suggests that weak divergence in core genome and ancestral haplotypes are maintained by permanent recombination in mites while the 56-kDa protein gene is diverging in higher speed due to selection by the mammalian immune system.
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Affiliation(s)
- Patimaporn Wongprompitak
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; UM2, ISEM, UMR 5554, CNRS-UM2-IRD, Université Montpellier 2 CC065, Place E. Bataillon, 34095 Montpellier Cedex 5, France
| | - Veasna Duong
- Virology Unit, Institut Pasteur in Cambodia, 5 Monivong blvd, PO Box 983, Phnom Penh, Cambodia
| | - Wichittra Anukool
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Graduate Program in Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Lay Sreyrath
- Virology Unit, Institut Pasteur in Cambodia, 5 Monivong blvd, PO Box 983, Phnom Penh, Cambodia
| | | | - Laurent Gavotte
- UM2, ISEM, UMR 5554, CNRS-UM2-IRD, Université Montpellier 2 CC065, Place E. Bataillon, 34095 Montpellier Cedex 5, France
| | - Catherine Moulia
- UM2, ISEM, UMR 5554, CNRS-UM2-IRD, Université Montpellier 2 CC065, Place E. Bataillon, 34095 Montpellier Cedex 5, France
| | - Emmanuel Cornillot
- UM1, CPBS, UMR 5236, CNRS-UM1-UM2, 1919 route de Mende, 34293 Montpellier Cedex 5, France
| | - Pattama Ekpo
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Yupin Suputtamongkol
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Philippe Buchy
- Virology Unit, Institut Pasteur in Cambodia, 5 Monivong blvd, PO Box 983, Phnom Penh, Cambodia
| | - Roger Frutos
- UM2, CPBS, UMR 5236, CNRS-UM1-UM2, 1919 route de Mende, 34293 Montpellier Cedex 5, France; Cirad, UMR 17, Cirad-Ird, TA-A17/G, Campus International de Baillarguet, 34398 Montpellier Cedex 5, France.
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25
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Phommasone K, Paris DH, Anantatat T, Castonguay-Vanier J, Keomany S, Souvannasing P, Blacksell SD, Mayxay M, Newton PN. Concurrent Infection with murine typhus and scrub typhus in southern Laos--the mixed and the unmixed. PLoS Negl Trop Dis 2013; 7:e2163. [PMID: 24009783 PMCID: PMC3757080 DOI: 10.1371/journal.pntd.0002163] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Daniel H. Paris
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Josée Castonguay-Vanier
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sommay Keomany
- Salavan Provincial Hospital, Salavan, Salavan Province, Lao PDR
| | | | - Stuart D. Blacksell
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
- * E-mail:
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26
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Varghese GM, Janardhanan J, Trowbridge P, Peter JV, Prakash JAJ, Sathyendra S, Thomas K, David TS, Kavitha ML, Abraham OC, Mathai D. Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome. Int J Infect Dis 2013; 17:e981-7. [PMID: 23891643 DOI: 10.1016/j.ijid.2013.05.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/20/2013] [Accepted: 05/20/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES This study sought to document the clinical and laboratory manifestations, genetic variability, and outcomes of scrub typhus, an often severe infection caused by Orientia tsutsugamushi, in South India. METHODS Patients admitted to a large teaching hospital with IgM ELISA-confirmed scrub typhus were evaluated. Clinical examination with a thorough search for an eschar, laboratory testing, chest X-ray, and outcome were documented and analyzed. Additionally, a 410-bp region of the 56-kDa type-specific antigen gene of O. tsutsugamushi was sequenced and compared with isolates from other regions of Asia. RESULTS Most of the 154 patients evaluated presented with fever and non-specific symptoms. An eschar was found in 86 (55%) patients. Mild hepatic involvement was seen in most, with other organ involvement including respiratory, cardiovascular, and renal. Multi-organ dysfunction was noted in 59 (38.3%), and the fatality rate was 7.8%. Hypotension requiring vasoactive agents was found to be an independent predictor of mortality (p<0.001). The phylogeny of 26 samples showed 17 (65%) clustering with the Kato-like group and eight (31%) with the Karp-like group. CONCLUSIONS The presentation of scrub typhus can be variable, often non-specific, but with potentially severe multi-organ dysfunction. Prompt recognition is key to specific treatment and good outcomes. Further study of the circulating strains is essential for the development of a successful vaccine and sensitive point-of-care testing.
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Affiliation(s)
- George M Varghese
- Medicine Unit I and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India.
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27
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Wongprompitak P, Anukool W, Wongsawat E, Silpasakorn S, Duong V, Buchy P, Morand S, Frutos R, Ekpo P, Suputtamongkol Y. Broad-coverage molecular epidemiology of Orientia tsutsugamushi in Thailand. INFECTION GENETICS AND EVOLUTION 2011; 15:53-8. [PMID: 21712103 DOI: 10.1016/j.meegid.2011.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 06/01/2011] [Accepted: 06/13/2011] [Indexed: 11/18/2022]
Abstract
Orientia tsutsugamushi, an obligate intracellular bacterium closely related to the genus Rickettsia, is the causative agent of scrub typhus, a major cause of febrile illness in rural areas of Asia-Pacific region. Scrub typhus is transmitted by the bite of infected mites of the genus Leptotrombidium. The region of the 56-kDa TSA gene spanning from variable domain I (VDI) to variable domain IV (VDIV) was sequenced and used for genotyping 77 O. tsutsugamushi samples from human patients confirmed with scrub typhus from 2001 to 2003 and 2009 to 2010 in different regions of Thailand. These sequences were also compared to previously published 56-kDa TSA sequences. Only 4 genotypes out of 8 previously reported in Thailand were identified, i.e. Karp, JG-v, TA763 and Kato, respectively. Two strains were not associated with known genotypes but were closely related to Taiwanese strains. The Karp genotype was confirmed as the predominant clade. The JG-v and TA763 genotypes, in contrast to other studies, also were found. The genotype TA716 was not found, except for one strain previously described.
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Affiliation(s)
- Patimaporn Wongprompitak
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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