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Modi T, Sood T, Moudgil S, Arora N. Neurological manifestations of scrub typhus: encephalitis and Guillain-Barré syndrome (GBS). BMJ Case Rep 2023; 16:e253350. [PMID: 36990652 PMCID: PMC10069484 DOI: 10.1136/bcr-2022-253350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Scrub typhus is a tropical febrile illness that mainly affects rural populations in tropical and subtropical countries. It can range in severity from a mild febrile illness to multisystem involvement. Systemic dysfunction often appears in the second week of sickness, and hepatic, renal and brain involvement are well documented. Although encephalitis is the most frequent neurological ailment, a wide range of unusual complications involving the central and peripheral nervous systems have been identified-however, concomitant multiaxial involvement of the central and peripheral nervous systems is unique. We report a case of a young man with serologically confirmed scrub typhus presenting with fever, eschar, altered sensorium and progressive quadriplegia with hyporeflexic deep tendon reflexes. MRI revealed changes suggestive of encephalitis, and there was evidence of axonopathy on nerve conduction studies. A diagnosis of scrub typhus encephalitis with concomitant Guillain-Barré syndrome was made. He received doxycycline and intravenous immunoglobulin therapy, in addition to supportive treatment.
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Affiliation(s)
- Tanish Modi
- Department of Internal Medicine, GMCH, Chandigarh, India
| | - Tina Sood
- Department of Internal Medicine, GMCH, Chandigarh, India
| | | | - Navneet Arora
- Department of Internal Medicine, PGIMER, Chandigarh, India
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2
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Basu S, Chakravarty A. Neurological Manifestations of Scrub Typhus. Curr Neurol Neurosci Rep 2022; 22:491-498. [PMID: 35727462 DOI: 10.1007/s11910-022-01215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The occurrence of cases of scrub typhus is on the rise in South Asian and Southeast Asian countries. The present review discusses neurological complications following scrub typhus to appraise clinicians practicing in endemic regions about considering this treatable disease in the differential diagnosis of acute febrile illnesses, especially when accompanied with clinical neurological features. RECENT FINDINGS While the association of aseptic meningitis, encephalitis, and meningoencephalitis with scrub typhus is well known, more recently described neurological syndromes associated with scrub typhus include acute disseminated encephalomyelitis, various cranial nerve palsies, cerebellitis, cerebrovascular diseases including cerebral venous sinus thrombosis, transverse myelitis, longitudinally extensive transverse myelitis, Guillain-Barré syndrome, opsoclonus-myoclonus syndrome, parkinsonism, and many more. Early diagnosis is key to successful treatment. While diagnostic confirmation is generally made by the detection of IgM antibody by either ELISA or indirect fluorescent antibody tests, conventional PCR using 56 kDa gene (cPCR) and loop-mediated isothermal amplification assay (LAMP assay), as well as a newly introduced metagenomic next-generation sequencing (mNGS), are currently available for detection of Orientia tsutsugamushi infection in clinically suspected cases. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The cutaneous hallmark of the disease is the "eschar." Scrub typhus results in multisystem involvement. Neurological compromise is present in about 20% of scrub typhus patients and affects both the central nervous system and the peripheral nervous system. The postulated underlying mechanisms include direct invasion of the organism, a vasculitis-like process, or an immune-mediated injury. Diagnosis of scrub typhus is confirmed by detection of O. tsutsugamushi IgM antibody in serum. Awareness among clinicians regarding the varied presentations of this disease is very important in order to reduce morbidity and mortality. Co-infection with dengue and/or chickungunya viruses may occur in endemic regions. The history of an acute febrile illness preceding the neurological illness is crucial. A very careful search for the eschar is essential; however, the absence of the skin lesion cannot exclude the diagnosis of scrub typhus. Neurological manifestations mostly respond to doxycycline therapy.
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Affiliation(s)
- Sagar Basu
- Department of Neurology, KPC Medical College, Kolkata, India
| | - Ambar Chakravarty
- Department of Neurology, Vivekananda Institute of Medical Science, Kolkata, India.
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Imad HA, Ali AA, Nahuza M, Gurung R, Ubaid A, Maeesha A, Didi SA, Dey RK, Hilmy AI, Hareera A, Afzal I, Matsee W, Nguitragool W, Nakayama EE, Shioda T. Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives. Trop Med Infect Dis 2021; 6:tropicalmed6040208. [PMID: 34941664 PMCID: PMC8707333 DOI: 10.3390/tropicalmed6040208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022] Open
Abstract
Scrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without early diagnosis and treatment, the disease can develop fatal complications. We retrospectively reviewed de-identified data from a 23-year-old woman who presented to an emergency department with complaints of worsening abdominal pain. On presentation, she appeared jaundiced and toxic-looking. Other positive findings on abdominal examination were a positive Murphey’s sign, abdominal guarding and hepatosplenomegaly. Magnetic resonance cholangiopancreatography demonstrated acalculous cholecystitis. Additional findings included eschar on the medial aspect of the left thigh with inguinal regional lymphadenopathy. Further, positive results were obtained for immunoglobulins M and G, confirming scrub typhus. The workup for other infectious causes of acute acalculous cholecystitis (AAC) detected antibodies against human herpesvirus 4 (Epstein–Barr virus), suggesting an alternative cause of AAC. Whether that represented re-activation of the Epstein–Barr virus could not be determined. As other reports have described acute acalculous cholecystitis in adult scrub typhus patients, we recommend doxycycline to treat acute acalculous cholecystitis in endemic regions while awaiting serological confirmation.
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Affiliation(s)
- Hisham Ahmed Imad
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
- Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan; (E.E.N.); (T.S.)
- Correspondence: or ; Tel.: +66-631501402
| | - Aishath Azna Ali
- Department of Surgery, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.A.A.); (M.N.); (R.G.); (A.U.)
| | - Mariyam Nahuza
- Department of Surgery, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.A.A.); (M.N.); (R.G.); (A.U.)
| | - Rajan Gurung
- Department of Surgery, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.A.A.); (M.N.); (R.G.); (A.U.)
| | - Abdulla Ubaid
- Department of Surgery, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.A.A.); (M.N.); (R.G.); (A.U.)
| | - Aishath Maeesha
- Department of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.M.); (S.A.D.); (R.K.D.); (A.I.H.)
| | - Sariu Ali Didi
- Department of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.M.); (S.A.D.); (R.K.D.); (A.I.H.)
| | - Rajib Kumar Dey
- Department of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.M.); (S.A.D.); (R.K.D.); (A.I.H.)
| | - Abdullah Isneen Hilmy
- Department of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, Maldives; (A.M.); (S.A.D.); (R.K.D.); (A.I.H.)
- Gastrointestinal Unit, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town 7935, South Africa
| | - Aishath Hareera
- Health Protection Agency, Ministry of Public Health, Malé 20002, Maldives; (A.H.); (I.A.)
| | - Ibrahim Afzal
- Health Protection Agency, Ministry of Public Health, Malé 20002, Maldives; (A.H.); (I.A.)
| | - Wasin Matsee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Wang Nguitragool
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Emi. E. Nakayama
- Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan; (E.E.N.); (T.S.)
| | - Tatsuo Shioda
- Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan; (E.E.N.); (T.S.)
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Markaki I, Konsoula A, Markaki L, Spernovasilis N, Papadakis M. Acute acalculous cholecystitis due to infectious causes. World J Clin Cases 2021; 9:6674-6685. [PMID: 34447814 PMCID: PMC8362504 DOI: 10.12998/wjcc.v9.i23.6674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder not associated with the presence of gallstones. It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals. In this subgroup of patients, infectious causes comprise the primary etiology. We, herein, discuss the pathophysiological mechanisms involved in AAC, focusing on the infectious causes. AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia. Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens. In conclusion, additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.
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Affiliation(s)
- Ioulia Markaki
- Department of Emergency, General Hospital of Kythira “Trifyllio”, Kythira 80200, Greece
| | - Afroditi Konsoula
- Department of Emergency, General Hospital of Mytilene "Vostaneio", Lesvos 81132, Greece
| | - Lamprini Markaki
- Department of Pediatrics, "Agia Sofia" Children's Hospital, Athens 11527, Greece
| | | | - Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 40235, NRW, Germany
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Venkatesh MH, Viswanathan S, Selvaraj J, Pillai V. Acute cerebellar ataxia and peripheral neuropathy due to an atypical infection. BMJ Case Rep 2021; 14:14/3/e242229. [PMID: 33731395 PMCID: PMC7978079 DOI: 10.1136/bcr-2021-242229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This 18-year-old boy presented to the hospital with symptoms of cerebellar dysfunction preceded by an acute febrile illness with rash. Examination showed evidence of left-sided cerebellar dysfunction and polyneuropathy. Empirical treatment for leptospirosis and scrub typhus was initiated. MRI was normal. Other organ dysfunctions in the form of thrombocytopenia and transaminitis were also observed. He recovered without sequelae. A diagnosis of acute cerebellar ataxia and polyneuropathy due to scrub typhus was made.
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Affiliation(s)
| | - Stalin Viswanathan
- Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education, Pondicherry, India
| | - Jayachandran Selvaraj
- Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education, Pondicherry, India
| | - Vivekanandan Pillai
- Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education, Pondicherry, India
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Garg D, Manesh A. Neurological facets of scrub typhus: A comprehensive narrative review. Ann Indian Acad Neurol 2021; 24:849-864. [PMID: 35359522 PMCID: PMC8965938 DOI: 10.4103/aian.aian_739_21] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Scrub typhus is one of the most frequent causes of acute febrile illness in South and South-east Asian countries. Neurological features accompany 20% of scrub typhus infections, and may affect the central or peripheral nervous system, and sometime, may even occur in combination. Of late, its recognition among clinicians has increased with widening detection of its cutaneous hallmark, called eschar. Multiple mechanisms underlie neurological involvement, including direct invasion (meningitis, encephalitis), vasculitis (myositis) or immune-mediated mechanisms (opsoclonus, myoclonus, optic neuritis, Guillain–Barre syndrome). Despite an immunological basis for several neurological manifestations, response to doxycycline is remarkable, although immune therapy may be necessary for severe involvement. Scientific literature on scrub typhus neurology chiefly emanates from case reports, case series and small studies, and a comprehensive review is warranted to aid clinicians in recognising neurological involvement. This review aims at enriching this gap, and summarises clinical features, laboratory findings, and treatment options for various neurological facets of scrub typhus.
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Lee KH, Heo ST, Jeong SU, Kim MY, Jeong WS, Hyun CL, Kim YK, Yoo JR. Acute Cholangitis Caused by Boryong Strain of Orientia tsutsugamushi. Infect Chemother 2020; 52:621-625. [PMID: 32869554 PMCID: PMC7779989 DOI: 10.3947/ic.2020.52.4.621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022] Open
Abstract
Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.
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Affiliation(s)
- Keun Hwa Lee
- Department of Microbiology, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Mi Yeon Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Woo Seong Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Chang Lim Hyun
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - Young Kyu Kim
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Jeong Rae Yoo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
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8
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Acute Severe Calculous Cholecystitis with Multiorgan Failure Complicated by Scrub Typhus. Case Rep Surg 2019; 2019:7505108. [PMID: 31341695 PMCID: PMC6612987 DOI: 10.1155/2019/7505108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/27/2019] [Accepted: 06/17/2019] [Indexed: 12/07/2022] Open
Abstract
Scrub typhus is a febrile illness and can present with manifestations ranging from subclinical symptoms to multiorgan failure and death. Scrub typhus is a rare etiology of acute cholecystitis. A patient presenting with the features of acute cholecystitis who does not respond to standard treatment should be screened for scrub typhus in a typhus endemic region. We report a case of a 70-year-old female with acute severe calculous cholecystitis with multiorgan failure complicated by scrub typhus. She improved remarkably after starting doxycycline for scrub typhus. Scrub typhus should be considered as a trigger in a patient presenting with cholecystitis in a typhus endemic region.
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Rajapakse S, Weeratunga P, Sivayoganathan S, Fernando SD. Clinical manifestations of scrub typhus. Trans R Soc Trop Med Hyg 2018; 111:43-54. [PMID: 28449088 DOI: 10.1093/trstmh/trx017] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/11/2017] [Indexed: 01/10/2023] Open
Abstract
The mite-borne rickettsial zoonosis scrub typhus is widely prevalent in parts of Southeast and Far East Asia, and northern Australia. The disease is an acute febrile illness, associated with rash and often an eschar, which responds dramatically to treatment with antibiotics. In some cases it results in a serious illness leading to multiple organ involvement and death. The disease manifestations are thought to result from a systemic vasculitis, caused by both direct effects of the organisms as well as an exaggerated immune response, although little is understood about its pathogenesis. A wide spectrum of clinical manifestations, affecting nearly every organ system, have been described with scrub typhus. Some of these manifestations are serious and life threatening. In this systematic review, we summarise the typical and atypical manifestations of scrub typhus reported in the literature. Awareness of these unusual manifestations will hopefully guide clinicians towards diagnosing the condition early, and initiating early appropriate antibiotics and other supportive measures.
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Affiliation(s)
- Senaka Rajapakse
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka
| | - Praveen Weeratunga
- University Medical Unit, National Hospital, Regent Street, Colombo 08, Sri Lanka
| | - Sriharan Sivayoganathan
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka
| | - Sumadhya Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka
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Sakai K, Ishii N, Ebihara Y, Mochizuki H, Shiomi K, Nakazato M. [Guillan-Barré syndrome following scrub typus: two case reports]. Rinsho Shinkeigaku 2016; 56:577-579. [PMID: 27477576 DOI: 10.5692/clinicalneurol.cn-000864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Case 1: A 66-year-old man was admitted because of progressive gait disturbance and dysphagia after developing red rash. He was diagnosed as Guillain-Barré syndrome (GBS) and treated by intravenous immunoglobulin therapy (IVIg). Two weeks later, he could swallow and walk without any abnormalities. Case 2: A 58-year-old woman was admitted because of gait disturbance, bilateral peripheral facial nerve palsies, and respiratory failure one week after developing fever and rash. She was diagnosed as GBS and treated with IVIg. She underwent mechanical ventilation, while she could wean off it one month later and her limb strengths improved. We confirmed both patients had scrub typhus by serological studies. Peripheral neuropathy is one of the complications of scrub typhus. In addition, this disease sometimes leads to severe GBS. GBS should be included in differential diagnosis when peripheral neuropathies develop in the course of treating scrub typhus, and we should keep in mind that scrub typhus is one of the causes of GBS.
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Affiliation(s)
- Katsuya Sakai
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
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11
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Lee H, Ji M, Hwang JH, Lee JY, Lee JH, Chung KM, Lee CS. Acute Cholecystitis in Patients with Scrub Typhus. J Korean Med Sci 2015; 30:1698-700. [PMID: 26539017 PMCID: PMC4630489 DOI: 10.3346/jkms.2015.30.11.1698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/11/2015] [Indexed: 11/20/2022] Open
Abstract
Acute cholecystitis is a rare complication of scrub typhus. Although a few such cases have been reported in patients with scrub typhus, the clinical course is not well described. Of 12 patients, acute cholecystitis developed in 66.7% (8/12) of patients older than 60 yr. The scrub typhus group with acute cholecystitis had marginal significant longer hospital stay and higher cost than the group without cholecystitis according to propensity score matching. Scrub typhus should be kept in mind as a rare etiology of acute cholecystitis in endemic areas because the typical signs of scrub typhus such as skin rash and eschar can present after the abdominal pain.
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Affiliation(s)
- Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Misuk Ji
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Ja-Yeon Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Ju-Hyung Lee
- Department of Preventive Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Kyung Min Chung
- Department of Microbiology, Chonbuk National University Hospital, Jeonju, Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Korea
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12
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Devarajan V, Nambi PS, Gopalakrishnan R, Murali A. Scrub Typhus in Hospitalized Children. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Metabolic responses to Orientia tsutsugamushi infection in a mouse model. PLoS Negl Trop Dis 2015; 9:e3427. [PMID: 25569562 PMCID: PMC4287389 DOI: 10.1371/journal.pntd.0003427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/17/2014] [Indexed: 01/10/2023] Open
Abstract
Tsutsugamushi disease is an infectious disease transmitted to humans through the bite of the Orientia tsutsugamushi-infected chigger mite; however, host-pathogen interactions and the precise mechanisms of damage in O. tsutsugamushi infections have not been fully elucidated. Here, we analyzed the global metabolic effects of O. tsutsugamushi infection on the host using 1H-NMR and UPLC-Q-TOF mass spectroscopy coupled with multivariate statistical analysis. In addition, the effect of O. tsutsugamushi infection on metabolite concentrations over time was analyzed by two-way ANOVAs. Orthogonal partial least squares-discriminant analysis (OPLS-DA) showed distinct metabolic patterns between control and O. tsutsugamushi-infected mice in liver, spleen, and serum samples. O. tsutsugamushi infection caused decreased energy production and deficiencies in both remethylation sources and glutathione. In addition, O. tsutsugamushi infection accelerated uncommon energy production pathways (i.e., excess fatty acid and protein oxidation) in host body. Infection resulted in an enlarged spleen with distinct phospholipid and amino acid characteristics. This study suggests that metabolite profiling of multiple organ tissues and serum could provide insight into global metabolic changes and mechanisms of pathology in O. tsutsugamushi-infected hosts. Scrub typhus is an acute febrile illness caused by attacks of Orientia tsutsugamushi-carrying mites, and is the most prevalent febrile illness in the Asia-Pacific region. If not properly treated with antibiotics, patients often develop severe vasculitis that affects multiple organs, and the mortality rate can reach 30%. To explore the pathogenic mechanisms underlying the host-pathogen interaction, we characterized metabolic changes in various organs and the serum of O. tsutsugamushi-infected hosts. After O. tsutsugamushi infection, the host experienced decreased energy production, as well as a severe deficiency in re-methylation sources and glutathione, which impaired purine synthesis, DNA and protein methylation. In addition, abnormal pathways for phosphatidylcholine (PC) biosynthesis and phosphoethanolamine methylation were utilized in the enlarged spleen of O. tsutsugamushi-infected hosts. These results suggested that metabolic profiling could provide insight into global metabolic changes in O. tsutsugamushi-infected hosts, and increase our understanding of the pathogenic mechanisms of O. tsutsugamushi, as well as providing novel therapeutic targets for scrub typhus.
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Agarwal VK, Reddy GKM, Krishna MR, Ramareddy G, Saroj P, Bandaru VCSS. Predictors of scrub typhus: a study from a tertiary care center. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60704-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Viswanathan S, Muthu V, Iqbal N, Remalayam B, George T. Scrub typhus meningitis in South India--a retrospective study. PLoS One 2013; 8:e66595. [PMID: 23799119 PMCID: PMC3682970 DOI: 10.1371/journal.pone.0066595] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/08/2013] [Indexed: 12/13/2022] Open
Abstract
Background Scrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reports Methods A retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness- a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits. Results Sixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol. Conclusion Meningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.
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Affiliation(s)
- Stalin Viswanathan
- Department of General Medicine, Indira Gandhi Medical College, Kathirkamam, Pondicherry, India.
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