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Yang X, Zhang L, Chen S, Chen W, Zhang Y, Zhang Y, Liang J, Lv Y, Wang W, Zhou Y, Huang R, Pan D, Li X, Li Q. A case of neonatal tsutsugamushi disease diagnosed with the aid of rickettsial macrogenomic detection. BMC Pediatr 2024; 24:90. [PMID: 38302958 PMCID: PMC10835854 DOI: 10.1186/s12887-024-04561-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Tsutsugamushi, also known as bush typhus, is a naturally occurring disease caused by Orientia tsutsugamushi. We reported a case of vertical mother-to-newborn transmission of Orientia tsutsugamushi infection in a newborn from Yunnan (China). CASE PRESENTATION Decreased fetal movements were observed at 39 weeks of gestation. After birth, the newborn (female) had recurrent fever, shortness of breath, and bruising around the mouth and extremities. At 5 h 58 min of age, the newborn was admitted for fever, shortness of breath and generalized rash. The liver was palpable 3 cm below the costal margin, and the limbs showed pitting edema. There was subcutaneous bleeding. Investigations suggested heavy infection, myocardial damage, decreased platelets. Treatment with cefotaxime and ampicillin failed. The mother was hospitalized at 29 weeks of gestation with a fever for 4 consecutive days, and an ulcerated crust was found in the popliteal fossa. Due to this pregnancy history, A diagnosis of Orientia tsutsugamushi infection was suspected in our index case and confirmed by macrogenomic testing and she was treated with vancomycin and meropenem, and later azithromycin for 1 week. The newborn was discharged in good general condition, gradually normalizing body temperature, and decreasing rash and jaundice. There were no abnormalities on subsequent blood macrogenomic tests for the baby. And one month later she showed good mental health, sleep, and food intake and no fever, rash, or jaundice. CONCLUSION Determining the cause of symptoms is the key to treating diseases, especially the rare diseases that can be misdiagnosed. SUITABLE FOR PEOPLE WITH Infectious Diseases; Neonatology; Obstetrics.
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Affiliation(s)
- Xu Yang
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China.
| | - Ling Zhang
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
| | - Shanping Chen
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
| | - Wei Chen
- Department of Infectious Diseases, Pu'er People's Hospital, Pu'er, 665000, China
| | - Yushan Zhang
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
| | - Yi Zhang
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
| | - Jialong Liang
- General Practice, Pu'er People's Hospital, Pu'er, 665000, China
| | - Ying Lv
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
| | - Weiyan Wang
- Department of Anesthesiology, Pu'er People's Hospital, Pu'er, 665000, China
| | - Yini Zhou
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
| | - Rui Huang
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
| | - Dongju Pan
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
| | - Xueyu Li
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
| | - Qiurong Li
- Department of Paediatrics, Pu'er People's Hospital, Pu'er, 665000, China
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Pradeep J, Anitharaj V, Sangeetha B. Human rickettsial infections in India - A review. J Vector Borne Dis 2024; 61:5-22. [PMID: 38648402 DOI: 10.4103/0972-9062.392255] [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: 06/29/2023] [Accepted: 10/27/2023] [Indexed: 04/25/2024] Open
Abstract
Rickettsial infections are emerging and/or re-emerging disease that poses a serious global threat to humans and animals. Transmission to humans and animals is through the bite of the ectoparasites including ticks, fleas and chigger mites. Most of the rickettsial diseases are endemic in India, but underdiagnosed. This review is aimed at analyzing the prevalence of rickettsiosis in India and the advancement of rickettsial diagnosis. We have conducted a systematic review on the prevalence of rickettsial disease in India ranging from 1.3% to 46.6% for spotted fever, 2.4% to 77.8% for scrub typhus and 1% to 46.4% for Q fever, based on the literature published with the evidence of isolation, serological, and molecular diagnostics. Search engines Medline/PubMed, Science Direct, ProQuest, and EBSCO were used to retrieve the articles from electronic databases by using appropriate keywords to track the emergence of these rickettsial diseases in India for the period of 1865 to till date. We retrieved 153 published rickettsial articles on hospital-based studies from India that were purely made on the basis of prevalence and the laboratory parameters viz., Weil-Felix test (WF) and Rapid Immunochromatographic tests (RICT) with reference to the gold standard IFA and ELISA. More epidemiological studies are required for epidemic typhus to know the exact prevalence status of this louse-borne rickettsiosis in India. Currently, there is no confirmed specific inflammatory marker for rickettsial diseases. Moreover, serological cross-reactivity is an important aspect, and it should be investigated in endemic areas, there is also a need to include molecular diagnostic techniques for further confirmation in healthcare settings.
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Affiliation(s)
- J Pradeep
- Department of Microbiology, Mahatma Gandhi Medical Advanced Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be-University), Puducherry, India
| | - V Anitharaj
- Department of Microbiology, Panimalar Medical College and Hospital, Chennai, India
| | - B Sangeetha
- Block Technology Manager, Department of Agriculture, Government of Puducherry, Karaikal, Puducherry, India
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Liang P, Su Z, Chen M, Li S. Congenital scrub typhus: a case report and literature review. Front Pediatr 2023; 11:1251746. [PMID: 38054188 PMCID: PMC10694191 DOI: 10.3389/fped.2023.1251746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
Background This study aimed to analyze the clinical course of a newborn with congenital scrub typhus caused by vertical transmission and explore early diagnosis and treatment strategies. The clinical data of the neonate were retrospectively analyzed and the related literature was reviewed. Case presentation The newborn was a full-term one, with a good Apgar score at birth. The neonate had apnea at 3 h of life, requiring NICU care and IV antibiotics (piperacillin) for suspected sepsis. An examination revealed hepatosplenomegaly. Blood tests revealed anemia and thrombocytopenia and a chest x-ray showed patchy inflammation. On the second day of life, he developed a fever. On the third day of life, he required mechanical ventilation because his condition worsened after he presented with dyspnea, hypotension, depressed sensorium, and other signs of sepsis. Importantly, the neonate's mother had a history of scrub typhus at 31+ weeks of gestation. While the blood culture result was still pending, high-throughput sequencing of blood and cerebrospinal fluid was performed. To address the suspected scrub typhus infection, oral azithromycin dry suspension was added to the treatment regimen. High-throughput sequencing results on the 5th day of life confirmed a significant presence of 16SrRNA sequences in the blood, suggesting an Orientia tsutsugamushi infection. The neonate steadily recovered and was discharged 16 days after hospitalization. The neonate was followed up for 9 months, and the outcome was favorable with normal growth and development. Conclusions This article reports a case of congenital Orientia tsutsugamushi infection, a rare condition caused by vertical transmission. Our review of the literature, combined with the presented case, brings the total number of documented congenital scrub typhus cases caused by vertical transmission to eight. Regrettably, one patient from this group unexpectedly died on the 10th day of hospitalization, resulting in a mortality rate of 12.5% (1/8). The special transmission mode and clinical manifestations of this disease will serve as an alert to doctors for timely diagnosis and treatment. Because of the non-specific clinical manifestations of congenital scrub typhus, limited understanding, low index of suspicion among clinicians, and a lack of diagnostic facilities, scrub typhus is seriously underdiagnosed in pregnant women, fetuses, and neonates.
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Affiliation(s)
- Pinghua Liang
- Department of Pediatrics, Yuexi Hospital of the Sixth Affiliated Hospital, Sun Yat-sen University (Xinyi People’s Hospital), Xinyi, China
| | - Zengling Su
- Department of Pediatrics, Yuexi Hospital of the Sixth Affiliated Hospital, Sun Yat-sen University (Xinyi People’s Hospital), Xinyi, China
| | - Min Chen
- Department of Pediatrics, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sitao Li
- Department of Pediatrics, Yuexi Hospital of the Sixth Affiliated Hospital, Sun Yat-sen University (Xinyi People’s Hospital), Xinyi, China
- Department of Pediatrics, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Cao Y, Liu P, Song Q, Wang J. Case report: A case of sepsis caused by rickettsial infection-induced hemophagocytic syndrome. Front Med (Lausanne) 2023; 10:1209174. [PMID: 37608831 PMCID: PMC10440429 DOI: 10.3389/fmed.2023.1209174] [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: 04/20/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare histiocytic disorder characterized by reactive hyperplasia of the mononuclear phagocytic system, which is primarily caused by dysfunction of cytotoxic killer cells and natural killer cells, leading to antigen clearance barriers and the overactivation of the mononuclear phagocytic system due to continuous antigen stimulation. HLH encompasses a group of clinical syndromes marked by the overproduction of inflammatory cytokines. A 68-year-old Chinese man presented with persistent fever, chills, nausea, and vomiting; the patient had no history of any underlying conditions. Laboratory investigations revealed decreased levels of red blood cells, white blood cells, and platelets, along with reduced natural killer cell activity, increased CD25, hyperferritinemia, and the detection of Rickettsia DNA in his blood, meeting the diagnostic criteria of the Histiocyte Society HLH-2004 guidelines. The patient was treated with antibiotics, improving anemia, glucocorticoid therapy, and continuous renal replacement therapy (CRRT), temporarily improving his condition. However, the patient died after 2 years from chronic renal failure caused by septic shock.
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Affiliation(s)
| | | | | | - Jing Wang
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
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Deglurkar R, Thangavel NP, Murugesan A, Plakkal N. Scrub typhus due to vertical transmission in a neonate: rare presentation of a common tropical infection. BMJ Case Rep 2023; 16:e253172. [PMID: 37316285 PMCID: PMC10277054 DOI: 10.1136/bcr-2022-253172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Vertical transmission as a route of infection has been well reported in many viral infections. Scrub typhus is a zoonotic disease transmitted by ticks which has had a resurgence in recent times in several tropical countries. It affects all age groups including neonates. Reports of neonates affected with scrub typhus are few, and vertical transmission is rare. We report a case, where a newborn was symptomatic with signs of infection within the first 72 hours of life and Orientia tsutsugamushi, the causative organism was confirmed by PCR in both mother and baby.
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Affiliation(s)
- Revati Deglurkar
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER, Puducherry, India
| | - Nanmaaran Periyannan Thangavel
- Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER, Puducherry, India
| | - Ambalakkuthan Murugesan
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER, Puducherry, India
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, JIPMER, Puducherry, India
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Chiranth SB, Ashwini KR, Gowda VK, Sanjay KS, Ahmed M, Basavaraja GV. Profile of Neurological Manifestations in Children Presenting With Rickettsial Disease. Indian Pediatr 2022. [PMID: 35014614 PMCID: PMC8964390 DOI: 10.1007/s13312-022-2473-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective To study the profile of neurological manifestation of rickettsial disease in children. Methods Review of hospital records was done in a tertiary care hospital for the period from January to December, 2020. Data of all the children fulfilling the inclusion criteria i.e., clinical criteria and serology were retrieved from the hospital records. Results Of the total 7974 children admitted over this period, 178 were diagnosed with rickettsial disease wherein 54 (33.3%) had neurological involvement. Convulsions (59%), altered sensorium (56%), headache (44%), meningeal signs (37%), ataxia, (11%), lateral rectus palsy (7.5%) and stroke (7.5%) were the major neurological manifestations. Cerebrospinal fluid (CSF) analysis done in 30 (55%) children showed pleocytosis [median (IQR) cells 15 (3.75, 50)] with lymphocyte predominance [median (IQR) lymphocytes 11.5 (3, 38.75)] and elevated proteins [median IQR 41.5 (29.75,61)]. Neuroimaging abnormalities noticed were cerebral edema (n=7), cerebellar hyperintensities (n=5), basal ganglia infarcts (n=2) and hippocampal hyperintensities (n=1). Conclusion Early recognition of rickettsial infection as a cause of neurological manifestation would facilitate early specific management.
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Negi T, Kandari LS, Arunachalam K. Update on prevalence and distribution pattern of tick-borne diseases among humans in India: a review. Parasitol Res 2021; 120:1523-1539. [PMID: 33797610 DOI: 10.1007/s00436-021-07114-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
In the present scenario, tick-borne diseases (TBDs) are well known for their negative impacts on humans as well as animal health in India. The reason lies in their increased incidences due to global warming, environmental and ecological changes, and availability of suitable habitats. On a global basis, they are now considered a serious threat to human as well as livestock health. The major tick-borne diseases in India include Kyasanur forest disease (KFD), Crimean-congo hemorrhagic fever (CCHF), Lyme disease (LD), Q fever (also known as coxiellosis), and Rickettsial infections. In recent years, other tick-borne diseases such as Babesiosis, Ganjam virus (GANV), and Bhanja virus (BHAV) infections have also been reported in India. The purpose of this paper is to review the history and the current state of knowledge of tick-borne diseases in the country. The conclusion of this review is extending the requirement of greater efforts in research and government management for the diagnosis and treatment and as well as prevention of these diseases so that tick-borne disease burden should be minimizing in India.
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Affiliation(s)
- Tripti Negi
- School of Environment and Natural Resources, Doon University, Dehradun, Uttarakhand, 248 012, India.
| | - Laxman Singh Kandari
- Department of Forestry and Natural Resources, School of Agriculture and Allied Science, HNB Garhwal University, Srinagar, Uttarakhand, 246 174, India
| | - Kusum Arunachalam
- School of Environment and Natural Resources, Doon University, Dehradun, Uttarakhand, 248 012, India
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Sahu R, Rawool DB, Dhaka P, Yadav JP, Mishra SP, Kumar M, Vergis J, Malik SS, Barbuddhe SB. Current perspectives on the occurrence of Q fever: highlighting the need for systematic surveillance for a neglected zoonotic disease in Indian subcontinent. ENVIRONMENTAL MICROBIOLOGY REPORTS 2021; 13:138-158. [PMID: 33314653 DOI: 10.1111/1758-2229.12918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
Coxiellosis or Q fever is an important global occupational zoonotic disease caused by one of the most contagious bacterial pathogens - Coxiella burnetii, which ranks one among the 13 global priority zoonoses. The detection of C. burnetii infection is exhibiting an increasing trend in high-risk personnel around the globe. It has increasingly been detected from foods of animal origin (including bulk milk, eggs, and meat) as well as tick vectors in many parts of the world. Coxiellosis is reported to be an important public health threat causing spontaneous abortions in humans and potential reproductive failure, which would result in production losses among livestock. Further, comprehensive coverage of the reports and trends of Q fever in developing countries, where this infection is supposed to be widely prevalent appears scarce. Also, the pathogen remains grossly neglected and underreported. Moreover, policymakers and funding agencies do not view it as a priority problem, especially in the Indian subcontinent, including Sri Lanka, Bhutan, Pakistan, Nepal, Bangladesh and Maldives. Here, we review the occurrence and epidemiology of the disease in a global context with special emphasis on its status in the Indian subcontinent.
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Affiliation(s)
- Radhakrishna Sahu
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
| | - Deepak Bhiwa Rawool
- ICAR- National Research Centre on Meat, Hyderabad, Telangana, 500 092, India
| | - Pankaj Dhaka
- School of Public Health and Zoonoses, College of Veterinary Science, GADVASU, Ludhiana, Punjab, 141004, India
| | - Jay Prakash Yadav
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
| | - Sidharth Prasad Mishra
- Department of Animal Genetics and Breeding, West Bengal University of Animal and Fishery Sciences, Kolkata, West Bengal, 700037, India
| | - Manesh Kumar
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
| | - Jess Vergis
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
| | - Satyaveer Singh Malik
- Division of Veterinary Public Health, ICAR- Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243 122, India
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Abdul Samad TE, Kamalarathnam CN. Clinical Profile of Scrub Typhus in Newborns. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1864-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Srinivasan S, Kalaimani S, Jude Prakash JA, Menon T. Comparison of nested polymerase chain reaction and real-time polymerase chain reaction targeting 47kda gene for the diagnosis of scrub typhus. Indian J Med Microbiol 2019; 37:50-53. [PMID: 31424010 DOI: 10.4103/ijmm.ijmm_19_170] [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: 11/04/2022]
Abstract
Introduction Scrub typhus is a zoonotic infection caused by Orientia tsutsugamushi which is transmitted by Leptotrombidium mites. The disease manifests as a mild-to-severe illness with non-specific clinical symptoms. Rapid diagnosis and prompt treatment are essential for patient management. Both serological and molecular methods are used for the diagnosis of scrub typhus. The present study assessed the usefulness of detection of the gene encoding the 47kDa outer-membrane protein (OMP) for the laboratory diagnosis of scrub typhus. Materials and Methods Nested polymerase chain reaction (nPCR) and real-time PCR targeting 47 kDa OMP antigen gene of O. tsutsugamushi were performed on ethylenediaminetetraacetic acid blood samples. Results Six of the 103 (5.8%) patients showed the presence of 47kDa gene by nPCR. Seventy of 103 (67.9%) cases showed the presence of 47kDa gene by qPCR. Among the 70 positive cases, the majority of them were females (40/70, 57.1%). The highest number of positive cases was observed during October-February. Conclusion Real-time PCR targeting O. tsutsugamushi-specific 47-kDa gene is more sensitive than nPCR and may be the assay of choice for the detection of the organism in patients with suspected scrub typhus.
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Affiliation(s)
- Seethalakshmi Srinivasan
- Department of Microbiology, Dr. AL Mudaliar PG Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu, India
| | - Saravanan Kalaimani
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Thangam Menon
- Department of Microbiology, Dr. AL Mudaliar PG Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu, India
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Pradeep J, Kumar S, Stephen S, Kamboj DV, Gunasekaran D, Hanifah M. Detection of acute Q fever human cases by indirect immunofluorescence & real-time polymerase chain reaction in a tertiary care hospital in Puducherry. Indian J Med Res 2019; 148:449-452. [PMID: 30666008 PMCID: PMC6362714 DOI: 10.4103/ijmr.ijmr_692_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jothimani Pradeep
- Department of Microbiology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (Deemed University), Puducherry 607 402, India
| | - Sanjay Kumar
- Department of Biotechnology, Defence Research & Development Establishment, Gwalior 474 002, Madhya Pradesh, India
| | - Selvaraj Stephen
- Department of Microbiology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (Deemed University), Puducherry 607 402, India
| | - Dev Vrat Kamboj
- Department of Biotechnology, Defence Research & Development Establishment, Gwalior 474 002, Madhya Pradesh, India
| | - Dhandapany Gunasekaran
- Department of Paediatrics, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (Deemed University), Puducherry 607 402, India
| | - Mohammed Hanifah
- Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (Deemed University), Puducherry 607 402, India
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Ganesh R, Suresh N, Pratyusha LL, Janakiraman L, Manickam M, Andal A. Clinical profile and outcome of children with scrub typhus from Chennai, South India. Eur J Pediatr 2018; 177:887-890. [PMID: 29637374 DOI: 10.1007/s00431-018-3143-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 03/01/2018] [Accepted: 04/04/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. We prospectively studied the clinico-laboratory profile and outcome of 358 children aged 1 day to 18 years diagnosed with scrub typhus from Chennai, South India. All children (100%) had fever. Eschar was seen in 67%. All children were treated with oral doxycycline and those with complications were treated with intravenous chloramphenicol/azithromycin. Rapid defervescence (within 48 h) after initiation of doxycline was seen in 306 (85%) and 52 (14.5%) developed complications. Multivariate logistic regression analysis revealed that children who had an elevated aspartate amino transferase (> 120 IU/L) and the presence of thrombocytopenia (platelet count less than 1 lac cells/mm3) at admission had high risk of developing complications. The overall mortality rate in this series was 0.8%. CONCLUSION Our 4-year study highlights the clinico-laboratory profile of Scrub typhus in children from Chennai, South India. Early recognition and prompt treatment reduces the complication and mortality. What is Known: • Scrub typhus is endemic to tsutsugamushi triangle, a geographical triangle extending from northern Japan in the east to Pakistan and Afghanistan in the west and northern Australia in the south. • There is paucity of data regarding its clinico-laboratory profile in neonates as well as its predictors of outcome. What is New: • Children who had an elevated AST and the presence of thrombocytopenia at admission had high risk of developing complications.
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Affiliation(s)
- Ramaswamy Ganesh
- Kanchi Kamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, Tamil Nadu, 600034, India.
| | - Natarajan Suresh
- Kanchi Kamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, Tamil Nadu, 600034, India
| | - L L Pratyusha
- Kanchi Kamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, Tamil Nadu, 600034, India
| | - Lalitha Janakiraman
- Kanchi Kamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, Tamil Nadu, 600034, India
| | - Mani Manickam
- Kanchi Kamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, Tamil Nadu, 600034, India
| | - A Andal
- Kanchi Kamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, Tamil Nadu, 600034, India
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Pradeep J, Stephen S, Ambroise S, Gunasekaran D. Diagnosis of Acute Q Fever by Detection of Coxiella burnetii DNA using Real-Time PCR, Employing a Commercial Genesig Easy Kit. J Clin Diagn Res 2017; 11:DC10-DC13. [PMID: 29207703 PMCID: PMC5713725 DOI: 10.7860/jcdr/2017/31005.10606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/24/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Query (Q) fever is an important zoonosis and a cause of concern for humans, due to the potential bioterrorism threat posed by the causative agent, Coxiella burnetii. Because of the danger of contracting the illness, isolation attempts are seldom made. Serological and molecular diagnostic tests are the main option. AIM To study the prevalence of acute Q fever in Puducherry and surrounding districts of Tamil Nadu, India, employing a new commercial Real-Time Polymerase Chain Reaction (RT-PCR) kit and confirming it by the gold standard Immunofluorescence Assay (IFA). MATERIALS AND METHODS Acute phase blood samples from 72 consecutive febrile patients and 24 healthy individuals were included in this prospective study. DNA was extracted from the buffy coats and preserved at -80°C. Detection of C. burnetii was carried out employing a commercial Real-Time PCR kit. Serum samples were tested for IgM (Phase I+II) and IgG (Phase I+II) by QM-120 and QG-120, Coxiella burnetii IFA Fuller Laboratories, California, USA. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated keeping IFA as the reference. RESULTS Presumptive diagnosis of acute Q fever was made in two febrile patients by the Genesig Easy kit (2.78%). In addition to these two PCR positive cases, one more patient was positive for both Phase II IgM and Phase II IgG antibodies by the gold standard IFA. All 24 healthy controls were negative for Q fever by both PCR and IFA. The sensitivity, specificity, NPV and PPV for Genesig Easy kit PCR were: 66.67%, 100%, 100% and 98.57 % respectively against IFA as the reference. CONCLUSION The true prevalence of Q fever in India and other developing countries is poorly understood, owing to the difficulties in the diagnosis of this infection. Since molecular diagnostic tests have good specificity and are mandated for confirmation of single acute samples, validation of commercial Q fever PCR kits is the need of the hour. Genesig Easy kit in our hands was found to be reliable with the moderate sensitivity and high specificity. Performing both PCR (with acute specimens) and IFA (with paired sera) would be ideal for Q fever diagnosis.
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Affiliation(s)
- Jothimani Pradeep
- Ph.D Scholar, Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, SBV University, Pillaiyarkuppam, Puducherry, India
| | - Selvaraj Stephen
- Professor, Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, SBV University, Pillaiyarkuppam, Puducherry, India
| | - Stanley Ambroise
- Specialist Grade I, Department of General Medicine, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry, India
| | - Dhandapany Gunasekaran
- Professor, Department of Paediatrics, Mahatma Gandhi Medical College and Research Institute, SBV University, Pillaiyarkuppam, Puducherry, India
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Stephen S, Ambroise S, Pradeep J, Gunasekaran D, Sangeetha B, Sarangapani K. Unreliability of three commercial Coxiella burnetii phase II IgM ELISA kits for the seroscreening of acute Q fever in human cases. Indian J Med Res 2017; 146:386-391. [PMID: 29355147 PMCID: PMC5793475 DOI: 10.4103/ijmr.ijmr_1815_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND & OBJECTIVES Seroprevalence of Q fever (QF) caused by Coxiella burnetii has been reported from different parts of India. Usually serological/molecular tests are employed for detection of infection. The present study was undertaken to verify the validity of three different QF phase II IgM ELISA kits for acute QF diagnosis by comparing with the gold standard indirect fluorescent antibody assay (IFA). METHODS Fifty eight serum samples collected from 42 patients (26 patients provided acute sample only and 16 both acute and convalescent samples) which were examined by all three commercial kits, were cross-checked with QF Phase II IgM IFA for confirmation. RESULTS Eleven patients were positive for C. burnetii antibodies by IFA in acute and/or convalescent serum samples. Taking IFA as a reference, percentages of sensitivity, specificity, positive predictive value and negative predictive value for Virion-Serion/Vircell/NovaTec were 36.36, 61.29, 25.00, 73.08; 81.82, 35.48, 31.03, 84.62 and 100, 25.81, 32.35, 100 per cent, respectively. INTERPRETATION & CONCLUSIONS The three different ELISA kits exhibited poor agreement amongst them and unacceptable level of false positivity. IFA remains to be the only option for diagnosing acute QF. Discrepancy between the clinical findings and IFA/ELISA results needs confirmation by C. burnetii DNA detection in real-time polymerase chain reaction.
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Affiliation(s)
- Selvaraj Stephen
- Department of Microbiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Stanley Ambroise
- Department of General Medicine, Indira Gandhi Government General Hospital & Post Graduate Institute, Puducherry, India
| | - Jothimani Pradeep
- Department of Microbiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Dhandapany Gunasekaran
- Department of Paediatrics, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Balakrishnan Sangeetha
- Department of Microbiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Kengamuthu Sarangapani
- Department of Microbiology, Indira Gandhi Government General Hospital & Post Graduate Institute, Puducherry, India
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Pradeep J, Stephen S, Pooja P, Akshayavardhini A, Sangeetha B, Antony PX. Coxiellosis in domestic livestock of Puducherry and Tamil Nadu: Detection of Coxiella burnetii DNA by polymerase chain reaction in slaughtered ruminants. Vet World 2017; 10:667-671. [PMID: 28717320 PMCID: PMC5499085 DOI: 10.14202/vetworld.2017.667-671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 05/03/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM In the course of our Indian Council of Medical Research project on coxiellosis in Puducherry and Tamil Nadu, 5.64% goat, 1.85% sheep, 1.06% buffaloes, and 0.97% cattle were positive for Coxiella burnetii antibodies by enzyme linked immunosorbent assay kit (IDEXX, Liebefeld, Switzerland). In this preliminary study, we have proceeded to look for C. burnetii DNA in those antibody positive specimens employing an imported commercial C. burnetii polymerase chain reaction (PCR) kit. MATERIALS AND METHODS Blood samples were collected during slaughtering. All 15 blood samples of antibody positive ruminants and three antibody negative samples were subjected to conventional Trans-PCR assay with a commercial PCR kit (Genekam Biotechnology AG, Duisburg, Germany). An in-house Trans-PCR was included in the study for comparison. RESULTS A total of 15 antibody positive and three antibody-negative serum samples belonging to 11 goat, 4 sheep, 1 cattle, and 2 buffaloes were tested in duplicate for the presence of C. burnetii DNA by the commercial agar gel PCR kit and an in-house Trans-PCR. Only one buffalo serum sample was positive for C. burnetii with a band at 243 bp in in-house Trans-PCR. DISCUSSION Seropositivity for C. burnetii need not necessarily translate into infectivity status of the animal. Conversely, seronegative ruminants can shed C. burnetii. Rapid disintegration of C. burnetii DNA during the storage period is an important impediment in QF-PCR research. This is the first time the performance of this commercial PCR kit is being validated in India. CONCLUSION Commercial PCR kit, Genekam did not identify any positive sample, probably because it targeted a larger amplicon of 687 bp.
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Affiliation(s)
- Jothimani Pradeep
- Department of Microbiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Selvaraj Stephen
- Department of Microbiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Pratheesh Pooja
- Department of Genomics and Proteomics, Central Interdisciplinary Research Facility, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Anbalagan Akshayavardhini
- Department of Genomics and Proteomics, Central Interdisciplinary Research Facility, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Balakrishnan Sangeetha
- Department of Microbiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, India
| | - Prabakar Xavier Antony
- Department of Veterinary Microbiology, Rajiv Gandhi Institute of Veterinary Education and Research, Puducherry, India
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