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Lau ACC, Mohamed WMA, Nakao R, Onuma M, Qiu Y, Nakajima N, Shimozuru M, Mohd-Azlan J, Moustafa MAM, Tsubota T. The dynamics of the microbiome in Ixodidae are shaped by tick ontogeny and pathogens in Sarawak, Malaysian Borneo. Microb Genom 2023; 9:mgen000954. [PMID: 36757789 PMCID: PMC9997734 DOI: 10.1099/mgen.0.000954] [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] [Received: 03/31/2022] [Accepted: 12/19/2022] [Indexed: 02/10/2023] Open
Abstract
Tick-borne diseases have recently been considered a potential emerging public health threat in Malaysia; however, fundamental studies into tick-borne pathogens and microbiome appear limited. In this study, six tick species (Ixodes granulatus, Haemaphysalis hystricis, Haemaphysalis shimoga, Dermacentor compactus, Dermacentor steini and Dermacentor atrosignatus) collected from two primary forests and an oil palm plantation in Sarawak, Malaysian Borneo, were used for microbiome analysis targeting bacterial 16S rDNA using next-generation sequencing (NGS). In addition, bacterial species were further characterized in conventional PCRs to identify potential pathogens. Sequences generated from NGS were first filtered with the Decontam package in R before subsequent microbial diversity analyses. Alpha and beta analyses revealed that the genus Dermacentor had the highest microbial diversity, and H. shimoga significantly differed in microbial composition from other tick species. Alpha and beta diversities were also significantly different between developmental stages of H. shimoga. Furthermore, we observed that some bacterial groups were significantly more abundant in certain tick species and developmental stages of H. shimoga. We tested the relative abundances using pairwise linear discriminant analysis effect size (LEfSe), which also revealed significant microbial composition differences between Borrelia-positive and Borrelia-negative I. granulatus ticks. Finally, pathogenic and potentially pathogenic bacteria circulating in different tick species, such as Rickettsia heilongjiangensis, Ehrlichia sp., Anaplasma sp. and Bartonella spp. were characterized by PCR and sequencing. Moreover, Coxiella and Francisella-like potential symbionts were identified from H. shimoga and D. steini, respectively. More studies are required to unravel the factors associated with the variations observed in this study.
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Affiliation(s)
- Alice C. C. Lau
- Laboratory of Wildlife Biology and Medicine, Department of Environmental Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, 060-0818, Japan
| | - Wessam Mohamed Ahmed Mohamed
- Laboratory of Parasitology, Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, 060-0818, Japan
- Division of Bioinformatics, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Hokkaido, 001-0020, Japan
- Department of Biochemistry and Microbiology, Rutgers The State University of New Jersey, New Brunswick, 08901, New Jersey, USA
| | - Ryo Nakao
- Laboratory of Parasitology, Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, 060-0818, Japan
| | - Manabu Onuma
- Biodiversity Division, National Institute of Environmental Studies, Tsukuba, 305-806, Japan
| | - Yongjin Qiu
- Division of International Research Promotion, International Institute for Zoonosis Control, Hokkaido University, Sapporo, 001-0020, Japan
| | - Nobuyoshi Nakajima
- Biodiversity Division, National Institute of Environmental Studies, Tsukuba, 305-806, Japan
| | - Michito Shimozuru
- Laboratory of Wildlife Biology and Medicine, Department of Environmental Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, 060-0818, Japan
| | - Jayasilan Mohd-Azlan
- Institute of Biodiversity and Environmental Conservation, Universiti Malaysia Sarawak, Kota Samarahan, 94300, Sarawak, Malaysia
| | - Mohamed Abdallah Mohamed Moustafa
- Laboratory of Parasitology, Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, 060-0818, Japan
- Department of Animal Medicine, Faculty of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Toshio Tsubota
- Laboratory of Wildlife Biology and Medicine, Department of Environmental Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, 060-0818, Japan
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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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3
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Hidajat M, de Vocht F. Occupational zoonoses potential in Southeast Asia. Occup Med (Lond) 2020; 70:323-326. [DOI: 10.1093/occmed/kqaa082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mira Hidajat
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Grigg MJ, William T, Clemens EG, Patel K, Chandna A, Wilkes CS, Barber BE, Anstey NM, Dumler JS, Yeo TW, Reller ME. Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia. Emerg Infect Dis 2020; 26. [PMID: 32568664 PMCID: PMC7323546 DOI: 10.3201/eid2607.191722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Orientia tsutsugamushi, spotted fever group rickettsioses, and typhus group rickettsioses (TGR) are reemerging causes of acute febrile illness (AFI) in Southeast Asia. To further delineate extent, we enrolled patients >4 weeks of age with nonmalarial AFI in Sabah, Malaysia, during 2013-2015. We confirmed rickettsioses (past or acute, IgG titer >160) in 126/354 (36%) patients. We confirmed acute rickettsioses (paired 4-fold IgG titer rise to >160) in 38/145 (26%) patients: 23 O. tsutsugamushi, 9 spotted fever group, 4 TGR, 1 O. tsutsugamushi/spotted fever group, and 1 O. tsutsugamushi/TGR. PCR results were positive in 11/319 (3%) patients. Confirmed rickettsioses were more common in male adults; agricultural/plantation work and recent forest exposure were risk factors. Dizziness and acute hearing loss but not eschars were reported more often with acute rickettsioses. Only 2 patients were treated with doxycycline. Acute rickettsioses are common (>26%), underrecognized, and untreated etiologies of AFI in East Malaysia; empirical doxycycline treatment should be considered.
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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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7
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Satjanadumrong J, Robinson MT, Hughes T, Blacksell SD. Distribution and Ecological Drivers of Spotted Fever Group Rickettsia in Asia. ECOHEALTH 2019; 16:611-626. [PMID: 30993545 PMCID: PMC6910891 DOI: 10.1007/s10393-019-01409-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 05/30/2023]
Abstract
Spotted fever group and related rickettsia (SFGR) are a neglected group of pathogens that belong to the genus Rickettsia. SFGR are zoonotic and are transmitted by arthropod vectors, primarily ticks, fleas and mites to accidental hosts. These emerging and re-emerging infections are widely distributed throughout the world. Land-use change and increasing human-wildlife conflict compound the risk of SFGR infection to local people in endemic areas and travelers to these regions. In this article, we discuss the rickettsial organisms causing spotted fever and related diseases, their arthropod vectors in Asia and the impact of land-use change on their spread.
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Affiliation(s)
- Jaruwan Satjanadumrong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, Bangkok, 10400, Thailand
| | - Matthew T Robinson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7FZ, UK
| | - Tom Hughes
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, Bangkok, 10400, Thailand
- EcoHealth Alliance, 460 West 34th Street, 17th Floor, New York, NY, USA
| | - Stuart D Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, Bangkok, 10400, Thailand.
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7FZ, UK.
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8
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Tappe D, Gross Y, Ngui R, Rauch J, Tay ST, Lim YAL. High Seroprevalence Against Typhus Group and Spotted Fever Group Rickettsiae in Rural Indigenous Populations of Peninsular Malaysia. Vector Borne Zoonotic Dis 2019; 19:323-327. [DOI: 10.1089/vbz.2018.2391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Yvonne Gross
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Romano Ngui
- Department of Parasitology and Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jessica Rauch
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yvonne Ai Lian Lim
- Department of Parasitology and Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Salgado Lynn M, William T, Tanganuchitcharnchai A, Jintaworn S, Thaipadungpanit J, Lee MH, Jalius C, Daszak P, Goossens B, Hughes T, Blacksell SD. Spotted Fever Rickettsiosis in a Wildlife Researcher in Sabah, Malaysia: A Case Study. Trop Med Infect Dis 2018; 3:E29. [PMID: 30274426 PMCID: PMC6136627 DOI: 10.3390/tropicalmed3010029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/14/2018] [Accepted: 02/28/2018] [Indexed: 11/22/2022] Open
Abstract
We present evidence for a case of spotted fever rickettsiosis with severe complications in a young adult male. Although spotted fever group rickettsiae (SFGR) have been reported as the most prevalent cause of rickettsiosis in rural areas of Sabah, Malaysia since the 1980s, this is the first detailed case report of suspected SFGR in the state. Current data on the prevalence, type, and thorough clinical reports on complications of SFGR and other rickettsioses in Sabah is lacking and required to raise the awareness of such diseases. There is a need to emphasize the screening of rickettsioses to medical personnel and to encourage the use of appropriate antibiotics as early treatment for nonspecific febrile illnesses in this region. Suspected rickettsioses need to be considered as one of the differential diagnoses for patients presenting with acute febrile illness for laboratory investigations, and early treatment instituted.
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Affiliation(s)
- Milena Salgado Lynn
- Danau Girang Field Centre, c/o Sabah Wildlife Department, Sandakan 90009, Sabah, Malaysia.
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK.
- Wildlife Health, Genetic and Forensic Laboratory, c/o Sabah Wildlife Department, Kota Kinabalu 88100, Sabah, Malaysia.
- Sustainable Places Research Institute, Cardiff University, Cardiff CF10 3BA, UK.
| | - Timothy William
- Jesselton Medical Centre, Kota Kinabalu, Sabah 88300, Malaysia.
| | - Ampai Tanganuchitcharnchai
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7FZ, UK.
| | - Suthatip Jintaworn
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
| | - Janjira Thaipadungpanit
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
| | - Mei Ho Lee
- EcoHealth Alliance, New York, NY 10001-2320, USA.
| | - Cyrlen Jalius
- Danau Girang Field Centre, c/o Sabah Wildlife Department, Sandakan 90009, Sabah, Malaysia.
- Wildlife Health, Genetic and Forensic Laboratory, c/o Sabah Wildlife Department, Kota Kinabalu 88100, Sabah, Malaysia.
| | - Peter Daszak
- EcoHealth Alliance, New York, NY 10001-2320, USA.
| | - Benoît Goossens
- Danau Girang Field Centre, c/o Sabah Wildlife Department, Sandakan 90009, Sabah, Malaysia.
- School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK.
- Sustainable Places Research Institute, Cardiff University, Cardiff CF10 3BA, UK.
- Sabah Wildlife Department, Kota Kinabalu, Sabah 88100, Malaysia.
| | - Tom Hughes
- EcoHealth Alliance, New York, NY 10001-2320, USA.
| | - Stuart D Blacksell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7FZ, UK.
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
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Xu G, Walker DH, Jupiter D, Melby PC, Arcari CM. A review of the global epidemiology of scrub typhus. PLoS Negl Trop Dis 2017; 11:e0006062. [PMID: 29099844 PMCID: PMC5687757 DOI: 10.1371/journal.pntd.0006062] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/15/2017] [Accepted: 10/21/2017] [Indexed: 12/18/2022] Open
Abstract
Scrub typhus is a serious public health problem in the Asia-Pacific area. It threatens one billion people globally, and causes illness in one million people each year. Caused by Orientia tsutsugamushi, scrub typhus can result in severe multiorgan failure with a case fatality rate up to 70% without appropriate treatment. The antigenic heterogeneity of O. tsutsugamushi precludes generic immunity and allows reinfection. As a neglected disease, there is still a large gap in our knowledge of the disease, as evidenced by the sporadic epidemiologic data and other related public health information regarding scrub typhus in its endemic areas. Our objective is to provide a systematic analysis of current epidemiology, prevention and control of scrub typhus in its long-standing endemic areas and recently recognized foci of infection. Scrub typhus is a serious public health problem in the Asia-Pacific area. There is an estimated one million new scrub typhus infections each year, and over one billion people around the world are at risk. Without appropriate treatment, the case fatality rate of scrub typhus can reach 30% or even higher. Scrub typhus has long been a neglected infectious disease so many aspects of the disease, including its diagnosis to prevention, are unknown. We here provide a comprehensive review of the epidemiology, prevention and control of scrub typhus.
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Affiliation(s)
- Guang Xu
- Department of Pathology, The University of Texas Medical Branch, Galveston, Texas, United States of America
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - David H. Walker
- Department of Pathology, The University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Peter C. Melby
- Department of Internal Medicine, Division of Infectious Diseases, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Christine M. Arcari
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas, United States of America
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11
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Blacksell SD, Kantipong P, Watthanaworawit W, Turner C, Tanganuchitcharnchai A, Jintawon S, Laongnuanutit A, Nosten FH, Day NPJ, Paris DH, Richards AL. Underrecognized arthropod-borne and zoonotic pathogens in northern and northwestern Thailand: serological evidence and opportunities for awareness. Vector Borne Zoonotic Dis 2017; 15:285-90. [PMID: 25988437 PMCID: PMC4449621 DOI: 10.1089/vbz.2015.1776] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although scrub typhus and murine typhus are well-described tropical rickettsial illnesses, especially in Southeast Asia, only limited evidence is available for rickettsia-like pathogens contributing to the burden of undifferentiated febrile illness. Using commercially available kits, this study measured immunoglobulin G (IgG) antibody seroprevalence for Coxiella burnetii, Ehrlichia chaffeensis, Bartonella henselae, Anaplasma phagocytophilum, and spotted fever group rickettsiae (SFGR) in 375 patients enrolled in undifferentiated febrile illness studies at Chiangrai (northern Thailand) and Mae Sot (Thai–Myanmar border). Ehrlichia and SFGR were the most common causes of IgG seropositivity. A distinct relationship between age and seropositivity was found in Chiangrai with acquisition of IgG titers against Ehrlichia, Bartonella, Anaplasma, and SFGR in young adulthood, suggesting cumulative exposure to these pathogens. At Mae Sot, high early IgG titers against Ehrlichia and SFGR were common, whereas Anaplasma and Bartonella IgG titers increased at 50–60 years. Q fever associated with low IgG positivity at both study sites, with significantly higher prevalence at 30 years of age in Chiangrai. These data suggest that other rickettsial illnesses could contribute to the burden of febrile illness in Thailand and possibly adjacent regions. Improved diagnostics and better understanding of antibody longevity and cross-reactivity will improve identification and management of these easily treatable infectious diseases.
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Affiliation(s)
- Stuart D Blacksell
- 1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Wanitda Watthanaworawit
- 1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,4Shoklo Malaria Research Unit (SMRU), Tak, Thailand
| | | | - Ampai Tanganuchitcharnchai
- 1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sutathip Jintawon
- 1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - François H Nosten
- 1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,4Shoklo Malaria Research Unit (SMRU), Tak, Thailand
| | - Nicholas P J Day
- 1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Daniel H Paris
- 1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Allen L Richards
- 5Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland.,6Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Kho KL, Koh FX, Hasan LIM, Wong LP, Kisomi MG, Bulgiba A, Nizam QNH, Tay ST. Rickettsial seropositivity in the indigenous community and animal farm workers, and vector surveillance in Peninsular Malaysia. Emerg Microbes Infect 2017; 6:e18. [PMID: 28400593 PMCID: PMC5457682 DOI: 10.1038/emi.2017.4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/13/2016] [Accepted: 11/21/2016] [Indexed: 12/20/2022]
Abstract
Rickettsioses are emerging zoonotic diseases that are often neglected in many countries in Southeast Asia. Rickettsial agents are transmitted to humans through exposure to infected arthropods. Limited data are available on the exposure of indigenous community and animal farm workers to the aetiological agents and arthropod vectors of rickettsioses in Peninsular Malaysia. Serological analysis of Rickettsia conorii and Rickettsia felis was performed for 102 individuals from the indigenous community at six rural villages and 87 workers from eight animal farms in Peninsular Malaysia in a cross-sectional study. The indigenous community had significantly higher seropositivity rates for R. conorii (P<0.001) and R. felis (P<0.001), as compared to blood donors from urban (n=61). Similarly, higher seropositivity rates for R. conorii (P=0.046) and R. felis (P<0.001) were noted for animal farm workers, as compared to urban blood donors. On the basis of the sequence analysis of gltA, ompA and ompB, various spotted fever group rickettsiae closely related to R. raoultii, R. heilongjiangensis, R. felis-like organisms, R. tamurae, Rickettsia sp. TCM1, R. felis, Rickettsia sp. LON13 and R. hulinensis were identified from tick/flea samples in animal farms, indigenous villages and urban areas. This study describes rickettsial seropositivity of the Malaysian indigenous community and animal farm workers, and provides molecular evidence regarding the presence of rickettsial agents in ticks/fleas infesting domestic animals in Peninsular Malaysia.
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Affiliation(s)
- Kai Ling Kho
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Fui Xian Koh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | - Li Ping Wong
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Masoumeh Ghane Kisomi
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Awang Bulgiba
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Quaza Nizamuddin Hassan Nizam
- Department of Veterinary Services, Ministry of Agriculture and Agro-Based Industry Malaysia, Federal Government Administrative Centre, 62630 Putrajaya, Malaysia
| | - Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Khan SA, Bora T, Chattopadhyay S, Jiang J, Richards AL, Dutta P. Seroepidemiology of rickettsial infections in Northeast India. Trans R Soc Trop Med Hyg 2016; 110:487-94. [PMID: 27618917 DOI: 10.1093/trstmh/trw052] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/02/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Resurgence of scrub typhus was reported in Northeast India in 2010 after a gap of 67 years since World War II. However, the presence of other rickettsial infections remained unknown from this region. A seroepidemiological investigation was undertaken in the scrub typhus affected areas from 2013-2015 in Assam, Arunachal Pradesh and Nagaland to assess the exposure to other rickettsial diseases besides scrub typhus. METHODS Samples were collected from people residing in scrub typhus reporting areas. Serology was performed by an indirect ELISA for the three rickettsial agents' viz., scrub typhus group orientiae (STGO), spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR). A sample with total net absorbance ≥1.000 was considered as positive. An entomological survey was also carried out in the affected areas. RESULTS Overall, 1265 human blood samples were collected, of which 30.8% (n=390), 13.8% (175) and 4.2% (53) had antibodies against STGO, SFGR and TGR respectively. Presence of antibodies against more than one of the rickettsial groups was also detected. Among the arthropods collected, chiggers of Leptotrombidium deleinse, fleas belonging to Ctenocephalides felis and Pulex irritans, ticks belonging to Rhipicephalus microplus, Haemaphysalis spp. were predominant. Candidatus Rickettsia senegalensis was detected in C. felis. CONCLUSIONS Our findings confirm wide circulation of rickettsial infections and their probable vectors in the northeast region of India.Accession numbers: KU163367, KU163368, KU499847, KU499848.
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Affiliation(s)
- Siraj Ahmed Khan
- Regional Medical Research Centre (ICMR), N.E. Region, Post Box no. 105, Dibrugarh-786001, Assam, India
| | - Trishna Bora
- Regional Medical Research Centre (ICMR), N.E. Region, Post Box no. 105, Dibrugarh-786001, Assam, India
| | | | - Ju Jiang
- Naval Medical Research Center, Silver Spring, Maryland 20910-7500 USA
| | - Allen L Richards
- Naval Medical Research Center, Silver Spring, Maryland 20910-7500 USA
| | - Prafulla Dutta
- Regional Medical Research Centre (ICMR), N.E. Region, Post Box no. 105, Dibrugarh-786001, Assam, India
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Mohd Zain SN, Amdan SASK, Braima KA, Abdul-Aziz NM, Wilson JJ, Sithambaran P, Jeffery J. Ectoparasites of murids in peninsular Malaysia and their associated diseases. Parasit Vectors 2015; 8:254. [PMID: 25924677 PMCID: PMC4422404 DOI: 10.1186/s13071-015-0850-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 04/12/2015] [Indexed: 11/30/2022] Open
Abstract
A considerable number of rat-borne ectoparasite studies have been conducted since the early 1930s in the Malayan Peninsula (now known as peninsular Malaysia). The majority of studies were field surveys and collections of specimens across the region, and were conducted primarily to catalogue the ectoparasite host distribution and discover novel species. This has generated a signification amount of information, particularly on the diversity and host distribution; other aspects such as morphology, host distribution and medical significance have also been investigated. Amongst the four main groups (mites, fleas, ticks, lice), rat-borne mites have received the most attention with a particular emphasis on chiggers, due to their medical importance. More recent studies have examined the distribution of ectoparasites in rats from different habitat type simplicating a high prevalence of zoonotic species infesting rat populations. Despite being capable of transmitting dangerous pathogens to human, the health risks of rat-borne ectoparasites appear to be small with no serious outbreaks of diseases recorded. Although an extensive number of works have been published, there remain gaps in knowledge that need to be addressed, such as, the distribution of under studied ectoparasite groups (listrophorids and myobiids), determining factors influencing infestation, and understanding changes to the population distribution over time.
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Affiliation(s)
- Siti Nursheena Mohd Zain
- Institute of Biological Sciences, Faculty of Sciences, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Syed Arnez Syed Khalil Amdan
- Yayasan Peneraju Pendidikan Bumiputera, 15-1, Mercu UEM, Jalan Stesen Sentral 5, Kuala Lumpur Sentral, 50470, Kuala Lumpur, Malaysia.
| | - Kamil A Braima
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Noraishah M Abdul-Aziz
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - John-James Wilson
- Institute of Biological Sciences, Faculty of Sciences, University Malaya, 50603, Kuala Lumpur, Malaysia. .,Museum of Zoology, Institute of Biological Sciences, Faculty of Sciences, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | | | - John Jeffery
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Mariana A, Mohd KB, Halimaton I, Suhaili ZA, Shahrul-Anuar MS, Nor ZM, Ho TM. Acarine ectoparasites of Panti Forest Reserve in Johore, Malaysia. Asian Pac J Trop Biomed 2015; 1:1-5. [PMID: 23569714 DOI: 10.1016/s2221-1691(11)60057-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 12/27/2010] [Accepted: 12/28/2010] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To identify the presence of acarine ectoparasites and determine whether there is any potential public health risk in Panti Forest Reserve, Johore, Malaysia. METHODS Trapping of animals and avifauna was conducted simultaneously along 5 expedition trails using 150 wire traps, 10 harp traps and 30 mist nets for 6 consecutive nights. A total of 140 animals consisting of 7 species of birds, 19 species of bats, 6 species of rodents and 1 species of tree-shrew as well as 8 myriapods were examined. RESULTS Infestation rates of ticks, mesostigmatid mites and chiggers on animals examined were 24.3%, 28.6% and 27.9%, respectively. Infestation on bats was low (1.5%) and none occurred on birds. Majority of ticks extracted were at immature stages (78.9%). Genera of ticks on animals were Amblyomma, Dermacentor, Haemaphysalis and Ixodes. Ixodes granulatus was the only species of ticks identified from the animals. Examination of ticks under vegetation revealed 54% adults leading to identification of 3 species of ticks. A total of 7 species of mesostigmatid mites were found. 6 species were on rodent, Maxomys surifer and another one species, Laelaps nuttalli was found only on Leopoldamys sabanus. Laelaps sanguisugus was the only mesostigmatid found infesting tree-shrews. Seven genera of chiggers were identified. From this, 5 genera were on rodents, 4 genera on tree-shrews and 1 genus on a bat. CONCLUSIONS A total of 16 genera, 2 sub-genus and 14 species of acarine ectoparasites were found in this area. Findings of the survey demonstrate the presence of three spesies of acarine ectoparasites which have potential health risk i.e. Ixodes granulatus, Laelaps nuttalli and Leptotrombidium deliense.
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Affiliation(s)
- A Mariana
- Acarology Unit, Infectious Diseases Research Centre, Institute for Medical Research, 50588 Kuala Lumpur, Malaysia
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Premaratna R, Ariyaratna N, Attanayake C, Bandara W, Chandrasena N, de Silva HJ. Rickettsial infection among military personnel deployed in Northern Sri Lanka. BMC Infect Dis 2014; 14:3864. [PMID: 25527099 PMCID: PMC4335424 DOI: 10.1186/s12879-014-0688-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Military personnel deployed in field actvities report on frequent tick bites. Therefore they may run the risk of exposure to rickettsial organisms. Methods In order to assess the risk of exposure to rickettsial organisms, two groups of military personnel who were deployed in field activities of Nothern Sri Lanka were investigated. The first group was studied in order to assess the sero-prevalence of rickettsioses and consisted of soldiers who were admitted following injuries during field activities. The second group was studied to identify the incidence of acute rickettsioses during their acute febrile presentations. They were tested with IFA-IgG against spotted fever group rickettsioses (SFG), scrub typhus (ST) and murine typhus. Results In the first group, 48/57 (84%) military personnel had serological evidence of exposure to rickettsioses (in all, IFA-IgG titer ≥ 1:128): 33/50 (66%) to SFG rickettsioses, 1/50 (2%) to ST and 14/50 (28%) had mixed titers for both (in all, titers were higher for SFG). While all of them were in military uniform most of the time and frequently slept on scrub land, 35/57 (61.4%) had never used insect repellents and none were on doxycycline prophylaxis. 48/57 (84%) had experienced tick bites during field activity. In the second group, there were 49 who presented with acute febrile illness with a mean duration of 8.5 days (SD 3.2). 33/49 (67.3%) were serologically positive for acute rickettsioses (IgG ≥1:256); 26 (79%) due to ST and 7 (21%) due to SFG rickettsioses, Conclusions Exposure to rickettsial disease was common among soldiers who were deployed in Northern Sri Lanka. Scrub typhus was the predominent species accounting for acute febrile illness. Further studies are needed to understand the reasons for very high sero-prevalence for SFG rickettsioses with no anticedent febrile illness. Use of preventive measures was not satisfactory. The high sero-prevelence of SFG rickettsioses is likely to interfere with serological diagnosis of acute SFG rickettsioses in this population.
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Affiliation(s)
- Ranjan Premaratna
- Departments of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | | | | | - Wijesinghe Bandara
- Department of Microbiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Nilmini Chandrasena
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - H Janaka de Silva
- Departments of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
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Aung AK, Spelman DW, Murray RJ, Graves S. Rickettsial infections in Southeast Asia: implications for local populace and febrile returned travelers. Am J Trop Med Hyg 2014; 91:451-60. [PMID: 24957537 DOI: 10.4269/ajtmh.14-0191] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rickettsial infections represent a major cause of non-malarial febrile illnesses among the residents of Southeast Asia and returned travelers from that region. There are several challenges in recognition, diagnosis, and management of rickettsioses endemic to Southeast Asia. This review focuses on the prevalent rickettsial infections, namely, murine typhus (Rickettsia typhi), scrub typhus (Orientia tsutsugamushi), and members of spotted fever group rickettsiae. Information on epidemiology and regional variance in the prevalence of rickettsial infections is analyzed. Clinical characteristics of main groups of rickettsioses, unusual presentations, and common pitfalls in diagnosis are further discussed. In particular, relevant epidemiologic and clinical aspects on emerging spotted fever group rickettsiae in the region, such as Rickettsia honei, R. felis, R. japonica, and R. helvetica, are presented. Furthermore, challenges in laboratory diagnosis and management aspects of rickettsial infections unique to Southeast Asia are discussed, and data on emerging resistance to antimicrobial drugs and treatment/prevention options are also reviewed.
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Affiliation(s)
- Ar Kar Aung
- Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia
| | - Denis W Spelman
- Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia
| | - Ronan J Murray
- Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia
| | - Stephen Graves
- Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia
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Tay ST, Mohamed Zan HA, Lim YAL, Ngui R. Antibody prevalence and factors associated with exposure to Orientia tsutsugamushi in different aboriginal subgroups in West Malaysia. PLoS Negl Trop Dis 2013; 7:e2341. [PMID: 23936576 PMCID: PMC3731234 DOI: 10.1371/journal.pntd.0002341] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 06/16/2013] [Indexed: 11/19/2022] Open
Abstract
Background Limited data is available on the current status of scrub typhus infection in the aboriginal population in Malaysia. This study was aimed to provide recent data on the degree of exposure of 280 individuals from seven aboriginal subgroups to Orientia tsutsugamushi (causative agent of scrub typhus) in West Malaysia. The environment, socioeconomic and behavioural risk factors associated with the disease were also investigated. Methods/Findings The antibody prevalence to O. tsutsugamushi ranged from 0 to 36.4% in seven subgroups, with high prevalence rates noted in subgroups involved in agricultural activity and the lowest prevalence rates noted in subgroups whose main occupations were associated to fishing. Univariate analysis indicated populations with age above 18 years (OR = 1.15, 95% CI = 1.02–1.30, P = 0.015), working (OR = 1.99, 95% CI = 1.01–3.92, P = 0.044), working at agriculture area (OR = 1.18, 95% CI = 0.98–1.42, P = 0.031), receiving household income less than US$ 166.7 (RM500) per month (OR = 2.43, 95% CI = 1.16–5.11, P = 0.016) and having close contact with animal pets (OR = 4.06, 95% CI = 1.20–13.76, P = 0.016) are significantly associated with exposure to O. tsutsugamushi. Multivariate analysis confirms that participants who are above 18 years old, receiving household income less than US$ 166.7 (RM500) per month and having close contact with animal pets are 3.6 times (95% CI = 1.81–7.03, P<0.001), 1.3 times (95% CI = 1.14–1.64, P = 0.002) and 1.2 times (95% CI = 1.05–1.06, P = 0.006) more likely to have exposure to O. tsutsugamushi, respectively. Conclusion The present study indicates that scrub typhus is still an important disease in the aboriginal population in Malaysia. Awareness about the disease and education on the preventive measures are important in reducing the risk of acquiring scrub typhus in the population studied. Scrub typhus has been recognized as a public health problem in the rural areas of Southeast Asia. The aboriginal population, one of the most impoverished groups in the Malaysia, may be exposed to the bite of Leptotrombidium mites (vector for scrub typhus) due to their involvement in the agricultural activities, living environment and personal habits. A serosurvey was conducted for seven aboriginal subgroups to determine antibody prevalence to O. tsutsugamushi, the causative agent of scrub typhus and to identify factors associated with scrub typhus. The findings in this study confirmed high antibody prevalence to O. tsutsugamushi in aboriginal subgroups who engaged in agricultural activity. Multivariate analysis showed that individuals who are above 18 years old, receiving household income less than US$ 166.7 (RM500) per month and having close contact with animal pets have higher exposure rates to scrub typhus. Institution of appropriate preventive measures is important in reducing the risk of acquiring scrub typhus in the population studied.
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Affiliation(s)
- Sun Tee Tay
- Tropical Infectious Diseases Research and Education Centre, Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Yasunaga H, Horiguchi H, Kuwabara K, Hashimoto H, Matsuda S. Delay in tetracycline treatment increases the risk of complications in Tsutsugamushi disease: data from the Japanese Diagnosis Procedure Combination database. Intern Med 2011; 50:37-42. [PMID: 21212571 DOI: 10.2169/internalmedicine.50.4220] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Tsutsugamushi disease (scrub typhus) is caused by Orientia tsutsugamushi, and has been endemic in Asia and Western Pacific islands. Though sporadic case reports have described the clinical consequences of this vector-borne disease, data on the actual incidence of complications or mortality are scarce. It also remains unclear how a delay in effective treatments affects the occurrence of complications associated with this Rickettsial disease. METHODS Using the Japanese Diagnosis Procedure Combination inpatient database in Japan, we identified patients with Tsutsugamushi disease between July 1 and December 31 in 2007 and 2008. We examined location of hospitals, patient's age, sex, comorbidities, complications, inhospital deaths, date of admission, date of starting therapy with tetracyclines. A logistic regression was conducted to analyze the association between delay in effective treatments and the occurrence of complications. RESULTS A total of 210 cases were identified. Overall, 29 (13.8%) had at least one complication and two deaths were identified. Age was a significant risk factor for complications [odds ratio (OR), 1.48; 95% confidence interval (CI), 1.08-2.03; p=0.014, for a 10-year age increase]. Patients with ≥2 days delay in treatment with tetracyclines had a significantly higher risk of complications compared to those with no delay (OR, 2.71; 95% CI, 1.03-7.12; p=0.044). CONCLUSION Tsutsugamushi disease remains a threat to public health. Our study clearly indicates the importance of early diagnosis and immediate tetracycline treatment to prevent severe complications in Tsutsugamushi disease.
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Affiliation(s)
- Hideo Yasunaga
- Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Japan.
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