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Jian H, Yang QX, Duan JX, Lai SY, Che GL, Teng J, Chang L, Liu XJ, Luo LL, Liu F. mNGS helped diagnose scrub typhus-associated HLH in children: a report of two cases. Front Public Health 2024; 12:1321123. [PMID: 38784570 PMCID: PMC11111966 DOI: 10.3389/fpubh.2024.1321123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Background Scrub typhus, caused by the Orientia tsutsugamushi (Ot), is a widespread vector-borne disease transmitted by chigger mites. Hemophagocytic lymphohistiocytosis (HLH) is considered to be one of the potentially severe complications. The diagnosis of scrub typhus-associated HLH may be overlooked due to the non-specific clinical characteristics and the absence of pathognomonic eschar. Case presentation We obtained clinical data from two patients in the South of Sichuan, China. The first case involved a 6-year-old girl who exhibited an unexplained fever and was initially diagnosed with sepsis, HLH, and pulmonary infection. The other patient presented a more severe condition characterized by multiple organ dysfunction and was initially diagnosed with septic shock, sepsis, HLH, acute kidney injury (AKI), and pulmonary infection. At first, a specific examination for scrub typhus was not performed due to the absence of a characteristic eschar. Conventional peripheral blood cultures yielded negative results in both patients, and neither of them responded to routine antibiotics. Fortunately, the causative pathogen Orientia tsutsugamushi (Ot) was detected in the plasma samples of both patients using metagenomics next-generation sequencing (mNGS) and further confirmed by polymerase chain reaction. Subsequently, they both were treated with doxycycline and recovered quickly. Conclusion The unbiased mNGS provided a clinically actionable diagnosis for an uncommon pathogen-associated infectious disease that had previously evaded conventional diagnostic approaches.
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Affiliation(s)
- Hui Jian
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Qiu-xia Yang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Jia-xin Duan
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Shu-yu Lai
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Guang-lu Che
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Jie Teng
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Li Chang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Xiao-juan Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Li-li Luo
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
- Department of Pediatric Critical Care Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Fang Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
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Maharshi S, Gupta PK, Sharma KK, Pokharna R, Nijhawan S, Sharma SS. Scrub Typhus: An Acute Precipitant for Acute on Chronic Liver Failure. J Clin Exp Hepatol 2024; 14:101344. [PMID: 38322816 PMCID: PMC10840006 DOI: 10.1016/j.jceh.2024.101344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
Acute-on-chronic liver failure (ACLF) is a clinical syndrome with high mortality. Many acute precipitating factors have been implicated in triggering the acute event of ACLF, with bacterial infections being a common precipitant. However, many other precipitants can cause ACLF; therefore, identification of these factors early in the golden window and their treatment can result in improved prognosis. Scrub typhus usually presents as uncomplicated acute febrile illness but rarely as complicated. Few case reports of scrub-typhus-induced acute liver failure have been reported but none with scrub-typhus-precipitating ACLF so far. Therefore, we are reporting a case of scrub-typhus-precipitating ACLF, where timely intervention with antibiotics results in improved outcome.
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Affiliation(s)
- Sudhir Maharshi
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Pankaj K. Gupta
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Kamlesh K. Sharma
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Rupesh Pokharna
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
| | - Shyam S. Sharma
- Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India
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Ritu GP, Arif W, Sihag KK, Chakravarthi A, Anthony TN, Srinivasan L, Balakrishnan V, Kumar A, Ayanar E, Devaraju P. Comparative Evaluation of Different Tissues and Molecular Techniques for the Zoonotic Surveillance of Scrub Typhus. Vector Borne Zoonotic Dis 2024; 24:299-307. [PMID: 38181193 DOI: 10.1089/vbz.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Background and Objectives: Scrub typhus (ST) is detected in one-fourth of patients with acute febrile illnesses, confirming its nationwide re-emergence. The disease, if not diagnosed, can lead to multiple organ dysfunction and mortality. Being a vector-borne zoonotic disease, the molecular survey for pathogens in animal hosts is essential to predict the risk of its transmission to humans. Hence, this study aimed at identifying the effective animal tissue and molecular technique for zoonotic surveillance of ST infection in small animal hosts. Methods: Rodents/shrews were trapped from seventeen randomly selected villages in Puducherry between July and September, 2022. The presence of Orientia tsutsugamushi in ectoparasites and tissues including blood, lung, liver, spleen, kidney, heart, brain, and intestine retrieved from the animals was screened by nested PCR targeting 56 kDa, real-time PCR (qPCR) targeting 47 kDa and traD, and conventional PCR targeting groEL. The Weil-Felix test was carried out to detect antibodies against O. tsutsugamushi in rodent/shrew serum samples. Diagnostic accuracy measures of the molecular tests were calculated for each of the tissues by latent class modeling. Results: O. tsutsugamushi detected in the rodents/shrews were identified to be Karp-like and Kawasaki-like strains. Upon statistical analysis, qPCR targeting 47 kDa exhibited the highest accuracy measures in most of the tissues analyzed, with perfect sensitivity and specificity of 100% and 97% for intestine and lung samples for the epidemiological surveillance, respectively. Interpretation and Conclusion: The study recommends qPCR targeting 47 kDa gene and analysis of intestine and lung along with blood for the zoonotic surveillance of ST infection.
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Affiliation(s)
- Georgina Parren Ritu
- MSc. Public Health Entomology Student, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | - Waseema Arif
- Unit of One Health, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | - Krishan Kumar Sihag
- Unit of One Health, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | | | | | - Lakshmy Srinivasan
- Unit of One Health, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | | | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | - Elango Ayanar
- Unit of Vector Biology and Control, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
| | - Panneer Devaraju
- Unit of One Health, ICMR-Vector Control Research Centre, Indira Nagar, Puducherry
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Kim D, Cho YH, Bong JB, Kim YS, Shin BS, Kang HG. Acute ischemic stroke in Tsutsugamushi: understanding the underlying mechanisms and risk factors. BMC Neurol 2024; 24:42. [PMID: 38267851 PMCID: PMC10807141 DOI: 10.1186/s12883-024-03534-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Tsutsugamushi (scrub typhus) is an acute infectious febrile disease common in the Asia-Pacific region. Common symptoms of tsutsugamushi include lymphadenopathy, fever, and myalgia, and it rarely causes acute ischemic stroke (AIS). However, we hypothesized that tsutsugamushi infection could trigger AIS. METHOD We retrospectively examined patients diagnosed with AIS within 2 weeks of tsutsugamushi diagnosis at three hospitals over a 15-year period. We categorized patients who developed AIS while being treated for tsutsugamushi as the case group and those (of similar age and sex) who did not develop AIS as the control group. The case and control groups consisted of 22 and 66 participants, respectively. When a scattered pattern was observed or lesions were found in two or more vascular territories on diffusion-weighted imaging, the pattern was defined as embolic. Other patterns were defined as nonembolic. RESULTS Among the 19 patients, excluding three with transient ischemic stroke, 15 (78.9%) showed an embolic pattern. Although fever was common in the control group, it was less common in the case group. A higher D-dimer level at the time of hospitalization was associated with the development of AIS in patients with tsutsugamushi. CONCLUSIONS AIS in patients with tsutsugamushi showed an embolic rather than a non-embolic pattern on brain magnetic resonance imaging. It was more likely to occur in patients with risk factors for stroke. Tsutsugamushi patients with AIS were likely to have no fever or high D-dimer levels. We hypothesized that D-dimers play an important role in the pathophysiology, where tsutsugamushi infection increases the likelihood of AIS.
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Affiliation(s)
- Dain Kim
- Medical School, Jeonbuk National University, Jeonju, 54907, South Korea
| | - Yeon Hee Cho
- Medical School, Jeonbuk National University, Jeonju, 54907, South Korea
| | - Jeong Bin Bong
- Department of Neurology, Chosun University School of Medicine, Gwangju, 64153, South Korea
| | - Young Seo Kim
- Department of Neurology, Wonkwang University School of Medicine, Iksan, 54538, South Korea
| | - Byoung-Soo Shin
- Department of Neurology, Research Institute of Clinical Medicine of Jeonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju-si, 54907, Jeonbuk-do, South Korea
- Biomedical Research Institute, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonju, South Korea
| | - Hyun Goo Kang
- Department of Neurology, Research Institute of Clinical Medicine of Jeonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju-si, 54907, Jeonbuk-do, South Korea.
- Biomedical Research Institute, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonju, South Korea.
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Yadav B, Soni R, Biswal M, Suri V, Rohilla M. Clinical profile and outcomes of Scrub typhus in pregnant women presenting to a tertiary care hospital of North India. J OBSTET GYNAECOL 2023; 43:2141617. [PMID: 36428288 DOI: 10.1080/01443615.2022.2141617] [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: 11/27/2022]
Abstract
Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging endemic zoonosis in the Asia Pacific region. It is a febrile condition ranging in severity from mild to severe, with fatality rates as high as 30%. The present study aims towards analysing the clinical profile and pregnancy outcomes in 27 cases of scrub typhus admitted to a tertiary care centre in North India. The medical records of 27 pregnant women who had scrub typhus were analysed. The IgM ELISA was used to look for IgM antibodies to Orientia tsutsugamushi in the patient's serum sample. An optical density of more than or equal to 0.468 was considered as positive. Majority of the pregnant females delivered healthy and live babies. However, poor foetal outcomes were observed in four (14.8%) cases with intrauterine deaths occurring in two (7.4%) cases and still birth in one (3.7%) case, while one (3.7%) patient had spontaneous abortion. Maternal mortality was reported in one patient (3.7%) due to a delay in diagnosis. In endemic settings, a strong index of suspicion for scrub typhus is necessary in pregnant females presenting with fever. The key to reducing morbidity in both the mother and foetus is early diagnosis and treatment.Impact StatementWhat is already known on this subject? Scrub typhus is a febrile condition ranging in severity from mild to severe, with 30% mortality in untreated patients.What do the results of this study add? Majority of the pregnant females delivered healthy and live babies. However, poor foetal outcomes were observed in four (14.8%) cases with intrauterine deaths occurring in two (7.4%) cases and still birth in one (3.7%) case, while one (3.7%) patient had spontaneous abortion. Maternal mortality was reported in one patient (3.7%) due to a delay in diagnosis.What are the implications of these findings for clinical practice and/or further research? In endemic settings, a strong index of suspicion for scrub typhus is necessary for pregnant females presenting with fever. The key to reducing morbidity in both the mother and foetus is early diagnosis and treatment.
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Affiliation(s)
- Bhavana Yadav
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Ranu Soni
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics & Gynecology, PGIMER, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics & Gynecology, PGIMER, Chandigarh, India
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Kang KW, Hong KW, Lee SK. Identification of novel variants for complicating cardiac disease in the scrub typhus infection using whole genome sequencing. Korean J Intern Med 2023; 38:865-871. [PMID: 37939667 PMCID: PMC10636548 DOI: 10.3904/kjim.2023.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND/AIMS Scrub typhus infection has been known to complicate cardiovascular diseases mainly attributing to high mortality. Genetic susceptibility loci for complicating cardiac diseases such as atrial fibrillation, heart failure, and ischemic heart disease identified by genomic study have been limited in scrub typhus infection. Therefore, we investigated the genetic novel variants predicting complicating cardiac diseases in patients with confirmed scrub typhus infection using whole genome sequencing. METHODS We performed a prospective study for eight consecutive patients with scrub typhus infection. During follow-up, six cases were clinically diagnosed with complicating cardiac diseases and two controls without complicating cardiac diseases. The whole genomes of the all patients were sequenced, and the individual sequence variants were compared between accordcase and control patients. Variant genotypes were compared and identified as a single nucleotide polymorphism (SNP) of the different genotype distributions between six cases and two controls. RESULTS The GG genotype in SNP (rs4977397) of solute carrier 24 family member 2 (SLC24A2) gene and non-TT genotype in SNP (rs2676750) of adenosine deaminase, RNA specific, B2 (ADARB2) gene were distinctively found in the case patients with complicated cardiac disease, compared with control patents in the scrub typhus infection. CONCLUSION We suggest that the SNPs of SLC24A2 and ADARB2 might be genetic surrogate markers for complicating cardiac diseases in the scrub typhus infection. Our study show that early detection based on individual sequence variants might be feasible to predict complicating cardiac diseases in patients with scrub typhus infection, if further studies with more participants confirm these findings.
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Affiliation(s)
- Ki-Woon Kang
- Division of Cardiology, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul,
Korea
| | | | - Seong-Kyu Lee
- Division of Endocrinology, Department of Internal Medicine, Eulji University Hospital, Daejeon,
Korea
- Department of Biochemistry-Molecular Biology, Eulji University School of Medicine, Daejeon,
Korea
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7
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Kabir KI, Satapathy AK, Gullla KM, John J, Dwibedi B, Mahapatro S, Das RR. Macrolides versus other antibiotics in pediatric scrub typhus: A meta-analysis. Indian J Med Microbiol 2023; 46:100460. [PMID: 37945110 DOI: 10.1016/j.ijmmb.2023.100460] [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: 04/23/2023] [Revised: 07/02/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND While Doxycycline is the recommended drug for treating scrub typhus, there is a growing trend of using Macrolides and Other antibiotics due to their perceived advantages. In this study, we compared the efficacy of Macrolides versus Other antibiotics in the treatment of pediatric scrub typhus. METHODS Meta-analysis of randomized controlled trials (RCTs) with GRADE (Grading of Recommendations, Assessment, Development and Evaluation) application. Major databases were searched till 30th December 2022. Children of all age groups were included. Primary outcomes included mortality rate and time to defervescence (h). RESULTS Of the 103 citations retrieved, 5 trials, including 383 children up to 15 years of age with probable and confirmed cases of scrub typhus, were included. None of the trials reported mortality rate. The pooled results from the trials found no significant difference between Azithromycin and Other antibiotics for any of the outcome measures. The certainty of evidence for the primary outcome was deemed to be of "very low certainty", while the certainty of evidence for the secondary outcomes ranged from "low to moderate certainty". CONCLUSIONS The current meta-analysis revealed that there was no significant difference between Azithromycin and Other antibiotics (such as Doxycycline and Chloramphenicol) in the treatment of scrub typhus in children. However, it's important to note that the evidence generated for the primary outcome was of "very low certainty". PROSPERO REGISTRATION NUMBER CRD42021276577.
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Affiliation(s)
| | | | | | - Joseph John
- Department of Pediatrics, AIIMS, Bhubaneswar, 751019, India.
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Bansal SB, Ramasubramanian V, Prasad N, Saraf N, Soman R, Makharia G, Varughese S, Sahay M, Deswal V, Jeloka T, Gang S, Sharma A, Rupali P, Shah DS, Jha V, Kotton CN. South Asian Transplant Infectious Disease Guidelines for Solid Organ Transplant Candidates, Recipients, and Donors. Transplantation 2023; 107:1910-1934. [PMID: 36749281 DOI: 10.1097/tp.0000000000004521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
These guidelines discuss the epidemiology, screening, diagnosis, posttransplant prophylaxis, monitoring, and management of endemic infections in solid organ transplant (SOT) candidates, recipients, and donors in South Asia. The guidelines also provide recommendations for SOT recipients traveling to this region. These guidelines are based on literature review and expert opinion by transplant physicians, surgeons, and infectious diseases specialists, mostly from South Asian countries (India, Pakistan, Bangladesh, Nepal, and Sri Lanka) as well as transplant experts from other countries. These guidelines cover relevant endemic bacterial infections (tuberculosis, leptospirosis, melioidosis, typhoid, scrub typhus), viral infections (hepatitis A, B, C, D, and E; rabies; and the arboviruses including dengue, chikungunya, Zika, Japanese encephalitis), endemic fungal infections (mucormycosis, histoplasmosis, talaromycosis, sporotrichosis), and endemic parasitic infections (malaria, leishmaniasis, toxoplasmosis, cryptosporidiosis, strongyloidiasis, and filariasis) as well as travelers' diarrhea and vaccination for SOT candidates and recipients including travelers visiting this region. These guidelines are intended to be an overview of each topic; more detailed reviews are being published as a special supplement in the Indian Journal of Transplantation .
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Affiliation(s)
- Shyam Bihari Bansal
- Department of Nephrology and Kidney Transplantation, Medanta Institute of Kidney and Urology Medanta-Medicity, Gurgaon, India
| | | | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neeraj Saraf
- Department of Hepatology, Medanta, Medicity, Gurgaon, India
| | - Rajeev Soman
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, and Hospital, Hyderabad, India
| | - Vikas Deswal
- Department of Infectious Diseases, Medanta, Medicity, Gurgaon, India
| | - Tarun Jeloka
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujrat, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, PGIMER, Chandigarh, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dibya Singh Shah
- Department of Nephrology and Transplant Medicine, Institute of Medicine, Tribhuvan University of Teaching hospital, Kathmandu, Nepal
| | | | - Camille Nelson Kotton
- Transplant and Immunocompromised Host Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Silva-Ramos CR, Faccini-Martínez ÁA, Serna-Rivera CC, Mattar S, Hidalgo M. Etiologies of Zoonotic Tropical Febrile Illnesses That Are Not Part of the Notifiable Diseases in Colombia. Microorganisms 2023; 11:2154. [PMID: 37763998 PMCID: PMC10535066 DOI: 10.3390/microorganisms11092154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 09/29/2023] Open
Abstract
In Colombia, tropical febrile illnesses represent one of the most important causes of clinical attention. Febrile illnesses in the tropics are mainly zoonotic and have a broad etiology. The Colombian surveillance system monitors some notifiable diseases. However, several etiologies are not monitored by this system. In the present review, we describe eleven different etiologies of zoonotic tropical febrile illnesses that are not monitored by the Colombian surveillance system but have scientific, historical, and contemporary data that confirm or suggest their presence in different regions of the country: Anaplasma, Arenavirus, Bartonella, relapsing fever group Borrelia, Coxiella burnetii, Ehrlichia, Hantavirus, Mayaro virus, Orientia, Oropouche virus, and Rickettsia. These could generate a risk for the local population, travelers, and immigrants, due to which they should be included in the mandatory notification system, considering their importance for Colombian public health.
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Affiliation(s)
- Carlos Ramiro Silva-Ramos
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
| | - Álvaro A. Faccini-Martínez
- Servicio de Infectología, Hospital Militar Central, Bogotá 110110, Colombia;
- Servicios y Asesorías en Infectología—SAI, Bogotá 110110, Colombia
| | - Cristian C. Serna-Rivera
- Grupo de Investigación en Ciencias Veterinarias (CENTAURO), Línea de Investigación Zoonosis Emergentes y Re-Emergentes, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín 050034, Colombia;
- Grupo de Investigación en Genética, Biodiversidad y Manejo de Ecosistemas (GEBIOME), Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Universidad de Caldas, Manizales 170004, Colombia
| | - Salim Mattar
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería 230001, Colombia;
| | - Marylin Hidalgo
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
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Mukhopadhyay S, Gupta R, Shukla S, Bhattacharjee P, Bhatnagar R, Yadav S, Kamal SF, Virk A, Imran S, Liyakath A. Once Forgotten Now Re-emerging: Scrub Typhus Infection in Pediatric Patients From North West India. Cureus 2023; 15:e44044. [PMID: 37746469 PMCID: PMC10517703 DOI: 10.7759/cureus.44044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Background Scrub typhus is an important cause of acute febrile illness in children. It is one of the re-emerging infections in the Asia Pacific region. It is caused by the gram-negative bacteria Orientia tsutsugamushi and is spread by the bite of trombiculid mites. The initial symptomatology is nonspecific with fever, headache, vomiting, etc. The presence of eschar is said to be pathognomic. It is a systemic illness, and vasculitis is the basic pathogenic mechanism. Materials and methods A retrospective observational study was conducted in two medical colleges and associated hospitals of western Uttar Pradesh (UP) and Rajasthan, India. Case files of 21 confirmed cases of scrub typhus admitted from April 2021 to October 2022 were reviewed. Scrub typhus was suspected in children with acute undifferentiated fever, and suggestive signs and symptoms were confirmed serologically with IgM enzyme-linked immunoassay (ELISA). Demographic and clinical details were noted. Results During the study period, a total of 335 cases of acute undifferentiated fever were seen, and 6.2% of them were diagnosed as having scrub typhus infection on detailed investigation. The most common symptom was fever in 100% of them, vomiting in 57.1%, abdomen pain in 42.8%, and diarrhea in 19%. Maculopapular, erythematous rash was present in 19% of cases. None of the patients had eschar. Microvascular leakage was the main complication in 28.5%. Unusual complications seen were empyema and valvulitis in 4.7% of patients. Conclusion Scrub typhus is also seen in urban setups and in dry arid areas like Rajasthan and North West UP. So, relevant investigations should be a part of the evaluation in pediatric patients with acute undifferentiated fever. Eschar can be absent, and empyema and valvulitis are some uncommon complications. A high degree of suspicion and early diagnosis are essential as an undiagnosed infection is rapidly fatal.
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Affiliation(s)
| | - Rakesh Gupta
- Pediatrics, Government Institute of Medical Sciences, Greater Noida, IND
| | - Shalini Shukla
- Pathology and Laboratory Medicine, Government Institute of Medical Sciences, Greater Noida, IND
| | | | - Ruchika Bhatnagar
- Pediatrics, Government Institute of Medical Sciences, Greater Noida, IND
| | - Sanju Yadav
- Paediatrics, Government Institute of Medical Sciences, Greater Noida, IND
| | | | - Arashdeep Virk
- Pediatrics, Ananta Institute of Medical Sciences and Research, Rajsamand, IND
| | - Shazmeen Imran
- Paediatrics, Government Institute of Medical Sciences, Greater Noida, IND
| | - Azhar Liyakath
- Pediatrics, Government Institute of Medical Sciences, Greater Noida, IND
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11
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John KJ, George TK, Joy M, John B, Abraham O, Prasad J. Costs & outcomes of hospitalized scrub typhus infection in a tertiary hospital in south India. Indian J Med Res 2023; 157:559-567. [PMID: 37530311 PMCID: PMC10466492 DOI: 10.4103/ijmr.ijmr_3917_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 07/08/2023] Open
Abstract
Background & objectives Scrub typhus is a rickettsial infection seen along the Asian-Pacific rim and imposes a considerable burden on affected people in low- and middle-income countries. The present study was aimed to determine the direct cost of hospitalization of scrub typhus and its trend over six years. Methods This was a retrospective, observational, hospital based study of individuals admitted to the hospital, diagnosed with scrub typhus over six years, from January 2013 to December 2018. The potential out of pocket expenditure was evaluated. Results A total of 198 patients were included in the study. The median cost of admission (adjusted to INR 2020) for the six years (2013 to 2018) was found to be ₹ 37,026 (US $ 490) [interquartile range (IQR) 22,996-64,992]. The median cost for patients admitted to the intensive care unit (ICU) was ₹ 128,046 (US $ 1695) (IQR 71,575-201,171), while the cost for patients admitted to the ward-alone was ₹ 33,232 (US $ 440) (IQR 19,609-45,373). The multivariable analysis showed that ARDS and SOFA score were the independent predictors of ICU admission. Interpretation & conclusions Hospitalisation for scrub typhus is associated with a substantial healthcare expense. The predictors of increased cost were the presence of acute respiratory distress syndrome (ARDS), shock, increasing sequential organ failure assessment (SOFA) score and duration of hospital stay.
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Affiliation(s)
- Kevin John John
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tarun K. George
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Melvin Joy
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bimi John
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - O.C. Abraham
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jasmine Prasad
- Department of Community Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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12
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Huang X, Xie B, Long J, Chen H, Zhang H, Fan L, Chen S, Chen K, Wei Y. Prediction of risk factors for scrub typhus from 2006 to 2019 based on random forest model in Guangzhou, China. Trop Med Int Health 2023. [PMID: 37230481 DOI: 10.1111/tmi.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Scrub typhus is an increasingly serious public health problem, which is becoming the most common vector-borne disease in Guangzhou. This study aimed to analyse the correlation between scrub typhus incidence and potential factors and rank the importance of influential factors. METHODS We collected monthly scrub typhus cases, meteorological variables, rodent density (RD), Normalised Difference Vegetation Index (NDVI), and land use type in Guangzhou from 2006 to 2019. Correlation analysis and a random forest model were used to identify the risk factors for scrub typhus and predict the importance rank of influencing factors related to scrub typhus incidence. RESULTS The epidemiological results of the scrub typhus cases in Guangzhou between 2006 and 2019 showed that the incidence rate was on the rise. The results of correlation analysis revealed that a positive relationship between scrub typhus incidence and meteorological factors of mean temperature (Tmean ), accumulative rainfall (RF), relative humidity (RH), sunshine hours (SH), and NDVI, RD, population density, and green land coverage area (all p < 0.001). Additionally, we tested the relationship between the incidence of scrub typhus and the lagging meteorological factors through cross-correlation function, and found that incidence was positively correlated with 1-month lag Tmean , 2-month lag RF, 2-month lag RH, and 6-month lag SH (all p < 0.001). Based on the random forest model, we found that the Tmean was the most important predictor among the influential factors, followed by NDVI. CONCLUSIONS Meteorological factors, NDVI, RD, and land use type jointly affect the incidence of scrub typhus in Guangzhou. Our results provide a better understanding of the influential factors correlated with scrub typus, which can improve our capacity for biological monitoring and help public health authorities to formulate disease control strategies.
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Affiliation(s)
- Xiaobin Huang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Binbin Xie
- Department of Surveillance and Control, Hainan Tropical Diseases Research Center, Haikou, China
| | - Jiali Long
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Haiyan Chen
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Hao Zhang
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Lirui Fan
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Shouyi Chen
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Kuncai Chen
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yuehong Wei
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
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13
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Khatri P, Upadhyaya A, Kandel N, Upadhyaya S, Panth H. HLA-B27 Negative Reactive Monoarthritis of the Hip Joint Triggered by Scrub Typhus: A Case Report. JNMA J Nepal Med Assoc 2023; 61:475-478. [PMID: 37203900 PMCID: PMC10896433 DOI: 10.31729/jnma.8153] [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: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
Scrub typhus is common in rural Nepal's southern plains, but its diagnosis remains difficult due to a lack of clinical suspicion and poor diagnostic resources. The absence of common manifestations of the condition including eschar might further complicate this problem and may result in treatment delays. We report a case of scrub typhus with the primary presentation of reactive monoarthritis of the left hip joint in a 19-year-old male who presented with difficulty in walking, and pain over the left hip joint. Ultrasonography of the left hip and thigh showed features of synovitis and iliopsoas bursitis. After a meticulous workup, a diagnosis of human leukocyte antigen B27 negative reactive monoarthritis of the left hip joint triggered by scrub typhus infection was made and the patient was treated with doxycycline. Delays in treatment and the rate of complications can be prevented with high clinical suspicion and awareness of the atypical presentation of the condition. Keywords HLA-B27; case reports; reactive arthritis; scrub typhus.
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Affiliation(s)
- Prabin Khatri
- Department of Clinical Immunology and Rheumatology, Medanta Institute of Education & Research, Gurugram, Haryana, India
| | | | - Nirajan Kandel
- Sangla Primary Health Center, Tarkeshwor, Kathmandu, Nepal
| | | | - Himal Panth
- Arogya Multispecialty Healthcare and Diagnostic Center, Bhairahawa, Rupandehi, Nepal
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14
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Damodar T, Singh B, Prabhu N, Marate S, Gowda VK, Lalitha AV, Dsouza FS, Sajjan SV, Kariyappa M, Kinhal UV, Prathyusha PV, Desai A, Thennarasu K, Solomon T, Ravi V, Yadav R. Association of Scrub Typhus in Children with Acute Encephalitis Syndrome and Meningoencephalitis, Southern India. Emerg Infect Dis 2023; 29:711-722. [PMID: 36957990 PMCID: PMC10045701 DOI: 10.3201/eid2904.221157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Scrub typhus is an established cause of acute encephalitis syndrome (AES) in northern states of India. We systematically investigated 376 children with AES in southern India, using a stepwise diagnostic strategy for the causative agent of scrub typhus, Orientia tsutsugamushi, including IgM and PCR testing of blood and cerebrospinal fluid (CSF) to grade its association with AES. We diagnosed scrub typhus in 87 (23%) children; of those, association with AES was confirmed in 16 (18%) cases, probable in 55 (63%), and possible in 16 (18%). IgM detection in CSF had a sensitivity of 93% and specificity of 82% compared with PCR. Our findings suggest scrub typhus as an emerging common treatable cause of AES in children in southern India and highlight the importance of routine testing for scrub typhus in diagnostic algorithms. Our results also suggest the potential promise of IgM screening of CSF for diagnosis of AES resulting from scrub typhus.
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15
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Modi T, Sood T, Moudgil S, Arora N. Neurological manifestations of scrub typhus: encephalitis and Guillain-Barré syndrome (GBS). BMJ Case Rep 2023; 16:e253350. [PMID: 36990652 PMCID: PMC10069484 DOI: 10.1136/bcr-2022-253350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Scrub typhus is a tropical febrile illness that mainly affects rural populations in tropical and subtropical countries. It can range in severity from a mild febrile illness to multisystem involvement. Systemic dysfunction often appears in the second week of sickness, and hepatic, renal and brain involvement are well documented. Although encephalitis is the most frequent neurological ailment, a wide range of unusual complications involving the central and peripheral nervous systems have been identified-however, concomitant multiaxial involvement of the central and peripheral nervous systems is unique. We report a case of a young man with serologically confirmed scrub typhus presenting with fever, eschar, altered sensorium and progressive quadriplegia with hyporeflexic deep tendon reflexes. MRI revealed changes suggestive of encephalitis, and there was evidence of axonopathy on nerve conduction studies. A diagnosis of scrub typhus encephalitis with concomitant Guillain-Barré syndrome was made. He received doxycycline and intravenous immunoglobulin therapy, in addition to supportive treatment.
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Affiliation(s)
- Tanish Modi
- Department of Internal Medicine, GMCH, Chandigarh, India
| | - Tina Sood
- Department of Internal Medicine, GMCH, Chandigarh, India
| | | | - Navneet Arora
- Department of Internal Medicine, PGIMER, Chandigarh, India
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16
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Warrell CE, Osborne J, Mrcp LN, Gibney B, Carter DP, Warner J, Houlihan CF, Brooks TJG, Rampling T. Imported Rickettsial Infections to the United Kingdom, 2015-2020. J Infect 2023; 86:446-452. [PMID: 36948252 DOI: 10.1016/j.jinf.2023.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The burden of imported rickettsial infection in the UK is not previously described. This retrospective review identifies rickettsial cases diagnosed at the national reference laboratory between 2015-2022. METHODS Samples testing positive for spotted fever group, typhus group and scrub typhus IgG/IgM on acute and convalescent blood samples, and/or PCR on tissue/blood were categorised as suspected, confirmed or past infection. RESULTS 220 patients had rickettsioses, the commonest import was acute spotted fever group infection (61%, 125/205), 54% (62/114) from South Africa. Acute typhus group cases, 60% (40/67) from Southeast Asia. One patient with Rickettsia typhi bacteremia died. Scrub typhus group infections (5%, 10/205) were exclusively from Asia and the Western Pacific regions. Overall, 43% of confirmed cases (39/91) had not received doxycycline prior to results. CONCLUSIONS Rickettsial infections are important and under-recognised causes of imported fever in the UK. Thorough history, examination and timely treatment with doxycycline should be considered if there is suspicion of Rickettsia infection before testing.
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Affiliation(s)
- Clare E Warrell
- Rare and Imported Pathogens Laboratory, Salisbury, UK; London School of Hygiene and Tropical Medicine, London, UK.
| | - Jane Osborne
- Rare and Imported Pathogens Laboratory, Salisbury, UK
| | | | - Barry Gibney
- Rare and Imported Pathogens Laboratory, Salisbury, UK
| | | | | | - Catherine F Houlihan
- Rare and Imported Pathogens Laboratory, Salisbury, UK; Hospital for Tropical Diseaess, London, UCLH, UK; Department of Clinical Virology UCLH, UK; Infection and Immunity, University College London, United Kingdom
| | | | - Tommy Rampling
- Rare and Imported Pathogens Laboratory, Salisbury, UK; Hospital for Tropical Diseaess, London, UCLH, UK; Infection and Immunity, University College London, United Kingdom
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17
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A Case Report. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Parai D, Pattnaik M, Kshatri JS, Rout UK, Peter A, Nanda RR, Sahoo SK, Mansingh A, Choudhary HR, Dash GC, Praharaj I, Bhattacharya D, Pati S. Scrub typhus seroprevalence from an eastern state of India: findings from the state-wide serosurvey. Trans R Soc Trop Med Hyg 2023; 117:22-27. [PMID: 35947959 DOI: 10.1093/trstmh/trac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/30/2022] [Accepted: 07/29/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Scrub typhus is a mite-borne infectious disease caused primarily by the obligate intracellular bacteria Orientia tsutsugamushi, which is transmitted by chigger mites. The objective of this study was to determine the prevalence of scrub typhus among adults in Odisha, an eastern state of India. METHODS A descriptive cross-sectional study was conducted to analyse 1840 serum samples from five districts (Khordha, Cuttack, Ganjam, Malkangiri and Sundargarh) of Odisha collected during 2020-2021. Both immunoglobulin G (IgG) and IgM antibodies against scrub typhus were tested using commercial enzyme-linked immunosorbent assay kits. Point estimates of the 95% confidence interval and adjusted odds ratio were calculated. RESULTS Of 1840 participants, the prevalence of IgG positivity was 1034 (56.19%) and that of IgM was 523 (28.42%). The majority of participants were in the 18-45 y age group (53.7%). Cuttack had the highest IgG positivity (64.54%) and Malkangiri had the lowest (29.32%). The highest and lowest positivity for IgM were found in Malkangiri (40.84%) and Cuttack (25.30%), respectively. CONCLUSIONS With an increasing number of infections detected in the state, scrub typhus is emerging as a public health threat. Increasing awareness among the general public and healthcare professionals through health education campaigns regarding scrub typhus is essential. Early detection of the disease through the establishment of a laboratory surveillance system is required to control the transmission of scrub typhus.
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Affiliation(s)
- Debaprasad Parai
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Matrujyoti Pattnaik
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Jaya Singh Kshatri
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Usha Kiran Rout
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Annalisha Peter
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Rashmi Ranjan Nanda
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Subrat Kumar Sahoo
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Asit Mansingh
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Hari Ram Choudhary
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Girish Chandra Dash
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Ira Praharaj
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Debdutta Bhattacharya
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
| | - Sanghamitra Pati
- Department of Microbiology, Indian Council of Medical Research-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar 751023, India
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19
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Bhandari M, Singh RK, Laishevtcev A, Mohapatra TM, Nigam M, Mori E, Vasconcelos de Lacerda BCG, Coutinho HDM, Mishra AP. Revisiting scrub typhus: A neglected tropical disease. Comp Immunol Microbiol Infect Dis 2022; 90-91:101888. [PMID: 36252451 DOI: 10.1016/j.cimid.2022.101888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/18/2022] [Accepted: 09/29/2022] [Indexed: 02/08/2023]
Abstract
Scrub typhus is an under diagnosed re-emerging vector borne disease caused by an intracellular gram negative bacteria, Orientia. The disease is commonly prevalent in rural and hilly areas of Tsutsugumashi triangle. The diagnosis of the disease is very challenging due to similarity of its early symptoms with other febrile illnesses, like dengue and COVID 19, as well as non-availability of rapid, reliable and cost-effective methods. Moreover, the diverse clinical presentation in severe cases make it significant health problem. The occupational and behavioral risks responsible for the transmission lead to urgent need of vaccine development against the disease. The complete knowledge about its pathogenesis and the interaction with host's immune cells may help the scientists in developing the appropriate diagnostic methods as well as the vaccines.
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Affiliation(s)
- Munni Bhandari
- Department of Microbiology, School of Life Sciences, Hemvati Nandan Bahuguna Garhwal University, Srinagar (Garhwal) 246174, India.
| | - Rahul Kunwar Singh
- Department of Microbiology, School of Life Sciences, Hemvati Nandan Bahuguna Garhwal University, Srinagar (Garhwal) 246174, India.
| | - Alexey Laishevtcev
- Federal Research Center - All-Russian Scientific Research Institute of Experimental Veterinary Medicine named after K.I. Skryabin and Y.R. Kovalenko of the Russian Academy of Sciences, Moscow, Russia; Laboratory of Biocontrol and Antimicrobial Resistance, Orel State, University Named After I.S. Turgenev, Orel, Russia.
| | - Tribhuvan Mohan Mohapatra
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Manisha Nigam
- Department of Biochemistry, Hemvati Nandan Bahuguna Garhwal University, Srinagar Garhwal-246174, Uttarakhand, India.
| | - Edna Mori
- CECAPE - College of Dentistry, Av. Padre Cícero, 3917, Juazeiro do Norte, São José CE 63024-015, Brazil.
| | | | | | - Abhay Prakash Mishra
- Department of Pharmacology, Faculty of Health Science, University of Free State, Bloemfontein 9300, South Africa.
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Kala D, Sharma TK, Gupta S, Saini RV, Saini AK, Alsanie WF, Thakur VK, Kaushal A. Development of paper-based DNA sensor for detection of O. tsutsugamushi using sustainable GQDs@AuNPs nanocomposite. CHEMOSPHERE 2022; 300:134428. [PMID: 35395271 DOI: 10.1016/j.chemosphere.2022.134428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
The graphene quantum dots (GQDs) was synthesized using potato starch and water by hydrothermal method and further used for reduction of tetracholoroauric acid to form graphene quantum dots-gold (GQDs@AuNPs) nanocomposite. The GQDs/GQDs@AuNPs were analyzed using FTIR, UV-Vis, Flourometry and HR-TEM. The synthesized GQDs@AuNPs were further used for fabrication of cost-effective screen-printed paper electrode (SPPE) based DNA sensor for the detection of O. tsutsugamushi using htrA gene specific 5'NH2 linked DNA probe. Modification of SPPE using GQDs@AuNPs nanocomposite and ssDNA probe was monitored using EIS, FTIR, FE-SEM and AFM. The sensor detection limit (LOD) was assessed as 0.002 ng/μl from the standard calibration curve with the correlation coefficient, R2 = 0.993. The sensitivity of the DNA sensor was calculated as 7700 μA/cm2/ng for ssGDNA of O. tsutsugamushi using cyclic voltammetry. The sensor validation was done using scrub typhus patient's blood DNA samples. The sensor showed good storage stability at 4 °C for six months with just a loss of 12% of the initial current values. The SPPE/DNA sensor developed is very specific, sensitive, stable and detects O. tsutsugamushi in less time.
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Affiliation(s)
- Deepak Kala
- Amity Center of Nanotechnology, Amity University, Haryana, 122413, India; Department of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, 140413, India
| | - Tarun Kumar Sharma
- Department of Medical Biotechnology, Gujarat Biotechnology University (GBU), Gujarat International Finance and Tec (GIFT) City. Gandhinagar, Gujarat, 382355, India
| | - Shagun Gupta
- Department of Biotechnology, Maharishi Markandeshwar University, Mullana, Ambala, 134003, India
| | - Reena V Saini
- Department of Biotechnology, Maharishi Markandeshwar University, Mullana, Ambala, 134003, India
| | - Adesh K Saini
- Department of Biotechnology, Maharishi Markandeshwar University, Mullana, Ambala, 134003, India
| | - Walaa F Alsanie
- Department of Clinical Laboratories Sciences, The Faculty of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Vijay Kumar Thakur
- Biorefining and Advances Materials Research Centre, SRUC (Scotland's Rural College), Kings Buildings, Edinburgh, EH9 3JG, UK; School of Engineering, University of Petroleum and Energy Studies (UPES), Dehradun, 248007, India
| | - Ankur Kaushal
- Amity Center of Nanotechnology, Amity University, Haryana, 122413, India; Department of Biotechnology, Maharishi Markandeshwar University, Mullana, Ambala, 134003, India.
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Bhandari S, Bhandari S, Gautam K, Jha R, Devkota S. Meningeal Signs and Cerebellar Involvement in Scrub Typhus: A Case Report. Cureus 2022; 14:e25708. [PMID: 35812590 PMCID: PMC9270076 DOI: 10.7759/cureus.25708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/05/2022] Open
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22
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Gurung S, Karki S, Pokharel S, Bhatta K. Scrub typhus in a primary health care center of Nepal: A case series. Ann Med Surg (Lond) 2022; 75:103490. [PMID: 35386785 PMCID: PMC8978104 DOI: 10.1016/j.amsu.2022.103490] [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] [Received: 01/28/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Scrub typhus is endemic in most parts of Southeast Asia including Nepal. Fever, rash, headache, myalgia, eschar are the common clinical features. Though endemic, scrub typhus is grossly underdiagnosed in our country due to the lack of diagnostic tools and non-specific presentation of the disease. Here we present a series of 23 cases of scrub typhus from a primary healthcare center of Nepal. Method This is a retrospective case series done among 23 patients diagnosed with scrub typhus and admitted to Aaruchanaute Primary health care center between August 15, 2021 to September 14, 2021. Epidemiological, clinical features and clinical outcomes of all the patients are described. Results Among 23 patients admitted to the primary health care center,78% were of age group 20–60 with 47% male patients. Fever was reported by all patients followed by headache (65%), cough (43%) and eschar (8%). All patients were diagnosed by rapid diagnostic kit. 95% of patients had complete recovery whereas 1 patient was referred to a higher center due to complications he developed during the period of hospital stay. Conclusion We conclude that when a patient presents with fever and eschar, there should be a high index of suspicion for scrub typhus, though eschar may not be present in many of the cases. Early diagnosis and prompt treatment with antibiotics is the key as the disease entity shows a good response to treatment while preventing potentially fatal complications. Scrub typhus is a mite-borne, acute, febrile illness caused by Orientia tsutsugamushi. Fever, rash, headache, myalgia, gastrointestinal symptoms and eschar are the usual clinical presentation. Mostly underdiagnosed in Nepal because of lack of specialized diagnostic tools. Can also be missed while trying to exclude COVID-19 during this pandemic. This case series analyses the clinical presentation and management in a resource-limited setting.
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Affiliation(s)
- Shekhar Gurung
- Aaruchanaute Primary Health Care Center, Aarughat, Gorkha, Nepal
| | - Saurab Karki
- Military Hospital Itahari, Sunsari, Nepal
- Corresponding author. Military Hospital, Itahari-4, Sunsari, Nepal.
| | | | - Kishor Bhatta
- Aaruchanaute Primary Health Care Center, Aarughat, Gorkha, Nepal
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23
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Hong K, Shu Z, Li L, Zhong Y, Chen W, Nong C, Kong J. Diagnostic Value of CD4/CD8 in Scrub Typhus. Am J Trop Med Hyg 2022; 106:792-797. [PMID: 34902835 PMCID: PMC8922489 DOI: 10.4269/ajtmh.21-0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/20/2021] [Indexed: 11/07/2022] Open
Abstract
Scrub typhus is often misdiagnosed in febrile patients, leading to antibiotic abuse and multiple complications. We conducted a retrospective record review at the Fourth Affiliated Hospital of Guangxi Medical University in China. Data were collected on 52 patients with a confirmed diagnosis of scrub typhus and complete clinical data. In addition, data were collected on 52 patients with bloodstream infection, 25 patients with HIV infection, 112 patients with common community-acquired pneumonia (CCAP), and 36 patients with severe community-acquired pneumonia (SCAP) to serve as control groups. The peripheral blood CD4 and CD8 counts, CD4/CD8 ratio, C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, and β2 microglobulin levels; and the white blood cell count and neutrophil percentage were compared between the scrub typhus and the control groups. The value of these biomarkers in the diagnosis of scrub typhus was assessed using receiver-operating characteristic curve analysis. The scrub typhus group had a significantly lower CD4 count and CD4/CD8 ratio than the bloodstream infection, CCAP, and SCAP groups, and a significantly greater CD4 count and CD4/CD8 ratio than the HIV infection group. In contrast, the scrub typhus group had a significantly greater CD8 count than the bloodstream infection and CCAP and SCAP groups, and it had a lower level of CD8 than the HIV infection group. The areas under the curve of CD4/CD8 were more than 0.93 in the receiver-operating characteristic curve analysis. These findings suggest that the CD4/CD8 ratio is a useful ancillary test for diagnosing scrub typhus.
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Affiliation(s)
- Kangkang Hong
- Pulmonary and Critical Care Medicine Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China;,Department of Geriatric Medicine, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Ziping Shu
- Pulmonary and Critical Care Medicine Ward, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Laodong Li
- Pulmonary and Critical Care Medicine Ward, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Yu Zhong
- Department of Emergency, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Weiqian Chen
- Department of Geriatric Medicine, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Cunli Nong
- Department of Infectious Diseases, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Jinliang Kong
- Pulmonary and Critical Care Medicine Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China;,Address correspondence to Jinliang Kong, The First Affiliated Hospital of Guangzi Medical University, Shuangyong Rd., Nanning, China 540000. E-mail:
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Kabir KI, John J, Satapathy AK, Sahu S, Behera B, Padhy BM. Oral Azithromycin Versus Doxycycline in the Treatment of Children With Uncomplicated Scrub Typhus: A Randomized Controlled Trial. Pediatr Infect Dis J 2022; 41:224-229. [PMID: 34966141 DOI: 10.1097/inf.0000000000003372] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the efficacy of azithromycin versus doxycycline in treatment of children with uncomplicated scrub typhus in terms of percentage of children who attained remission of fever after 72 hours of administration of first dose of the study drug, mean time taken to attain fever defervescence, normalization of laboratory parameters, resolution of hepatosplenomegaly and lymphadenopathy. DESIGN Interventional, open-labeled randomized controlled trial. STUDY METHODS Patients admitted with undifferentiated fever in the In-Patient Department (IPD), Department of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, India, as per the inclusion criteria were randomized and was treated with azithromycin at 10 mg/kg/d in one group and doxycycline at 4.4 mg/kg/d for 5 days in the other group and was assessed based on the primary and secondary objectives. RESULTS There was no statistically significant difference between the percentage of children who attained remission of fever after 72 hours of administration of azithromycin (98.2%) and doxycycline (96.5%) (P value 0.47) and the average time taken for fever defervescence (azithromycin: 24.53 hours; doxycycline: 25.82 hours; P value 0.36). The odds of attaining fever remission in the doxycycline group as compared with the azithromycin group was 1.01 (95% confidence interval -0.60 to -1.71), which was also statistically not significant. There was less incidence of adverse drug events in the azithromycin group (1.78%) as compared with the doxycycline group (8.6%), which was statistically significant (P value 0.02). CONCLUSION Azithromycin is equally efficacious in terms of fever defervescence, resolution of clinical signs and laboratory parameters as doxycycline, is safer and better tolerated in children.
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Affiliation(s)
| | | | | | | | | | - Biswa Mohan Padhy
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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25
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Basukala S, Sharma S, Tamang A, Bhusal U. A suspected surgical case of acute abdomen: A case report of scrub typhus. Ann Med Surg (Lond) 2022; 74:103329. [PMID: 35145685 PMCID: PMC8818520 DOI: 10.1016/j.amsu.2022.103329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Scrub typhus presents with diverse clinical manifestations which range from sub-clinical disease to organ failure and fatal disease. Case presentation The patient presented with fever followed by acute abdominal pain and later developed septic shock with multi-organ failure. Radiological evaluations were normal, however, on thorough physical examination, an eschar was found in her right inguinal region. Clinical discussion Aside from classical clinical symptoms, it can also involve various organs, most commonly of respiratory, cardiovascular and hepatic systems. Additionally, suspected patients should be thoroughly examined for the presence of an eschar, especially over the covered areas such as the groin, genitalia, infra-mammary area and axilla. Conclusion Scrub typhus should be considered in all patients from an endemic area presenting as acute undifferentiated febrile illness associated with organ involvement. Positive finding of an eschar and high index of suspicion for the various presentations of scrub typhus can avoid unnecessary surgical exploration and aid in prompt diagnosis and treatment. The presentation of scrub typhus can either be non-specific, associated with pain abdomen or other organ dysfunction. It should be considered in all patients from an endemic area with acute undifferentiated febrile illness and organ involvement. Suspected patients should be thoroughly examined for the presence of an eschar, including the covered areas. High index of suspicion for its various presentations can avoid unnecessary surgical exploration and aid in prompt management.
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Affiliation(s)
- Sunil Basukala
- Department of Surgery, Shree Birendra Hospital (SBH), Kathmandu, Nepal
| | - Shriya Sharma
- College of Medicine, Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal
- Corresponding author.
| | - Ayush Tamang
- College of Medicine, Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal
| | - Ujwal Bhusal
- College of Medicine, Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal
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26
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Park H, Lim Y, Kim MC, Kim SE, Jeong IS, Choi YD, Kim DM. Case Report: Fulminant Myocarditis Successfully Treated With Extracorporeal Membrane Oxygenation in Ikeda Strain Orientia tsutsugamushi Infection. Front Cardiovasc Med 2022; 8:795249. [PMID: 35004906 PMCID: PMC8727758 DOI: 10.3389/fcvm.2021.795249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Scrub typhus is an acute zoonotic febrile illness caused by Orientia tsutsugamushi having a specific geographic endemic area. This infection could be complicated with multi-organ involvement including myocarditis with variable severity. Here, we report a rare case of scrub typhus with biopsy-proven acute fulminant myocarditis which progressed very rapidly to cardiac arrest and was treated successfully with extracorporeal cardiopulmonary resuscitation. Clinicians should be alert to possible rapid progression of scrub typhus myocarditis to fulminant form and be prepared for close monitoring and temporary mechanical support if indicated.
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Affiliation(s)
- Hyejin Park
- Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Medical Hospital, Gwangju, South Korea
| | - Yongwhan Lim
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Chonnam National University Medical Hospital, Gwangju, South Korea
| | - Min Chul Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Chonnam National University Medical Hospital, Gwangju, South Korea
| | - Seong Eun Kim
- Division of Infectious Disease, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Medical Hospital, Gwangju, South Korea
| | - In-Seok Jeong
- Department of Cardiothoracic Surgery, Chonnam National University Medical School, Chonnam National University Medical Hospital, Gwangju, South Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Dong-Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, South Korea
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Liu MF, Liu Y, Xu DR, Wan LG, Zhao R. mNGS helped diagnose scrub typhus presenting as a urinary tract infection with high D-dimer levels: a case report. BMC Infect Dis 2021; 21:1219. [PMID: 34876034 PMCID: PMC8650249 DOI: 10.1186/s12879-021-06889-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Scrub typhus is caused by O. tsutsugamushi and spreads through mite larvae biting the skin. Classic symptoms of the disease are eschar and lymphadenopathy. Previous reports have revealed clinical manifestations of scrub typhus, including gastrointestinal symptoms, meningoencephalitis, ocular flutter, pneumonitis, acute respiratory distress syndrome, and acute kidney injury. However, cases of scrub typhus presenting as a urinary tract infection (UTI) with high D-dimer levels could be easily misdiagnosed when clinical attention is insufficient, resulting in difficulty in making a timely diagnosis of the infection. Metagenomics next-generation sequencing (mNGS) is a revolutionary and highly sensitive method that may help in diagnosing atypical cases, even when trace amounts of pathogens are present. Case presentation A 52-year-old female presented with a 10-day history of fever, chills, headache and myalgia. She was initially diagnosed with influenza at a local clinic. Various antibacterials were used on the 2nd–12th day onwards; however, her symptoms persisted and were followed by increased urination duration, frequency, urgency and dysuria for 2 days. Orientia tsutsugamushi was confirmed as the pathogen responsible for the infection through mNGS analysis of her blood samples from Day 13 onwards. The patient’s temperature changed remarkably 24 h after the initiation of doxycycline. Over the next 48 h (i.e., Day 15 onwards), the patient showed clinical improvement. She recovered and was discharged from the hospital. Conclusions Scrub typhus can present atypical clinical symptoms, such as UTIs, in a febrile patient. mNGS may be a useful method for identifying O. tsutsugamushi infection in patients with atypical clinical manifestations.
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Affiliation(s)
- Mei-Fang Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yong Liu
- Department of Emergency, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - De-Rong Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China
| | - La-Gen Wan
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China.
| | - Rui Zhao
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People's Republic of China.
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28
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Liu X, Zhang Y, Zhang J, Lou Z, Xia H, Lu Z. The Early Diagnosis of Scrub Typhus by Metagenomic Next-Generation Sequencing. Front Public Health 2021; 9:755228. [PMID: 34858931 PMCID: PMC8632043 DOI: 10.3389/fpubh.2021.755228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: Scrub typhus is a mite-borne infection widespread in Southeast Asia, with clinical symptoms such as fever, chills, skin rash, eschar at the bite site, and other signs of acute febrile illness. The Rickettsia pathogen (Orientia tsutsugamushi) is always difficult to be diagnosed at an early stage by traditional clinical diagnostic methods, especially for patients without typical eschar. This greatly increases the mortality of patients with scrub typhus. A new approach should be introduced to improve its clinical diagnosis. Methods: During May 2018 to March 2021, 13 samples from 10 patients with suspected scrub typhus were collected. Metagenomic next-generation sequencing (mNGS) and other diagnostic methods (including serology using Weil–Felix reaction and indirect immunofluorescence test (IIFT) for scrub typhus and respiratory tract profile IgM as well as culture for routine bacteria) were used to identify the pathogens in this study. Results: The results of mNGS were all positive, with mapped reads of O. tsutsugamushi ranging from 1 to 460. Eight patients (80%) were diagnosed as scrub typhus. The other two were diagnosed as suspected scrub typhus due to the limited number of reads of the pathogen (one and two, respectively). According to clinical evidences, nine of the 10 patients were finally diagnosed as scrub typhus, except for patient 9 (suspected scrub typhus by mNGS with one specific reads of the pathogen) diagnosed as acute exacerbation of chronic obstructive pulmonary disease. For the five scrub typhus patients without typical eschar, mNGS gave all positive results (4–460 specific reads). For other methods, only Weil–Felix reaction of one patient detected the pathogen. In addition, the respiratory tract profile (IgM) detected various pathogens, but all were confirmed to be false positive. Conclusions: mNGS performed better than conventional clinical methods to early diagnose scrub typhus. This approach can be routinely carried out for early and precise diagnosis in clinical infections, especially for those hard to be identified by traditional diagnostic methods.
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Affiliation(s)
- Xianghong Liu
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
| | - Ye Zhang
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China
| | - Jun Zhang
- Emergency Department, Ganzhou People's Hospital, Ganzhou, China
| | - Zheng Lou
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China
| | - Han Xia
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China
| | - Zhijuan Lu
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, China
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Gautam J, Yadav RS, Shrestha S, Singh BM, Maharjan R. Scrub Typhus: Report of Three Cases From Rural Nepal and a Brief Literature Review. Cureus 2021; 13:e18376. [PMID: 34725620 PMCID: PMC8555355 DOI: 10.7759/cureus.18376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/29/2022] Open
Abstract
Scrub typhus is endemic among farmers in the rural southern part of Nepal. It is grossly underdiagnosed due to a lack of clinical suspicion and inadequate testing facilities. The most common clinical features of the disease include fever, rashes, vomiting, myalgia, and eschar. The disease may present with ocular changes such as conjunctival injection, gastrointestinal features such as hepatitis and splenomegaly, acute kidney injury (AKI), or neurological findings in the form of meningoencephalitis. Herein, we present a report of three cases of scrub typhus from a rural part of South-west Nepal who failed to receive appropriate treatment initially. One of the patients recovered well with the treatment, the other developed AKI but recovered over the next few weeks. One of the patients died due to sepsis/multiorgan failure secondary to scrub typhus. While managing such cases in places with limited diagnostic facilities, the incorporation of early appropriate empirical therapy for scrub typhus after a careful clinical assessment prevents complications and saves lives.
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Affiliation(s)
- Jeevan Gautam
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Randhir S Yadav
- Department of Pediatrics, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Shumneva Shrestha
- Department of Pediatrics, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Bishnu Mohan Singh
- Division of Clinical and Translational Research, Larkin Community Hospital, Miami, USA.,Internal Medicine, Hetauda City Hospital, Hetauda, NPL
| | - Renusha Maharjan
- Department of Surgical Nursing, Institute of Medcine, Kathmandu, NPL
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30
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Kim W, Lee SY, Kim SI, Sohng IK, Park SC, Jun S, Lee CS, Kim HY, Park EC. Identification of a Novel Antigen for Serological Diagnosis of Scrub Typhus. Am J Trop Med Hyg 2021; 105:1356-1361. [PMID: 34544047 DOI: 10.4269/ajtmh.20-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/29/2021] [Indexed: 11/07/2022] Open
Abstract
Scrub typhus is an acute infectious disease caused by the bacterium Orientia tsutsugamushi, which is widely distributed in northern, southern, and eastern Asia. Early diagnosis is essential because the average case fatality rate is usually >10% but can be as high as 45% if antimicrobial treatment is delayed. Although an O. tsutsugamushi 56-kDa type-specific antigen (TSA) is commonly used for serological diagnosis of scrub typhus, the 56-kDa TSA shows variations among O. tsutsugamushi strains, which may lead to poor diagnostic results. Therefore, the discovery of new antigenic proteins may improve diagnostic accuracy. In this study, we identified an O. tsutsugamushi 27 kDa antigen through an immunoinformatic approach and verified its diagnostic potential using patient samples. Compared with the O. tsutsugamushi 56-kDa antigen, the new 27-kDa antigen showed better diagnostic specificity with similar diagnostic sensitivity. Therefore, the O. tsutsugamushi 27-kDa antigen shows potential as a novel serological diagnostic antigen for scrub typhus, providing higher diagnostic accuracy for O. tsutsugamushi than the 56-kDa antigen.
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Affiliation(s)
- Wooyoung Kim
- Research Center for Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Republic of Korea.,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
| | - Sang-Yeop Lee
- Research Center for Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Republic of Korea.,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
| | - Seung Il Kim
- Research Center for Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Republic of Korea.,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea.,Department of Bio-Analysis Science, University of Science & Technology, Daejeon, Republic of Korea
| | - In-Kook Sohng
- Manufacture Business Division Curebio Ltd, Seoul, Republic of Korea
| | - Sun Cheol Park
- Research Center for Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Republic of Korea.,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
| | - Sangmi Jun
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea.,Center for Research Equipment, Korea Basic Science Institute, Cheongju, Republic of Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hye-Yeon Kim
- Research Center for Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Republic of Korea.,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea
| | - Edmond Changkyun Park
- Research Center for Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Republic of Korea.,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea.,Department of Bio-Analysis Science, University of Science & Technology, Daejeon, Republic of Korea
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Exploring Tropical Infections: A Focus on Scrub Typhus. Adv Skin Wound Care 2021; 33:550-552. [PMID: 32941229 DOI: 10.1097/01.asw.0000694148.60567.cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Scrub typhus is caused by Orientia tsutsugamushi and has a near global prevalence. It is associated with local and systemic manifestations that lead to morbidity and mortality. Given the nonspecific presentation of fever in a returning traveler, a high index of suspicion and thorough skin examination for eschar are critical to establishing a diagnosis. Early treatment is crucial to avoid severe outcomes, further highlighting the need to include scrub typhus in differential diagnosis. An accompanying narrative case explores the epidemiology, diagnosis, and management of scrub typhus.
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Thirteen-year-old Girl Presents With Kawasaki Disease-like Symptoms. Pediatr Infect Dis J 2021. [PMID: 34260487 DOI: 10.1097/inf.0000000000003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tshering S, Dorji N, Dem D, Om T. Scrub typhus in pregnancy presenting with permanent hearing loss: A case report. Clin Case Rep 2021; 9:e04451. [PMID: 34306685 PMCID: PMC8294048 DOI: 10.1002/ccr3.4451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/02/2021] [Accepted: 05/30/2021] [Indexed: 12/29/2022] Open
Abstract
As clinicians, we need to be vigilant about these rare and atypical presentations given the endemic nature of scrub typhus in southern belt of the country. Timely diagnosis and appropriate treatment is the key aspect to prevent further complications.
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Affiliation(s)
- Sangay Tshering
- Department of Obstetrics & GynecologyJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
| | - Namkha Dorji
- Department of Obstetrics & GynecologyJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
| | - Dago Dem
- Faculty of Post Graduate MedicineKhesar Gyalpo University of Medical Sciences of BhutanThimphuBhutan
| | - Tandin Om
- Faculty of Post Graduate MedicineKhesar Gyalpo University of Medical Sciences of BhutanThimphuBhutan
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Lu CT, Wang LS, Hsueh PR. Scrub typhus and antibiotic-resistant Orientia tsutsugamushi. Expert Rev Anti Infect Ther 2021; 19:1519-1527. [PMID: 34109905 DOI: 10.1080/14787210.2021.1941869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Scrub typhus is one of the most underdiagnosed and under-reported febrile illnesses requiring hospitalization, mainly occurring in Southeast and East Asia and the Pacific Islands, in an area referred to as the 'Tsutsugamushi Triangle.' Scrub typhus is a zoonotic rickettsial disease that is transmitted to humans by trombiculid mites.Areas covered: A MEDLINE/PubMed search of the available literature was performed to describe the role of antibiotic-resistant scrub typhus in therapy failure.Expert opinion: Scrub typhus is characterized by an eschar that may appear 2-3 days before sudden-onset fever with chills, headache, backache, myalgia, profuse sweating, vomiting, and enlarged lymph nodes. A macular or maculopapular skin rash can develop within 3-8 days after the onset of fever. Various antibiotics, such as chloramphenicol, tetracycline, doxycycline, macrolides, quinolones, and rifampicin, have been used to treat scrub typhus. Resistance to tetracycline has been proposed to underlie delayed clinical improvement since 1996, but recent reports have questioned the existence of doxycycline resistance. Nevertheless, the existence and importance of antibiotic-resistant scrub typhus remain uncertain and require further study.
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Affiliation(s)
- Chin-Te Lu
- Department of Infectious Diseases, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Lih-Shinn Wang
- Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
PURPOSE OF REVIEW Scrub typhus, caused by Orientia tsutsugamushi, is a widely neglected disease which is gaining global momentum because of its resurgence patterns. The disease is now being reported in newer regions as well as areas previously endemic areas. In this review, we aim to comprehensively review the data available to assist physicians in making an accurate diagnosis and appropriate management of the disease. RECENT FINDINGS Several diagnostic tests have been developed for confirming scrub typhus. However, there is lack of clarity on which tests are most appropriate in a given clinical scenario. A recent study has demonstrated that in early disease (<7 days) when serological tests remain negative, the quantitative polymerase chain reaction is the most sensitive test. Among the serological tests, both IgM enzyme-linked immunosorbent assay as well as rapid diagnostic tests revealed excellent sensitivities and specificities. SUMMARY With the reemergence of scrub typhus, a high degree of clinical suspicion is required to appropriately diagnose this disease which presents as an acute febrile illness. It can progress to develop various complications leading to multi-organ dysfunction syndrome. Mild illness responds well to antibiotic treatment with doxycycline and azithromycin. Further studies are required to determine the most optimal therapy in severe scrub typhus infections and superiority of one drug over the other.
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Owers Bonner KA, Cruz JS, Sacramento GA, de Oliveira D, Nery N, Carvalho M, Costa F, Childs JE, Ko AI, Diggle PJ. Effects of Accounting for Interval-Censored Antibody Titer Decay on Seroincidence in a Longitudinal Cohort Study of Leptospirosis. Am J Epidemiol 2021; 190:893-899. [PMID: 33274738 DOI: 10.1093/aje/kwaa253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
Accurate measurements of seroincidence are critical for infections undercounted by reported cases, such as influenza, arboviral diseases, and leptospirosis. However, conventional methods of interpreting paired serological samples do not account for antibody titer decay, resulting in underestimated seroincidence rates. To improve interpretation of paired sera, we modeled exponential decay of interval-censored microscopic agglutination test titers using a historical data set of leptospirosis cases traced to a point source exposure in Italy in 1984. We then applied that decay rate to a longitudinal cohort study conducted in a high-transmission setting in Salvador, Brazil (2013-2015). We estimated a decay constant of 0.926 (95% confidence interval: 0.918, 0.934) titer dilutions per month. Accounting for decay in the cohort increased the mean infection rate to 1.21 times the conventionally defined rate over 6-month intervals (range, 1.10-1.36) and 1.82 times that rate over 12-month intervals (range, 1.65-2.07). Improved estimates of infection in longitudinal data have broad epidemiologic implications, including comparing studies with different sampling intervals, improving sample size estimation, and determining risk factors for infection and the role of acquired immunity. Our method of estimating and accounting for titer decay is generalizable to other infections defined using interval-censored serological assays.
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Manappallil RG, Nambiar J, Anil R. Afebrile scrub typhus infection with cardiac manifestation. BMJ Case Rep 2021; 14:e240223. [PMID: 33849868 PMCID: PMC8051404 DOI: 10.1136/bcr-2020-240223] [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] [Accepted: 04/05/2021] [Indexed: 11/03/2022] Open
Abstract
Scrub typhus is an acute febrile disease transmitted via bites from mite larvae (chigger) infected with Orientia tsutsugamushi. Arrhythmias, ischaemic changes and QT prolongation are some of the observed ECG abnormalities. The patient being reported presented with angina and was found to have sinus bradycardia with ST elevation in inferior leads and T wave inversion in lateral leads. His coronary angiography was normal. Further evaluation leads to the diagnosis of scrub typhus infection. Following doxycycline therapy, his ECG became normal. Afebrile scrub typhus infection with cardiac manifestation is an uncommon scenario.
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Affiliation(s)
| | | | - Revathy Anil
- Internal Medicine, Baby Memorial Hospital, Calicut, Kerala, India
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Gu XL, Qi R, Li WQ, Jiao YJ, Yu H, Yu XJ. Misdiagnosis of scrub typhus as hemorrhagic fever with renal syndrome and potential co-infection of both diseases in patients in Shandong Province, China, 2013-2014. PLoS Negl Trop Dis 2021; 15:e0009270. [PMID: 33784301 PMCID: PMC8009391 DOI: 10.1371/journal.pntd.0009270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/23/2021] [Indexed: 01/27/2023] Open
Abstract
Background Scrub typhus, caused by Orientia tsutsugamushi, an obligate intracellular gram-negative bacterium, along with hemorrhagic fever with renal syndrome (HFRS), caused by hantaviruses, are natural-focus infectious diseases prevalent in Shandong Province, China. Both diseases have similar clinical manifestations in certain disease stages and similar epidemic seasons, which has caused difficulties for physicians in distinguishing them. The aim of this study was to investigate whether misdiagnosis of scrub typhus as HFRS occurred in patients in Shandong Province. Methods Serum samples (N = 112) of clinically suspected HFRS patients from 2013 to 2014 in Shandong Province were analyzed with enzyme-linked immunosorbent assay (ELISA) for antibodies to both hantavirus and Orientia tsutsugamushi. Results ELISA showed that 56.3% (63/112) and 8.0% (9/112) of clinically suspected HFRS patients were IgM antibody positive to hantavirus and O. tsutsugamushi, respectively. Among the hantavirus IgM antibody positive patients, 7.9% (5/63) were also IgM antibody positive to O. tsutsugamushi. Among the hantavirus IgM antibody negative sera, 8.2% (4/49) of sera were positive to O. tsutsugamushi. Conclusions We concluded that some scrub typhus patients were misdiagnosed as HFRS and co-infection of scrub typhus and HFRS might exist in China. Due to the different treatments for scrub typhus and HFRS, physicians should carefully differentiate between scrub typhus and HFRS and consider administering anti-rickettsia antibiotics if treatment for HFRS alone does not work. Scrub typhus is caused by O. tsutsugamushi and hemorrhagic fever with renal syndrome (HFRS) is caused by hantavirus. Both diseases have similar manifestations and have their peak epidemic season in the fall, which makes their clinical differentiation difficult to be differentiated from each other clinically. In this study, we found that scrub typhus was indeed misdiagnosed as HFRS and co-infection of O. tsutsugamushi and hantaviruses might exist in China. Owing to different treatments of HFRS and scrub typhus, physicians need pay attention to differentiate them; identify co-infection of HFRS and scrub typhus; and consider administering antibiotics if antiviral treatment alone does not work.
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Affiliation(s)
- Xiao-lan Gu
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Rui Qi
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Wen-qian Li
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yong-jun Jiao
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
| | - Hao Yu
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xue-jie Yu
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
- * E-mail:
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Gaba S, Gupta M, Gaba R, Lehl SS. Scrub Typhus: an Update*. CURRENT TROPICAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40475-021-00234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Watanabe Y, Mashimo S, Ichige H, Nagata H, Kojima M. Scrub typhus mimicking the clinical course of infectious mononucleosis: a case report. J Rural Med 2021; 16:62-66. [PMID: 33442438 PMCID: PMC7788302 DOI: 10.2185/jrm.2020-037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/11/2020] [Indexed: 01/22/2023] Open
Abstract
Objective: Scrub typhus is a relatively common life-threating disease; its
symptoms are non-specific and similar to those of other viral infections. Therefore, scrub
typhus might be underdiagnosed. Patient: Herein, we report a patient with scrub typhus whose clinical course
mimicked that of infectious mononucleosis. A 63-year-old male patient with hypertension
presented to our hospital complaining of symptoms including prolonged fever, pharyngeal
discomfort, and a mild headache. He showed the appearance of a rash after amoxicillin
administration. At the same time, he did not show a crusted rash on his body surface. Results: After a comprehensive examination, Epstein-Barr virus and
cytomegalovirus infections were ruled out. We suspected that this patient suffered from
scrub typhus on the basis of his usual lifestyle. Finally, polymerase chain reaction
analysis showed a positive result for deoxyribonucleic acid of Orientia
tsutsugamushi in his blood sample. Fortunately, he recovered naturally with
only supportive treatment during his hospitalization. Conclusion: We should observe and monitor patients with infectious
mononucleosis-like symptoms and emphasize the importance of a clinical interview.
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Affiliation(s)
- Yusuke Watanabe
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Shouta Mashimo
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Hiroyuki Ichige
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Hiroyuki Nagata
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Masayuki Kojima
- Department of Surgery, Hitachiomiya Saiseikai Hospital, Japan
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Park SM, Gu MJ, Ju YJ, Cheon IS, Hwang KJ, Gill B, Shim BS, Jeong HJ, Son YM, Choi S, Jeung W, Han SH, Chu H, Yun CH. Intranasal Vaccination with Outer-Membrane Protein of Orientia tsutsugamushi induces Protective Immunity Against Scrub Typhus. Immune Netw 2020; 21:e14. [PMID: 33996170 PMCID: PMC8099613 DOI: 10.4110/in.2021.21.e14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 10/12/2020] [Accepted: 11/02/2020] [Indexed: 12/01/2022] Open
Abstract
Scrub typhus develops after the individual is bitten by a trombiculid mite infected with Orientia tsutsugamushi. Since it has been reported that pneumonia is frequently observed in patients with scrub typhus, we investigated whether intranasal (i.n.) vaccination with the outer membrane protein of O. tsutsugamushi (OMPOT) would induce a protective immunity against O. tsutsugamushi infection. It was particular interest that when mice were infected with O. tsutsugamushi, the bacteria disseminated into the lungs, causing pneumonia. The i.n. vaccination with OMPOT induced IgG responses in serum and bronchoalveolar lavage (BAL) fluid. The anti-O. tsutsugamushi IgA Abs in BAL fluid after the vaccination showed a high correlation of the protection against O. tsutsugamushi. The vaccination induced strong Ag-specific Th1 and Th17 responses in the both spleen and lungs. In conclusion, the current study demonstrated that i.n. vaccination with OMPOT elicited protective immunity against scrub typhus in mouse with O. tsutsugamushi infection causing subsequent pneumonia.
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Affiliation(s)
- Sung-Moo Park
- Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea
| | - Min Jeong Gu
- Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea
| | - Young-Jun Ju
- Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea
| | - In Su Cheon
- Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.,Laboratory Sciences Division, International Vaccine Institute, Seoul 08826, Korea
| | - Kyu-Jam Hwang
- Division of Zoonotic and Vector Borne Disease Research, Center for Infectious Disease Research, National Institute of Health, Cheongju 28159, Korea
| | - Byoungchul Gill
- Division of Zoonotic and Vector Borne Disease Research, Center for Infectious Disease Research, National Institute of Health, Cheongju 28159, Korea
| | - Byoung-Shik Shim
- Laboratory Sciences Division, International Vaccine Institute, Seoul 08826, Korea
| | - Hang-Jin Jeong
- Division of Zoonotic and Vector Borne Disease Research, Center for Infectious Disease Research, National Institute of Health, Cheongju 28159, Korea
| | - Young Min Son
- Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea
| | - Sangho Choi
- Division of Zoonotic and Vector Borne Disease Research, Center for Infectious Disease Research, National Institute of Health, Cheongju 28159, Korea
| | - Woonhee Jeung
- Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea
| | - Seung Hyun Han
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Korea
| | - Hyuk Chu
- Division of Zoonotic and Vector Borne Disease Research, Center for Infectious Disease Research, National Institute of Health, Cheongju 28159, Korea
| | - Cheol-Heui Yun
- Department of Agricultural Biotechnology and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.,Institutes of Green Bio Science and Technology, Seoul National University, Pyeongchang 25354, Korea.,Interdisciplinary Program in Agricultural Genomics, Seoul National University, Seoul 08826, Korea
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Xin H, Fu P, Sun J, Lai S, Hu W, Clements ACA, Sun J, Cui J, Hay SI, Li X, Li Z. Risk mapping of scrub typhus infections in Qingdao city, China. PLoS Negl Trop Dis 2020; 14:e0008757. [PMID: 33264282 PMCID: PMC7735632 DOI: 10.1371/journal.pntd.0008757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 12/14/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The emergence and re-emergence of scrub typhus has been reported in the past decade in many global regions. In this study, we aim to identify potential scrub typhus infection risk zones with high spatial resolution in Qingdao city, in which scrub typhus is endemic, to guide local prevention and control strategies. METHODOLOGY/PRINCIPAL FINDINGS Scrub typhus cases in Qingdao city during 2006-2018 were retrieved from the Chinese National Infectious Diseases Reporting System. We divided Qingdao city into 1,101 gridded squares and classified them into two categories: areas with and without recorded scrub typhus cases. A boosted regression tree model was used to explore environmental and socioeconomic covariates associated with scrub typhus occurrence and predict the risk of scrub typhus infection across the whole area of Qingdao city. A total of 989 scrub typhus cases were reported in Qingdao from 2006-2018, with most cases located in rural and suburban areas. The predicted risk map generated by the boosted regression tree models indicated that the highest infection risk areas were mainly concentrated in the mid-east and northeast regions of Qingdao, with gross domestic product (20.9%±1.8% standard error) and annual cumulative precipitation (20.3%±1.1%) contributing the most to the variation in the models. By using a threshold environmental suitability value of 0.26, we identified 757 squares (68.7% of the total) with a favourable environment for scrub typhus infection; 66.2% (501/757) of the squares had not yet recorded cases. It is estimated that 6.32 million people (72.5% of the total population) reside in areas with a high risk of scrub typhus infection. CONCLUSIONS/SIGNIFICANCE Many locations in Qingdao city with no recorded scrub typhus cases were identified as being at risk for scrub typhus occurrence. In these at-risk areas, awareness and capacity for case diagnosis and treatment should be enhanced in the local medical service institutes.
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Affiliation(s)
- Hualei Xin
- Division of Infectious Disease, Qingdao City Center for Disease Control and Prevention, Qingdao, Shandong, China
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- World Health Organization (WHO) Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peng Fu
- Department of Anesthesiology, Qingdao Fuwai Cardiovascular Hospital, Qingdao, Shandong, China
| | - Junling Sun
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shengjie Lai
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Geography and Environmental Science, University of Southampton, Southampton 1BJ, United Kingdom
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Wenbiao Hu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Archie C. A. Clements
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Jianping Sun
- Division of Infectious Disease, Qingdao City Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Jing Cui
- Division of Infectious Disease, Qingdao City Center for Disease Control and Prevention, Qingdao, Shandong, China
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Xiaojing Li
- Division of Infectious Disease, Qingdao City Center for Disease Control and Prevention, Qingdao, Shandong, China
- * E-mail: (XL); (ZL)
| | - Zhongjie Li
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (XL); (ZL)
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Kazaura M. Knowledge, attitude and practices about dengue fever among adults living in Pwani Region, Tanzania in 2019. Afr Health Sci 2020; 20:1601-1609. [PMID: 34394220 PMCID: PMC8351831 DOI: 10.4314/ahs.v20i4.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dengue fever (DF) is currently widespread in tropical and sub-tropical countries. Among the triggers of epidemic include urbanization and internal migrations. Within the past few years, there have been DF outbreaks in Tanzania. Although Pwani region is among the predicted risk areas for the DF, there is insufficient data about people's knowledge, attitude and practices towards prevention of DF in their settings. Therefore, the aim of this study was to assess knowledge, attitude and practices about DF among adults in Pwani region in Tanzania. METHODS The cross-sectional study conducted in Mkuranga District, Pwani region in Tanzania. We used face-to-face interviews to collect data. The main analytical procedure was descriptive using frequencies. RESULTS The majority, 97.7%, were aware of DF. Nevertheless, almost 80% had a low knowledge on symptoms, transmission and vector control measures. Furthermore, less than 20% had positive attitude towards dengue fever prevention, severity of the illness and health seeking behavior. CONCLUSION Lack of enough knowledge and positive attitude about disease transmission, symptoms and preventive measures put the population at high risk of contracting the disease. There is need to create and improve friendly, correct and simple information, education and education messages for the rural populations.
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Sardana V, Shringi P. Neurological Manifestations of Scrub Typhus: A Case Series from Tertiary Care Hospital in Southern East Rajasthan. Ann Indian Acad Neurol 2020; 23:808-811. [PMID: 33688133 PMCID: PMC7900736 DOI: 10.4103/aian.aian_97_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 11/04/2022] Open
Abstract
Scrub typhus is an acute febrile infectious illness caused by rickettsia species Orientia tsutsugamushi. In recent years, scrub typhus has reemerged as a life-threatening disease in India Scrub typhus has diverse clinical manifestations ranging from a nonspecific febrile illness to severe multiorgan dysfunction, and neurological complications are also common. Spectrum of neurological complications varies from common complications such as aseptic meningitis, meningoencephalitis and cerebellitis to rare complications such as myelitis, cerebral hemorrhage, acute disseminated encephalomyelitis (ADEM), and cerebral infarction. Scrub typhus is not a common cause of acute febrile illness in state like Rajasthan, but has emerged as a life-threatening disease in recent years along with dreaded neurological complications. This case series highlights various neurological manifestations of scrub typhus as early diagnosis and treatment of neurological complications have good prognosis.
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Affiliation(s)
- Vijay Sardana
- Department of Neurology, Government Medical College, Kota, Rajasthan, India
| | - Prashant Shringi
- Department of Neurology, Government Medical College, Kota, Rajasthan, India
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Kannan K, John R, Kundu D, Dayanand D, Abhilash KPP, Mathuram AJ, Zachariah A, Sathyendra S, Hansdak SG, Abraham OC, Gunasekaran K, Iyadurai R, Abraham AM, Prakash JAJ, Yesudhason BL, Veeraraghavan B, Kavitha ML, Jose LR, Sumana MN, Saravu K, Varghese GM. Performance of molecular and serologic tests for the diagnosis of scrub typhus. PLoS Negl Trop Dis 2020; 14:e0008747. [PMID: 33180784 PMCID: PMC7660479 DOI: 10.1371/journal.pntd.0008747] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/25/2020] [Indexed: 01/19/2023] Open
Abstract
Diagnosis of scrub typhus, caused by the bacterium Orientia tsutsugamushi, is challenging because of the overlap of its non-specific symptoms with other infections coupled with the lack of sufficient data on the performance of diagnostic tests. Early diagnosis of scrub typhus is crucial to improve outcomes and this study evaluates the diagnostic performance of various tests. The present study aims at assessing the accuracy of various rapid diagnostic tests, serologic tests, and nucleic acid amplification methods on well-characterized patient samples. Adult patients with acute febrile illness and manifestations suggestive of scrub typhus confirmed by positive PCR in the blood, eschar or tissue were characterized as cases. Patients with acute febrile illness and a confirmed alternate etiology such as culture-confirmed typhoid, smear/PCR positive for malaria, PCR/NS1 antigen positive for dengue, PCR positive for influenza, PCR/MAT positive for leptospirosis, PCR positive for spotted fever were characterized as controls with other infections. The healthy controls consisted of subjects from the same geographic region. We performed the following tests on blood samples for scrub typhus and calculated the sensitivity, specificity, positive predictive value, and negative predictive value: (1) Quantitative real time PCR using 47kDa gene (qPCR); (2) Conventional PCR using 56kDa gene (cPCR); (3) Loop-mediated isothermal amplification assay (LAMP assay); (4) Immunofluorescence assay (IFA); (5) Enzyme-linked immunosorbent assay (ELISA); (6) Weil-Felix test(WF test); and (7) Immunochromatographic Rapid Diagnostic Test (RDT).Among the 316 participants, 158 had confirmed scrub typhus (cases) and 158 were controls. ELISA and RDT detecting Orientia tsutsugamushi specific IgM antibodies had excellent discriminative potential with sensitivities and specificities of 92%, 94% and 92%, 92% respectively. The sensitivity and specificity of IFA were found to be 95% and 74% respectively. IgM serology had a false positivity rate of 8% with other acute febrile illnesses such as dengue, leptospirosis and spotted fever due to the nonspecific binding of the pentavalent IgM. LAMP assay had 91.7% sensitivity and 77.2% specificity while qPCR provided excellent sensitivity (97%) and perfect specificity. In conclusion, ELISA and RDT detecting Orientia tsutsugamushi specific IgM antibodies have excellent sensitivity and specificity while the accuracy of IFA is suboptimal for the diagnosis of scrub typhus. Given its perfect specificity and superior sensitivity, qPCR is preferred for diagnostic confirmation in reference laboratories particularly for diagnosis of early disease with less than 7 days duration. This study provides a comprehensive evaluation of all currently available diagnostic tests for scrub typhus.
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Affiliation(s)
- Kavitha Kannan
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rebecca John
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Debasree Kundu
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Divya Dayanand
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Alice Joan Mathuram
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anand Zachariah
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sowmya Sathyendra
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Samuel G. Hansdak
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - O. C. Abraham
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthik Gunasekaran
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Asha M. Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Balaji Veeraraghavan
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - M. L. Kavitha
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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Kala D, Gupta S, Nagraik R, Verma V, Thakur A, Kaushal A. Diagnosis of scrub typhus: recent advancements and challenges. 3 Biotech 2020; 10:396. [PMID: 32834918 PMCID: PMC7431554 DOI: 10.1007/s13205-020-02389-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Scrub typhus is a mite-borne, acute febrile illness caused by the bacterium Orientia tsutsugamushi. It is a re-emerging infectious disease of the tsutsugamushi triangle. Scrub typhus is transmitted through bites of contaminated chiggers (larval stage). Diagnosis of scrub typhus is challenging as its symptoms mimic with other acute febrile illnesses. Several methods are effectual for diagnosis of scrub typhus that includes enzyme-linked immunosorbent assay (ELISA), immunofluorescence assay (IFA), immunochromatographic test (ICT), Weil-Felix, polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP). Weil-Felix test was initially used for the diagnosis of scrub typhus in underdeveloped countries but not preferred due to a lack of both specificity and sensitivity. Other immuno-based methods like IFA and ELISA are most outrank for detection of scrub typhus due to their higher sensitivity and specificity, but not vigorous to lay bare the infection at early stages and need the convalescent sampling for verification of positive samples. On another deed, PCR based methods becoming acceptable over era due to its dexterity of early-stage diagnosis with higher specificity and sensitivity but lack its applicability in circumstances of scrub typhus due to the variegated genetic makeup of Orientia tsutsugamushi among its serotypes. The present review focused on various detection methods along with their advantages and disadvantages used in the diagnosis of scrub typhus. A comparison between available methods of diagnosis with challenges in the detection of scrub typhus is also summarized.
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Affiliation(s)
- Deepak Kala
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
| | | | | | | | - Atul Thakur
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
| | - Ankur Kaushal
- Amity Center of Nanotechnology, Amity University, Haryana, 122413 India
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Acharya KP, Adhikari N, Tariq M. Scrub typhus: A serious public health issue in Nepal. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Thakur CK, Chaudhry R, Gupta N, Vinayaraj EV, Singh V, Das BK, Jadon RS, Wig N, Lodha R, Kabra SK, Dey AB, Chhabra M. Scrub typhus in patients with acute febrile illness: a 5-year study from India. QJM 2020; 113:404-410. [PMID: 31790119 DOI: 10.1093/qjmed/hcz308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/17/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Scrub typhus was once thought to be a disease of rural origin and was confined to specific pockets in South Asia. Early diagnosis and treatment is extremely important as it is associated with high mortality if left untreated. AIM To delineate the clinical and molecular epidemiology of scrub typhus in patients presenting with acute febrile illness from various parts of India. METHODS During the study period of 5 years (October 2013 to October 2018), a total of 1742 patients with acute febrile illness <15 days were enrolled after taking informed consent. Patients were diagnosed using IgM Enzyme-linked immunosorbent assay (ELISA) based on the pre-determined region specific cut offs. Patients with positive IgM ELISA were also subjected to IgM Immunofluorescence assay and nested polymerase chain reaction (PCR) assay. The demographic and relevant clinical details of the patients were documented and analyzed. RESULTS A total of 210 (12.1%) patients were diagnosed with scrub typhus. Of these, nested PCR was positive in only 85 patients. Sequencing and phylogenetic analysis showed that the predominant circulating genotypes were Gilliam and Karp. On multivariate analysis, acute respiratory distress syndrome, myocarditis, encephalitis/encephalopathy, jaundice and splenomegaly were significantly more common in those patients who were diagnosed with scrub typhus. A total of 14 patients diagnosed with scrub typhus succumbed to the illness. CONCLUSION Patients with fever, headache, pulmonary manifestations, CNS manifestations, myocarditis, transaminitis or thrombocytopenia presenting in the monsoon and post-monsoon season should be evaluated for scrub typhus irrespective of the geographical location in India.
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Affiliation(s)
| | | | - N Gupta
- Department of Microbiology
- Department of Medicine
| | | | | | | | | | | | | | | | - A B Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - M Chhabra
- Department of Microbiology, Dr. Ram Manohar Lohia Hospital, Post Graduate Institute of Medical Education and Research, Baba Kharak Singh Marg, Connaught Place, New Delhi 110001, India
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Chen J, Zheng XD, Dai QH, Hong WL, Li YP, Chen R, Ye BB, Mo XJ, Cui P, Ruan ZW. Diagnosis of severe scrub typhus infection by next-generation sequencing:a case report. BMC Infect Dis 2020; 20:270. [PMID: 32264829 PMCID: PMC7137524 DOI: 10.1186/s12879-020-04991-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/25/2020] [Indexed: 12/04/2022] Open
Abstract
Background Scrub typhus is an acute febrile illness, which was caused by Orientia tsutsugamushi and transmitted through the bite of chiggers. The diagnosis of scrub typhus could be missed diagnosis due to the absence of the pathognomonic eschar. Case presentation A 76-year-old man was hospitalized with fever and kidney injury and was diagnosed of hemorrhagic fever with renal syndrome first. However, the situation of the illness deteriorated into refractory septic shock and multiple organ dysfunction rapidly,although the treatment of anti-sepsis was used in 3rd-5th day. Orientia tsutsugamushi was determined to be the causative pathogen by Next-generation sequencing of his plasma sample in 6th day. Then, the patient was treated with doxycycline and azithromycin and recovered quickly. Conclusions Next-generation sequencing was a new diagnostic technology and could identify scrub typhus in accurately and fast without the pathognomonic eschar.
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Affiliation(s)
- Jie Chen
- Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China
| | - Xu-Dong Zheng
- Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China
| | - Qi-He Dai
- Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China
| | - Wei-Li Hong
- Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China
| | - You-Peng Li
- Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China
| | - Rui Chen
- Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China
| | - Bing-Bing Ye
- Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China
| | - Xiao-Jie Mo
- Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China
| | - Peng Cui
- BGI-Shanghai, Kangxin Rd, Pudong District, Shanghai, 201321, Guangdong, China
| | - Zhan-Wei Ruan
- Department of Emergency, Third Affiliated Hospital, Wenzhou Medical University, 108 Wansong Road, Zhejiang, 325200, China.
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Mrzljak A, Novak R, Pandak N, Tabain I, Franusic L, Barbic L, Bogdanic M, Savic V, Mikulic D, Pavicic-Saric J, Stevanovic V, Vilibic-Cavlek T. Emerging and neglected zoonoses in transplant population. World J Transplant 2020; 10:47-63. [PMID: 32257849 PMCID: PMC7109593 DOI: 10.5500/wjt.v10.i3.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/15/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
Abstract
Zoonoses represent a problem of rising importance in the transplant population. A close relationship and changes between human, animal and environmental health (“One Health” concept) significantly influence the transmission and distribution of zoonotic diseases. The aim of this manuscript is to perform a narrative review of the published literature on emerging and neglected zoonoses in the transplant population. Many reports on donor-derived or naturally acquired (re-)emerging arboviral infections such as dengue, chikungunya, West Nile, tick-borne encephalitis and Zika virus infection have demonstrated atypical or more complicated clinical course in immunocompromised hosts. Hepatitis E virus has emerged as a serious problem after solid organ transplantation (SOT), leading to diverse extrahepatic manifestations and chronic hepatitis with unfavorable outcomes. Some neglected pathogens such as lymphocytic choriomeningitis virus can cause severe infection with multi-organ failure and high mortality. In addition, ehrlichiosis may be more severe with higher case-fatality rates in SOT recipients. Some unusual or severe presentations of borreliosis, anaplasmosis and rickettsioses were also reported among transplant patients. Moreover, toxoplasmosis as infectious complication is a well-recognized zoonosis in this population. Although rabies transmission through SOT transplantation has rarely been reported, it has become a notable problem in some countries. Since the spreading trends of zoonoses are likely to continue, the awareness, recognition and treatment of zoonotic infections among transplant professionals should be imperative.
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Affiliation(s)
- Anna Mrzljak
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Rafaela Novak
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Nenad Pandak
- Depatment of Medicine, The Royal Hospital Muscat, Muscat 111, Oman
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | | | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, Zagreb 10000, Croatia
| | - Danko Mikulic
- Department of Abdominal and Transplant Surgery, Merkur University Hospital, Zagreb 10000, Croatia
| | - Jadranka Pavicic-Saric
- Department of Anesthesiology and Intensive Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health; School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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