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    Antinuclear antibodies in scrub typhus: Transient occurrence during acute illness.
    J Vector Borne Dis 2018 Jan-Mar;55(1):52-57
    Department of Critical Care, Christian Medical College & Vellore, India.
    Background & Objectives: The pathological hallmark of scrub typhus infection is focal or disseminated vasculitis. As with other infections, antinuclear antibodies (ANA) have been previously described in scrub typhus. However, the underlying mechanisms and implications of this immunological phenomenon is not well understood. Read More

    Clinical profile and risk factors associated with severe scrub typhus infection among non-ICU patients in semi-urban south India.
    J Vector Borne Dis 2018 Jan-Mar;55(1):47-51
    Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India.
    Background & Objectives: Scrub typhus is as an emerging infectious disease that generally causes acute febrile illness, with disease spectrum ranging from mild illness to multiorgan dysfunction. This study was aimed to report the clinical profile, complications and risk factors associated with severe illness in patients with scrub typhus, outside the intensive care setting.

    Methods: It was a prospective study, which involved recruitment of patients with acute febrile illness and diagnosed to have scrub typhus, who were admitted to the general medical wards of a tertiary care centre in Kanchipuram district, in semi-urban south India, over a 12 month period between June 2015 and May 2016. Read More

    Pulmonary Nocardiosis and Scrub Typhus in an Immunocompromised Host.
    J Glob Infect Dis 2018 Apr-Jun;10(2):108-111
    Department of Microbiology, Apollo Hospitals, Greams Road, Chennai, Tamil Nadu, India.
    Pulmonary infections are not uncommon in patients with an underlying immunocompromised condition. Unusual combination of microorganisms causing concomitant infections among these patients has also been reported. However, certain rare dual occurrences are usually unanticipated as in the case we present here. Read More

    Long-read whole genome sequencing and comparative analysis of six strains of the human pathogen Orientia tsutsugamushi.
    PLoS Negl Trop Dis 2018 Jun 6;12(6):e0006566. Epub 2018 Jun 6.
    Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
    Background: Orientia tsutsugamushi is a clinically important but neglected obligate intracellular bacterial pathogen of the Rickettsiaceae family that causes the potentially life-threatening human disease scrub typhus. In contrast to the genome reduction seen in many obligate intracellular bacteria, early genetic studies of Orientia have revealed one of the most repetitive bacterial genomes sequenced to date. The dramatic expansion of mobile elements has hampered efforts to generate complete genome sequences using short read sequencing methodologies, and consequently there have been few studies of the comparative genomics of this neglected species. Read More

    Scrub typhus initially manifested as diabetic ketoacidosis: A case report.
    IDCases 2018 7;12:165-166. Epub 2018 May 7.
    Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea.
    We report a case of a patient with scrub typhus who presented with diabetic ketoacidosis (DKA). The patient initially manifested with DKA, and was diagnosed with acute scrub typhus after evaluation the precipitating factors of DKA. No other complications of scrub typhus were noted. Read More

    Awareness and Work-Related Factors Associated with Scrub Typhus: A Case-Control Study from South Korea.
    Int J Environ Res Public Health 2018 Jun 1;15(6). Epub 2018 Jun 1.
    Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju, 123 Dongdae-ro, Gyeongju-si 38066, Korea.
    This study aimed to examine the awareness and the work-related factors associated with scrub typhus to provide data essential for evidence-based preventive strategies. A community-based case control study was carried out in the rural areas of Gyeongsangbuk-do, South Korea. Confirmed cases of scrub typhus ( = 57) were based on laboratory tests performed by the Korean Centers for Disease Control and Prevention (KCDC), 114 matched neighborhood controls, age (±6 years), gender and area of residence in the Gyeongsangbuk-do of South Korea. Read More

    Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand.
    PLoS Negl Trop Dis 2018 05 31;12(5):e0006477. Epub 2018 May 31.
    Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
    Background: Tropical infectious diseases like dengue, scrub typhus, murine typhus, leptospirosis, and enteric fever continue to contribute substantially to the febrile disease burden throughout Southeast Asia while malaria is declining. Recently, there has been increasing focus on biomarkers (i.e. Read More

    Clinical Profile and Therapeutic Response of Scrub Typhus in Children: A Recent Trend from Eastern India.
    J Trop Pediatr 2018 May 23. Epub 2018 May 23.
    Department of Pediatric Medicine, Institute of Postgraduate Medical Education & Research (I.P.G.M.E.& R.), 244, AJC Bose Road, 700020 Kolkata, India.
    Objective: The aim of this study was to assess the clinico-laboratory parameters, complications and therapeutic responses in children with scrub typhus in Eastern India.

    Materials And Methods: In this prospective, observational study, all children (age, <12 years) with suspected scrub typhus with a compatible clinical scenario were enrolled consecutively over six months. Cases confirmed by means of a positive IgM serology or a positive Weil-Felix reaction (OXK = 1/80 or above) were administered enteral doxycycline (4. Read More

    The reliability of the clinical examination in predicting hemodynamic status in acute febrile illness in a tropical, resource-limited setting.
    Trans R Soc Trop Med Hyg 2018 Apr;112(4):200-205
    Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok.
    Introduction: The clinical examination alone is widely considered unreliable when assessing fluid responsiveness in critically ill patients. Little evidence exists on the performance of the clinical examination to predict other hemodynamic derangements or more complex hemodynamic states.

    Materials And Methods: Patients with acute febrile illness were assessed on admission, both clinically and per non-invasive hemodynamic measurement. Read More

    Changing Trend of Infectious Diseases in Nepal.
    Adv Exp Med Biol 2018 ;1052:19-38
    Nepal Medical College, Attarkehl, Gokarneswor-8, Kathmandu, Nepal.
    Many infectious/communicable diseases (IDs) are endemic in Nepal. Until a decade and half ago, IDs were the major cause of both morbidity and mortality accounting 70% for both. However, as a result of various preventive measures implemented by both the state and non-state actors, the overall IDs have shown a changing (declining) trend. Read More

    Dissemination of , a Causative Agent of Scrub Typhus, and Immunological Responses in the Humanized DRAGA Mouse.
    Front Immunol 2018 30;9:816. Epub 2018 Apr 30.
    Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States.
    Scrub typhus is caused by , an obligated intracellular bacterium that affects over one million people per year. Several mouse models have been used to study its pathogenesis, disease immunology, and for testing vaccine candidates. However, due to the intrinsic differences between the immune systems in mouse and human, these mouse models could not faithfully mimic the pathology and immunological responses developed by human patients, limiting their value in both basic and translational studies. Read More

    Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, 2016: Clinical and Laboratory Findings.
    Pediatr Infect Dis J 2018 May 9. Epub 2018 May 9.
    Indian Council of Medical Research, New Delhi, India.
    Background: Seasonal outbreaks of acute encephalitis syndrome (AES) with high fatality have been occurring in Gorakhpur, Uttar Pradesh, India for several years. We conducted investigations during the 2016 outbreak, to identify the etiology.

    Methods: We included 407 hospitalized AES patients with CSF pleocytosis (>5 cells/cmm) in our study. Read More

    Diagnostic performance of serological tests to detect antibodies against acute scrub typhus infection in central India.
    Indian J Med Microbiol 2018 Jan-Mar;36(1):108-112
    Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India.
    Background: Differentiating scrub typhus from other acute febrile illness is difficult due to non specificity of clinical symptoms and relative absence of eschar in Indian population. The diagnosis thus relies mainly on laboratory tests. Antibody based serological tests are mainstay of scrub typhus diagnosis. Read More

    Orientia tsutsugamushi uses two Ank effectors to modulate NF-κB p65 nuclear transport and inhibit NF-κB transcriptional activation.
    PLoS Pathog 2018 05 7;14(5):e1007023. Epub 2018 May 7.
    Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, School of Medicine, Richmond, Virginia, United States of America.
    Orientia tsutsugamushi causes scrub typhus, a potentially fatal infection that threatens over one billion people. Nuclear translocation of the transcription factor, NF-κB, is the central initiating cellular event in the antimicrobial response. Here, we report that NF-κB p65 nuclear accumulation and NF-κB-dependent transcription are inhibited in O. Read More

    Scrub typhus diagnosis on acute specimens using serological and molecular assays - a 3-year prospective study.
    Diagn Microbiol Infect Dis 2018 Jun 24;91(2):112-117. Epub 2018 Feb 24.
    Department of Microbiology, Melaka Manipal Medical College, Manipal Campus, Manipal Academy of Higher Education (MAHE), Manipal, India. Electronic address:
    Scrub typhus (ST) is an underdiagnosed acute febrile illness in the Asia Pacific region with recent reemergence. Clinical diagnosis is difficult, and laboratory confirmation is largely based on serological and molecular tests. However, Weil-Felix test still remains the only test available in much of the rural tropics where a disproportionate number of cases occur. Read More

    Complexity of type-specific 56 kDa antigen CD4 T-cell epitopes of Orientia tsutsugamushi strains causing scrub typhus in India.
    PLoS One 2018 26;13(4):e0196240. Epub 2018 Apr 26.
    Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States.
    Orientia tsutsugamushi (Ots) is an obligate, intracellular, mite-transmitted human pathogen which causes scrub typhus. Understanding the diversity of Ots antigens is essential for designing specific diagnostic assays and efficient vaccines. The protective immunodominant type-specific 56 kDa antigen (TSA) of Ots varies locally and across its geographic distribution. Read More

    A Case Report and Literature Review of Scrub Typhus With Acute Abdomen and Septic Shock in a Child-The Role of Leukocytoclastic Vasculitis and Granulysin.
    Am J Dermatopathol 2018 Apr 24. Epub 2018 Apr 24.
    Department of Dermatology, Chang Gung Memorial Hospital, Linko, Taipei, Taiwan.
    Scrub typhus is becoming a clinically important cause of acute undifferentiated febrile illness in Taiwan. The incubation period is between 6 and 21 days after exposure. It is transmitted by chiggers (larva of trombiculid mite) in long grasses and in dirt-floor homes, with infection characterized by a flu-like illness of fever, headache, and myalgia lasting approximately 1 week. Read More

    Metabolic characterization of serum from mice challenged with -infected mites.
    New Microbes New Infect 2018 May 22;23:70-76. Epub 2018 Feb 22.
    Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD, USA.
    Scrub typhus is an acute zoonosis caused by the obligate intracellular Gram-negative bacterium To better understand the host response elicited by natural infection by chigger feeding, ICR mice were infected by (Lc1) chiggers, and the metabolic profiles of their serum were examined over several time points after initiation of feeding. ICR mice were infected by either naive Lc1 chiggers (i.e. Read More

    Distribution of tick-borne diseases in Japan: Past patterns and implications for the future.
    J Infect Chemother 2018 Jul;24(7):499-504
    Department of Tropical Medicine and Center for Medical Entomology, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan. Electronic address:
    The rapid geographical spread of tick-borne diseases (TBDs) worldwide has recently provoked significant concerns amongst public health authorities. Tick-borne pathogens are maintained in enzootic cycles involving ticks and wild animal hosts, with epizootic spread to other mammals, including livestock and humans. Despite the increasing public health concern, current TBD diagnostic tests and treatments are inadequate, and predictive models of future risks posed by TBDs are limited by the heterogeneity of environmental, vector, and host factors, even in neighboring regions. Read More

    Scrub typhus re-emergence in India: Contributing factors and way forward.
    Med Hypotheses 2018 Jun 31;115:61-64. Epub 2018 Mar 31.
    Immunology Laboratories, Department of Clinical Microbiology, Christian Medical College, Vellore, India. Electronic address:
    Scrub typhus is a mite borne infectious disease which has re-emerged in India in the 3rd millennium after years of quiescence. In this review, the authors hypothesize the various factors responsible for resurgence of this disease. The main drivers that could have contributed to the upsurge in scrub typhus cases in past two decades are changes in land use land cover (LULC) and urbanisation which are; as a result of the population explosion, causing a strain on sanitation and also increased diversion of forest land for agricultural use. Read More

    Comparative Study of Two Droplet-Based Dissolving Microneedle Fabrication Methods for Skin Vaccination.
    Adv Healthc Mater 2018 Jun 16;7(11):e1701381. Epub 2018 Apr 16.
    Department of Biotechnology, Building 123, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
    Dissolving microneedles (DMNs) have been widely studied in medical applications due to their pain-free administration, superior efficiency, and safe drug delivery. In skin vaccination, preserving the activity of the encapsulated antigen is an important consideration, as antigen activity is lost during DMN fabrication because of various stress factors. These stress factors vary between fabrication methods and each method affects the antigen's activity to different degrees. Read More

    Meningitis due to scrub typhus: the importance of a differential diagnosis in an endemic area.
    BMJ Case Rep 2018 Apr 13;2018. Epub 2018 Apr 13.
    Oxford University Clinical Research Unit, Patan Hospital, Kathmandu, Nepal.
    A patient with fever and neck stiffness was treated as partially treated bacterial meningitis based on history, examination and cerebrospinal fluid analysis. After initial improvement with ceftriaxone, vancomycin and dexamethasone, symptoms recurred. Fever resolved promptly after treatment was started with doxycycline, when scrub typhus immunoglobulin M test came positive. Read More

    Kinetics of IgM and IgG antibodies after scrub typhus infection and the clinical implications.
    Int J Infect Dis 2018 Jun 10;71:53-55. Epub 2018 Apr 10.
    Department of Infectious Diseases, Christian Medical College, Vellore 632004, Tamil Nadu, India.
    Objectives: The serological detection of IgM antibodies is the most widely used test to diagnose scrub typhus infection. However, the kinetics of IgM and IgG antibodies post-infection remain elusive, which could contribute to false positivity. The objective of this study was to document the nature of the evolution of these antibody titres after infection. Read More

    A Case of Scrub Typhus complicated with a Splenic Infarction.
    Infect Chemother 2018 Mar;50(1):55-58
    Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
    We present a patient with scrub typhus complicated with a splenic infarction. A 40-year-old man visited the emergency medical center complaining of fever for the previous week. He had no past medical history, but reported engaging in outdoor activities. Read More

    Clinical profile and outcome of children with scrub typhus from Chennai, South India.
    Eur J Pediatr 2018 Jun 10;177(6):887-890. Epub 2018 Apr 10.
    Kanchi Kamakoti CHILDS Trust Hospital & The CHILDS Trust Medical Research Foundation, 12-A, Nageswara Road, Nungambakkam, Chennai, Tamil Nadu, 600034, India.
    Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. We prospectively studied the clinico-laboratory profile and outcome of 358 children aged 1 day to 18 years diagnosed with scrub typhus from Chennai, South India. All children (100%) had fever. Read More

    Acute Encephalitis Syndrome in Eastern Uttar Pradesh, India: Changing Etiological Understanding.
    J Med Entomol 2018 May;55(3):523-526
    Indian Council of Medical Research, New Delhi, India.
    Seasonal outbreaks of acute encephalitis syndrome (AES) with high case fatality have been occurring in Gorakhpur division in Eastern Uttar Pradesh, India, for more than three decades. Japanese encephalitis virus (JEV) accounted for <10% of AES cases, while the etiology of the remaining cases remained largely unknown. Investigations conducted during the 2014 and 2015 outbreaks indicated Orientia tsutsugamushi (Haruo Hayashi 1920) (Norio Ogata 1929) Tamura et al. Read More

    A case of typhoidal tularemia in a male Japanese farmer.
    Int J Infect Dis 2018 Jun 7;71:56-58. Epub 2018 Apr 7.
    Department of Infection Control, Fukushima Medical University, Fukushima, Japan.
    In Japan, most tularemia cases occur after contact with hares (hunting, cooking) and involve the glandular or ulceroglandular form. Here, we present a case of typhoidal tularemia in a 72-year-old Japanese male farmer who presented with fever, fatigue, and right lower abdominal pain. Computed tomography revealed intestinal wall thickening at the ascending colon, pleural effusion, and ascites. Read More

    Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India.
    PLoS Negl Trop Dis 2018 03 28;12(3):e0006346. Epub 2018 Mar 28.
    Department of Microbiology, King George's Medical University, Lucknow, India.
    Background: Acute Encephalitis Syndrome (AES) is a major seasonal public health problem in Bihar, India. Despite efforts of the Bihar health department and the Government of India, burden and mortality of AES cases have not decreased, and definitive etiologies for the illness have yet to be identified.

    Objectives: The present study was undertaken to study the specific etiology of AES in Bihar. Read More

    Genetic diversity of Orientia tsutsugamushi strains circulating in Northeast India.
    Trans R Soc Trop Med Hyg 2018 Jan;112(1):22-30
    Department of Medicine, Assam Medical College & Hospital, Dibrugarh-786002, Assam, India.
    Background: Scrub typhus, caused by the intracellular bacteria Orientia tsutsugamushi is widely distributed in Southeast Asian countries with antigenically divergent strains reported across the Asia-Pacific belt. The present study was conducted to characterize the circulating strains of Orientia tsutsugamushi prevailing in two Northeastern states of India-the gateway to most Southeast Asian countries.

    Methods: A total of 278 (98 clinical and 180 field collected) scrub typhus positive blood samples collected from December 2014 to December 2016 were subjected for amplification of partial 56 KDa, 47 KDa and 16SrRNA genes of Orientia. Read More

    Febrile illness in Asia: gaps in epidemiology, diagnosis and management for informing health policy.
    Clin Microbiol Infect 2018 Mar 23. Epub 2018 Mar 23.
    Infectious Diseases Data Observatory, University of Oxford, UK; Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, University of Oxford, UK. Electronic address:
    Background: Increasing evidence is becoming available on the aetiology and management of fevers in Asia; the importance of these fevers has increased with the decline in the incidence of malaria.

    Aims: To conduct a narrative review of the epidemiology and management of fevers in South and South-East Asia and to highlight gaps in our knowledge that impair evidence-based health policy decisions.

    Sources: A narrative review of papers published since 2012 on developments in fever epidemiology, diagnosis and treatment in South and South-East Asia. Read More

    Scrub typhus point-of-care testing: A systematic review and meta-analysis.
    PLoS Negl Trop Dis 2018 03 26;12(3):e0006330. Epub 2018 Mar 26.
    Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
    Background: Diagnosing scrub typhus clinically is difficult, hence laboratory tests play a very important role in diagnosis. As performing sophisticated laboratory tests in resource-limited settings is not feasible, accurate point-of-care testing (POCT) for scrub typhus diagnosis would be invaluable for patient diagnosis and management. Here we summarise the existing evidence on the accuracy of scrub typhus POCTs to inform clinical practitioners in resource-limited settings of their diagnostic value. Read More

    Prevalence of scrub typhus in pyrexia of unknown origin and assessment of interleukin-8, tumor necrosis factor-alpha, and interferon-gamma levels in scrub typhus-positive patients.
    Indian J Pathol Microbiol 2018 Jan-Mar;61(1):76-80
    Department of Microbiology, J. N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
    Background: Scrub typhus is lesser known cause of fever of unknown origin in India. Even if there have been reports documenting the prevalence of scrub typhus in different parts of India, it is still an unknown entity, and clinicians usually do not consider it as differential diagnosis. The present study was performed to document the prevalence of scrub typhus among febrile patients in western part of Uttar Pradesh and to assess the clinical profile of infected patients on the one hand and knowledge, attitude, and practices among clinicians on the other. Read More

    Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh.
    Emerg Infect Dis 2018 Apr;24(4)
    We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5. Read More

    Development of a rapid and visual nucleotide detection method for a Chinese epidemic strain of Orientia tsutsugamushi based on recombinase polymerase amplification assay and lateral flow test.
    Int J Infect Dis 2018 May 13;70:42-50. Epub 2018 Mar 13.
    Huadong Research Institute for Medicine and Biotechniques, Nanjing 210002, Jiangsu, China; China Pharmaceutical University, Nanjing, Jiangsu, China; Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address:
    Objectives: Orientia tsutsugamushi is an obligate intracellular pathogen that causes scrub typhus. Diagnosing scrub typhus remains a challenge, and a sensitive, specific, simple, and rapid diagnostic test is still needed.

    Methods: A recombinase polymerase amplification (RPA) assay combined with a lateral flow (LF) test targeting the 56-kDa gene of a Karp-like strain of O. Read More

    Central nervous system lesions in scrub typhus rediscovered: An autopsy report.
    Neurol India 2018 Mar-Apr;66(2):434-438
    Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
    While neurological manifestations in scrub typhus have been well described both in clinical and radiological reports in the literature, neuropathological features are rarely reported. They range from subtle "typhus nodules" to more widespread capillaritis. Familiarity with pathological features is essential for correct interpretation. Read More

    Mathematical Modeling for Scrub Typhus and Its Implications for Disease Control.
    J Korean Med Sci 2018 Mar 19;33(12):e98. Epub 2018 Mar 19.
    Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea.
    Background: The incidence rate of scrub typhus has been increasing in the Republic of Korea. Previous studies have suggested that this trend may have resulted from the effects of climate change on the transmission dynamics among vectors and hosts, but a clear explanation of the process is still lacking. In this study, we applied mathematical models to explore the potential factors that influence the epidemiology of tsutsugamushi disease. Read More

    Scrub Typhus - A Major Cause of Pediatric Intensive Care Admission and Multiple Organ Dysfunction Syndrome: A Single-Center Experience from India.
    Indian J Crit Care Med 2018 Feb;22(2):107-110
    Pediatric Intensive Care unit, Institute of Child Health, Kolkata, West Bengal, India.
    Aim Of The Study: Scrub typhus has been globally recognized as an emerging infectious disease contributing significantly to pyrexia of unknown origin (PUO) and a potential cause of multiorgan dysfunction syndrome (MODS). We studied the incidence of scrub typhus as a cause of pediatric intensive care unit (PICU) admission and MODS in our hospital and its clinical and laboratory characteristics to measure the incidence of MODS caused by scrub typhus.

    Materials And Methods: This study was done in a pediatric teaching hospital in Kolkata, India. Read More

    Characterization of the rhesus macaque (Macaca mulatta) scrub typhus model: Susceptibility to intradermal challenge with the human pathogen Orientia tsutsugamushi Karp.
    PLoS Negl Trop Dis 2018 03 9;12(3):e0006305. Epub 2018 Mar 9.
    Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
    Background: Scrub typhus is an important endemic disease in tropical Asia caused by Orientia tsutsugamushi for which no effective broadly protective vaccine is available. The successful evaluation of vaccine candidates requires well-characterized animal models and a better understanding of the immune response against O. tsutsugamushi. Read More

    Evaluation of haematological and volume, conductivity and scatter parameters of leucocytes for aetiological diagnosis of undifferentiated fevers.
    Trans R Soc Trop Med Hyg 2017 Dec;111(12):546-554
    Department of Medicine, Himalayan Institute of Medical Sciences, Dehradun, India.
    Background: In this follow-up study, we aimed to establish the cut-off values of the volume, conductivity and scatter (VCS) parameters of leucocytes that significantly differ in dengue fever, malaria, scrub typhus and enteric fever, as described in our pilot study.

    Methods: A prospective observational case-control study was undertaken on patients with an established diagnosis of acute malaria (n=476), dengue fever (n=927), scrub typhus (n=425), bacterial sepsis (n=1598) or enteric fever (n=885) and the haematological and VCS data obtained by the Coulter LH 750 analyser were compared with controls.

    Results: Malaria significantly altered the platelet count and plateletcrit. Read More

    Autofluorescence microscopy for paired-matched morphological and molecular identification of individual chigger mites (Acari: Trombiculidae), the vectors of scrub typhus.
    PLoS One 2018 1;13(3):e0193163. Epub 2018 Mar 1.
    Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
    Background: Conventional gold standard characterization of chigger mites involves chemical preparation procedures (i.e. specimen clearing) for visualization of morphological features, which however contributes to destruction of the arthropod host DNA and any endosymbiont or pathogen DNA harbored within the specimen. Read More

    Under-diagnosis of rickettsial disease in clinical practice: A systematic review.
    Travel Med Infect Dis 2018 Mar 1. Epub 2018 Mar 1.
    Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands. Electronic address:
    Background: Rickettsial diseases present as acute febrile illnesses, sometimes with inoculation eschars.

    Methods: We performed a systematic review of studies published between 1997 and 2017 to assess the underestimation of non-eschar rickettsial disease (NERD) relative to eschar rickettsial disease (ERD), as a cause of acute fever in patients with rickettsial diseases that commonly present with eschar(s): scrub typhus (ST), Mediterranean spotted fever (MSF), and African tick-bite fever. We compared ERD/NERD ratios according to study design: 'complete approach' studies, with testing performed in all patients with 'unspecified febrile illness'; versus 'clinical judgement' studies, with testing performed if patients presented with specific symptoms. Read More

    Effects of Rifampin and Doxycycline Treatments in Patients with Uncomplicated Scrub Typhus: An Open-label Randomized Controlled Trial.
    Clin Infect Dis 2018 Feb 15. Epub 2018 Feb 15.
    Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea.
    Background: Doxycycline is currently the most frequently used treatment in patients with scrub typhus, but doxycycline-resistant strains have been found, necessitating the development of a new treatment. Rifampin is known to be effective even for such strains. Thus, this study aimed to compare the effects of rifampin and doxycycline treatment in patients with scrub typhus in areas in which resistance to doxycycline has not been reported. Read More

    Aetiology of acute encephalitis syndrome in Uttar Pradesh, India from 2014 to 2016.
    J Vector Borne Dis 2017 Oct-Dec;54(4):311-316
    Department of Microbiology, King George's Medical University, Lucknow, India.
    Background & Objectives: It is imperative to know the aetiology of acute encephalitis syndrome (AES) for patient management and policy making. The present study was carried out to determine the prevalence of common aetiological agents of AES in Uttar Pradesh (UP) state of India.

    Methods: Serum and/or CSF samples were collected from AES patients admitted at Gandhi Memorial and Associated Hospital, King George's Medical University, Lucknow, a tertiary care centre, UP during 2014-16. Read More

    Clinical proteomic analysis of scrub typhus infection.
    Clin Proteomics 2018 14;15. Epub 2018 Feb 14.
    1Drug & Disease Target Team, Korea Basic Science Institute (KBSI), Cheongju, 28119 Republic of Korea.
    Background: Scrub typhus is an acute and febrile infectious disease caused by the Gram-negative α-proteobacterium from the family Rickettsiaceae that is widely distributed in Northern, Southern and Eastern Asia. In the present study, we analysed the serum proteome of scrub typhus patients to investigate specific clinical protein patterns in an attempt to explain pathophysiology and discover potential biomarkers of infection.

    Methods: Serum samples were collected from three patients (before and after treatment with antibiotics) and three healthy subjects. Read More

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