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    Comparative Study of Two Droplet-Based Dissolving Microneedle Fabrication Methods for Skin Vaccination.
    Adv Healthc Mater 2018 Apr 16: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 Apr 10. Epub 2018 Apr 10.
    Department of Infectious Diseases, Christian Medical College, Vellore- 632004, Tamil Nadu, India.
    Objectives: Serology detecting IgM antibodies is the most widely used test to diagnose scrub typhus infection. However, kinetics of IgM and IgG antibodies post-infection remains elusive which could contribute to false positivity. The objective of this study is to document the nature of evolution of these antibody titers after infection. Read More

    ACUTE CHOLECYSTITIS AS AN UNUSUAL PRESENTATION OF SCRUB TYPHUS: A REPORT OF TWO CASES AND REVIEW OF THE LITERATURE.
    Southeast Asian J Trop Med Public Health 2017 Jan;48(1):143-9
    Scrub typhus rarely presents with acute cholecystitis. We present 2 cases of scrub typhus with cholecystitis. The first patient is a 62 year old female who presented to the hospital with fever and body aches for 1 week and right upper quadrant abdominal pain for 3 days. 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 Apr 10. 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 Apr 4. Epub 2018 Apr 4.
    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 Apr 7. 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 Mar 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, 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, Lao PDR; Centre for Tropical Medicine and Global Health, University of Oxford, UK.
    Background: There is increasing evidence on the aetiology and management of fevers in Asia, the importance of which has risen with declines in malaria incidence.

    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 of 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 Mar 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 Mar 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 Mar 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

    Dysregulated Th1 Immune and Vascular Responses in Scrub Typhus Pathogenesis.
    J Immunol 2018 Feb;200(4):1233-1240
    Department of Microbiology and Immunology, Center for Tropical Diseases, Center for Biodefense and Emerging Infectious Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555; and
    Scrub typhus is an emerging, insect-transmitted disease caused by a Gram- and LPS-negative bacterium that replicates freely within professional phagocytes and endothelial cells. Scrub typhus is prevalent with high mortality rates, but information regarding its molecular pathogenesis, microbial virulence determinants, and key immune responses is limited. Improved animal models have recently been developed that respectively resemble the pathological features of self-limiting or severe scrub typhus in humans. Read More

    Spectrum of cardiac manifestations and its relationship to outcomes in patients admitted with scrub typhus infection.
    World J Crit Care Med 2018 Feb 4;7(1):16-23. Epub 2018 Feb 4.
    Medical Intensive Care Unit, Christian Medical College, Vellore 632004, India.
    Aim: To study the spectrum of cardiac manifestations in scrub typhus infection and assess its relationship to outcomes.

    Methods: Demographic data, electrocardiographic (ECG) changes, left ventricular (LV) systolic and diastolic function, myocardial injury (defined as troponin T > 14 pg/mL), and pericardial effusion were documented. Myocarditis was diagnosed when myocardial injury was associated with global LV systolic dysfunction. Read More

    Spectrum of infections in acute febrile illness in central India.
    Indian J Med Microbiol 2017 Oct-Dec;35(4):480-484
    Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India.
    Introduction: Infectious agent when enters in the host results in febrile illness. This may lead to increase in morbidity or even mortality in undiagnosed/untreated cases. There are many aetiological agents which lead to acute febrile illness. Read More

    Comparison of Scrub Typhus Meningitis with Acute Bacterial Meningitis and Tuberculous Meningitis.
    Indian Pediatr 2018 01;55(1):35-37
    Departments of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India. Correspondence to: Dr. Winsley Rose, Professor, Department of Paediatrics, Christian Medical College, Vellore 632004, Tamilnadu, India.
    Objective: To compare scrub typhus meningitis with bacterial and tuberculous meningitis.

    Methods: Children aged <15 years admitted with meningitis were screened and those who fit criteria for diagnosis of scrub typhus meningitis (n=48), bacterial meningitis (n=44) and tuberculous meningitis (n=31) were included for analysis. Clinical features, investigations and outcomes were compared between the three types of meningitis. Read More

    An Update on Host-Pathogen Interplay and Modulation of Immune Responses during Orientia tsutsugamushi Infection.
    Clin Microbiol Rev 2018 Apr 31;31(2). Epub 2018 Jan 31.
    Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
    The obligate intracellular bacterium is the causative agent of scrub typhus in humans, a serious mite-borne disease present in a widespread area of endemicity, which affects an estimated 1 million people every year. This disease may exhibit a broad range of presentations, ranging from asymptomatic to fatal conditions, with the latter being due to disseminated endothelial infection and organ injury. Unique characteristics of the biology and host-pathogen interactions of , including the high antigenic diversity among strains and the highly variable, short-lived memory responses developed by the host, underlie difficulties faced in the pursuit of an effective vaccine, which is an imperative need. Read More

    [Epidemiology of scrub typhus and influencing factors in Yunnan province, 2006-2013].
    Zhonghua Liu Xing Bing Xue Za Zhi 2018 Jan;39(1):54-57
    State Key Laboratory of Pathogen and Bio-security, Institute of Microbiology and Epidemiology, Academy of Military Medical Science, Beijing 100071, China.
    To understand the epidemiological characteristics of scrub typhu and influencing factors in Yunnan province, and provide further information for the prevention and control of scrub typhus. Based on the incidence data of scrub typhus reported in Yunnan from 2006 to 2013, the epidemiological characteristics of scrub typhus were analyzed and related environmental factors were identified with panel negative binomial regression model. A total of 8 980 scrub typhus cases were reported during 2006-2013 in Yunnan. Read More

    Predictors of Severity in Pediatric Scrub Typhus.
    Indian J Pediatr 2018 Jan 24. Epub 2018 Jan 24.
    Department of Pediatrics, Indira Gandhi Medical College and Research Institute (IGMC&RI), Pondicherry, India.
    Objective: To identify the factors that can predict the severity of scrub typhus in children.

    Methods: This prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children <12y of age admitted with fever for more than 7d and positive IgM ELISA for scrub typhus were included in the study. Read More

    Orientia tsutsugamushi Is Highly Susceptible to the RNA Polymerase Switch Region Inhibitor Corallopyronin A and .
    Antimicrob Agents Chemother 2018 Apr 27;62(4). Epub 2018 Mar 27.
    Department of Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
    Scrub typhus is a potentially lethal infection caused by the obligate intracellular bacterium Reports on the emergence of doxycycline-resistant strains highlight the urgent need to develop novel antiinfectives against scrub typhus. Corallopyronin A (CorA) is a novel α-pyrone compound synthesized by the myxobacterium that was characterized as a noncompetitive inhibitor of the switch region of the bacterial RNA polymerase (RNAP). We investigated the antimicrobial action of CorA against the human-pathogenic Karp strain of and The MIC of CorA against was remarkably low (0. Read More

    Acute transverse myelitis following scrub typhus: A case report and review of the literature.
    J Spinal Cord Med 2018 Jan 19:1-4. Epub 2018 Jan 19.
    a Department of Neurosurgery , Chonnam National University Hospital and Medical School, Biomedical Research Institute , Gwangju , Korea.
    Context Scrub typhus is an acute febrile disease caused by Orientia tsutsugamushi. The disease can usually involve the lungs, heart, liver, spleen and brain through hematogenous dissemination. However, very rarely, acute transverse myelitis in the spinal cord develops from scrub typhus. Read More

    Scrub Typhus Outbreak in Chonburi Province, Central Thailand, 2013.
    Emerg Infect Dis 2018 Feb;24(2):361-365
    Investigation of a scrub typhus outbreak in Thailand during September 2013 found that 9.1% of Thai soldiers and 11.1% of residents living in areas surrounding training sites had antibodies against the causative agent, Orientia tsutsugamushi. Read More

    Molecular Epidemiology of an Gene Encoding a 56-kDa Type-Specific Antigen in Chiggers, Small Mammals, and Patients from the Southwest Region of Korea.
    Am J Trop Med Hyg 2018 Feb 4;98(2):616-624. Epub 2018 Jan 4.
    Division of Infectious disease investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Korea.
    A phylogenetic analysis of was performed to elucidate its antigenic diversity in chiggers, small mammals, and patients. Between September 2014 and December 2016, a total of 3,816 chiggers were identified within nine species of four genera in the southwest region of Korea: (49.9%; 1,907/3,816), (21. Read More

    Tropical Fevers in Indian Intensive Care Units: A Prospective Multicenter Study.
    Indian J Crit Care Med 2017 Dec;21(12):811-818
    Professor Emeritus Pathology, PGIMS, Rohtak, Haryana, India.
    Background And Aims: Infections in tropics often present as undifferentiated fevers with organ failures. We conducted this nationwide study to identify the prevalence, profile, resource utilization, and outcome of tropical fevers in Indian Intensive Care Units (ICUs).

    Materials And Methods: This was a multicenter prospective observational study done in 34 ICUs across India (July 2013-September 2014). Read More

    Differentiation of severe fever with thrombocytopenia syndrome from scrub typhus.
    Clin Infect Dis 2017 Dec 25. Epub 2017 Dec 25.
    Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
    We developed a severe fever with thrombocytopenia syndrome (SFTS) differentiation score in the cohort including 21 patients with SFTS and 91 patients with scrub typhus. This scoring using criteria (score > 1) of altered mental status, leukopenia, prolonged aPTT, and normal CRP provided 100% sensitivity and 97% specificity for SFTS. Read More

    Clinical Profile of Scrub Typhus Meningoencephalitis among South Indian Children.
    J Trop Pediatr 2017 Dec 18. Epub 2017 Dec 18.
    Department of Community Medicine, Indira Gandhi Medical College and Research Institute, 255, Vazhudavoor Road, Kathirkamam, Puducherry 605009, India.
    Re-emerging scrub typhus is gaining recognition as an important cause of paediatric meningoencephalitis in tropics. We studied the clinical profile of scrub typhus meningoencephalitis (STME) in children <12 years. Of 270 serology-confirmed cases of scrub typhus, 14 (5%) had features consistent with STME and 9 (64%) of these children were between 5 and 12 years of age; 12 (85%) children presented to the hospital during the second week of illness. Read More

    Longevity of antibody and T-cell responses against outer membrane antigens of Orientia tsutsugamushi in scrub typhus patients.
    Emerg Microbes Infect 2017 Dec 20;6(12):e116. Epub 2017 Dec 20.
    Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
    Scrub typhus, caused by Orientia tsutsugamushi infection, has been a serious public health issue in the Asia-Pacific region, with rising incidence and sporadic outbreaks. However, human protective immunity against specific antigens has been poorly characterized for this bacterium. In addition, immunity produced in early vaccine trials or even after natural infections, did not last long and had poor cross-reactivity among various genotypes. Read More

    Drug treatment of scrub typhus: a systematic review and meta-analysis of controlled clinical trials.
    Trans R Soc Trop Med Hyg 2017 Aug;111(8):336-344
    Department of Pathology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
    Scrub typhus, a potentially fatal infection caused by the pathogen Orientia tsutsugamushi, has a wide geographical distribution. This systematic review analyses the evidence from prospective controlled clinical studies for the efficacy of antibiotics in the treatment of scrub typhus. PubMed, Embase, Scopus, Cochrane Library, CINAHL and clinical trial registries in China, India and Sri Lanka were searched for controlled prospective clinical trials (randomized, quasi-randomized or non-randomized) enrolling patients with confirmed scrub typhus for treatment with antibiotics. Read More

    Renal Manifestation in Scrub Typhus during a Major Outbreak in Central Nepal.
    Indian J Nephrol 2017 Nov-Dec;27(6):440-445
    Health Services Research, United Health Group, OptumInsight, CT, USA.
    Renal involvement and acute kidney injury (AKI) are common clinical manifestations seen in scrub typhus, a vector-borne tropical disease. There are no data on renal manifestation in scrub typhus in Nepal. We conducted a prospective study to analyze the incidence, urinary abnormalities, course, severity, outcome, and the predictors of AKI in patients with scrub typhus during a major outbreak in Central Nepal. Read More

    Rapid Diagnosis of Tick-Borne Illnesses by Use of One-Step Isothermal Nucleic Acid Amplification and Bio-Optical Sensor Detection.
    Clin Chem 2018 Mar 5;64(3):556-565. Epub 2017 Dec 5.
    Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;
    Background: Scrub typhus and severe fever with thrombocytopenia syndrome (SFTS) are the most common tick-borne illnesses in South Korea. Early differentiation of SFTS from scrub typhus in emergency departments is essential but difficult because of their overlapping epidemiology, shared risk factors, and similar clinical manifestations.

    Methods: We compared the diagnostic performance of one-step isothermal nucleic acid amplification with bio-optical sensor detection (iNAD) under isothermal conditions, which is rapid (20-30 min), with that of real-time PCR, in patients with a confirmed tick-borne illness. Read More

    Guillain-Barre Syndrome with Falciparum Malaria and Scrub Typhus Mixed Infection-An Unusual Combination.
    J Clin Diagn Res 2017 Sep 1;11(9):OD10-OD11. Epub 2017 Sep 1.
    Professor, Department of Medicine, Kasturba Hospital, Manipal University, Manipal, Karnataka, India.
    Guillain-Barre Syndrome is very rare in parasitic and rickettsial infection. Here we report a case of Plasmodium falciparum and scrub typhus mixed infection, presented with quadriparesis. Clinical, Serological, CSF analysis and Nerve Conduction Studies were consistent with Acute Inflammatory Demyelinating Polyneuropathy (variant of GBS). Read More

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