Helicobacter 2017 Aug 18. Epub 2017 Aug 18.

Chosun University College of Medicine Internal Medicine, Gwangju, Korea.

Background: Aside from Helicobacter pylori, another cause for the development or worsening of gastrointestinal ulcers is scrub typhus, an acute febrile disease caused by Orientia tsutsugamushi. We aimed to compare the endoscopic characteristics of peptic ulcers caused by these infectious agents.

Methods: This retrospective case-control study involved patients who underwent upper gastrointestinal endoscopy at Chosun University Hospital in Korea. Read More

Epidemiol Health 2017 Aug 18. Epub 2017 Aug 18.

Jeju Special Self-Governing Provincial Office, Jeju-si, Korea.

Purpose: Scrub typhus is the most common febrile disease in Autumn season. Jeju Island is the largest island in South Korea and has a distinctive oceanic climate. This study aimed to identify epidemiological characteristics of scrub typhus in Jeju. Read More

Infect Immun 2017 Sep 18;85(9). Epub 2017 Aug 18.

University Hospital Marburg, Institute of Virology, Marburg, Germany

Infect Immun 2017 Sep 18;85(9). Epub 2017 Aug 18.

Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Am J Trop Med Hyg 2017 Jul 31. Epub 2017 Jul 31.

Department of Neurology, Seoul National University Hospital, Seoul, South Korea.

Orientia tsutsugamushi is a major cause of vector-borne infection in Asia. Prompt recognition and appropriate treatment are crucial because of its potentially fatal complications and lack of response to beta-lactam antibiotics. The present study retrospectively evaluated the clinical characteristics and laboratory findings of 16 patients with scrub typhus-related central nervous system (CNS) infections. Read More

Am J Trop Med Hyg 2017 Aug 14. Epub 2017 Aug 14.

National Institute of Epidemiology, Chennai, India.

Seasonal outbreaks of acute encephalitis syndrome (AES) with high mortality occur every year in Gorakhpur region of Uttar Pradesh, India. Earlier studies indicated the role of scrub typhus as the important etiology of AES in the region. AES cases were hospitalized late in the course of their illness. Read More

Natl Med J India 2017 Mar-Apr;30(2):69-72

Department of Internal Medicine, Government Medical College, Kota, Rajasthan, India.

Background: Scrub typhus, a potentially fatal rickettsial infection, is common in India. It usually presents with acute febrile illness along with multi-organ involvement caused by Orientia tsutsugamushi. As there was an outbreak of scrub typhus in the Hadoti region of Rajasthan and there is a paucity of data from this region, we studied this entity to describe the diverse epidemiological, clinico-radiological, laboratory parameters and outcome profile of patients with scrub typhus in a tertiary care hospital. Read More

J Assoc Physicians India 2017 Aug;65(8):47-50

Senior Resident, Department of Medicine, IGMC, Shimla, Himachal Pradesh.

Background: Most common cause of jaundice in south east Asia is of infective etiology. Combination of fever with jaundice can cause diagnostic problem as this duo is present in many infective diseases. Timely diagnosis by simple laboratory investigations can save a lot of time and prevent morbidity and mortality. Read More

J Assoc Physicians India 2017 Aug;65(8):24-27

Professor and Head, Department of Microbiology, Goa Medical College, Bambolim, Goa.

Background And Objective: Rickettsial infections are an important cause of undifferentiated febrile illness in tropics. While scrub typhus was reported from Goa, other rickettsial infections have not been reported earlier. The present study was planned to identify pattern of rickettsial infections in Goa. Read More

J Clin Diagn Res 2017 Jun 1;11(6):DL01-DL02. Epub 2017 Jun 1.

Associate Professor, Community Medicine, Yenepoya University, Mangalore, India and Regional Technical Advisor South-East Asia, TEPHINET, Task Force for Global Health, Inc., USA.

Respirology 2017 Aug 1. Epub 2017 Aug 1.

Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore.

Pneumonia in the tropics poses a heavy disease burden. The complex interplay of climate change, human migration influences and socio-economic factors lead to changing patterns of respiratory infections in tropical climate but also increasingly in temperate countries. Tropical and poorer countries, especially South East Asia, also bear the brunt of the global tuberculosis (TB) pandemic, accounting for almost one-third of the burden. Read More

Indian J Pediatr 2017 Jul 28. Epub 2017 Jul 28.

Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

PLoS Negl Trop Dis 2017 Jul 27;11(7):e0005815. Epub 2017 Jul 27.

Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea.

Background: Natural killer (NK) cells are essential immune cells against several pathogens. Not much is known regarding the roll of NK cells in Orientia tsutsugamushi infection. Thus, this study aims to determine the level, function, and clinical relevance of NK cells in patients with scrub typhus. Read More

PLoS Negl Trop Dis 2017 Jul 24;11(7):e0005765. Epub 2017 Jul 24.

Department of Ophthalmology, Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America.

Background: Scrub typhus is a life-threatening disease, due to infection with O. tsutsugamushi, a Gram-negative bacterium that preferentially replicates in endothelial cells and professional phagocytes. Meningoencephalitis has been reported in scrub typhus patients and experimentally-infected animals; however, the neurological manifestation and its underlying mechanisms remain poorly understood. Read More

Emerg Infect Dis 2017 Aug;23(8):1434

Emerg Infect Dis 2017 Aug;23(8):1389-1391

Using a large, passive, febrile surveillance program in Iquitos, Peru, we retrospectively tested human blood specimens for scrub typhus group orientiae by ELISA, immunofluorescence assay, and PCR. Of 1,124 participants, 60 (5.3%) were seropositive, and 1 showed evidence of recent active infection. Read More

Emerg Infect Dis 2017 Aug;23(8):1414-1416

Outbreaks of acute encephalitis syndrome (AES) have been occurring in Gorakhpur Division, Uttar Pradesh, India, for several years. In 2016, we conducted a case-control study. Our findings revealed a high proportion of AES cases with Orientia tsutsugamushi IgM and IgG, indicating that scrub typhus is a cause of AES. Read More

Emerg Infect Dis 2017 Aug;23(8):1412-1414

Scrub typhus in Bhutan was first reported in 2009. We investigated an outbreak of scrub typhus in a remote primary school during August-October 2014. Delay in recognition and treatment resulted in 2 deaths from meningoencephalitis. Read More

PLoS Negl Trop Dis 2017 Jul 19;11(7):e0005763. Epub 2017 Jul 19.

Department of Pathology, The University of Texas Medical Branch, Galveston, Texas, United States of America.

Scrub typhus, caused by a Gram-negative obligately intracellular coccobacillus, Orientia tsutsugamushi, is a long neglected but important tropical disease. Orientia tsutsugamushi causes illness in one million people each year, and 1 billion people are at risk. Without appropriate diagnosis and treatment, the disease can cause severe multiorgan failure with a case fatality rate of 7-15%. Read More

Am J Trop Med Hyg 2017 Aug 19;97(2):544-547. Epub 2017 Jul 19.

Department of Zoology, University of Oxford, Oxford, United Kingdom.

Malaria has been a military problem throughout history capable of causing epidemics that stop military operations. Individual mortality was examined from records of the three major wars of the 20th century that involved Australia in which 133 (1914-1919), 92 (1943-1945), and two (1965-1967) soldiers are known to have died with malaria. Those dying were predominately enlisted soldiers with a mean age of 29 years often complicated by other infections such as influenza, pneumonia or scrub typhus. Read More

Am J Trop Med Hyg 2017 Jul;97(1):30-37

Division of Zoonoses, Center for Immunology and Pathology, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea.

We investigated the 47-kDa outer membrane protein (OMP), which is a periplasmic serine protease and an antigenic major surface protein of Orientia tsutsugamushi, as a vaccine candidate. We developed a conventional subunit vaccine expressing recombinant 47-kDa OMP (rec47) and a DNA vaccine (p47). In mouse immunization experiments, intranasal immunization with rec47 alone or with rec47 plus heat-labile enterotoxin B subunit from Escherichia coli or plus cholera toxin (CT) as adjuvants induced a higher amount of rec47-specific antibodies than intramuscular immunization with p47 alone or with p47 plus pBOOST2-samIRF7/3 (pB) as adjuvant. Read More

J Microbiol Immunol Infect 2017 Jun 22. Epub 2017 Jun 22.

School of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address:

Background/purpose: The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear.

Methods: We conducted a retrospective study to identify the characteristics of the elderly aged ≥65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011.

Results: Among 441 cases, including 187 cases of scrub typhus, 166 acute Q fever, and 88 murine typhus, 68 (15. Read More

J Neurosci Rural Pract 2017 Jul-Sep;8(3):421-426

All India Institute of Medical Sciences, New Delhi, India.

Scrub typhus is caused by Orientia tsutsugamushi characterized by focal or disseminated vasculitis and perivasculitis which may involve the lungs, heart, liver, spleen and central nervous system. It was thought to have been eradicated from India. Recently it is being reported from many areas of India. Read More

Diagn Microbiol Infect Dis 2017 Sep 19;89(1):1-6. Epub 2017 Jun 19.

Department of Internal Medicine, Chosun University Hospital, Gwangju 501-717, Republic of Korea.

This retrospective study aimed to evaluate the levels of coagulation factors and presence of disseminated intravascular coagulation (DIC) in patients with scrub typhus. We included patients confirmed to have scrub typhus at the Chosun University Hospital between September 2004 and December 2009. The DIC scores were evaluated in 365 patients and 36 healthy controls. Read More

Indian J Pediatr 2017 Jul 4. Epub 2017 Jul 4.

Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, 632004, India.

Objective: To compare the children admitted with scrub typhus with and without meningitis.

Methods: All children admitted with scrub typhus over a 62 mo period were reviewed. Statistical analysis was performed to compare those with and without meningitis for demographic, clinical, investigations and outcome parameters. Read More

J Clin Exp Hepatol 2017 Jun 7;7(2):158-160. Epub 2016 Oct 7.

Department of Hepatology, PGIMER, Chandigarh, India.

Coinfections contribute significantly to diagnostic challenges of acute febrile illnesses, especially in endemic areas. The confusion caused by overlapping clinical features impedes timely management. Herein, we report an unusual, previously unreported case of a pregnant woman suffering from a coinfection of scrub typhus and hepatitis E virus. Read More

Int J Infect Dis 2017 Aug 23;61:114-120. Epub 2017 Jun 23.

General Practice School of Guangxi Medical University, Nanning, Guangxi Province, 530021, China. Electronic address:

Objectives: This study aimed to investigate whether von Willebrand factor (vWF) and high mobility group box 1 (HMGB1) are associated with the severity and clinical outcome of scrub typhus and to seek novel biomarkers for surveillance and prediction of the prognosis of this infection.

Methods: Serum concentrations of vWF and HMGB1 were measured twice by ELISA for scrub typhus patients (n=103), once prior to doxycycline therapy and then on day 7 of doxycycline therapy; concentrations were measured once for healthy controls (n=32).

Results: Among the total 103 patients enrolled, 38 had disease complicated by multiple organ dysfunction syndrome (MODS). Read More

Indian J Gastroenterol 2017 May 14;36(3):239-242. Epub 2017 Jun 14.

S M S Medical College, Sir Padampat Mother and Child Health Institute, J L N Marg, Jaipur, 302 017, India.

Neonatal hepatitis with acute liver failure due to varied etiology including various infections is reported in the past. Scrub typhus as a cause of neonatal hepatitis has rarely been reported in literature. A high index of clinical suspicion is required for early diagnosis and timely treatment. Read More

WHO South East Asia J Public Health 2016 Sep;5(2):117-122

Microbiology Unit, Department of Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.

Scrub typhus is an acute, febrile illness, caused by the bacterium Orientia tsutsugamushi, that affects millions annually in the endemic Asia-Pacific region. In untreated cases, the case-fatality rates range from 6% to 35%. In Bhutan, there was a probable outbreak in Gedu in 2009, which resulted in heightened awareness of the disease. Read More

Pediatr Infect Dis J 2017 Jul;36(7):696-697

Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

BMC Infect Dis 2017 Jun 10;17(1):413. Epub 2017 Jun 10.

Viral and Rickettsial Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD, USA.

Background: Scrub typhus (ST) is a disease caused by an obligate intracellular bacterium, Orientia tsutsugamushi, an organism that requires a BSL3 laboratory for propagation. The disease is hallmarked by an eschar at the site of the chigger bite, followed by the development of fever, malaise, myalgia, anorexia, and papulomacular rash. Indirect immunofluorescent assay (IFA) is the gold standard for scrub typhus diagnosis, however, the subjectivity of the assay, the need for a specialized laboratory and instruments has limited the wide use of the test in resource limited areas. Read More

Indian J Crit Care Med 2017 May;21(5):326-328

National Center for Disease Control, New Delhi, India.

Scrub typhus can affect lungs from mild illness like pneumonitis to a severe illness like acute respiratory distress syndrome (ARDS). Such patients may be very challenging to treat when their hypoxemia becomes severe and refractory to treatment. Main treatment is supportive in terms of mechanical ventilation. Read More

Trans R Soc Trop Med Hyg 2017 Mar;111(3):137-139

Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan.

Background: There are an estimated one million patients with scrub typhus in the Asia-Pacific region. There are few reports describing the incidence of scrub typhus in Vietnam.

Methods: Blood samples collected from 63 patients clinically diagnosed as having scrub typhus from July 2015 to September 2016 were subjected to genotyping of Orientia tsutsugamushi. Read More

J Vet Med Sci 2017 Jul 22;79(7):1261-1263. Epub 2017 May 22.

Department of Microbiology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.

We examined 33 rodents captured in an urban area of Osaka City, Japan for IgG antibodies against Seoul virus, severe fever with thrombocytopenia syndrome virus, hepatitis E virus, Leptospira interrogans, Yersinia pestis, spotted fever, typhus and scrub typhus group rickettsiae. We found that 3 (9.1%) and 1 (3. Read More

Am J Trop Med Hyg 2017 May;96(5):1084-1087

Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.

AbstractRickettsial infections are recognized as important causes of fever throughout southeast Asia. Herein, we determined the seroprevalence to rickettsioses within rural and urban populations of northern Vietnam. Prevalence of individuals with evidence of prior rickettsial infections (IgG positive) was surprisingly low, with 9. Read More

Am J Trop Med Hyg 2017 May;96(5):1005-1006

Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea.

Indian J Med Res 2016 Dec;144(6):901-909

Department of Medicine, Himalayan Institute of Medical Sciences, Dehradun, India.

Background & Objectives: Scrub typhus is a re-emerging mite-borne rickettsiosis, which continues to be underdiagnosed, with lethal consequences. The present study was conducted to determine the seasonality, clinical presentation and predictors of mortality in patients with scrub typhus at a tertiary care teaching hospital in northern India.

Methods: Scrub typhus was suspected in patients attending the hospital as per the standard case definition and serological evidence was obtained by performing an IgM ELISA. Read More

Indian J Med Res 2016 Dec;144(6):893-900

ICMR-Vector Control Research Centre, Puducherry, India.

Background & Objectives: Human cases of scrub typhus are reported every year from Puducherry and adjoining areas in southern India. However, information on the presence of causative agent, Orientia tsutsugamushi, and its vectors is lacking. Hence, the objective of the study was to find out the vector as well as pathogen distribution in rodents and shrews present in the scrub typhus-reported areas in southern India. Read More

Korean J Pediatr 2017 Apr 25;60(4):124-127. Epub 2017 Apr 25.

Department of Pediatrics, Chonbuk National University Children's Hospital, Jeonju, Korea.

Purpose: Chloramphenicol and tetracycline are not recommended for treating scrub typhus in pediatric patients because of potential side effects, such as aplastic anemia or tooth discoloration. While clarithromycin has recently been used in adults, few reports have been published on its effects in pediatric patients. We report the clinical profiles of pediatric scrub typhus and the effects of clarithromycin on scrub typhus in children. Read More

Trans R Soc Trop Med Hyg 2017 Feb;111(2):43-54

Department of Parasitology, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka.

The mite-borne rickettsial zoonosis scrub typhus is widely prevalent in parts of Southeast and Far East Asia, and northern Australia. The disease is an acute febrile illness, associated with rash and often an eschar, which responds dramatically to treatment with antibiotics. In some cases it results in a serious illness leading to multiple organ involvement and death. Read More

PLoS One 2017 18;12(4):e0175890. Epub 2017 Apr 18.

Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.

Background: The aim of this study is to investigate the clinical significance of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for acute kidney injury (AKI) in patients with scrub typhus.

Methods: From 2014 to 2015, 145 patients were diagnosed with scrub typhus. Of these, we enrolled 138 patients who were followed up until renal recovery or for at least 3 months. Read More

Microb Pathog 2017 Jun 12;107:335-340. Epub 2017 Apr 12.

Department of Virology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.

Orientia tsutsugamushi is the causative agent of scrub typhus. It is an obligate intracellular bacterium that grows only in eukaryotic cells. Macrophages play an important role in innate immunity by surveilling the human body for pathogens. Read More

BMC Infect Dis 2017 Apr 13;17(1):273. Epub 2017 Apr 13.

Institute of Tropical Medicine, Department of Clinical Sciences, Nationale straat 155, 2000, Antwerp, Belgium.

J Assoc Physicians India 2016 Dec;64(12):30-34

Senior Resident, Department of Medicine, IGMC Shimla, Himachal Pradesh.

Background: Scrub typhus is a documented disease in Himachal Pradesh, but there have been no clinico-epidemiological studies in this area. The present study is done with IgM ELISA as a diagnostic test which has higher sensitivity and specificity as most of previous studies had used Weil Felix test as a diagnostic test.

Methodology: This was a prospective observational study. Read More

Case Rep Infect Dis 2017 13;2017:6214083. Epub 2017 Mar 13.

Department of Internal Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.

Dengue fever and scrub typhus are common causes of acute febrile illness of unclear origin in Asia. Though coinfections of many vector-borne diseases have been described, articles on dengue and scrub typhus coinfection are distinctly limited. In case of coinfection with dengue and scrub typhus, vigilant monitoring of vitals, platelets transfusion, and timely treatment with doxycycline are necessary. Read More

Indian Pediatr 2017 Mar;54(3):223-229

Smile Healthcare, Rehabilitation and Research Foundation, Smile Institute of Child Health, Ramdaspeth, Akola; *Department of Pediatrics, Ashwini Medical College, Solapur; and #Dr Yewale Multispeciality Hospital for Children, Navi Mumbai; for Indian Academy of Pediatrics "Guidelines on Rickettsial Diseases in Children" Committee. Correspondence to: Dr Narendra Rathi, Consultant Pediatrician, Smile Healthcare, Rehabilitation and Research Foundation, Smile Institute of Child Health, Ramdaspeth, Akola, Maharashtra, India.

Objective: To formulate practice guidelines on rickettsial diseases in children for pediatricians across India.

Justification: Rickettsial diseases are increasingly being reported from various parts of India. Due to low index of suspicion, nonspecific clinical features in early course of disease, and absence of easily available, sensitive and specific diagnostic tests, these infections are difficult to diagnose. Read More

Indian J Nephrol 2017 Mar-Apr;27(2):151-153

Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.

Scrub typhus is a rickettsial infection commonly seen in Asia. The clinical presentation ranges from nonspecific febrile illness to potentially fatal multiorgan involvement such as liver, kidney, or lung. Central nervous system involvement is uncommon. Read More

BMJ Open 2017 Mar 15;7(3):e013882. Epub 2017 Mar 15.

Department of Internal Medicine, Changwon Gyeongsang National University Hospital, Changwon, Korea.

Objectives: Renal involvement in scrub typhus ranges from simple urinary abnormalities to acute kidney injury (AKI) leading to death. This study evaluated the incidence, predictors and prognosis of AKI associated with scrub typhus according to the RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria.

Methods: We retrospectively evaluated the medical records of patients diagnosed with scrub typhus from January 2001 to November 2013 in Gyeongsang National University Hospital. Read More

Mil Med 2017 Mar;182(S1):369-375

Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910.

Scrub typhus (ST) is an infection caused by Orientia tsutsugamushi. Historically, ST was ranked as the second most important arthropod-borne medical problem only behind malaria during World War II and the Vietnam War. The disease occurs mainly in Southeast Asia and has been shown to emerge and reemerge in new areas, implying the increased risk for U. Read More

PLoS Negl Trop Dis 2017 Mar 10;11(3):e0005453. Epub 2017 Mar 10.

Department of Pathology, Center for Biodefense and Emerging Infectious Diseases, Center for Tropical Diseases, Sealy Center for Vaccine Development, Institute of Human Infections and Immunity, School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America.

Background: Scrub typhus, a febrile illness of substantial incidence and mortality, is caused by infection with the obligately intracellular bacterium Orientia tsutsugamushi. It is estimated that there are more than one million cases annually transmitted by the parasitic larval stage of trombiculid mites in the Asia-Pacific region. The antigenic and genetic diversity of the multiple strains of O. Read More