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    Use of Multiplex Real-Time PCR to Diagnose Scrub Typhus.
    J Clin Microbiol 2017 Feb 15. Epub 2017 Feb 15.
    Division of Infectious Diseases and Tropical Medicine, Department of Internal dMedicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
    Scrub typhus, caused by Orientia tsutsugamushi, is a common cause of acute undifferentiated febrile illness in the Asia--Pacific region. However, its non-specific clinical manifestation often prevents early diagnosis. We propose the use of PCR and serologic tests as diagnostic tools. Read More

    Molecular detection of Orientia tsutsugamushi from suspected scrub typhus cases.
    Indian J Pathol Microbiol 2017 Jan-Mar;60(1):70-73
    Department of Microbiology, Dr. A. L. Mudaliar PG Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, Tamil Nadu, India.
    Context: Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The disease is under-diagnosed in India, because of low index of suspicion and also due to its nonspecific presentation, and lack of confirmatory diagnostic tests.

    Aims: This study was undertaken to diagnose scrub typhus in patients with undifferentiated fevers by serology and molecular methods. Read More

    Prevalence and clinical presentation of Rickettsia, Coxiella, Leptospira, Bartonella and chikungunya virus infections among hospital-based febrile patients from December 2008 to November 2009 in Bangladesh.
    BMC Infect Dis 2017 Feb 13;17(1):141. Epub 2017 Feb 13.
    International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
    Background: We conducted a study to identify Rickettsia, Coxiella, Leptospira, Bartonella, and Chikungunya virus infections among febrile patients presenting at hospitals in Bangladesh.

    Methods: We collected blood samples from patients at six tertiary hospitals from December 2008 to November 2009 and performed laboratory tests at the United States Centers for Disease Control and Prevention (CDC).

    Results: Out of 720 enrolled patients, 263 (37%) were infected with Rickettsia; 132 patients had immunofluorescence antibody titer >64 against spotted fever, 63 patients against scrub typhus fever and 10 patients against typhus fever. Read More

    Prevalence and Risk Factors for Scrub Typhus in South India.
    Trop Med Int Health 2017 Feb 7. Epub 2017 Feb 7.
    Christian Medical College, Vellore, India.
    Objective: To determine the prevalence and risk factors of scub typhus in Tamil Nadu, South India.

    Methods: We performed a clustered seroprevalence study of the areas around Vellore. All participants completed a risk factor survey, with seropositive and seronegative participants acting as cases and controls, respectively, in a risk factor analysis. Read More

    Epidemiological profile of acute respiratory distress syndrome patients: A tertiary care experience.
    Lung India 2017 Jan-Feb;34(1):38-42
    Department of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India.
    Background: Acute respiratory distress syndrome (ARDS) is seen in critically ill patients. Its etiological spectrum in India is expected to be different from that seen in western countries due to the high prevalence of tropical infections.

    Aim: To study the epidemiological profile of ARDS patients. Read More

    Retrospective survey of severe fever with thrombocytopenia syndrome in patients with suspected rickettsiosis in Japan.
    J Infect Chemother 2017 Jan 26;23(1):45-50. Epub 2016 Oct 26.
    Department of Virology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan. Electronic address:
    Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by the SFTS virus (SFTSV). The aim of this study was to clarify whether SFTS is potentially mis-diagnosed as rickettsioses, including spotted fever, typhus fever, and scrub typhus, which are also tick-borne disease. A total of 464 serum samples collected from 222 patients with clinically suspected rickettsiosis between 1999 and 2012 were tested for antibodies against the SFTSV. Read More

    Successfully Managed Acute Transverse Myelitis Related to Scrub Typhus and Serial Image Findings.
    Am J Trop Med Hyg 2017 Jan 23. Epub 2017 Jan 23.
    Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
    Central nervous system involvement manifesting as meningitis or meningoencephalitis is a known complication of scrub typhus, but very few spinal cord lesions such as acute transverse myelitis (ATM) have been reported in association with this disease. Scrub typhus patients with a spinal lesion present with neurologic symptoms including dysuria, motor, and sensory weakness. Herein, we describe a rare case of ATM associated with scrub typhus. Read More

    Orientia tsutsugamushi Ank9 is a multifunctional effector that utilizes a novel GRIP-like Golgi localization domain for Golgi-to-endoplasmic reticulum trafficking and interacts with host COPB2.
    Cell Microbiol 2017 Jan 19. Epub 2017 Jan 19.
    Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
    Orientia tsutsugamushi causes scrub typhus, a potentially fatal infection that afflicts 1 million people annually. This obligate intracellular bacterium boasts one of the largest microbial arsenals of ankyrin repeat-containing protein (Ank) effectors, most of which target the endoplasmic reticulum (ER) by undefined mechanisms. Ank9 is the only one proven to function during infection. Read More

    Acute kidney injury due to tropical infectious diseases and animal venoms: a tale of 2 continents.
    Kidney Int 2017 Jan 11. Epub 2017 Jan 11.
    George Institute for Global Health, New Delhi, India, and University of Oxford, Oxford, UK.
    South and Southeast Asia and Latin American together comprise 46 countries and are home to approximately 40% of the world population. The sociopolitical and economic heterogeneity, tropical climate, and malady transitions characteristic of the region strongly influence disease behavior and health care delivery. Acute kidney injury epidemiology mirrors these inequalities. Read More

    Genotypic characterization of Orientia tsutsugamushi from patients in two geographical locations in Sri Lanka.
    BMC Infect Dis 2017 Jan 13;17(1):67. Epub 2017 Jan 13.
    Department of Medicine, Faculty of Medicine, University of Kelaniya, Thalagolla Road, PO Box 6, Ragama, Sri Lanka.
    Background: To date more than 20 antigenically distinct strains of Orientia tsutsugamushi (OT) reported within the tsutsugamushi triangle that cause an undifferentiated acute febrile illness in humans. Genotypic characterization of OT in different geographic regions or within the same country, is important in order to establish effective diagnostics, clinical management and to develop effective vaccines. Genetic and antigenic characterization of OT causing human disease in OT-endemic regions is not known for Sri Lanka. Read More

    Rapid increase of scrub typhus incidence in Guangzhou, southern China, 2006-2014.
    BMC Infect Dis 2017 Jan 5;17(1):13. Epub 2017 Jan 5.
    The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China.
    Background: In the last decade, scrub typhus (ST) has been emerging or re-emerging in some areas of Asia, including Guangzhou, one of the most affected endemic areas of ST in China.

    Methods: Based on the data on all cases reported in Guangzhou from 2006 to 2014, we characterized the epidemiological features, and identified environmental determinants for the spatial distribution of ST using a panel negative binomial model.

    Results: A total of 4821 scrub typhus cases were reported in Guangzhou during 2006-2014. Read More

    Evaluation of a broad-ranging and convenient enzyme-linked immunosorbent assay using the lysate of infected cells with five serotypes of Orientia tsutsugamushi, a causative agent of scrub typhus.
    BMC Microbiol 2017 Jan 5;17(1). Epub 2017 Jan 5.
    Department of Virology 1, National Institute of Infectious Diseases, 1-23-1, Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan.
    Background: Scrub typhus is a mite-borne rickettsiosis caused by infection of Orientia tsutsugamushi, which is endemic to several Asia-Pacific Rim countries, including Japan. Although micro-indirect immunofluorescent assay (micro-IFA) is the standard method for the serological diagnosis of scrub typhus, enzyme-linked immunosorbent assay (ELISA) is considered to be more objective, by providing digitized results as opposed to being subject to the judgment of the evaluator as in micro-IFA. Therefore, the aim of this study was to develop a broad-ranging ELISA using the five major prevalent serotypes of O. Read More

    Differences in Clinical and Laboratory Features for Different Genotypes of Orientia tsutsugamushi in Guangzhou, Southern China.
    Vector Borne Zoonotic Dis 2017 Jan 5. Epub 2017 Jan 5.
    Guangzhou Center for Disease Control and Prevention , Guangzhou, China .
    Purpose: To describe the genotypes distribution of Orientia tsutsugamushi, in Guangzhou, and explore differences in clinical and laboratory features among genotypes.

    Method: We collected blood or eschar samples of all scrub typhus cases reported in 2013 from 10 district hospitals positive for PCR. We further tested the PCR-positive samples for DNA sequencing and phylogenetic analysis. Read More

    Serological Diagnosis of Acute Scrub Typhus in Southern India: Evaluation of InBios Scrub Typhus Detect IgM Rapid Test and Comparison with other Serological Tests.
    J Clin Diagn Res 2016 Nov 1;10(11):DC07-DC10. Epub 2016 Nov 1.
    Teaching Faculty, Department of Microbiology, Hallym University College of Medicine , Chuncheon, Gangwon do, South Korea .
    Introduction: Scrub Typhus (ST) is being reported from different parts of India in the recent past. However, the diagnosis and confirmation of ST cases require specific serological and molecular diagnostic tests. Both rapid and conventional ELISA tests need to be properly evaluated. Read More

    Scrub typhus: radiological and clinical findings in abdominopelvic involvement.
    Jpn J Radiol 2017 Jan 2. Epub 2017 Jan 2.
    Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.
    Purpose: To describe the clinical and radiological findings of abdominopelvic involvement in scrub typhus.

    Materials And Methods: Abdominopelvic computed tomography (CT) of 78 patients with scrub typhus were evaluated by two readers. The presence of gallbladder wall thickening, arterial inhomogeneous enhancement of the liver, periportal edema, splenic infarction, hepatomegaly, splenomegaly, ascites, pleural effusion, and sites of lymphadenopathy were evaluated. Read More

    Characteristics of Pediatric Scrub Typhus Eschar in South Indian Children.
    Pediatr Dermatol 2016 Dec 16. Epub 2016 Dec 16.
    Pediatrics, Indira Gandhi Medical College and Research Institute (IGMC&RI), Puducherry, India.
    Background: Knowledge of anatomic location of eschar is useful in diagnosing scrub typhus early in children and to initiate appropriate treatment.

    Methods: All children younger than 12 years of age admitted with confirmed diagnosis of scrub typhus over a 17-month period were included and the presence of eschar and other characteristics were recorded and analyzed.

    Results: Of 107 confirmed patients with scrub typhus, 37 (34. Read More

    The Epidemiology and Characteristics of Q fever and Co-infections with Scrub Typhus, Murine Typhus or Leptospirosis in Taiwan: A Nationwide Database Study.
    Zoonoses Public Health 2016 Dec 14. Epub 2016 Dec 14.
    Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
    Q fever (QF) is a worldwide zoonosis associated with outbreaks. Only a few nationwide studies regarding the surveillance and epidemiology of human QF have been reported. Although QF is endemic in Taiwan, a nationwide database investigation of the epidemiology and characteristics of QF and its associations with scrub typhus (ST), murine typhus (MT) and leptospirosis (LS) has never been reported. Read More

    Acute Undifferentiated Febrile Illness in Patients Presenting to a Tertiary Care Hospital in South India: Clinical Spectrum and Outcome.
    J Glob Infect Dis 2016 Oct-Dec;8(4):147-154
    Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
    Background: Acute undifferentiated febrile illness (AUFI) may have similar clinical presentation, and the etiology is varied and region specific.

    Materials And Methods: This prospective observational study was conducted in a tertiary hospital in South India. All adult patients presenting with AUFI of 3-14 days duration were evaluated for etiology, and the differences in presentation and outcome were analyzed. Read More

    A Cost-Effective Approach to the Diagnosis and Management of Acute Infectious Encephalitis.
    Eur Neurol 2017 8;77(1-2):66-74. Epub 2016 Dec 8.
    Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
    Setting: A tertiary care teaching hospital in India.

    Objective: To report a syndromic approach to acute encephalitis syndrome (AES) and propose a cost-effective model.

    Study Design: AES patients were categorized by the presence or absence of myalgia/rash into systemic and neurological AES. Read More

    Generation of protective immunity against Orientia tsutsugamushi infection by immunization with a zinc oxide nanoparticle combined with ScaA antigen.
    J Nanobiotechnology 2016 Nov 26;14(1):76. Epub 2016 Nov 26.
    Department of Microbiology and Immunology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
    Background: Zinc oxide nanoparticle (ZNP) has been applied in various biomedical fields. Here, we investigated the usage of ZNP as an antigen carrier for vaccine development by combining a high affinity peptide to ZNP.

    Results: A novel zinc oxide-binding peptide (ZBP), FPYPGGDA, with high affinity to ZNP (K a  = 2. Read More

    Scrub Typhus: An Emerging Neglected Tropical Disease in Nepal.
    J Nepal Health Res Counc 2016 May;14(33):122-127
    Epidemiology and Disease Control Division, Department of Health Services, Nepal.
    Background: Scrub typhus is a neglected tropical disease and is under reported from Nepal. The objective of this study was to investigate the sero-epidemiology of scrub typhus in patients suffering from acute febrile illness.

    Methods: A total of 434 specimens collected from July to November 2015 at National Public Health Laboratory (NPHL) were investigated for detection of immunoglobulin M (IgM) antibody to Orientiatsutsugamushi. Read More

    Epstein-Barr Virus Associated Hemophagocytic Syndrome after Scrub Typhus Infection.
    Infect Chemother 2016 Dec 8;48(4):330-333. Epub 2016 Nov 8.
    Division of Infectious Diseases, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
    There have been a small number of cases of scrub typhus-associated hemophagocytic syndrome (HPS), most of which were treated successfully using adequate antibiotics. Here, we report a case of Epstein-Barr virus (EBV)-associated HPS after scrub typhus infection that was not improved using antirickettsial treatment. A 73-year-old male who had been diagnosed with scrub typhus according to an eschar and a positive serology was transferred to our institution because of a persistent fever despite 7-day doxycycline therapy. Read More

    Scrub Typhus Leading to Acute Encephalitis Syndrome, Assam, India.
    Emerg Infect Dis 2017 Jan 15;23(1):148-150. Epub 2017 Jan 15.
    To determine the contribution of Orientia tsutsugamushi, the agent of scrub typhus, as a cause of acute encephalitis syndrome (AES) in Assam, India, we conducted a retrospective study of hospital patients with symptoms of AES during 2013-2015. Our findings suggest that O. tsutsugamushi infection leads to AES and the resulting illness and death. Read More

    Epidemiology & risk factors of scrub typhus in south India.
    Indian J Med Res 2016 Jul;144(1):76-81
    Department of Community Health, Christian Medical College & Hospital, Vellore, India.
    Background & Objectives: Scrub typhus is a major public health threat in South and Southeastern Asian countries including India. Understanding local patterns of disease and factors that place individuals at risk is pivotal to future preventive measures against scrub typhus. The primary aim of this study was to identify specific epidemiological and geographical factors associated with an increased risk of developing scrub typhus in this region. Read More

    Scrub typhus in pregnancy: Maternal and fetal outcomes.
    Obstet Med 2016 Dec 5;9(4):164-166. Epub 2016 May 5.
    Department of Medicine Unit 1, Christian Medical College, Vellore, India.
    Scrub typhus is an important unrecognized cause for undifferentiated acute febrile illness in India associated with poor fetal outcomes. Maternal and fetal outcomes among pregnant patients with scrub typhus presenting to a tertiary care university teaching hospital from January 2010 to July 2012 were studied. Scrub typhus was diagnosed by clinical criteria along with scrub ELISA positivity or an eschar. Read More

    Comparison of Preferred Bite Sites Between Mites and Ticks on Humans in Korea.
    Am J Trop Med Hyg 2016 Nov 19;95(5):1021-1025. Epub 2016 Sep 19.
    Department of Internal Medicine, Yeungnam University, College of Medicine, Daegu, South Korea.
    Identification of mite and tick bite sites provides important clinical information. The predominant mite species in Korea associated with scrub typhus are Leptotrombidium pallidum and Leptotrombidium scutellare The most abundant tick species is Haemaphysalis longicornis To date, there has been no comparative study on preferred bite sites between mites and ticks in humans. This study included a review of medical records and a field study. Read More

    An Unusual Presentation of Scrub Typhus.
    J Clin Diagn Res 2016 Sep 1;10(9):OD07-OD08. Epub 2016 Sep 1.
    Associate Professor, Department of Medicine, Kasturba Medical College , Manipal, Karnataka, India .
    Presentation of scrub typhus associated with brachial neuritis is extremely rare with only a few cases reported so far. Here, we report a case of a 45-year-old female who presented with fever and right shoulder pain. Laboratory parameters showed leucocytosis with ELISA and PCR for scrub typhus positive. Read More

    Meteorological factors affecting scrub typhus occurrence: a retrospective study of Yamagata Prefecture, Japan, 1984-2014.
    Epidemiol Infect 2017 Feb 28;145(3):462-470. Epub 2016 Oct 28.
    Department of Microbiology,Yamagata Prefectural Institute of Public Health,Yamagata City,Yamagata,Japan.
    Climate change, by its influence on the ecology of vectors might affect the occurrence of vector-borne diseases. This study examines the effects of meteorological factors in Japan on the occurrence of scrub typhus, a mite-borne zoonosis caused by Orientia tsutsugamushi. Using negative binomial regression, we analysed the relationships between meteorological factors (including temperature, rainfall, snowfall) and spring-early summer cases of scrub typhus in Yamagata Prefecture, Japan, during 1984-2014. Read More

    Severe Fever with Thrombocytopenia Syndrome in Patients Suspected of Having Scrub Typhus.
    Emerg Infect Dis 2016 Nov;22(11):1992-1995
    To determine prevalence of severe fever with thrombocytopenia syndrome in South Korea, we examined serum samples from patients with fever and insect bite history in scrub typhus-endemic areas. During the 2013 scrub typhus season, prevalence of this syndrome among patients suspected of having scrub typhus was high (23.0%), suggesting possible co-infection. Read More

    Chest radiographic manifestations of scrub typhus.
    J Postgrad Med 2016 Oct-Dec;62(4):235-238
    Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
    Background And Rationale: Respiratory system involvement in scrub typhus is seen in 20-72% of patients. In endemic areas, good understanding and familiarity with the various radiologic findings of scrub typhus are essential in identifying pulmonary complications.

    Materials And Methods: Patients admitted to a tertiary care center with scrub typhus between October 2012 and September 2013 and had a chest X ray done were included in the analysis. Read More

    An outbreak investigation of scrub typhus in Western Province, Solomon Islands, 2014.
    Western Pac Surveill Response J 2016 Jan-Mar;7(1):6-9. Epub 2016 Jan 26.
    Office of the WHO Representative in Solomon Islands, Honiara, Solomon Islands .
    Objective: To identify the etiology and risk factors of undifferentiated fever in a cluster of patients in Western Province, Solomon Islands, May 2014.

    Methods: An outbreak investigation with a case control study was conducted. A case was defined as an inpatient in one hospital in Western Province, Solomon Islands with high fever (> 38. Read More

    Pattern of Clinical Presentation, Laboratory Findings and Mortality Risk Among Patients of Scrub Typhus in Western Himalayas.
    J Assoc Physicians India 2016 Mar;64(3):26-30
    Principal, I. G. Medical College, Shimla, Himachal Pradesh.
    Objective: To study the pattern of the clinical presentation, laboratory findings and mortality risk among patients infected by scrub typhus in Western Himalayan region of India.

    Methods: We studied all serologically confirmed cases of scrub typhus admitted to our hospital from July 2010 through December 2011. Presence of IgM antibodies to scrub typhus antigens by ELISA was considered as serological confirmation of the diagnosis. Read More

    Scrub Typhus Presenting as Acute Cerebellitis.
    J Assoc Physicians India 2016 Feb;64(2):69-70
    Department of Medicine.
    Scrub typhus is known to present with varied presentation including involvement of central nervous system. We present a case who presented with fever and features of isolated cerebellitis. Serum showed IgM antibodies to scrub typhus by ELISA. Read More

    Infections and Thrombocytopenia.
    J Assoc Physicians India 2016 Feb;64(2):11-12
    Febrile patient with thrombocytopenia is commonly encountered by physicians especially during monsoon and perimonsoon period. Infections with protozoa, bacteria and viruses can cause thrombocytopenia with or without disseminated intravascular coagulation. Commonly dengue, malaria, scrub typhus and other rickettsial infections, meningococci, leptospira and certain viral infections present as fever with thrombocytopenia. Read More

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