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PubMed1993

Rapid diagnosis of scrub typhus by a passive hemagglutination assay using recombinant 56-kilodalton polypeptides.

The genes encoding the 56-kDa polypeptides were amplified by polymerase chain reaction from the genomic DNAs of three serotypes of Rickettsia tsutsugamushi, Gilliam, Karp, and Boryong. The amplified products were cloned into expression vector pIH821, and the recombinant antigens were expressed in Escherichia coli as fusion proteins with maltose-binding protein. The recombinant 56-kDa polypeptides were purified by affinity chromatography for the sensitization of sheep erythrocytes. The recombinant 56-kDa polypeptides were evaluated with 89 serum specimens from health blood donors, 94 serum specimens from scrub typhus patients, and 31 serum specimens from patients with other febrile diseases by a passive hemagglutination assay (PHA). Among the scrub typhus patients diagnosed by indirect immunofluorescent-antibody testing, the antibodies to R. tsutsugamushi were detected in 93 patients (99%). One serum specimen from a healthy person showed a false-positive reaction by this method. The recombinant PHA showed no cross-reactions with sera obtained from other febrile patients with diseases such as murine typhus, hemorrhagic fever with renal syndrome, and leptospirosis. In conclusion, this recombinant PHA could be substituted for the conventional indirect immunofluorescent-antibody test and the immunoperoxidase test.

Antibodies, Bacterial↗
PubMed1980

A study of small mammals in the Ciloto field station area, West Java, Indonesia, with special reference to vectors of plague and scrub typhus.

From June 1977 to June 1978 a study of smal mammals was carried out in the Ciloto field station area, West Java, Indonesia by the WHO Vector Biology and Control Research Unit-II. The objectives of the investigations were to determine the diversity and density of rodent species, to find potential plague and scrub typhus vectors and to study their host-parasite relationships. In the 13 month period a total of 6 species of murids were identified; two species of campestral rats (R. tiomanicus and R. argentiventer), one species of peri-domestic (R. exulans), one species of domestic (R.r. diardii), and two species of forest rats (R. bartelsii and R. bukit). In addition, three species of insectivores (Suncus murinus, Hylomys suillus and Crocidura monticola), and one species of carnivore were found. Of the three habitats studies (mixed, ricefield and lalang), 10 species of small mammals were found in the mixed while four species of commensal murids were found in both the ricefield and the lalang. Of the four commensal murid species R. exulans had the highest density. R. tiomanicus was common but not abundant, and least common was R. argentiventer. R.r. diardii was occasionally found in the field. The mean litter size of gravid R. tiomanicus was 7.1, R. exulans 4.3, R. argentiventer 7.5 and R.r. diardii 9. Male R. tiomanicus, R. argentiventer and R.r. diardii with spermatozoa present in animals over 55 gm. Animals of less than 50 gm had no sperm. In R. exulans spermatozoa were present in specimens weighing 24-66 gm. No sperm were detected in those below 20 gm. The flea index of Xenopsylla cheopis and Stivalius cognatus as determined for R. tiomanicus was 0.3 and 2.3;l for R.r. diardii 2.2 and 1.7; for R. exulans 0.3 and 0.5; and for R. argentiventer 0.4 and 1.7 respectively. S. cognatus had a significantly higher density than X. cheopis among the campestral and peridomestic rats, but the density of X. cheopis was significantly in the domestic rat. Overall infestation rates were equally high in both mixed and lalang habitats, but low in the ricefield. Flea indices were highest in the mixed habitat, lower in lalang, and lowest in ricefield. The putative vector of scrub typhus (Leptotrombidium (L.) deliense) was quite prevalent on campestral rats, less so on domestic ones and least on peridomestic. Overall infestation rates were equally high in both mixed and lalang habitats and low in the ricefield. Chiggers load per animal was significantly higher in the mixed habitat, lower in lalang and lowest in the ricefield.

Animals↗
PubMed1993

Serological reactivity of sera from scrub typhus patients against Weil-Felix test antigens.

Sera from 17 patients of scrub typhus in the acute and convalescent phases were tested by indirect immunoperoxidase test, Weil-Felix (WF) test, enzyme-linked immunosorbent assay (ELISA), and immunoblotting. In the comparison of antibody titers between acute- and convalescent-phase sera, we recognized a parallelism of increment between the titers in WF test and titers of immunoglobulin M (IgM) in ELISA against Proteus mirabilis strain OXK-whole cells and OXK-lipopolysaccharides (Proteus OXK-LPS). Furthermore, IgM antibodies from almost all of WF test-positive sera recognized LPS from Proteus OXK in immunoblotting. Based on these results, it was concluded that IgM antibody rather than IgG may participate in WF test, and that Proteus OXK-LPS may have one of antigenic epitopes common to the components of R. tsutsugamushi.

Agglutination Tests↗
PubMed1997

Seroepidemiologic evidence for murine and scrub typhus in Malang, Indonesia.

Indonesian military personnel stationed in Malang, East Java were among troops deployed to central Cambodia as part of the United Nations' Transition Authority Cambodia peace-keeping operation in 1992. Predeployment blood samples obtained from a cohort of Indonesian soldiers indicated a high prevalence of antibodies to antigens of Rickettsia typhi or Orientia (formerly Rickettsia) tsutsugamushi, the etiologic agents for murine and scrub typhus, respectively. To evaluate the potential risk of these rickettsial diseases in the Malang area, a subsequent seroepidemiologic survey was conducted. This study involved civilian personnel residing within one of three Malang kelurahans (neighborhoods) representing urban, suburban, and rural communities. The heads-of-households from 197 homes completed a detailed epidemiologic survey. In addition, blood samples were collected from 464 individuals residing within the households surveyed. Examination of civilian blood samples disclosed that 34.7% and 1.3% of the study participants were seroreactive to R. typhi and O. tsutsugamushi, respectively. These results were similar to those obtained earlier from the military samples. In addition, assessment of 78 blood samples obtained from peridomestic rodents trapped from within or near the households surveyed showed that 28 were reactive to R. typhi antigens and four were reactive to O. tsutsugamushi antigens. These data indicate that military and civilian personnel living in the Malang area of East Java are at risk of infection with rickettsiae that are antigenically indistinguishable from those that cause murine and scrub typhus.

Adolescent↗
PubMed1986

Effect of sublethal gamma radiation on host defenses in experimental scrub typhus.

The effect of sublethal gamma radiation on inbred mice chronically infected with scrub typhus rickettsiae was examined. Inbred mice which were inoculated with the Gilliam or Karp strain of Rickettsia tsutsugamushi by the subcutaneous route harbored the infection for at least 1 year. Irradiation of these animals at 12 or 52 weeks postinoculation with normally sublethal levels induced a significantly higher percentage of rickettsemic mice (recrudescence) than was seen in the unirradiated, similarly infected control animals. In addition, sublethal irradiation at 12 weeks induced a quantitative increase in total rickettsiae. Homologous antibody titers to the rickettsiae were examined for 5 weeks after irradiation to determine the role of the humoral response in radiation-induced recrudescence. Unirradiated, infected mice showed consistent titers of about 320 throughout the 5-week observation period, and the titer was not affected by exposure of up to 500 rads of gamma radiation. Drug dose-dependent radioprotection and modification of recrudescence was noted in infected, irradiated mice treated with the antiradiation compound S-2-(3-aminopropylamino)ethyl phosphorothioic acid. The results of this investigation supported the conclusion that the recrudescence of a chronic rickettsial infection in the appropriate host after immunological impairment due to gamma radiation can result in an acute, possibly lethal rickettsemia.

Amifostine↗
PubMed2002

Expression of recombinant proteins of Orientia tsutsugamushi and their applications in the serodiagnosis of scrub typhus.

In this study, recombinant proteins that encompassed the AD I-AD III regions of 56 kDa immunodominant gene of 2 Orientia tsutsugamushi (OT) serotypes; Gilliam and TA763 were expressed in Escherichia coli. Both recombinant proteins exhibited serologic cross-reactivity with the rabbit antisera against various OT serotypes, as evaluated by enzyme-linked immunosorbent assay (ELISA), but not against other rickettsial species, including Rickettsia typhi, R. prowazekii and TT118 SFG rickettsiae. The feasibility of using the recombinant proteins as a diagnostic reagent was further evaluated by ELISA using sera from blood donors and scrub typhus patients. The results suggested a higher affinity of the antihuman IgM than IgG with both recombinant proteins. The IgM ELISA findings were agreeable with the results of indirect immunoperoxidase (IIP) assay especially with sera of high antibody (1:1600). However, more than one antigen are probably needed for development of an effective assay for serodiagnosis of scrub typhus in endemic areas.

Animals↗
PubMed1980

The longevity of antibody to Rickettsia tsutsugamushi in patients with confirmed scrub typhus.

Serological surveillance for up to two years of 114 patients with laboratory confirmed scrub typhus showed that antibody to Rickettsia tsutsugamushi as demonstrated by the indirect fluorescent antibody test is short-lived. The mean reversion time from mean peak titre (1:499) was 48.9 weeks and the calculated annual reversion rate to a titre less than 1:50 was 61%. This can be used to estimate attack rates based on point prevalence of antibody. The relationship between antibody prevalence and attack rates observed by other workers was confirmed using this model. The possible uses of the finding and its implications in Malaysia are briefly discussed.

Adult↗
PubMed1975

Clinical observations of scrub typhus on Penghu (the Pescadores Islands).

Between May and September 1973, 68 cases of scrub typhus in Chinese military personnel on the Pescadores Islands were studied. The common symptoms and signs were fever, chills, headache, eschar, myalgia, and lymph node enlargement. Most eschars were located in the axilla, waist, groin and genitals, and neck. These lesions were painless and not noticed by the patients themselves. Regional lymph node enlargement at the site of eschar drainage was common. Relative bradycardia with fever was observed in 40%, a skin rash in 35% of the patients. Leucopenia was noted more frequently in the febrile than in the convalescent stage, but more than half of the patients had a normal count. Lymphocytosis was prominent, especially during the convalescent period. An acceleration of ESR was noted. Instead of depression of the erythroid series in the marrow which was reported previously, 47% of examined patients were found to have erythroid hyperplasia. Two patients showed marked hypocellularity of the marrow in the acute febrile stage; later on became normocellular. Albuminuria was present in 15 and BUN increased in 12 patients. Elevation of serum bilirubin and SGOT was also noted. Biologic false positive VDRL tests were observed in nine patients. In 30 tests elevation of Proteus OX-K titres between 1:160 and 1:640 was noted. A geometric mean OX-K titre rise in the patients is presented; the mean titre reached a peak in the third week of illness, and then fell off. Most of the patients were treated with tetracycline 500 mg every six hours for about nine days. The fever usually subsided within 36 hours. Complications or mortality were not encountered.

Adult↗
PubMed1977

Host defenses in experimental scrub typhus: effect of chloramphenicol.

The effect of chloramphenicol treatment on the development of immunity to scrub typhus in mice was studied. Chemotherapy was administered either shortly before infection and for 14 days thereafter (group I), or from 7 to 21 days postinfection (group II). Although the full course of either regimen resulted in complete protection of the mice against subsequent challenge with the homologous strain of Rickettsia tsutsugamushi, initiation of chemotherapy at 7 days postinfection resulted in more rapid development of immunity against both the original infection and subsequent challenge. In both treatment groups, a 1- to 2- day hiatus was observed between immunity to challenge in the treated animal and the ability to transfer this immunity to syngeneic recipients with lymphocyte-enriched spleen cells. Similarly, complement-fixing antibodies were not detectable until shortly after the animals were able to resist challenge. These data supported the conclusion that the rickettsiostatic effect of chloramphenicol allows the infected animal time to mount an effective immune response and, further, that initiation of chemotherapy early in the infection may delay development of this response.

Animals↗
PubMed1978

Gamma-irradiated scrub typhus immunogens: development and duration of immunity.

The development and duration of immunity to lethal scrub typhus infection was studied in BALB/c mice vaccinated with gamma-irradiated Rickettsia tsutsugamushi, strain Karp. One intraperitoneal injection containing approximately 10(8) 50% mouse lethal doses (MLD(50)) of irradiated organisms elicited an immune response protective against challenge with 10(5) MLD(50) of viable Karp. The same mass of immunogen given in three injections at 5-day intervals increased homologous (Karp strain) protection 25-fold and heterologous (Kato strain) protection 60-fold. Further temporal expansion of the immunization regimen did not increase protection. Subcutaneous vaccination provided significant, but lower, levels of protection than were achieved by intraperitoneal immunization, but the levels of cell-transferable immunity elicited by the two routes were approximately the same. Immunologically specific protection after intraperitoneal vaccination developed rapidly enough to provide resistance against simultaneous challenge with 200 MLD(50) of Karp. Homologous immunity was protective against a 10(6)-MLD(50) challenge 7 days after completion of the three-injection regimen, remained at that level for 3 months, dropped to 10(4) MLD(50) by 9 months, and was effective against a 50-MLD(50) Karp challenge at 12 months. Protection against heterologous challenge was first observed on day 17 and peaked on day 38, when the mice resisted a 10(5)-MLD(50) Kato challenge. Thereafter, heterologous protection waned rapidly and was not significant at 6 months.

Animals↗
PubMed1976

Host defenses in experimental scrub typhus: role of cellular immunity in heterologous protection.

The relative contributions of cellular and humoral immunity in scrub typhus infections were studied in inbred mice employing paired strains of Rickettsia tsutsugamushi differing in virulence. An infectious dose (100 MID50) of the less virulent Gilliam strain resulted in heterologous immune protection against an otherwise lethal challenge (1,000 MLD50) of the virulent Karp strain. Partial heterologous protection against lethal Karp challenge was observed in animals preimmunized with the Gilliam strain as early as 3 days prior to challenge, whereas complete protection against illness and death existed in animals immunized at least 7 days prior to challenge. In the heterologous protection provided by prior Gilliam infection, the role of humoral immunity was not of primary importance for the following reasons: (i) significant levels of complement-fixing antibody against R. tsutsugamushi were not detectable until long after animals were solidly immune; (ii) antibody eventually appearing after Gilliam immunization exhibited a consistently low complement-fixing titer against the immunizing homologous (Gilliam) strain and contained no detectable activity against the heterologous challenge (Karp) strain; and (iii) passive transfer of large quantities of serum from Gilliam immune mice, themselves immune to Karp challenge, failed to protect recipients against a similar challenge. However, protection was afforded by the passive transfer of serum containing antibody against Karp, suggesting a major role for antibody in protection against homologous infection. This heterologous challenge system was particularly useful because it minimized the role of humoral immunity, at least early in the course of infection, and allowed a definitive examination of the cellular response. Cell-mediated immunity played a major role in the heterologous protection observed after Gilliam immunization. This was evidenced by the significant protection against Karp challenge afforded by the passive transfer of spleen cells from animals immunized with Gilliam 7 to 63 days previously. Of the immune spleen cells, only those which were nonadherent, presumably lymphocytes, were capable of transferring passive heterologous protection. This protective effect of nonadherent cells could be ablated by depleting the cell population of thymus-derived or T cells with anti-theta serum and complement prior to transfer but not by use of anti-immunoglobulin serum and complement, which selectively removes bone marrow-derived or B cells. These results suggested that the cell in immune spleens capable of conferring heterologous protection was a T lymphocyte.

Animals↗
PubMed1982

Serodiagnosis of tsutsugamushi fever (scrub typhus) by the indirect immunoperoxidase technique.

The indirect immunoperoxidase technique was assessed for the serodiagnosis of tsutsugamushi fever (scrub typhus). The antigens were peritoneal smears prepared from mice infected intraperitoneally with the Karp, Kato, and Gilliam strains of Rickettsia tsutsugamushi. Treatment of the mice with cyclophosphamide apparently increased the number of the rickettsiae, and it minimized the exudate that interfered with the specific staining. The rickettsiae were seen as clusters in the juxtanuclear region of the mesothelial cells and also as free particles outside of the cells. By the indirect immunoperoxidase technique, the sera from all of the patients (49 samples from 30 patients) were positive for the R. tsutsugamushi antibody. The antibody titers (immunoglobulin G [IgG] and IgM) determined by the indirect immunoperoxidase technique correlated with those determined by the indirect immunofluorescence technique. Thus, the indirect immunoperoxidase technique was useful for quantifying both IgG and IgM antibodies to the rickettsia.

Antibodies, Bacterial↗
PubMed1968

Ecological considerations in scrub typhus. 3. Methods of area control.

The best of the known methods for control of the chigger vectors of scrub typhus is the application of dieldrin to the ground and low-lying vegetation as a fog or spray at the rate of 2.5 lb to the acre (28 kg/hectare). This has produced a more than 91% reduction in the numbers of Leptotrombidium (L.) akamushi (Brumpt, 1910) and L. (L.) deliense (Walch, 1922) for at least 2 years. Aldrin applied at the rate of 2.25 lb per acre (2.5 kg/hectare) is also highly effective, but less so than dieldrin. Lindane at the rate of about 5 lb per acre (5.7 kg/hectare) ranks third, but offers protection for only about 2 months. Because of the potential hazards to wildlife when such long-acting compounds are used, application of organophosphorous or carbamate insecticides may be used instead in areas where reapplication every few weeks is feasible. Fenthion and arprocarb are promising compounds for this purpose.

Animals↗
PubMed2000

Evaluation of a commercially available recombinant-protein enzyme-linked immunosorbent assay for detection of antibodies produced in scrub typhus rickettsial infections.

The 56-kDa major outer membrane protein antigen of Orientia tsutsugamuchi is the immunodominant antigen in human scrub typhus (ST) infections. An enzyme-linked immunosorbent assay (ELISA) using a recombinant 56-kDa protein (r56) to detect specific immunoglobulin M (IgM) produced in ST infections was developed, and its performance was evaluated using sera from patients with active ST (n = 59), spotted fever (SF) (n = 31), and murine typhus (MT) (n = 6) and from those without rickettsial infection (n = 52). The r56 ELISA was compared to an ELISA using native whole cell lysate of O. tsutsugamushi Karp or O. tsutsugamushi Gilliam as antigens. The performance of the assays using r56 was similar to that of those using native antigens. Using indirect immunoperoxidase (IIP) as the reference test, sensitivities were 86, 88, and 88% while specificities were 84, 90, and 87% in the three assays. Furthermore, cross-reactivity in confirmed cases of SF and MT was low (5.4, 2.7, and 2.7% respectively). The additional use of IgG in the r56 ELISA gave improved performance (sensitivity, 80%; specificity, 96%; cross-reactivity in SF and MT, 2.7%). The detection of high levels of IgG in some IgM-negative patients illustrates the importance of including a test for IgG in the detection of secondary or reactivated infections, since many of these patients were from regions in Thailand where these infections are endemic.

Antibodies, Bacterial↗