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PubMed2006

Epidemiology of scrub typhus in eastern Taiwan, 2000-2004.

The epidemiology of scrub typhus in eastern Taiwan was studied by analyzing the data from the CDC Web reporting system. A total of 1,396 cases with 403 confirmed cases were reported in the period of 2000 to 2004. The cases were commonly found in all counties with the highest number in Yuli Township, Hualien County (53 cases) and Taitung City, Taitung County (40 cases). Monthly changes in the number of cases showed epidemic periods in the spring with a peak in May, and again in the fall, with an October-November peak. The occurrence of disease varied with age, gender, and occupation. Our results showed that the infection rates in the elderly (50-69 years old), males (62.8%), and farmers (25.6%) were higher than those in other age groups, females, and other occupations. Five major clinical symptoms, fever, headache, eschar, rash, and lymphadenopathy, were observed in 90.1, 61.9, 23.1, 21.6, and 10.7% of the cases, respectively. Almost 90% (89.3%) of the cases showed 1-3 clinical symptoms and some showed 4-5 symptoms (10%). Only one patient with no symptoms (0.8%) was found. This paper reports the status of scrub typhus in eastern Taiwan, and suggests that a health education program could train individuals to self-recognize the disease symptoms.

Adolescent↗
PubMed2006

Relevance of Weil-Felix test in diagnosis of scrub typhus in India.

OBJECTIVE: To study the relationship of Weil-Felix test and microimmunofluorescence test. METHODS: Sera of 21 patients with clinical diagnosis of scrub typhus were subjected to Weil-Felix and Microimmunofluorescence tests. RESULTS: On Weil-Felix test, 13 (62%) sera showed titers 1: > or = 40-320. 7 patients showed titers 1: > or = 320, 3 showed titers 1 : 160, 2 showed titers 1 : 80 and 1 patients showed titers 1 : 40, to Proteus OXK antigen. All 21 sera showed significant titers to O. tsutsugamushi on microimmunofluorescence. CONCLUSION: Weil-Felix test is not a very sensitive test in diagnosis of scrub typhus but due to of lack of availability of definitive tests in India it canbe a useful tool when used and interpreted in the correct clinical context.

Adolescent↗
PubMed2006

Scrub typhus-associated acute disseminated encephalomyelitis.

BACKGROUND: Acute disseminated encephalomyelitis (ADEM) is a monophasic demyelinating disease of the central nervous system, typically occurring after infections or vaccinations. To our knowledge, scrub typhus has not been described in association with ADEM. CASE REPORT: A 77-year-old man was admitted with fever, convulsions and an altered level of consciousness. On neurological examination, the patient was stuporous and had nuchal rigidity and left hemiparesis. A generalized tonic-clonic seizure was observed. Serum and cerebrospinal fluid samples were positive for anti-Orientia tsutsugamushi antibody. Despite a 10-day course of parenteral minocycline, his clinical condition deteriorated. Serial cranial magnetic resonance images demonstrated progressively extensive areas of signal hyperintensity on conventional T2-weighted and fluid attenuated inversion recovery sequence images, mainly affecting the periventricular white matter. After administration of intravenous high-dose corticosteroids, the patient had limited improvement. CONCLUSIONS: This is the first identifiable case of ADEM temporally associated with scrub typhus alone.

Aged↗
PubMed1991

Clinical and laboratory features of murine typhus in south Texas, 1980 through 1987.

OBJECTIVE: --The clinical and laboratory features of patients with murine typhus have not been extensively reviewed since 1946. We have updated these findings in patients from south Texas who were examined by modern clinical and laboratory methods from 1980 through 1987. DESIGN: --Patients were identified by serological methods in this case series, and clinical, epidemiologic, laboratory, and therapeutic data were compiled and analyzed. SETTING: --The majority of patients (77 of 80) were identified in a primary care community hospital setting; the remainder (3 of 80) were ambulatory hospital outpatients. PATIENTS: --From 1980 through 1987, a total of 345 patients were diagnosed with murine typhus; 90 of these patients were seen at four hospitals in south Texas; of these, 80 had clinical and laboratory data available for review. MAIN OUTCOME MEASURES: --The frequency of common clinical manifestations (eg, headache, fever, and rash) and laboratory findings (eg, leukocyte and platelet counts and serum chemistry abnormalities) of patients with infectious diseases was tabulated. Clinical severity was semiquantitatively assessed and was correlated with clinical, laboratory, and therapeutic results. RESULTS: --Most cases (69%) occurred from April through August. Rash occurred in 54%; the triad of fever, headache, and rash was observed in only 12.5% of patients when first examined by a physician; respiratory and gastrointestinal symptoms were also frequent. Multiple organ involvement was documented by frequent abnormal laboratory findings of the hematologic, respiratory, hepatic, and renal systems. Disease severity was related to older patient age, the presence of renal dysfunction, leukocytosis, and hypoalbuminemia, and previous therapy with sulfa antibiotics. CONCLUSIONS: --Infection by Rickettsia typhi causes a systemic illness with clinical and laboratory abnormalities not previously recognized or described. Early clinical diagnosis and treatment are needed to avoid undue morbidity and mortality.

Diagnosis, Differential↗
PubMed1990

Murine typhus on the northern Dalmatian islands, Yugoslavia.

The present epidemiological study had the objective to establish whether and to what extent resident islander populations might be affected by the natural foci of murine typhus. To this end, 294 serum specimens were collected during summer and autumn of 1985 from the northern Dalmatian islanders, all of which were tested for anti-Rickettsia typhi (R. typhi) complement fixing (CF) antibodies. These were detected and confirmed at both stages of the screening, namely during the first stage, conducted on the northern Dalmatian islands, where 63.3% of the representative population had a titre of 1:4 or higher and during the second stage, carried out on the island of Vir, with 68.1% of the residents found R. typhi positive unlike in the former. The majority of positive sera were found in the 21-60-year group, peaking in the 21-30- and 31-40-year groups with fewer positive sera among the subjects over 60 and the fewest among the residents below 20 years of life. Thus, current differences in antibody rates in various age groups were shown to be statistically significant. Murine typhus immunity in resident islander populations could be detected from the age of 10 years on, and was shown to become almost equal to the adult population's positive sera levels in the 16-20-year age group. No differences were revealed with regard to the infective agent exposure between the male and female populations representative of the total population or in any of the age groups.

Adult↗
PubMed1989

[Typhus infection (Brill's disease) in the environment of a large city].

The data on the epidemiological analysis of 675 cases of infection of the typhus nature, detected in Leningrad in 1974-1986, are presented. The seasonal morbidity curve, the age structure of patients, the character of the clinical course of the disease and other data gave a reason for the diagnosis of Brill's disease. The comparison of the relative data on morbidity rates in typhus at different periods of the current century was made.

Adolescent↗
PubMed1986

Prevalence and distribution of spotted fever and typhus infections in Sierra Leone and Ivory Coast.

A serosurvey for evidence of rickettsial infections was conducted in the rural populations of several tropical rain forest areas in Sierra Leone and Ivory Coast. Seropositivity rates were surprisingly high in both countries, with more than 7% of the individuals in some districts having antibodies to spotted fever-group rickettsiae. No significant difference was found in the overall prevalence of diagnostic antibody titers to spotted fever-group rickettsiae in Sierra Leone (5.3%) and Ivory Coast (6.2%). However, there was a significant difference (p less than 0.001) in the prevalence of diagnostic antibody titers to typhus rickettsiae in the two countries. There were no marked geographic differences within either country in overall prevalence of rickettsial infections, but there were possible area differences in specific seropositivity rates to typhus- and spotted fever-group rickettsiae in Sierra Leone. In both countries, age and sex differences were important in determining seropositivity, but there was no indication of an age-sex interaction. In Sierra Leone, 59 of the 80 positive sera (73.8%) were from persons age 15 or above (p less than 0.001), and 50 of the 80 (62.5%) were from males (p = 0.05). In Ivory Coast, 33 of the 37 positive sera (89.2%) were from the greater than or equal to 15-age group, and 28 of the 37 (75.7%) were from males (p less than 0.001 for both age and sex). The identification of specific areas endemic for these rickettsial diseases should facilitate the diagnosis and treatment of patients with rickettsial illnesses in West Africa.

Adolescent↗
PubMed1988

Murine typhus infection complicated by dengue haemorrhagic fever.

Murine typhus is endemic in many South East Asian countries but it has not been reported from the island of Borneo. Recently we attended to an English lady who contracted the disease in Brunei. Her clinical course unexpectedly turned stormy in the third week of the illness accompanied by severe thrombocytopenia. She made a complete recovery. Serological studies here and subsequently in England confirmed that she suffered from recent murine typhus infection complicated by dengue haemorrhagic fever.

Adult↗
PubMed1986

Epidemiology of murine typhus in Texas. 1980 through 1984.

From 1980 through 1984, a total of 200 cases of murine typhus were reported in Texas. All cases were confirmed by the indirect fluorescent antibody assay or latex agglutination test. Patients ranged in age from 1 to 90 years (median, 35 years). Fifty-one percent were female. Seventy-four percent of the patients resided in south Texas. Illness occurred in all months of the year, but 40% of the cases had onset in April, May, or June. Annual incidence increased with age and was higher in Hispanics. Murine typhus continues to be an important public health problem in Texas.

Adolescent↗
PubMedDate not supplied

[Current results and methods in eradication of typhus fever on the Serbian territory excluding autonomic provinces].

Since 1969 Serbia has been conducting the programme of eradication louse-borne typhus. To this effect of Law on the eradication of communicable diseases has been passed. In addition to Republic Commission, as well as 6 regional commissions, and 18 communal commissions in whose territory the disease is being eradicated, have been formed. The operations consist of four phases: preparatory attack, consolidation and final phase. The methods and measures applied under the programme include the measures concerned with the control of vectors, i.e. lousiness, measures to detect the source of infection, respectively patients with louse-borne typhus and Brill-Zinsser disease. The control of louseiness effected through the impregnation of underwears and bed linens by means of syntheic insecticides (DDT, Maltox), as well as through health education activities, has yielded good results, so that the highest rate of lousiness: 9.08% (Sjenica, Tutin 4.37%), was reduced to less than 1% in 1972. To detect the source of infection, both active and pasiive investigation has been carried out. Active investigation included regular control of the health state through thermometry applied to registered households with lice. Passive investigation is carried out trough out -patient units and residential services which take care of all febrile patients coming from endemic areas. The results obtained from the three-year operations indicate that the percentage of dected patients with Brill-Zinsser amounts to 0--4--3.9%, as well as that it is still lagging behind with respect to the immunity acquired through previous affections in the endemic areas. The distribution of detected patients with Brill-Zinsser especially indicates that a small number of patients from endemic ares has been detected. The paper presents the criteria for the evaluation of results, making a proposal that a professional body should be formed at the federal level to coordinate the methods and programmes of operations. In addition that body's task would be to expand the operations to all endemic areas in the country.

Adolescent↗
PubMed1966

Evidence of typhus infection in domestic animals in Egypt.

Previous work suggested that domestic animals could act as a reservoir of epidemic typhus. To test this hypothesis, sera from buffaloes, camels, donkeys, goats, pigs and sheep in different parts of Egypt were submitted to the complement-fixation test, using the common soluble typhus antigen. The highest percentage of positive results was obtained with camel and donkey sera and the positivity rate was higher towards the end of the year than in June and July. Animals from the Western Desert area were more frequently positive than those from other regions. Attempts to isolate rickettsiae by intraperitoneal injection of guinea-pigs resulted in some febrile reactions, but so far no rickettsiae have been isolated.

Animals↗
PubMed1979

Forecasting the onset of a scrub typhus epidemic in the Pescadores Islands of Taiwan using daily maximum temperatures.

Daily maximum atmospheric temperatures were used to forecast the seasonal onset of scrub typhus in the Pescadores Islands of Taiwan. The day of the year on which the temperature first reached 30 degrees C was selected as the predictive base. Predictions for 1977 closely matched observed events. The model provides an easy and effective means to forecast the start of scrub typhus epidemics in the Pescadores Islands and could be used for such practical purposes as determining when prophylactic antibiotics should be administered to subjects whose risk of infection with Rickettsia tsutsugamushi is high.

Disease Outbreaks↗
PubMed1984

Spotted fever and murine typhus in the Negev desert region of Israel, 1981.

During 1981, 52 cases of rickettsiosis caused by the spotted fever group of rickettsiae were reported in a population of 250 000 living in the Negev desert region of Israel. Retrospectively, at least 5 of these cases were serologically shown to have been caused by Rickettsia typhi, the agent of murine typhus. Most cases of rickettsial disease occurred in the summer months and one half of all cases occurred in children aged 9 years or less. While the specificity of a physician's diagnosis of the rickettsial diseases appears to be high (i.e., few cases of other diseases are misdiagnosed as either spotted fever or murine typhus), the sensitivity of the physician's diagnosis may be lower (i.e., many cases of these diseases presenting as fevers of unknown origin are not diagnosed as rickettsial disease). These findings may also be important for other countries of the region.

Adolescent↗
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↗
PubMed1980

Scrub typhus survey of Biak and Owi islands: ectoparasites of small mammals and rickettsial isolations.

A survey of smnall mammals and their ectoparasites was conducted on the islands of Biak and Owi, Indonesia, in August 1976. Two species of chiggers known to serve as vectors of scrub typhus were found: Leptotrombidium (Leptotrombidium) deliense from Rattus exulans, R. ruber, and R. r. septicus; L. (L.) flectcheri from R. exulans, R. leucopus and R. r. septicus. Rickettsia tsutsugamushi was isolated from the spleens of R. exulans and R. r. septicus. The favored ecotype of the chigger and rat hosts of R. tsutsugamushi appeared to be coarse, low-lying native vegetation on a porous coralline soil. These and similar nearby coral islands should be considered high risk areas for scrub typhus.

Animals↗
PubMed1980

Rodent and scrub typhus survey in a ricefield at Kramat Tunngak area, Tanjung Priok, Jakarta, Indonesia.

Trapping of small mammals in a ricefield at Kramat Tunggak around Tanjung Priok in Jakarta city, was carried out from July 1977 through June 1978. Of three species of rodents, R.argentiventer was found to be the predominant species in the ricefield. R.r.diardii was an intermittent resident, and the presence of R.norvegicus was interesting observation. S.murinus, a house shrew, was also present. R.argentiventer was the dominant species during the periods when the rice grains were available as a source of food. Infestation with Gamasid mites and non-vector chiggers was found common in all rodent species examined. R. argentiventer was the only species found infested with the classical scrub typhus vector (L. (L.) deliense). The density and mean chigger-load of the scrub typhus vector chiggers were found to be high in stages 4 and 5 of the ricefields when the micro-habitats were favourable. The oriental rat flea (X. cheopis) was found infesting all species of rodents.

Agriculture↗
PubMed1995

Persistently elevated serum transcobalamin II in a patient with cerebral malaria and typhus infections.

A 25-year-old man presented with a history of fever, chills and vomiting for three days. The parasite count was 207 ring-forms of P. falciparum per 1000 red cells. He developed hemoglobinuria and excreted hemoglobin in the urine 0.20-0.30 g/dl for 14 days during admission. Many blood transfusions were administered for correcting anemia. Although the malarial parasites disappeared one week after anti-malarial therapy, however, the fever and hemoglobinuria persisted. The Weil-Felix reaction OXK was positive with a titre of 1:40 on admission and increased to 1:160 on the second week. Chloramphenical and prednisolone were given for treatment of typhus fever and all symptoms subsided. Serum TCII levels were found to be increased and persisted high during the hemoglobinuria. The clearance of TCII was lower and increased relatively slowly to the normal level on day 30. On the other hand, TCII excretion in the urine was found to be increased during hemoglobinuria. These findings indicate that the catabolism and clearance of TCII in this patients is impaired with increased TCII excretion in the urine in parallel to the hemoglobinuria. Serum TCII level is, therefore, increased and persistently high in a patient with malaria and typhus fever infections with hemoglobinuria.

Adult↗
PubMed1995

Effectiveness of a dot-blot immunoassay of anti-Rickettsia tsutsugamushi antibodies for serologic analysis of scrub typhus.

We compared a commercially available dot-blot immunoassay system with the indirect immunofluorescence assay (IFA) in tests of known negative and known positive sera from scrub typhus cases. Using a panel of 100 sera from patients with various rickettsial and nonrickettsial infections, we observed that the IFA was 99% specific and the dipstick assay was 98% specific. In tests of 91 sera (30 negative and 61 positive for scrub typhus antibodies) from a study of febrile patients in Malaysia, using the standard of an IFA titer < 1:64 as negative, an IFA titer > 1:128 as positive, and an IFA titer = 1:64 as either positive or negative (supported by clinical records), dipsticks were 83% specific and 90% sensitive. The quantitative correlation of the dipsticks to IFA titers was confirmed by significant differences in geometric means of inverse IFA titers corresponding to the number of positive dipstick spots (no dots = 8.5, one dot = 43.3, two dots = 206.7, and three dots = 676.9). The assay would enable physicians and public health workers who deal with patients to quickly diagnose and appropriately treat most cases of the disease, especially in areas of high prevalence where the proportion of false-positive results to true-positive results would be low.

Antibodies, Bacterial↗