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Tsutsugamushi disease (scrub typhus).

Two patients with Tsutsugamushi disease (fever) were successfully treated with tetracycline derivatives after typical eschars were found, although one of the patients was initially misdiagnosed as having a drug reaction eruption. Prompt diagnosis and treatment are important because this disease can be associated with considerable morbidity and simple effective treatment is easily available.

Adult↗

Scrub typhus in Himalayas.

Himachal Pradesh state of India is situated in the outer Himalayan ranges. During the rainy season, several cases of acute febrile illness of unknown origin occurred. Orientia tsutsugamushi was identified as the causative agent by microimmunofluorescence and PCR. Two new genotypes of O. tsutsugamushi were identified in the region.

Fever↗

Scrub typhus pneumonitis with delayed resolution.

A 35-year-old lady was admitted to hospital with fever and dry cough. Chest radiograph showed bilateral basal infiltrate. Her Weil-Felix test was strongly positive (OX-K > 1:160) and her fever came down with intravenous tetracycline. There was no improvement in the lung shadow and spirometry showed a severe restrictive defect. Open lung biopsy confirmed the diagnosis of interstitial pneumonitis. CT of thorax 6 months after presentation showed partial resolution of the interstitial shadow.

Adult↗

Protection against scrub typhus infection engendered by the passive transfer of immune sera.

The passive transfer of convalescent sera did not protect the majority of mice against challenge with the homologous strain and was completely ineffective against challenge with strains unrelated by fluorescent antibody techniques. When the immune sera was incubated with the rickettsia in vitro and then inoculated into the mice a dramatic increase occurred in the number of surviving mice. The importance of these data in relation to published results with other species of rickettsia is discussed.

Animals↗

Distribution of rats infected with Rickettsia tsutsugamushi (scrub typhus) in an edge habitat.

No focalization of rats (Rattus tiomanicus and R. argentiventer) infected with Rickettsia tsutsugamushi could be discerned over a 500 m trapping transect at the border between a forest and lalang grass (Imperata cylindrica). R. tiomanicus appeared to occupy 250 m of the transect on the average and had periods during which infections were observed which averaged 97 days. Calulations indicated that more than 50% of individuals become infected over their life-time. The high rate of infection in this and other areas described in earlier publications and the habits of the rats suggest that infected mites are densely and widely dispersed in the areas studied in Malaysia.

Animals↗

Experimental infection of mouse peritoneal mesothelium with scrub typhus rickettsiae: an ultrastructural study.

The infection cycle of Rickettsia tsutsugamushi in mouse peritoneal mesothelial cells, observed late in the course of an established infection, intimately involved the host cell plasma membrane. Organisms multiplied in the cytoplasm, moved to the cell periphery, and acquired a host-membrane coat as they budded from the cell surface. Rickettsiae enveloped by this membrane entered other mesothelial cells, apparently by a phagocytic mechanism. Organisms escaped from the phagocytic vacuole as the vacuole membrane and host membrane coat disintegrated. Free rickettsiae replicated by binary fission in the cell cytoplasm. Rickettsial infection of mesothelial cells induced conspicuous cellular hypertrophy with increased numbers of unaltered cytoplasmic organelles.

Animals↗

Scrub typhus in the Eastern Solomon Islands and Northern Vanuatu (New Hebrides).

Rickettsia tsutsugmushi has been isolated from Rattus rattus from Vanua Lava island in Northern Vanuatu (New Hebrides) and from R. exulans and Leptotrombidium akamushi on Ndende island in the Eastern Solomon Islands. The well-known vector mite L. deliense was found on Mota Lava and Vanua Lava in Vanuatu, but no isolation was made from pools of this mite. Serology confirms that R. tsutsugamushi infects humans in the Banks group of islands in Northern Vanuatu and that infection is much more widespread in the Solomon Islands than the limited isolations indicate.

Animals↗

Application of serologic diagnosis of tsutsugamushi disease (scrub typhus) in Korea where the disease was recently recognized to be endemic.

In Korea, tsutsugamushi disease is a recently recognized infection. It has become clear that it is more prevalent than leptospirosis or hemorrhagic fever with renal syndrome. Accurate diagnosis of the disease is necessary for the selection of effective antimicrobial agents which can prevent fatalities and shorten the course. For the diagnosis, various serologic tests are used. Sensitivity and specificity of a test depend on various factors. In this report, microbiological aspects of the infection were briefly described and the Weil-Felix, indirect immunofluorescence and indirect immunoperoxidase tests were compared for their applicability in routine use and usefulness in the diagnosis. Their interpretations were also briefly discussed.

Adolescent↗

Scrub typhus and chiggers in northern Thailand.

It was reconfirmed that L. deliense was the most dominant chigger during the rainy season in northern Thailand. Overall prevalence of IgG antibody against R. tsutsugamushi among the rural villagers in the northern most part of Thailand was nearly 60% at the level over 1 : 10 by an indirect immunofluorescent test. The level of IgG and IgM antibody titers was considerably high as greater than or equal to 1 : 2560 in some sera, but did not markedly vary by age groups or sexes. Based on detection of IgM antibody, the probability of new or reinfections were considered.

Animals↗

Sero-epidemiological survey of scrub typhus.

A total of 1017 human sera from ecologically different areas in the states of Rajasthan and Jammu & Kashmir were subjected to the CF test using the Gilliam strain antigen of R. tsutsugamushi. Results revealed that 2.4% and 3.5% of the populations examined in the two states respectively, were found to possess antibodies to the test antigen. The titres of positive sera varied from 1:8 to 1:32. Findings of this survey could be correlated with the local topography, presence or absence of vector and the exposure of susceptible population to the rickettsial agent. However, the presence of hidden foci in the neighbouring areas not covered by the current survey cannot be ruled out.

Antibodies, Bacterial↗

Scrub typhus infection in rats in four habitats in Peninsular Malaysia.

Rickettsia tsutsugamushi isolations were attempted from blood samples obtained from rats captured in four adjacent habitats near Kuala Lumpur, Malaysia. Antibody surveys were also made. Rickettsial infections were most frequent in rats captured in the forest and in lalang grass (Imperata cylindrica) and least frequent in the most extensively disturbed habitat, an Orang Asli (aborigine) village. Forest rats such as Rattus sabanus (31%), as well as rats in the subgenus R. (Rattus), i.e. R. tiomanicus (26%) and R. argentiventer (35%) had frequent active infections. The house rat R. exulans had less frequent infections (15%). Frequency of antibody occurrence followed a similar pattern. No marked seasonal differences in the frequency of infections could be detected during the 18-month study.

Animals↗

[Sero-negative tsutsugamushi disease (scrub typhus) diagnosed by polymerase chain reaction].

We report a case of sero-negative tsutsugamushi disease diagnosed by polymerase chain reaction (PCR). A 54-year-old man who worked in Nagano prefecture presented with flu-like symptoms that did not respond to cephalosporin therapy. On admission to another hospital, chest roentgenography revealed abnormal shadows; liver dysfunction was also present. Despite therapy, the patient's condition gradually worsened and he was transferred to our intensive care unit. Erythema on all extremities and scabs on the right medial femoral region and the dorsum of the left foot suggested a diagnosis of tsutsugamushi disease. We administered minocycline and gave percutaneous cardiopulmonary support for adult respiratory distress syndrome. Despite all efforts, the patient died. Although serologic tests were not positive, Karp strains of R. tsutsugamuschi were identified on PCR amplification. Autopsy revealed evidence of acute hemorrhagic pancreatitis, which has not been reported previously in tsutsugamushi disease. We conclude that PCR techniques may be useful in confirming a diagnosis of early tsutsugamushi disease.

DNA, Bacterial↗