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PubMed2005

Etiology of obscure fever in children at a university hospital in northeast Thailand.

Obscure fever is not an uncommon problem in Thailand. We studied 25 children with obscure fever admitted to Srinagarind (university) Hospital in Northeast Thailand. The etiology was identified in 52% of the cases: dengue (40%), leptospirosis (8%), and micrococcus septicemia (4%). Two cases with primary dengue infection developed dengue shock syndrome. The case with leptospirosis developed infection-associated, hemophagocytic syndrome. We found no cases of Japanese encephalitis, scrub typhus or murine typhus.

Adolescent↗
PubMed2005

A preliminary survey of ectoparasites of small mammals in Kuala Selangor Nature Park.

Trapping of small mammals was conducted at 5 study sites in Kuala Selangor Nature Park (KSNP) from 20-24 June 2005. A total of 11 animals comprising 2 species of rodents, Maxomys whiteheadi and Rattus exulans were caught from 3 sites, i.e from an area of mixed secondary forest and mangrove swamp; an area of mangrove swamp, and from an area of lalang fringing mangrove swamp. From these animals, the following 7 species of ectoparasites were found: Laelaps echidninus, Laelaps nuttalli, Ascoschoengastia indica, Leptotrombidium deliense, Hoplopleura pectinata, Hoplopleura pacifica and Polyplax spinulosa. One of the ectoparasites found, L. deliense is a known vector of scrub typhus and thus may pose potential health risks to visitors to KSNP.

Animals↗
PubMedDate not supplied

Differential diagnosis of acute liver failure in India.

BACKGROUND: Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Complicated forms of certain infectious diseases like falciparum malaria, leptospirosis, dengue fever, ricketsial fever, typhoid fever, haemophagocytosis, herpes simplex virus, cytomegalovirus, tuberculosis or amoebic liver abscess can present with altered mentation and/or bleeding manifestations in presence of jaundice and mimic ALF due to acute viral hepatitis (AVH). METHODS: We describe our experience in last 2 years with 28 patients of ALF due to above mentioned conditions (ALF-ID) and compared them with 28 patients with ALF due to AVH (ALF-AVH). RESULTS: In ALF-ID, typhoid fever was present in 1, haemophagocytosis in 1, ricketsial infection in 4 (scrub typhus = 2, endemic typhus = 2), amoebic liver abscess in 4, leptospirosis in 5, dengue fever in 5 and falciparum malaria in 8 patients. In ALF-AVH, hepatitis E and B co-infection was responsible in 1, hepatitis A and E co-infection in 1 and hepatitis E, B and C co-infection in 1, hepatitis E in 18, hepatitis A in 2 and hepatitis B in 5 patients. Differentiation of various forms of ALF-ID from ALF-AVH depends on various clinical, haematological and biochemical parameters, in addition to specific diagnostic tests. Patients with ALF-AVH had mortality rate of 50% (14/28) and ALF-ID had mortality rate of 25% (7/28). CONCLUSIONS: In developing countries, ALF-mimicking infections should be looked for in differential diagnosis of ALF. Early identification and treatment of these infections is important in reducing mortality.

Adolescent↗
PubMed1991

The United States Army Special Forces--Walter Reed Army Institute of Research Field Epidemiological Survey Team (Airborne), 1965-1968.

In 1965, an innovative concept in field medicine was launched in the form of a team of highly-trained, multi-disciplined AM-EDD specialists who were assigned to the Walter Reed Army Institute of Research and attached to the 5th Special Forces Group (Abn) while in Vietnam. Officially designated the U.S. Army Special Forces--Walter Reed Army Institute of Research Field Epidemiologic Survey Team (Airborne) (WRAIR-FEST), these personnel took their investigative skills into some of the more remote areas of Vietnam to study disease transmission in militarily hostile circumstances. From 1966-1968, numerous important studies of arthropod-borne diseases, including malaria, scrub typhus, and plague, and of gastrointestinal disorders, medically important arthropods, and cutaneous diseases were successfully conducted.

Epidemiologic Methods↗
PubMedDate not supplied

Hemorrhagic fever with renal syndrome in Korea.

Several clinical variants of hemorrhagic fever with renal syndrome (HFRS) are caused by Hantaan and related viruses. Since 1951, 500-900 patients with HFRS have been hospitalized annually in Korea. Although HFRS is associated primarily with rural areas, it is now being recognized as an urban problem and a particular hazard to laboratory staff using rodents for research. Recently, epidemic outbreaks of leptospirosis and scrub typhus have occurred during the HFRS season, leading to confusion in diagnosis. Serologic diagnosis of HFRS is based on the demonstration of IgM antibodies to Hantaviruses by the indirect fluorescent antibody technique or enzyme-linked immunosorbent assay. The specific Hantavirus causing infection can be identified on the basis of titers of plaque-reduction neutralizing antibody. Results of studies with monoclonal antibodies suggest that viral subtypes exist for each Hantaviral serotype presently recognized. While infection with Hantaviruses is known to be a problem of worldwide dimensions, present evidence indicates that it occurs over a wider area than previously recognized. Vertical transmission of Hantaan virus in a pregnant woman has been documented.

Animals↗
PubMed1989

Hemorrhagic fever with renal syndrome.

Hantaviruses, the causative agents of HFRS, have become more widely recognized. Epidemiologic evidence indicates that these pathogens are distributed worldwide. People who come into close contact with infected rodents in urban, rural and laboratory environments are at particular risk. Transmission to man occurs mainly via the respiratory tract. The epidemiology of the hantaviruses is intimately linked to the ecology of their principal vertebrate hosts. Four distinct viruses are now recognized within the hantavirus genus and that number is likely to increase to six very soon; however, further investigations are necessary. Much more work is still needed before we fully understand the wide spectrum of clinical signs and symptoms of HFRS as well as the pathogenicity of the different viruses in the hantavirus genus of the Bunyaviridae family. HFRS is difficult to diagnose on clinical grounds alone and serological evidence is often needed. A fourfold rise in IgG antibody titer in a 1-week interval, and the presence of the IgM type of antibodies against hantaviruses are good evidence for an acute hantavirus infection. Physicians should be alert for HFRS each time they deal with patients with acute febrile flu-like illness, renal failure of unknown origin and sometimes hepatic dysfunction. Especially the mild form of HFRS is difficult to diagnose. Acute onset, headache, fever, increased serum creatinine, proteinuria and polyuria are signs and symptoms compatible with a mild form of HFRS. Differential diagnosis should be considered for the following diseases in the endemic areas of HFRS: acute renal failure, hemorrhagic scarlet fever, acute abdomen, leptospirosis, scrub typhus, murine typhus, spotted fevers, non-A, non-B hepatitis, Colorado tick fever, septicemia, dengue, heartstroke and DIC. Treatment of HFRS is mainly supportive. Recently, however, treatment of HFRS patients with ribavirin in China and Korea, within 7 days after onset of fever, resulted in a reduced mortality as well as shortened course of illness.

Animals↗
PubMed1986

Antigens of virulent and attenuated Rickettsia tsutsugamushi.

We studied the antigens present in L929 mouse fibroblast or rabbit testicular cells, which had been infected or not with a prototype strain of Rickettsia tsutsugamushi, the causal agent of scrub typhus, and its attenuated variant. Immunoblotting revealed four antigens, designated 1, 1a, 2 and 3, which appeared to be specifically associated with infection with this organism. Antigens 1 and 1a had similar mol. wt of about 60 kD and antigen 2 and 3 had mol. wts of 45 kD and 28 kD respectively. Whereas antigen 1a, 2 and 3 were common to infection with either the virulent or the attenuated strains of the organism, antigen 1 was only detected in cells infected with the virulent strain and was reactive only with the antiserum raised against cells infected with that strain. In addition, two antigens were also detected by crossed immunoelectrophoresis, one of which was similarly associated with infection with the virulent strain as antigen 1, while the other was common to infection with either of the strains. It seems that the antigenic cross reaction between the two strains may account, in part at least, for the protection of mice against infection with the virulent strain afforded by the attenuated strain, while the loss or modification of antigen 1 might be associated with attenuation of the organism with respect to its virulence to mice.

Animals↗
PubMed1978

Serological evidence for the presence of rickettsial infections in parts of Nigeria.

Weil-Felix tests using OX19 and OXK proteus antigens reveal high antibody titers to OXK and OX19 antigens in patients reporting at the University of Nigeria Teaching Hospital, Enugu with clinical diagnosis of pyrexia of unknown origin. These findings suggest the presence of either or both scrub typhus fever and Epidemic typhus fever in this community. While the advisablility of using other diagnostic techniques to support and confirm positive Weil-Felix reaction will be useful, it is felt that the above findings are strong evidences for the prevalence of these diseases in this part of Nigeria.

Antibodies, Bacterial↗
PubMed1983

[Rickettsioses. A disease of tourism].

Clinical diagnosis of rickettsial diseases, which are acute infections of variable severity, cannot be done without knowledge of the epidemiologic background. It must be confirmed subsequently by indirect immunofluorescence, which is the choice serologic test. Among the 225 cases of rickettsial disease confirmed between 1980 and 1982, 118 cases of mediterranean spotted fever were acquired in the south of France during the summer. The other cases of spotted fever and all the cases of murine, louse-borne and scrub typhus occurred in tourists who had recently come back from countries where rickettsial morbidity still persists.

Humans↗
PubMed1978

Rodent zoonoses in North Queensland: the occurrence and distribution of zoonotic infections in North Queensland rodents.

A study of potentially zoonotic infections was carried out on 351 rodents trapped in north-eastern Queensland. Their ecosystems included towns, agricultural and livestock areas, wookland and rainforest. Nine serotypes of salmonellae were obtained from asymptomatic carries in predominantly settled locations. Two strains of Ps. pseudomallei occurred in rainforest near Innisfail and one on a cattle property adjacent to Townsville. Ps. aeruginosa caused bronchopneumonia in one animal from Townsville harbour. Ifection by leptospirae of six serogroups and seven serovars were identified by serological or cultural examinations. Enzootic foci occurred on the Mount Spec rainforest where celledoni and australis were being excreted by rats adjacent to the Paluma dam system. In addition to the scrub typhus locations at Rocky Creek, Atherton Tableland and Bullocky Creek, near Ingham, which were confirmed, a new focus of infection by R. tsutsugamushi was identified at El Arish near Tully. Water rat (H. chrysogaster) at Townsville harbour constituted a reservoir of toxoplasmosis. In addition to the known human pathogenic helminths H. nana and H. diminuta, localized foci of hookworms (Ancylostoma spp.) were found. Histological evidence of cytomegalic disease of the salivary glands or kidneys was a common finding.

Animals↗
PubMed1975

Isolation of Icterohaemorrhagiae from Microtus monte belli trapped at the Nagaoka area, Niigata Prefecture in Japan.

Three strains of leptospira were isolated from field rodents on the occasion of scrub typhus survey on the Nagaoka, Kurojo, Kamikawanishi area, Niigata Prefecture in September 1961. Out of 10 Microtus montebelli 3 strains of leptospira by means of heart puncture in febrile stage from guinea pigs. They were identified as icterohaemorrhagiae by cross-agglutination-lysis and a cross absorption tests. It was the first report of icterohaemorrhagiae in Microtus montebelli in Japan.

Animals↗
PubMed1986

A serological survey of scrub, tick, and endemic typhus in Sabah, East Malaysia.

A seroepidemiological survey of 837 people and 383 febrile patients was performed in rural areas of Sabah. We determined that the rickettsial diseases scrub typhus and endemic typhus were uncommon causes of febrile illness, as was tick typhus, except in forest dwelling peoples. The rate of occurrence of SFGR specific antibody was 16.5% among 412 forest dwellers, indicating that tick typhus may be a frequent cause of illness in this population.

Adolescent↗
PubMed1990

Murine typhus identified as a major cause of febrile illness in a camp for displaced Khmers in Thailand.

Scrub and murine typhus have been identified as causes of illness among the 238,000 displaced Khmer people residing in temporary settlements on the Thai side of the Thai-Cambodian border. Still, the true extent of the problem and the relative frequency of infection with scrub typhus as compared to murine typhus are unknown. We evaluated consecutive patients with unexplained pyrexia (documented fever, no exclusionary diagnosis, and constitutional symptoms) in 1 temporary settlement over 1 month. Laboratory studies included culture of blood and assay of paired sera for rickettsial IgM and IgG antibody, for dengue IgM and IgG antibody, and for leptospiral IgM and IgG antibody. Among 37 patients (27 adults and 10 children), 28 (75%) had a rickettsiosis (26 cases of murine typhus and 2 cases of scrub typhus). No case of enteric fever, dengue, or leptospirosis was diagnosed. The illnesses of 9 patients were not identified. Signs and symptoms did not distinguish confirmed rickettsial infections from undiagnosed illnesses. The 1 month attack rate of rickettsial infection was 29/100,000 for children and 185/100,000 for adults. Murine typhus was a major cause of febrile illness in this settlement.

Adult↗