[Classic type tsutsugamushi disease].
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An epidemiological study in a mature oil palm estate in Peninsular Malaysia has demonstrated a low prevalence of R. tsutsugamushi infection in small mammals. The direct fluorescent antibody technique for assaying infections in chiggers proved more sensitive than mouse inoculation. Most infections in both chiggers and rodents were caused by the Karp strain.
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Rickettsia tsutsugamushi, strain Gilliam, replicates in cultures of resident peritoneal macrophages from BALB/c mice. Macrophage cultures treated with culture supernatants of spleen cells from rickettsial-infected mice stimulated with heat-killed rickettsiae markedly suppressed macrophage infection by rickettsiae. Rickettsiacidal activity of activated macrophages was dependent upon both lymphokine concentration and time of incubation in lymphokines. Treatment of macrophage cultures with lymphokines before exposure to viable rickettsiae resulted in an immediate decrease in percent macrophages infected and numbers of viable intracellular rickettsiae. In these cultures, enhanced intracellular killing was also apparent with further incubation (24 hr). The immediate effect of lymphokine-pretreated macrophages was dissociated from intracellular killing by infecting macrophage cultures first and adding lymphokines after infection. In these cultures, both percent macrophages infected and titers of viable intracellular rickettsiae were dramatically reduced as well.
Tsutsugamushi disease is characterized by the early appearance of a black crust at the bitten area and the subsequent development of macular or macropapular rush on the whole body with high fever. While treatment with tetracycline derivatives and chloramphenicols is effective, delayed diagnosis or inappropriate treatment will lead to fatality. In this report, we describe two typical cases of tsutsugamushi disease and discuss other incidences in Kanagawa Prefecture, Japan, in 1998. One of the present two patients was diagnosed to be a case of the new type by Kawasaki strain of Rickettsia tsutsugamushi, while responsible strain was not identified for the other case. Since the disease is spreading widely even to suburban areas, we emphasize the need to consider the possible diagnosis of tsutsugamushi disease in patients with generalized eruption and high fever.
OBJECTIVE: In order to identify the types of natural foci of tsutsugamushi disease to provide basis for prevention, a series of studies were carried out in Fujian, Zhejiang and Jiangsu Provinces. METHODS: (1) Representative points for investigation in three Provinces were selected. (2) Data on geographical landscape and epidemiology were collected. (3) Field survey and experimental studies on rats and chigger mites in relation to the disease. RESULTS: Three representative types of natural foci of tsutsugamushi disease were demonstrated. They were (1) Coastal island type, mainly in Fujian with major reservoir host as Rattus losea and major vector mite as L. deliense; prevalent season: summer; type of Rt: Gilliam: (2) Inland mountain - forest type in Zhejiang with major reservoir host as R. confucianus and major vector miteas L. gaohuense; prevalent season: summer; type of Rt: Gilliam. (3) Inland plain - hills type in Jiangsu with major reservoir hosts: Apodemus agrarius, R. confucianus, R. norvegicus and Crocidura lasiura; major vector mite: L. scutellare; prevalent seasons: autumn and winter; type of Rt: Kawasaki. CONCLUSION: The types of Rt, reservoir hosts, vector chigger mites and epidemiological features of tsutsugamushi disease in Fujian, Zhejiang and Jiangsu Province were found different. Thus, the preventive measures should also be distinct from one another.
OBJECTIVE: To investigate the region for the epidemic area of tsutsugamushi disease. METHODS: Epidemiological studies, Orientia tsutsugamushi isolation, and preventive measures were used. RESULTS: The region belonged to epidemic area of south subtropical zone. The main host was found Rattus norvegicu. The main biological vector was Leptotrombidium deliens. The seasonal trends of the quantity of Rattus norvegicu and Leptotrombidium deliens were consistent with the incidence change of the disease in the region. Orientia tsutsugamushi has been isolated from Rattus norvegicu and Leptotrombidium deliens. Data showed that Orientia tsutsugamushi isolated strains mainly belongs to Karp. Sero-epidemiological data showed that antibodies of Orientia tsutsugamushi are 100.0% positive in the residents of the region and 4.0% in army men. After taking comprehensive preventive measures, the incidence was descending. CONCLUSION: Nan Peng Lie island was proved an epidemic area of tsutsugamushi disease.
OBJECTIVE: In order to provide basic data of tsutsugamushi disease in Shandong province, for the control and prevention of this disease in residents and army-men. METHODS: Aetiological, serological and epidemiological methods were used to investigate the natural foci of autumn-winter type tsutsugamushi disease. RESULTS: The peak of tsutsugamushi disease epidemic in Shandong province was in October with cases in this month accounted for 80% of all in a year, that showed autumn-winter type. The main reservoir hosts were Apodemus agrarius, Rattus norvegicus and Cricetulus triton, accounted for 82.87%, 85.47% and 13.04% respectively. It was confirmed that natural infection existed among Leptotrombidium (L.) scutellare, L. palpalis, L. linhuaikonense and Walchia pacifica. The main vector of transmission was Leptotrombidium scutellare. 41 strains of Rickettsia tsutsugamushi were isolated from the blood samples of patients, rodents and chigger mites but with weak toxicity. 90% of the serotypes of the strains belonged to Gilliam type. The distribution of the cases had a sporadic nature. More than 80% of the cases were young or middle aged peasants. Clinical symptoms were mild, with some differences in different areas. CONCLUSION: The natural foci type of tsutsugamushi disease in Shandong could be divided into plain and hilly types.
OBJECTIVE: To investigate natural foci of tsutsugamushi disease whose incidence has increased in the Nan Peng Lie Islands in China, an area where this disease has not been previously recorded. METHODS: We recorded the natural foci and isolated Orientia tsutsugamushi (O. tsutsugamushi) organism. We also studied prevention measures. RESULTS: These islands had the natural foci of a south subtropical zone. The main host and vector were Rattus norvegicus and Leptotrombidium deliens (L. deliens), respectively. The seasonal quantity trends of Rattus norvegicus and Leptotrombidium deliens were consistent with the incidence of human infection. Thirty-five strains of O. tsutsugamushi were isolated from Rattus norvegicus and L. deliense. The identification of 7 strains showed that most strains were Karp. Seroepidemiology showed a high prevalence of antibody against O. tsatsugamushi among local people. After prevention measures were used, the incidence was decreased. CONCLUSION: This was the first successful confirmation that the Nan Peng Lie Islands were natural foci of tsutsugamushi disease.
In recent years, the incidence of tsutsugamushi disease has increased in Nan Peng Lie Islands in China, and the disease has not been recorded in this region. The natural foci of tsutsugamushi disease were investigated in this paper. Isolation of Orientia tsutsugamushi and the study of preventive measures were also performed. The region was the island natural foci of south subtropical zone. The main host and vector were Rattus norvegicus and Leptotrombidium (L.) deliens respectively. The seasonal quantity trends of Rattus norvegicus and Leptotrombidium (L.) deliense were consistent with the incidence of human infection in the region. The strains of O. tsutsugamushi were isolated from Rattus norvegicus and Leptotrombidium (L.) deliense. The identification showed that most strains were Karp. The seroepidemiology showed a high prevalence of antibody against O. tsutsugamushi. After preventive measures were implemented, the incidence was descent. So Nan Peng Lie Islands were the natural foci of tsutsugamushi disease.