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PubMed2002

[An outbreak of epidemic louse-borne typhus in Tokyo 1914: a study on the prevention of epidemics].

In 1914, the third year of the Taisho era, a period of democracy and prosperity of Japan, Tokyo was attached by an outbreak of epidemic louse-borne typhus. The number of patients was 4,119 and number of deaths was 778 (mortality rate of 18.9%) in Tokyo and 7,309 patients had been suffering from typhus fever that year in Japan. Many possible causes of the outbreak were suspected by the Health Authority of the Home Office, but these were not confirmed. One of the most likely reasons is the poor and congested living conditions of seasonal construction workers. Laborers had moved from the northwest region of Japan where typhus fever had developed occasionally in those days. Some of the laborers probably brought pathogenic germs with lice. The main preventive method for epidemic louse-borne typhus was isolation of patients and disinfecting of the areas. Kitasato Shibasaburou proposed the improvement of residential conditions of workers to prevent the prevalence of disease, but the proposal was not accepted because of financial reasons of the government. Recurrence of the outbreak did not occur in the following years. However, a huge outbreak of typhus fever with 32,366 patients and 3,351 deaths, was documented in 1946, amidst the disordered conditions of Japan after World War II.

Communicable Disease Control↗
PubMed2005

Elevation of serum transcobalamin II in patients with scrub typhus.

Serum transcobalamin II levels were measured in scrub typhus patients. Eighteen out of fifty-two patients admitted to Maharat Nakhon Ratchasima Hospital were diagnosed with scrub typhus infection. The serum unsaturated vitamin B12 binding protein (UBBC) and total vitamin B12 binding protein (TBBC) levels in these patients were significantly higher than in normal subjects (p < 0.001). The mean serum transcobalamin II level in the typhus patients was also significantly higher than in the normal subjects (p=0.004). There was a significant correlation between serum TCII levels and typhus IgM or IgG titers (p < 0.05), but not to total IgM levels. These findings indicate that patients with scrub typhus had stimulation of the recticuloendothelial system as a result of a considerable increase in transcobalamin II levels.

Adolescent↗
PubMed2005

Short report: Abnormal liver function in scrub typhus.

Scrub typhus is one kind of rickettsial disease and may cause fever, cough, and skin rashes in infected humans. Regarding liver involvement, it was uncommon to be reported in previous medical literature from Western countries. This study observes the relationship between scrub typhus and liver function. From January 1998 to August 2003 in Kaohsiung Chang Gung Memorial Hospital in Taiwan, we observed 30 patients with scrub typhus, and 29 of them had liver function abnormality. In these patients, we found 89.3% with elevated aspartate aminotransferase (AST) levels, 91.7% with elevated alanine aminotransferase (ALT) levels, 84.2% with elevated alkaline phosphatase (ALP) levels, and 38.5% with elevated total bilirubin levels. In our study, there is a close relationship between scrub typhus and impaired liver function tests. Therefore, if patients are found with fever of unknown origin and abnormal liver function, we should take scrub typhus into consideration.

Female↗
PubMed2006

Scrub typhus: chest radiographic and clinical findings in 130 Thai patients.

OBJECTIVE: To describe chest radiographic findings and their clinical correlation in patients with scrub typhus diagnosed in Thailand and to determine abnormalities that assist in the diagnosis of scrub typhus. MATERIAL AND METHOD: Between July 2001 and December 2002, 130 patients with scrub typhus admitted to three hospitals in the northeastern Thailand were studied. Data of clinical presentations and chest radiographic findings, reviewed by two radiologists who were unaware of the final diagnosis, were analyzed. RESULTS: There were 33 women, 97 men; age range, 11-92 years; median age, 45 years old. Pulmonary symptoms occurred in 61.5% of the patients and eschar was found in 33.1%. Hepatic dysfunction occurred in 58.5% and cardiovascular dysfunction in 33%. Pulmonary involvement was the major presentation in 41.5%. Acute respiratory distress syndrome developed in 7 patients. Overall 5 patients died. The initial radiography showed abnormalities in 64.6% of the patients. Common radiographic abnormalities included bilateral reticular opacities (48.5%), cardiomegaly (28.5%), congestive heart failure (18.5%), air space nodules (13.1%), and pleural effusion (10.8%). Significant association between chest radiographic abnormalities and hepatic and cardiovascular dysfunction were documented. CONCLUSION: Chest radiography should be included in the initial evaluation of patients with suspected scrub typhus. Bilateral reticular infiltration, with or without cardiomegaly or congestive heart failure, was the most frequent radiographic finding of scrub typhus.

Adolescent↗
PubMed2006

Usefulness of nested PCR for the diagnosis of scrub typhus in clinical practice: A prospective study.

The aims of this study were to determine the diagnostic accuracy and clinical usefulness of using nested polymerase chain reaction (PCR) for the diagnosis of scrub typhus through a prospective comparison of nested PCR and indirect immunofluorescent antibody assay (IFA). We conducted a multi-center prospective study of patients who were suffering with possible scrub typhus infection. Whole blood samples were collected for PCR testing, and sera were obtained for serology evaluation using the indirect IFA and the passive hemagglutination assay (PHA). We prospectively studied 135 patients with possible scrub typhus. One hundred eighteen patients were confirmed as having scrub typhus, 7 patients were undetermined, and 10 patients were confirmed as having other diseases. The results of nested PCR assay showed a sensitivity of 82.2% and a specificity of 100%. Ninety-six of the 118 patients were positive for IgM on their admission day. Of the 22 patients who were negative for IgM antibody at admission, 19 had positive results for nested PCR of the buffy coat. The nested PCR assay of the buffy coat is useful as a rapid and reliable test for confirming the diagnosis of scrub typhus.

Adolescent↗
PubMed1995

Hepatic dysfunction in scrub typhus.

Scrub typhus is an acute febrile illness that generally causes non-specific symptoms and signs of which fever is the most common. It is one of the causes of "fevers of unknown origin" in the Asia-Pacific region. The relationship between hepatic dysfunction and scrub typhus has been given little attention in the literature. From 1982 to 1993, 47 patients diagnosed with scrub typhus at Tri-Service General Hospital, Taipei, were studied, with attention being given to hepatic dysfunction. The medical records of these patients were reviewed thoroughly. Hepatic dysfunction occurred in 77% (36/47) of patients. Among the liver function parameters, the percentage of abnormality was 74.5% for aspartate aminotransferase, 74.5% for alanine aminotransferase, 57.4% for alkaline phosphatase, 44.7% for lactate dehydrogenase and 44.7% for serum bilirubin. Six patients presented with a picture of true hepatitis similar to acute viral hepatitis. The results indicate that hepatocellular damage does occur in scrub typhus, and is perhaps, more common than previously realized. We recommend that the differential diagnosis of patients from high-risk groups and endemic areas who present with hepatitis-like symptoms should include examination for scrub typhus.

Adolescent↗
PubMed1997

Immunohistochemical diagnosis of typhus rickettsioses using an anti-lipopolysaccharide monoclonal antibody.

A monoclonal antibody directed against an epitope on the lipopolysaccharide of typhus-group rickettsiae was developed for the purpose of detecting this heat-stable, proteinase-resistant antigen in formalin-fixed, paraffin-embedded tissues. Rickettsia prowazekii organisms were identified in endothelium and macrophages in sections of the brains of three Egyptian men who died of epidemic louse-borne typhus in Cairo during World War II and in the brain from a recent case of typhus fever acquired in Burundi. R. typhi organisms were identified in endothelial cells from a fatal case of murine typhus and in experimentally infected mice. This approach is applicable not only to the study of archival tissues and experimental animal models but also could be used to establish a timely diagnosis of typhus-group rickettsiosis by immunohistochemical examination of cutaneous biopsies of rash lesions during the acute stage of illness.

Adolescent↗
PubMed1998

[Central anti-typhus committee (August 1, 1919-March 5, 1920)].

During the first period of the independence of Poland, just after the first World War (1919-1921), the fight against ramped epidemics of acute infectious diseases was a main priority. The most important task of the Ministry of Public Health was the organization of the control of infectious diseases, and especially typhus. In 1919, the government named the Central Anti-Typhus Committee. However, the Committee was a collective institution without necessary competences and resources and its efforts to control typhus epidemics have been unsuccessful. At the end of 1919, there was a dramatic spread of typhus especially in the eastern parts of the country, still suffering from the war. In March 1920, the Central Anti-Typhus Committee has been replaced by the Extraordinary Epidemic Commissariat which has been endowed with special, emergency staff and resources. The Commissariat was headed by Prof. Emil Godlewski, who was soon nicknamed "tyhus tsar"; for the most affected regions competent regional commissars were appointed. The legal ground of the Extra ordinary Epidemic Commissariat was the parliament bill on 14th July 1920. This body took over from the Public Health Minister responsibilities for the fight against epidemics. The work of Commissariat had stopped the epidemics and improved epidemical status of Poland which could be seen from 1923 onwards.

History, 20th Century↗
PubMed2002

Typhus vaccine developments from the First to the Second World War (on Paul Weindling's 'between bacteriology and virology...').

After the louse transmission of epidemic typhus had been established (1909), a small microorganism (thought to belong to a new genus, Rickettsia) was shown in enormous numbers in the guts of lice that had fed on human typhus victims. Attempts at cultivating this organism on inert media failed; transfer from louse to louse without loss of virulence for the vertebrate host was successful. Some scientists were not convinced of the etiologic role of Rickettsiae, because the presence of this microbe in blood and organs of victims or of experimentally infected animals was difficult to demonstrate. This uncertainty was dispelled in 1928, when in guinea pigs infected with material from the closely related disease Tabardillo (murine typhus) abundant Rickettsiae were revealed in the tunica vaginalis. Live vaccines, derived from strains of murine typhus and deployed in French North Africa, were considered by outside observers as unsafe. Killed vaccines were derived from the masses of Rickettsiae present in louse guts, in chick embryo yolk sacs or in vertebrate lungs. These developments were not spurned by any 'upswing of virology' but by the threat of typhus in endemic areas and, after 1938, in a war-torn world. Their basis was firmly anchored in bacteriological thought styles and techniques.

Animals↗
PubMed1980

Use of a sensitive microplate enzyme-linked immunosorbent assay in a retrospective serological analysis of a laboratory population at risk to infection with typhus group rickettsiae.

A microplate enzyme-linked immunosorbent assay (ELISA), developed for the detection of antibodies to typhus group rickettsiae, was used to analyze human sera from individuals engaged directly or indirectly in rickettsial research. The earliest serum available from each of 112 individuals was tested for immunoglobulin M (IgM) and IgG antibodies against Rickettsia typhi and Rickettsia prowazekii by ELISA at a 1:500 dilution. In at least one assay, nine sera had ELISA optical densities of greater than 0.2, which were above the mean optical densities plus three standard deviations of the other 103 sera. Three of the positive sera were from individuals with known clinical cases of typhus infection. The other sera with predominantly IgG titers were from individuals with extended laboratory exposure to rickettsiae or histories of typhus vaccination, or both. During continued serological surveillance, eight additional people with repeated occupational exposure to typhus rickettsiae had seroconversions in the ELISA to optical densities of greater than 0.2. No apparent clinical illness occurred in two individuals, whereas six clinical cases of infection occurred in others subsequent to accidental laboratory autoinoculation (one) or aerosol exposures (five). In the clinical infections, antibodies were first detected at 7 days, but in subsequent sera, rises and declines in titers were quite variable and were influenced by vaccination, relapse, and time and extent of antibiotic therapy. In primary infections the sera of several individuals who received immediate antibiotic therapy had brief strong IgM responses without pronounced increases in IgG. In contrast, much higher IgG levels were attained in three cases in which relapse occurred, the individual had previously been immunized, or treatment had been delayed. The microplate ELISA proved to be a highly sensitive and reliable test for detection of the human serological response to typhus antigens.

Anti-Bacterial Agents↗
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↗
PubMed1998

Murine typhus presenting as subacute meningoencephalitis.

Murine typhus is a febrile systemic illness, presenting with headache and undulating fever. Neurological involvement is considered a rare complication. During 1994 and 1995, 34 patients admitted to our hospital were diagnosed as having murine typhus. Five of these patients presented with a syndrome of subacute "aseptic" meningitis or meningoencephalitis. Three had bilateral papilloedema and 2 had focal neurological signs. None had a rash or other systemic findings suggestive of rickettsial disease. The diagnosis was based on serum and cerebrospinal fluid serology and on prompt response to doxycycline therapy. These cases suggest that neurological involvement in murine typhus is more common than previously suspected and that murine typhus should be included in the differential diagnosis of subacute meningitis in endemic areas.

Acute Disease↗
PubMedDate not supplied

Scrub typhus-associated hemophagocytic syndrome.

A patient was admitted to our hospital with fever of unknown origin, lymphadenopathy and moderate anemia. The diagnosis of scrub typhus (tsutsugamushi disease) was established on specific serologic demonstration of antibodies to the cross-reacting proteins OX-K antigen and reaffirmed by successful treatment with doxycycline. The diagnosis of hemophagocytic syndrome (HPS) was made on the cytologic findings of many histiocytes containing phagocytosed blood cells in the marrow aspirate. The hemophagocytosis phenomenon disappeared after the scrub typhus was successfully treated, thus suggesting the relationship between scrub typhus and hemophagocytosis. In a patient with rickettsial diseases including scrub typhus, associated with HPS, it is important to understand the relationship between the two disorders since the prognosis for HPS, if untreated, is very poor.

Adult↗
PubMed1977

Epidemiological and serological study of scrub typhus among Chinese military in the Pescadores islands of Taiwan.

An outbreak of 69 cases of scrub typhus occurred among Chinese military personnel stationed in the Pescadores Islands, Taiwan Province, Republic of China between May and November 1975. A retrospective epidemiological study of this outbreak indicated that military personnel over 40 were more likely to have scrub typhus than those under 40. High risk groups included the Garrison Force (home guard), anti-aircraft gunners and infantry and armoured units stationed at Hsing-jen. The onset of symptoms in 69% occurred within one year of residence in the Pescadores. The clinical course of scrub typhus and the serological response to infection were also studied. Eschar formation, fever, headache chills and lymph node enlargement were the predominant clinical manifestations noted. The indirect immunofluorescent antibody test (IFAT) demonstrated diagnostic (four-fold) rises in antibody titres to Rickettsia tsutsugamushi reference strains in 36 of 41 paired sera tested. 11 of 19 patients from whom only single sera were obtained had IFA titres presumptive of scrub typhus (greater than or equal to 1:160). Of 19 patients experiencing possible primary infections, 13 (68%) responded with antibodies directed against more than one reference strain of R. tsutsugamushi. These results suggest that several antigenically diverse strains of R. tsutsugamushi may be active in the Pescadores.

Animals↗
PubMed2003

[Murine typhus in Tenerife. Clinicoepidemiological study and differential clinical features with Q fever].

BACKGROUND AND OBJECTIVE: Our aim was to conduct a study to define the clinical and epidemiological characteristics of patients with murine typhus in Tenerife island (Canary islands, Spain). Moreover, we investigated the differential clinical features of this disease with regard to Q fever. PATIENTS AND METHOD: 5-year prospective study of patients with murine typhus (1998-2002) admited in a reference hospital in Tenerife, Spain. RESULTS: Thirty two patients were included. Flea bite and rat exposure were iuncommon (6.25%). The monthly distribution showed a peak of incidence in January, August and September, without a clear seasonal prevalence. Fever and headache were the most common clinical features. Rash was present in 28% of the cases. Both an increase in liver enzyme levels (88%) and thrombocytopenia (37.5%) were the most relevant laboratory findings. Organ complications were uncommon (18.75%). Antibiotics were administered to 90% of patients and cure was achieved in all them. Compared with Q fever, patients with murine typhus more commonly had rash (p = 0.006) and thrombocytopenia (p < 0.001). CONCLUSION: Murine typhus is an emerging rickettsiosis in Tenerife and must be considered in the differential diagnosis with Q fever.

Adolescent↗
PubMed1997

Retinal manifestations of acute murine typhus.

PURPOSE: To report the ocular manifestations of acute serologically confirmed murine typhus. METHODS: A retrospective analysis of the clinical history, photography and fluorescein angiography of two patients with acute murine typhus with ocular involvement was conducted. RESULTS: A 38 year old male and a 49 year old female were included in the study. Both complained of fever, headache, rash, night sweats and pulmonary symptoms. They had noted the recent onset of diminished visual acuity and floaters. Examination of the posterior pole revealed mild optic nerve head edema (in one patient), intraretinal hemorrhages and small localized areas of retinal whitening. The history confirmed that both patients had been exposed to fleas and the serologic testing was positive for Rickettsia typhi. The systemic and ocular findings resolved after the use of systemic antibiotics. CONCLUSION: Rickettsial diseases such as murine typhus should be included in the differential diagnosis of otherwise healthy individuals who present with an acute systemic febrile illness and retinitis or neuroretinitis. SUMMARY STATEMENT: The clinical features of two patients with serologically proven acute murine typhus with ocular involvement are presented. Both patients presented with a retinal whitening that resolved after treatment.

Acute Disease↗
PubMed2000

Establishment of a novel endothelial target mouse model of a typhus group rickettsiosis: evidence for critical roles for gamma interferon and CD8 T lymphocytes.

A mouse model of typhus rickettsiosis that reproduces the hematogenous dissemination to the critical target organs, including brain, lungs, heart, and kidneys, primary endothelial and, to a lesser degree, macrophage intracellular rickettsial infection, and typical vascular-based lesions of louse-borne typhus and murine typhus was established. Intravenous inoculation of C3H/HeN mice with Rickettsia typhi caused disease with a duration of the incubation period and mortality rate that were dependent on the infective dose of rickettsiae. Lethal infection was associated with high concentrations of R. typhi in the lungs and brain, despite a brisker humoral immune response to the rickettsiae than in the sublethal infection. Gamma interferon and CD8 T lymphocytes were demonstrated to be crucial to clearance of the rickettsiae and recovery from infection in experiments in which specific monoclonal antibodies were administered to deplete these components. Death of animals depleted of gamma interferon or CD8 T lymphocytes was associated with overwhelming rickettsial infection demonstrated by titers of infectious rickettsiae and by immunohistochemistry. An effective antirickettsial immune response was associated with elevated serum concentrations of IL-12 on Day 5 and increased secretion of IL-12 by concanavalin-A-stimulated spleen cells on Day 5. Evidence for transient suppression of the immune response consisted of marked reduction in the secretion of IL-2 and IL-12 by concanavalin-A-stimulated spleen cells on Days 10 and 15. This model offers excellent opportunities for study of attenuation and pathogenetic mechanisms of typhus rickettsiae, which are established biologic weapons of potential use in bioterrorism.

Animals↗
PubMed1998

Imported rickettsioses: think of murine typhus.

Murine typhus is a disease still prevalent in many parts of the world. Because the incidence in the US and Europe has declined rapidly, physicians in these continents have become unfamiliar with the clinical picture. Murine typhus is associated with significant morbidity and fatalities do occur, especially in the elderly and when late recognized. We present a patient with murine typhus that illustrates the wide variety of symptoms in this disease, which makes diagnosis difficult. However, if one keeps the possibility of murine typhus in mind, it is easily diagnosed and treated.

Diagnosis, Differential↗