Two Cases of Rickettsiosis Developed in the Same Period : Discrimination between Japanese Spotted Fever and Scrub Typhus
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日本紅斑熱とツツガムシ病はともにダニ類を介して発症するリケッチア感染症であり，両者とも発熱，皮疹，肝障害を呈するなど類似点の多い疾患である。我々は同時期に発症した日本紅斑熱とツツガムシ病の各1例を経験したので，臨床的相違点を主眼に症例報告を行う。症例1：59歳，女。2009年7月末より微熱と倦怠感あり。8月上旬より39℃台の発熱と手掌を含む全身に淡紅色の小型の紅斑が出現した。右背部に，中央に壊死を伴う小豆大の丘疹あり。血液検査では血小板減少と肝・腎機能障害を認めた。表在リンパ節は触知しなかった。臨床所見より日本紅斑熱を疑い，ミノサイクリンおよびレボフロキサシンを投与した。血清中の特異的抗体価は初診時に比べ，2週間後のペア血清でIgGとIgMの上昇を認め，日本紅斑熱と診断した。症例2：59歳，男。2009年7月末より38℃台の発熱があった。8月上旬に全身の紅斑が出現した。左背部に，周囲に発赤を伴う爪甲大の黒色壊死あり。表在リンパ節はすべて腫大しており，CT画像では縦隔，腹部など全身にリンパ節腫大を認めた。臨床所見よりツツガムシ病を疑い，ミノサイクリンを投与した。血清抗体は初診時採血でKato，Karp，およびGilliam株のIgMの上昇を認め，ツツガムシ病と診断した。2症例とも比較的典型例であり，刺し口の大きさや手掌の紅斑，全身性リンパ節腫大の有無で両疾患の鑑別が可能であった。Acute hemorrhagic diseases that occurred in Korea have been confirmed as Hemorrhagic fever with renal syndrome (HFRS), rickettsiosis and leptospirosis among suspect hemorrhagic disease patients. In this study, we report the results of serological test of 1,886 sera from suspect HFRS or rickettsiosis patients in Korea, 1989. 1. Of 1,886 sera from acute hemorrhagic disease patients tested in 1989, 344 murine typhus, 352 scrub typhus, 79 spotted fever and 27 leptospirosis were confirmed serologically. 2. It was confirmed that large numbers of murine typhus, scrub typhus and spotted fever patients occurred in Seoul city, Kyunggido and Cheollanamdo. Two murine typhus, two spotted fever and one scrub typhus patients were identified in Chejudo for the first time. 3. Murine typhus, scrub typhus and spotted fever patients occurred mainly in summer and fall and peak was from October to November. Leptospirosis occurred in spring or summer. 4. Of 344 murine typhus, male was 201 (59%) and female was 143 (41%). In scrub typhus, female were 59% and male were 41%. In leptospirosis, male were predominant and in spotted fever no sexual difference was found. 5. The majority of age of acute hemorrhagic disease patients in 1989 were above 20 years of age, however small number of children below the age of 10 were also found. 6. In 1989, 14 murine typhus, 6 scrub typhus, 4 spotted fever and one leptospirosis occurred in the Korean Army, and only one scrub typhus occurred in the U.S. Army. Above results revealed that a large number of murine typhus, scrub typhus and spotted fever patients occurred in Korea, and murine typhus, scrub typhus and spotted fever patients were confirmed serologically for the first time in Chejudo.
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A 56-year-old female goat herder had scrub typhus that persisted after receiving doxycycline for 5 days. Her symptoms continued, prompting us to perform further examinations that revealed coinfection of Q fever and scrub typhus via molecular and serological testing. We also isolated Orientia tsutsugamushi using BALB/c mice and L929 cells.
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Abstract Acute Q fever and scrub typhus are zoonoses endemic to southern Taiwan. Among the 137 patients with acute Q fever (89, 65.0%) or scrub typhus (43, 31.4%), we identified 5 patients (3.6%) who were co-infected with Coxiella burnetii and Orientia tsutsugamushi.
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Abstract Rickettsioses are endemic to Vietnam; however, only a limited number of clinical studies have been performed on these vectorborne bacteria. We conducted a prospective hospital-based study at 2 national referral hospitals in Hanoi to describe the clinical characteristics of scrub typhus and murine typhus in northern Vietnam and to assess the diagnostic applicability of quantitative real-time PCR assays to diagnose rickettsial diseases. We enrolled 302 patients with acute undifferentiated fever and clinically suspected rickettsiosis during March 2015–March 2017. We used a standardized case report form to collect clinical information and laboratory results at the time of admission and during treatment. We confirmed scrub typhus in 103 (34.1%) patients and murine typhus in 12 (3.3%) patients. These results highlight the need for increased emphasis on training for healthcare providers for earlier recognition, prevention, and treatment of rickettsial diseases in Vietnam.
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Scrub typhus has re-emerged as an important cause of acute febrile illness in India. There is a dearth of information on strain diversity of Orientia tsutsugamushi from Karnataka, India, hence the present study sought to address this issue. One hundred clinically suspected cases of scrub typhus/rickettsiosis (as per the DHR-ICMR guidelines) were included. Nested-polymerase chain reaction (PCR) for 56-kDa gene and phylogenetic analysis was performed. PCR was positive in 22 cases and phylogenetic analysis showed the presence of different strains, with predominance of clustering (57%) with Gilliam-type for the first time in Karnataka. Knowledge of genetic diversity has implications in development of diagnostics and vaccine.
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A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non-scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting.
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Transmission of Orientia tsutsugamushi, the aetiological agent for scrub typhus, to co-feeding mites
Experiments were conducted to investigate the potential for transmission of Orientia tsutsugamushi , the aetiological agent for scrub typhus, when naturally infected mite larvae were co-feeding with uninfected larvae. Larvae from colonies of Leptotrombidium deliense and L. imphalum infected with O. tsutsugamushi were used. Transmission of O. tsutsugamushi to previously uninfected L. deliense and Blankaartia acuscutellaris co-fed with infected L. deliense was shown to occur. The overall minimum rate of acquisition was 1·6% (4/258) for L. deliense and 2·5% (3/119) for B. acuscutellaris . When individual infected L. deliense were co-fed with B. acuscutellaris acquisition of O. tsutsugamushi was not detected. However, when 4 and 8 infected larvae were co-fed with B. acuscutellaris acquisition of O. tsutsugamushi was detected. Transmission of O. tsutsugamushi was not observed when uninfected L. deliense were co-fed with infected L. imphalum . This novel transmission route may explain the occurrence of rickettsiae in genera other than Leptotrombidium spp, which are considered to be the main vectors of O. tsutsugamushi .
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