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Hemophagocytic Lymphohistiocytosis: An Unusual Presentation of Scrub Typhus.

Scrub typhus is an important etiological cause for acute undifferentiated febrile illness in the Asia-Pacific region, including Sri Lanka. It is a mite-borne disease caused by Orientia tsutsugamushi. Hemophagocytic lymphohistiocytosis (HLH) is a rapidly progressive and potentially life-threatening hyperinflammatory syndrome rarely associated with scrub typhus. We herein describe a rare case of scrub typhus complicated by hemophagocytic lymphohistiocytosis in a 40-year-old previously healthy woman who presented with a history of an acute febrile illness. Following the observation of acute deter…

Identification of Trombiculid Chigger Mites Collected on Rodents from Southern Vietnam and Molecular Detection of Rickettsiaceae Pathogen.

Trombiculid "chigger" mites (Acari) are ectoparasites that feed blood on rodents and another animals. A crosssectional survey was conducted … pooled into 141 pools (10-20 chiggers per pool). Two pools (1.4%) of the chiggers were positive for Orientia tsutsugamushi. Ricketsia spp. was not detected in any pools of chiggers. Further studies are needed including a larger number and diverse hosts, and environmental factors to assess scrub typhus.

An overview of rickettsiae in Southeast Asia: Vector-animal-human interface.

Rickettsioses are emerging, and re-emerging diseases caused by obligate intracellular arthropod-borne bacteria that infect humans and animals worldwide. Various rickettsiae such as Orientia, Rickettsia, Anaplasma and Ehrlichia have been circulated in companion, domesticated and wild animals through bites of infected ticks, fleas, lice or mites. This review summarizes the infections of rickettsiae, including the newly discovered regional species Rickettsia thailandii, Candidatus Rickettsia sepangensis, Candidatus Rickettsia johorensis, Candidatus Rickettsia laoensis, Candidatus Rickettsia mahos…

Engineering of obligate intracellular bacteria: progress, challenges and paradigms.

It is estimated that approximately one billion people are at risk of infection with obligate intracellular bacteria, but little is known about the underlying mechanisms that govern their life cycles. The difficulty in studying Chlamydia spp., Coxiella spp., Rickettsia spp., Anaplasma spp., Ehrlichia spp. and Orientia spp. is, in part, due to their genetic intractability. Recently, genetic tools have been developed; however, optimizing the genomic manipulation of obligate intracellular bacteria remains challenging. In this Review, we describe the progress in, as well as the constraints that hin…

Multiple eschars in scrub typhus: a case report.

Eschar in scrub typhus aids in early diagnosis and institution of appropriate therapy; however, the eschar positivity rates vary greatly in endemic regions. Multiple eschars in scrub typhus are a rare presentation. Our patient presented with fever and multiple eschars and was empirically started on doxycycline. Nested polymerase chain reaction from all the four eschars and from EDTA blood were positive for 56-kDa type-specific antigen which is specific for Orientia tsutsugamushi The patient recovered completely after 7 days of antibiotic treatment. He was from an area where scrub typhus was no…

Polyarthritis and massive small bowel bleed: An unusual combination in scrub typhus.

Scrub typhus is an acute febrile illness caused by the intracellular parasite Orientia tsutsugamushi. Although most cases present with mild symptoms and signs and recover spontaneously, some cases can be severe with multi-organ dysfunction and a protracted course, which may be fatal if left untreated. Apart from fever and constitutional symptoms, atypical presentations allow this disease to mimic several common conditions. We report a case of scrub typhus in an 18-year-old male who presented with severe polyarthritis involving all large joints and a massive lower gastrointestinal bleed from ul…

A prospective study on distribution of eschar in patients suspected of scrub typhus.

Scrub typhus is an acute febrile illness caused by a tick bite infected with the bacteria Orientia tsutsugamushi The clinical diagnosis is difficult as the symptoms are similar to other febrile illnesses such as dengue, typhoid, leptospirosis and so on. An eschar, if present, will narrow down the provisional diagnosis towards scrub typhus. There are no data on the preferential sites of tick bites in an Indian population. We present here the preferential sites of tick bites in a South Indian population of 123 cases positive for eschar. Geographically, clothing styles vary leading to the differe…

Life-threatening scrub typhus with hemophagocytosis and acute respiratory distress syndrome in an infant.

Scrub typhus is a rickettsial disease, caused by Orientia tsutsugamushi, which is transmitted via the bite of a chigger. This disease is one of the most important infectious diseases in the Asia-Pacific area; however, a severe infant case has not yet been reported. Here, we present the case of an 8-month-old boy with scrub typhus accompanied by hemophagocytic lymphohistiocytosis (HLH). His rapid course was complicated by acute respiratory distress syndrome (ARDS), status epilepticus and disseminated intravascular coagulation (DIC). He recovered after clarithromycin therapy and intensive suppor…

Rickettsial infections and fever, Vientiane, Laos.

Rickettsial diseases have not been described previously from Laos, but in a prospective study, acute rickettsial infection was identified as the cause of fever in 115 (27%) of 427 adults with negative blood cultures admitted to Mahosot Hospital in Vientiane, Laos. The organisms identified by serologic analysis were Orientia tsutsugamushi (14.8%), Rickettsia typhi (9.6%), and spotted fever group rickettsia (2.6% [8 R. helvetica, 1 R. felis, 1 R. conorii subsp. indica, and 1 Rickettsia "AT1"]). Patients with murine typhus had a lower frequency of peripheral lymphadenopathy than those with scrub …

The past and present threat of rickettsial diseases to military medicine and international public health.

Morbidity and mortality caused by rickettsioses have had a major influence on military activities and public health for >2000 years. The threat posed by the rickettsioses is reviewed, focusing on the impact and epidemiology of those that have adversely influenced wartime operations and the current challenges posed by these diseases. With their uneven worldwide distribution, the discovery of drug-refractory strains of Orientia tsutsugamushi, the increased threat of their use in acts of bioterrorism, frequent deployment of troops to regions of endemicity, and exposures due to increased humanitar…

Human anti-scrub typhus rickettsia and rabbit anti-Proteus antibodies recognize similar epitope in the O-polysaccharide part of Proteus mirabilis OXK lipopolysaccharide.

In the Weil-Felix test, sera from patients infected with Orientia tsutsugamushi reacted with lipopolysaccharide (LPS) from Proteus mirabilis OXK strains. The O-polysaccharide of P. mirabilis OXK LPS consisted of pentasaccharide repeating units, with amidically-linked lysine residues. The lysine, linked to galacturonic residues, which plays an important role in the reaction with rabbit anti-OXK antibodies, was revealed with the aid of synthetic antigens. Using ELISA, immunoglobulin M antibodies from scrub typhus patients reacted with the O-specific polysaccharide of strain OXK LPS only. This re…

Blood-Brain Barrier Function and Biomarkers of Central Nervous System Injury in Rickettsial Versus Other Neurological Infections in Laos.

Blood-brain barrier (BBB) function and cerebrospinal fluid (CSF) biomarkers were measured in patients admitted to hospital with severe neuro … mptoms, AI, or biomarker levels that allowed distinction between severe neurological involvement by Orientia tsutsugamushi compared with Rickettsia species.

Congenital scrub typhus: a case report and literature review.

BACKGROUND: This study aimed to analyze the clinical course of a newborn with congenital scrub typhus caused by vertical transmission and ex … e 5th day of life confirmed a significant presence of 16SrRNA sequences in the blood, suggesting an Orientia tsutsugamushi infection. The neonate steadily recovered and was discharged 16 days after hospitalization. The neonate was followed up for 9 months, and the outcome was favorable with normal growth and development. CONCLUSIONS: This article reports …

Неврологические манифестации "Scrub Typhus": Серия судебных дел из больницы Tertiary Health in Southern East Radasthan.

Scrub tyhus — острая инфекционная болезнь, вызванная рикеттсийским видом Orictia tsutsugamushi. В последние годы в Индии скруб тифа вновь стал опасным для жизни заболеванием, которое проявляется в различных клинических проявлениях: от неконкретного фебрилического заболевания до серьезной многоорганической дисфункции, и неврологические осложнения также широко распространены. Спектр неврологических осложнений варьируется от таких распространенных осложнений, как асептический менингит, менингоэнцефалит и церебеллит, до редких осложнений, таких, как миелит, кровоизлияние в мозг, острый распределен

Совпадение в аннотации оригинала
Scrub typhus is an acute febrile infectious illness caused by rickettsia species Orientia tsutsugamushi. In recent years, scrub typhus has reemerged as a life-threatening disease in India Scrub typhus has diverse clinical manifestations ranging from a nonspecific febrile illness to severe multiorgan dysfunction, and neurological complications are also common…

Abducens nerve palsy in a patient with scrub typhus: a case report.

Abducens nerve palsy is a known but rare complication of a few bacterial and viral infections like Mycoplasma pneumonia, cytomegalovirus, Epstein-Barr virus, Hanta virus, herpes zoster, and measles. Abducens nerve palsy due to scrub typhus is extremely rare and so far only one case has been reported in the literature. Scrub typhus is a febrile illness caused by rickettsia, Orientia tsutsugamushi, a gram negative intracellular obligate parasite which is endemic in Asia. This disease can present with wide range of clinical manifestations with involvement of any organ system, alone or in combinat…

Scrub Typhus Presenting With Meningoencephalitis and Multiorgan Dysfunction Syndrome.

Scrub typhus is an acute febrile illness endemic in India and remains an important yet often underdiagnosed cause of severe systemic infection. It is caused by Orientia tsutsugamushi and is characterized by endothelial injury leading to widespread vasculitis. We report the case of a 62-year-old male with a history of chronic alcohol use and no known comorbidities, who presented with a short history of fever, myalgia, arthralgia, mild confusion, and gait difficulty. The illness rapidly progressed to scrub typhus septicemia complicated by pulmonary edema, pleural effusion, meningoencephalitis, a…

Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus.

When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus pro…

Case of scrub typhus complicated by severe disseminated intravascular coagulation and death.

Scrub typhus is an infectious disease that is caused by Orientia tsutsugamushi. The authors describe an autopsied case of scrub typhus complicated with severe disseminated intravascular coagulation (DIC). An 82-year-old man complained of fever 4 days after climbing a mountain. The patient was admitted to an urban hospital, and meropenem and ceftriaxone were administered. The patient's condition deteriorated and he was transferred to a second hospital. On physical examination, a black scab was found and scrub typhus was suspected. Despite intensive treatment, the patient died on the fifth day. …

Scrub typhus: clinical, pathologic, and imaging findings.

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The main pathologic change is focal or disseminated vasculitis caused by the destruction of endothelial cells and the perivascular infiltration of leukocytes. The diagnosis of scrub typhus is based on the patient's history of exposure, clinical features, and results of serologic testing. Regional and generalized lymphadenopathy is common. The pulmonary manifestations of scrub typhus include interstitial pneumonia, interstitial edema, and hemorrhage caused by vasculitis. Abdominal manifestations include splenomegaly, per…

Scrub typhus vaccine candidate Kp r56 induces humoral and cellular immune responses in cynomolgus monkeys.

A truncated recombinant 56-kDa outer membrane protein of the Karp strain of Orientia tsutsugamushi (Kp r56) was evaluated in cynomolgus monkeys (Macaca fascicularis) for immunogenicity and safety as a vaccine candidate for the prevention of scrub typhus. This recombinant antigen induced strong humoral and cellular immune responses in two monkeys and was found to be well tolerated. Antigen-specific immunoglobulin M (IgM) and IgG were produced to almost maximal levels within 1 week of a single immunization. Peripheral blood mononuclear cells from vaccinated animals showed an induction of antigen…