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The rickettsioses--zoonotic bacterial infections transmitted to humans by arthropods--were for many years considered to be oddities in travel medicine. During the previous 2 decades, however, reports of >450 travel-associated cases have been published worldwide, the vast majority being murine typhus caused by Rickettsia typhi, Mediterranean spotted fever caused by Rickettsia conorii, African tick bite fever caused by Rickettsia africae, and scrub typhus caused by Orientia tsutsugamushi. Most patients present with a benign febrile illness accompanied by headache, myalgia, and cutaneous eruptions, but severe complications and fatalities are occasionally seen. Current microbiological tests include culture, polymerase chain reaction, and serological analysis, of which only the latter method is widely available. Tetracyclines are the drugs of first choice and should be prescribed whenever a case of rickettsiosis is suspected. Preventive measures rely on minimizing the risk of arthropod bites when traveling in areas of endemicity.
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PMID:Rickettsioses and the international traveler. 1554 86

Scrub typhus is a rickettsial disease that is uncommon during pregnancy. We report a case of a 33-year-old woman, G1P0, 29 weeks pregnancy who presented to hospital with high fever, chill and headache for two weeks. Her diagnosis of scrub typhus was confirmed by serum immunofluorescent assay. She was successfully treated with chloramphenicol, but preterm delivery occurred. Her infant died from respiratory distress syndrome. No vertical transmission was demonstrated in this case. Scrub typhus should be listed in the differential diagnosis of acute febrile illness in pregnant women, who either live in, or return from, endemic areas. Chloramphenicol can be used safely during pregnancy if it is not circulating at the time of delivery.
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PMID:Scrub typhus during pregnancy: a case report and review of the literature. 1569 Nov 36

The epidemiology of scrub typhus in eastern Taiwan was studied by analyzing the data from the CDC Web reporting system. A total of 1,396 cases with 403 confirmed cases were reported in the period of 2000 to 2004. The cases were commonly found in all counties with the highest number in Yuli Township, Hualien County (53 cases) and Taitung City, Taitung County (40 cases). Monthly changes in the number of cases showed epidemic periods in the spring with a peak in May, and again in the fall, with an October-November peak. The occurrence of disease varied with age, gender, and occupation. Our results showed that the infection rates in the elderly (50-69 years old), males (62.8%), and farmers (25.6%) were higher than those in other age groups, females, and other occupations. Five major clinical symptoms, fever, headache, eschar, rash, and lymphadenopathy, were observed in 90.1, 61.9, 23.1, 21.6, and 10.7% of the cases, respectively. Almost 90% (89.3%) of the cases showed 1-3 clinical symptoms and some showed 4-5 symptoms (10%). Only one patient with no symptoms (0.8%) was found. This paper reports the status of scrub typhus in eastern Taiwan, and suggests that a health education program could train individuals to self-recognize the disease symptoms.
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PMID:Epidemiology of scrub typhus in eastern Taiwan, 2000-2004. 1693 41

Rickettsia is emerging in the subcontinent and clinically presents as non-specific febrile illness. At present there is no cheap & easily available diagnostic tool in our hand. Beside this, Weil-Felix test is becoming abandoned. So, high index of clinical suspicions is essential to diagnose rickettsia at early stage and to prevent mortality & morbidity. 40 cases were recorded among the admitted febrile patients in MMCH since 2003 to 2005. Cases were selected by clinical suspicions; exclusions of other common febrile illness & thereafter supported by lab. Investigations, specially by positive Weil-felix test. Cases were distributed through out the year but 19 (47.5%) cases were detected in March to May. 12 (30%) cases were found in August to October. The remaining 9 cases were detected in the rest 6 months. All (40) cases were presented with fever (100%), headache was present in 33 (82.5%) cases, rashes were present in 15 (37.5%) cases, isolated splenomegaly was found in 15 (37.5%) cases & hepatosplenomegaly in 12 (30%) cases, arthralgia in 13 (32.5%) cases, lymphadenopathy in 5 (12.5%) cases; 2 (5%) cases attended with unconsciousness & epistaxis in 1 (2.25%) case. Scrub typhus were 19 (47.5%), Indian tick typhus 16 (40%), 5 (12.5%) cases were with dual pathology and were associated with enteric fever. 15 (37.5%) cases were treated with tetracycline only. 20 (50%) cases with only doxyclycline & 5 (12.5%) cases with tetracycline and ceftriaxone as these cases were associated with enteric fever. All patients (100%) cured with treatment.
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PMID:Study on 40 cases of rickettsia. 1734 87

New antibiotics are required to have the antibacterial activity against doxycycline-resistant Orientia tsutsugamushi. An in vitro sensitivity study showed that telithromycin was more effective than erythromycin for Rickettsia, Bartonella, and Coxiella burnetii. In this prospective, open-label, randomized trial, we enrolled patients with mild-to-moderate scrub typhus. We compared the efficacy and safety of a 5-day telithromycin therapy with those of a 5-day doxycycline therapy at Chosun University Hospital or one of its two community-based affiliated hospitals (Jangheung Hospital and Cheomdan Hospital), which are all located in southwestern Korea, between September and December 2005. A total of 92 patients were randomly assigned to either the telithromycin group (n = 47) or the doxycycline group (n = 45). After the treatment, fever control time was 20.45 +/- 12.9 h in the telithromycin group and 22.60 +/- 21.44 h in the doxycycline group (P > 0.05). After the treatment, the cure rate was 100% in the telithromycin group and 97.8% in the doxycycline group (P > 0.05). Furthermore, there were no significant differences in time elapsed until such symptoms as headache, myalgia, and rash disappeared. No serious adverse events or death were noted following the treatment in both groups. There were no significant differences in adverse events. In conclusion, the efficacy and safety of a 5-day once-a-day regimen of 800 mg telithromycin were equivalent to those of a 5-day twice-a-day regimen of 100 mg doxycycline in patients with mild-to-moderate scrub typhus. Telithromycin could be considered a promising new antibacterial agent for patients with scrub typhus.
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PMID:Controlled trial of a 5-day course of telithromycin versus doxycycline for treatment of mild to moderate scrub typhus. 1740

Australia has 4 rickettsial diseases: murine typhus, Queensland tick typhus, Flinders Island spotted fever, and scrub typhus. We describe 7 cases of a rickettsiosis with an acute onset and symptoms of fever (100%), headache (71%), arthralgia (43%), myalgia (43%), cough (43%), maculopapular/petechial rash (43%), nausea (29%), pharyngitis (29%), lymphadenopathy (29%), and eschar (29%). Cases were most prevalent in autumn and from eastern Australia, including Queensland, Tasmania, and South Australia. One patient had a history of tick bite (Haemaphysalis novaeguineae). An isolate shared 99.2%, 99.8%, 99.8%, 99.9%, and 100% homology with the 17 kDa, ompA, gltA, 16S rRNA, and Sca4 genes, respectively, of Rickettsia honei. This Australian rickettsiosis has similar symptoms to Flinders Island spotted fever, and the strain is genetically related to R. honei. It has been designated the "marmionii" strain of R. honei, in honor of Australian physician and scientist Barrie Marmion.
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PMID:Flinders Island spotted fever rickettsioses caused by "marmionii" strain of Rickettsia honei, Eastern Australia. 1755 71

A 64-year-old man visited our clinic with a 9-day history of headache and fever. He had frequent, severe, electric shock-like pain in his left eye, forehead, and scalp. The body temperature was 37.1 degrees. Cranial nerve functions were intact. Limb weakness and stiff neck were absent. There were injection of the conjunctiva, a red rash on the trunk, and an eschar in the axilla. Abnormal laboratory findings included AST 40 IU, ALT 44 IU, CRP 16.0 mg/dl, WBC 11,090/microl, and proteinuria. CT scan was unremarkable. The cerebrospinal fluid (CSF) showed 2 polymorphs/microl, 6 lymphocytes/microl, 65 mg/dl of glucose, and 42 mg/dl of protein. A diagnosis of scrub typhus was made. Treatment with minocycline brought about prompt disappearance of the fever and dramatic clinical improvement. Increased antibody titers confirmed the diagnosis. Although almost all patients present with high fever and severe headache, only a small number of patients have CSF pleocytosis. The present case illustrates that pain in scrub typhus is, on rare occasions, indistinguishable from trigeminal neuralgia. Neurologists should have a high index of suspicion in patients with fever and headache during the epidemic season and should be familiar with the systemic symptoms and signs.
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PMID:[Case of tsutsugamushi disease (scrub typhus) presenting with fever and pain indistinguishable from trigeminal neuralgia]. 1763 12

Six cases of scrub typhus (tsutsugamushi disease) were reported to the Shizuoka Prefecture Hamamatsu City public health center during the seven years from 2001 to 2007. The content of the clinical record of the five cases were investigated. High serum titers of antibody to Gilliam-type Orientia tsutsugamushi were detected by immunofluorescense assay in most of these patients. Fever, rash, headache and relative bradycardia seen at a high frequency. On peripheral blood smear examination, atypical lymphocytes were detected in 3 cases. Serum electrolyte examination revealed hyponatremia in 4 (80%) patients; SIADH was suspected in one of these cases. All the patients improved promptly following start of therapy with intravenous or oral minocycline.
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PMID:[Tsutsugamushi disease during the last seven years in the past in Hamamatsu City, Shizuoka Prefecture--including evaluation of hyponatremia in scrub typhus]. 1869 86

Doxycycline is the recommended antibiotic for acute Q fever, scrub typhus, and murine typhus and defervescence often occurs within 3 days of treatment. Patients with delayed defervescence (> 3 days) are troublesome for clinicians. To investigate the characteristics of such patients, 18 and 88 cases with and without delayed defervescence, respectively, were studied. By univariate analysis, absence of headache (P = 0.004), jaundice (P = 0.030), icteric sclera (P = 0.030), relative bradycardia (P = 0.003), and pulmonary involvement on chest x-ray (P = 0.028) were significant findings in patients with delayed defervescence. By multivariate analysis, absence of headache (odds ratio [OR] = 8.310; 95% confidence interval [CI] = 1.990-34.706, P = 0.004), jaundice (OR = 6.242; 95% CI = 1.374-28.365, P = 0.018), and relative bradycardia (OR = 10.449; 95% CI = 2.137-51.088, P = 0.004) were the independent characteristics of patients with delayed defervescence. In treating acute Q fever, scrub typhus, and murine typhus with doxycycline, clinicians should be aware that delayed defervescence may occur in patients presenting with jaundice, relative bradycardia, and absence of headache.
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PMID:Clinical characteristics of acute Q fever, scrub typhus, and murine typhus with delayed defervescence despite doxycycline treatment. 1878 40

Scrub typhus is a zoonotic disease that is caused by Orientia tsutsugamushi. Although hepatic dysfunction occurred in 77-96.7% of the scrub typhus patients, its mechanism is unknown. IL-17 is a potent proinflammatory cytokine known for its role in several chronic disease conditions. Abundant IL-17 was found in conditions affected by microbial pathogens, including the synovial fluid of patients with Lyme arthritis or Chlamydia-induced reactive arthritis, Helicobacter pylori-infected gastric mucosa, and listeria infection. It is also suggested as a marker of acute hepatic injury. In our study, we postulated that IL-17 might be a cytokine with a role in hepatic dysfunction in scrub typhus. In September-November 2006, our study involved 43 patients with Boryong-type scrub typhus patients and 40 age- and sex-matched control healthy people. Scrub typhus was confirmed on the basis of immunofluorescence and a nested polymerase chain reaction assay. IL-17 was measured using human IL-17 immunoassay. We gathered the clinical and laboratory data by chart reviews. We used an independent t-test, Kolmogorov-Smirnov test, and correlation analysis. The IL-17 levels were significantly higher in scrub typhus patients than in the healthy group. Also, the patients with scrub typhus showed significantly higher aspartate aminotransferase and alanine aminotransferase levels, and lower hemoglobin levels than the healthy group. However, in our correlation analysis, we did not find any correlation between IL-17 and hepatic, kidney, and hemogram panels. The IL-17 level in patients with headaches was higher than in patients without headaches, showing a borderline significance. This suggests that IL-17 level might be a cause of a vasculitis-associated headache. More prospective, large-scale studies are needed about the mechanism of hepatic dysfunction and headaches in scrub typhus patients.
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PMID:Does IL-17 play a role in hepatic dysfunction of scrub typhus patients? 1948 73


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