ABSTRACT
Rickettsia tsutsugamushi causes an acute febrile illness known as scrub thypus. Humans get infected when they accidentally encroach the mite infested areas (mite islands) mainly in rural and sub-urban areas1. Scrub typhus is being increasingly reported in India. It should be considered in the differential diagnosis of patients with acute febrile illness, including those with thrombocytopenia, abnormalities in liver function tests, altered sensorium, atypical pneumonia, acute respiratory distress syndrome. We report a case Multi Organ Dysfunction due to scrub typhus infection. A thorough knowledge of scrub typhus including varied presentations and its complications is important for providing life saving treatment for patients.
ABSTRACT
Rickettsia tsutsugamushi causes an acute febrile illness known as scrub thypus. Humans get infected when they accidentally encroach the mite infested areas (mite islands) mainly in rural and sub-urban areas1. Scrub typhus is being increasingly reported in India. It should be considered in the differential diagnosis of patients with acute febrile illness, including those with thrombocytopenia, abnormalities in liver function tests, altered sensorium, atypical pneumonia, acute respiratory distress syndrome. We report a case Multi Organ Dysfunction due to scrub typhus infection. A thorough knowledge of scrub typhus including varied presentations and its complications is important for providing life saving treatment for patients.
ABSTRACT
Tsutsugamushi disease is an acute infectious disease caused by Rickettsia tsutsugamushi.The clinical symptoms of tsutsugamushi disease are varied and non-specific,such as sudden onset fever with chills,rash,skin eschar of ulcer,lymphadenectasis,et al.Patients could combine with multi-organ dysfunction,include respiratory failure,heart failure,mild renal or hepatic dysfunction,circulatory shock or hematological abnormalities.Since the symptoms and signs are non-specific and resemble other tropical infections like malaria,enteric fever,dengue or leptospirosis,appropriate laboratory tests are necessary to confirm diagnosis,and reduce misdiagnosis and missed diagnosis rate.The mainstay of treatment is the tetracycline,chloramphenicol,macrolide and quinolone group of antibiotics.In mild cases,recovery is complete.In severe cases with multi-organ failure,mortality may be as high as 24％.Improve the early diagnosis and timely treatment of the disease,for improving the prognosis of patients,reduce the disease burden is of great significance.
ABSTRACT
Background & objectives: The southern part of India has witnessed an increase in scrub typhus (ST) during the past ten years. ST outbreaks occurred during winter months but at intervals of one to three years. With only a few reports of ST in Puducherry, this study was undertaken to look for the persistence of ST cases in Puducherry and Tamil Nadu in the winter months. Methods: During relatively cooler months of September, 2012 to March, 2013, a total of 45 patients with fever and clinical suspicion of ST and who provided both acute and convalescent blood samples were included. Total WBC, platelet counts, serum creatinine, liver enzymes levels and a rapid immunochromatographic test (RICT) for ST were first done. Paired serum samples were analysed by two specific tests - ST IgM and IgG ELISA- and a non-specific, but widely used Weil-Felix (WF) test. Results: Of the 45 patients, 21 adults and seven children were confirmed as ST based on clinical and laboratory findings, and positivity in specific serological test(s). Setting ST IgM and IgG ELISA as reference, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for RICT were 91.67, 85.71 per cent; 90.48, 100 per cent; 91.67, 100 per cent and 90.48, 80.95 per cent, respectively. Similarly, for WF the values were 83.33, 75 per cent; 95.24, 100 per cent; 95.24, 100 per cent and 83.33, 70.83 per cent, respectively. Interpretation & conclusions: ST continues to persist in the cooler months in Puducherry and neighbouring Tamil Nadu with fever and myalgia as prominent features. None of the tests evaluated in this study was found to be ideal, but ST IgM/IgG ELISA was useful for batch testing and the non-specific WF test can be used in resource poor settings.
ABSTRACT
Twenty-four monoclonal antibodies were produced by immunizing BALB/c mice with Rickettsia tsutsugamushi Boryong strain and used for the analysis of antigenic characteristics of R.tsutsugamushi Boryong strain and antigenic heterogeneity of R.tsutsugamushi by indirect immunofluorescent(IF) test. R. tsutsugamushi Kato, Karp, Gilliam, TA686, TA716, TA763, TC586, TH1817, and Boryong were used for the analysis of antigenic heterogeneity of R.tsutsugamushi. Five monoclonal antibodies were reactive with 27-kDa protein, four monoclonal antibodies were reactive with 47-kDa protein, and eight monoclonal antibodies were reactive with 56-kDa protein of R.tsutsugamushi Boryong strain. The reactive protein of seven monoclonal antibodies could not be identified by immunoblotting method. All monoclonal antibodies to 27-kDa protein and three monoclonal antibodies to 47-kDa protein, and five monoclonal antibodies to 56-kDa protein were reactive with three to eight strains among nine strains of R. tsutsugamushi tested. One monoclonal antibody reactive to 47-kDa protein(KI18) and two monoclonal antibodies reactive to 56-kDa protein(KI36, and KI37) reacted with all the strains of R. tsutsugamushi tested. Strain-specific monoclonal antibody(KI58) could be found among antibodies which were reactive with 56-kDa protein. There was no strain which showed same reactivity pattern to these 24 monoclonal antibodies among nine strains. From this results, it could be concluded that Boryong strain is antigenically different from other strains of R.tsutsugamushi and antigenic heterogeneity of R.tsutsugamushi is due to the antigenic diversity of several proteins of R. tsutsugamushi including 56-kDa protein.