ABSTRACT
Pathologic findings of scrub typhus have been characterized by vasculitis of the microvasculature of the involved organ resulting from a direct invasion by Orientia tsutsugamushi. We experienced a case of acute respiratory distress syndrome (ARDS) associated with scrub typhus. The case was proven by eschar and high titer of serum IgM antibody (positive at 1:1280). Open lung biopsy showed diffuse alveolar damage (DAD) in the organizing stage without evidence of vasculitis. Immunofluorescent antibody staining and polymerase chain reaction for O. tsutsugamushi failed to demonstrate the organism in the lung tissue. The patient expired due to progressive respiratory failure despite doxycycline therapy. Immunologic mechanism, without direct invasion of the organism, may participate in the pathogenesis of ARDS associated with scrub typhus.
Subject(s)
Aged , Female , Humans , Infant, Newborn , Acute Disease , Fatal Outcome , Pulmonary Alveoli/pathology , Pulmonary Alveoli/injuries , Respiratory Distress Syndrome, Newborn/physiopathology , Respiratory Distress Syndrome, Newborn/pathology , Respiratory Distress Syndrome, Newborn/immunology , Respiratory Distress Syndrome, Newborn/complications , Scrub Typhus/physiopathology , Scrub Typhus/pathology , Scrub Typhus/immunology , Scrub Typhus/complications , VasculitisSubject(s)
Cells, Cultured , Humans , Lymphocyte Activation , Scrub Typhus/immunology , Specimen Handling , Tropical ClimateABSTRACT
Rickettsia tsutsugamushi was isolated from L. (L.) arenicola chiggers and three species of rats in an area of scrub and sedge along the Bay of Jakarta. This is the only finding in Indonesia of a cycle of the agent of scrub typhus associated with L. (L.) arenicola. A serologic survey of nearly 300 persons living in two kampungs near the site at which rickettsiae were recovered revealed one individual with antibodies to R. tsutsugamushi. Murine typhus, with a seropositivity rate of 6.5%, may be endemic at low levels.
Subject(s)
Animals , Antibodies/analysis , Disease Vectors , Humans , Indonesia , Mites/parasitology , Muridae/parasitology , Orientia tsutsugamushi/isolation & purification , Scrub Typhus/immunology , Trombiculidae/parasitology , Typhus, Endemic Flea-Borne/parasitology , Urban PopulationABSTRACT
An epidemiological study in a mature oil palm estate in Peninsular Malaysia has demonstrated a low prevalence of R. tsutsugamushi infection in small mammals. The direct fluorescent antibody technique for assaying infections in chiggers proved more sensitive than mouse inoculation. Most infections in both chiggers and rodents were caused by the Karp strain.
Subject(s)
Animals , Animals, Wild/immunology , Antibodies, Bacterial/analysis , Disease Vectors , Fluorescent Antibody Technique , Malaysia , Mites/immunology , Orientia tsutsugamushi/immunology , Rodentia/immunology , Scrub Typhus/immunology , Serotyping , Trombiculidae/immunologyABSTRACT
The passive transfer of convalescent sera did not protect the majority of mice against challenge with the homologous strain and was completely ineffective against challenge with strains unrelated by fluorescent antibody techniques. When the immune sera was incubated with the rickettsia in vitro and then inoculated into the mice a dramatic increase occurred in the number of surviving mice. The importance of these data in relation to published results with other species of rickettsia is discussed.