ABSTRACT
Scrub typhus is a zoonosis caused by Orientia tsutsugamushi (O. tsutsugamushi) occurring mainly in autumn in Korea. The need of new antibiotics has arisen with a report on strains resistant to antibiotics and chronic infection. This study aims to identify susceptibility of tigecycline in-vitro as a new therapeutic option for O. tsutsugamushi. Antibacterial activity of tigecycline against the O. tsutsugamushi was compared with doxycycline using flow cytometry assay. The inhibitory concentration 50 (IC50) was 3.59×10(-3) µg/mL in doxycycline-treated group. Whereas in 0.71×10(-3) µg/mL tigecycline-treated group. These findings indicate that tigecycline may be a therapeutic option for the treatment of scrub typhus.
Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial/drug effects , Inhibitory Concentration 50 , Minocycline/analogs & derivatives , Orientia tsutsugamushi/drug effects , Scrub Typhus/drug therapyABSTRACT
Scrub typhus is a rare form of disease caused by gram negative bacterium Orientia tsutsugamushi, of family Rickettsiaceae, transmitted by bite of infected trombiculid mite larva (chigger). The present prospective study is undertaken with the aim of the clinical manifestations, course, complications and outcome of scrub typhus in Haroti region of Rajasthan state during the recent epidemic. Method: This prospective study was conducted in indoor patients of MBS hospital and various private nursing homes in Kota city from August 2012 to November 2012. Twenty cases with positive Scrub typhus card test in the age group of 20 years to 60 years, comprising of 14 males and 06 females were included in the study group in clinically suspected cases with fever, rashes, cough with or without eschar and regional lymphadenopathy. Cases were studied in detail and followed up for improvement and any permanent damage or death. Results: Out of 20 patients, 16 patients improved and discharged from hospital in stable condition without any disability. 02 patients (10%) died because of late presentation and multiorgan involvement especially respiratory failure or meningoencephalitis. Conclusion: Haroti witnessed recent epidemic of Scrub typhus. Renal, respiratory and neurological complications were main cause of mortality and morbidity.
Subject(s)
Adult , Epidemics , Female , Humans , India , Male , Morbidity , Scrub Typhus/diagnosis , Scrub Typhus/drug therapy , Scrub Typhus/epidemiology , Scrub Typhus/mortality , Treatment Outcome , Young AdultABSTRACT
The use of quinolone for treatment of rickettsial diseases remains controversial. Recent clinical studies suggest that quinolone is not as effective as others in patients with rickettsial diseases including scrub typhus, although the mechanism is not well understood. In this study, we evaluated the mutation in gyrA associated with quinolone resistance. We prospectively enrolled scrub typhus patients, collected blood samples and clinical data from October, 2010 to November, 2011. Among the 21 patients enrolled, one initially received ciprofloxacin for 3 days but was switched to doxycycline due to clinical deterioration. We obtained the gyrA gene of Orientia tsutsugamushi from 21 samples (20 Boryong strain, 1 Kato strain) and sequenced the quinolone resistance-determining region. All of 21 samples had the Ser83Leu mutation in the gyrA gene, which is known to be associated with quinolone resistance. This suggests that quinolones may be avoided for the treatment of serious scrub typhus.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Amino Acid Sequence , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/genetics , Ciprofloxacin/therapeutic use , DNA Gyrase/genetics , Doxycycline/therapeutic use , Drug Resistance, Bacterial , Genotype , Molecular Sequence Data , Mutation , Orientia tsutsugamushi/classification , Phylogeny , Prospective Studies , Scrub Typhus/drug therapy , Sequence Alignment , Sequence Analysis, DNAABSTRACT
To study the clinical profile of and complications in children with scrub typhus. Prospective observational study. Tertiary care hospital. Children up to 12 years of age who had a fever for more than five days without an identifiable infection were included. All children who were suspected of having rickettsial infections were defined as having scrub typhus if they had a positive Weil-Felix test result [OX-K 1:80 or more] and one or more of the following clinical features [after exclusion of other diagnoses]: rash, edema, hepatosplenomegaly, lymphadenopathy, an eschar, and a tick bite or tick exposure. Thirty-five children were diagnosed with scrub typhus between February 2010 and February 2011. The age of the patients ranged from 1.5 to 12 years. Edema, crackles/rhonchi, hepatomegaly and hypotension were encountered in 60%, 23%, 91% and 34% of patients, respectively. An eschar was observed in 11% of the cases. Complications included myocarditis with cardiogenic shock in 34% of the cases and acute kidney injury in 20% of the cases. Anicteric hepatitis and thrombocytopenia were observed in 31% and 61% of cases, respectively. One patient died. High incidences of myocarditis and acute kidney injury were observed, which indicates that the children were treated at a late stage of the disease. Clinicians should be cognizant that myocarditis and acute kidney injury are serious manifestations of pediatric scrub typhus. 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Scrub Typhus/diagnosis , Acute Kidney Injury/etiology , Myocarditis/etiology , Scrub Typhus/drug therapy , Anti-Bacterial Agents , Doxycycline , Prospective Studies , Sex DistributionABSTRACT
No abstract available.
Subject(s)
Humans , Male , Middle Aged , Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Face , Orientia tsutsugamushi/isolation & purification , Scrub Typhus/drug therapy , Skin/drug effects , Treatment OutcomeABSTRACT
PURPOSE: Previous studies and our own clinical experience suggest that concurrent corticosteroid treatment for severe rickettsial disease with multiorgan failure may improve the clinical course or reduce mortality. However, the use of corticosteroids as adjunctive treatment for rickettsial diseases is controversial. We attempted to determine the influences of corticosteroid on the growth of Orientia tsutsugamushi in vitro to justify and evaluate the clinical applicability of corticosteroid in rickettsial disease. MATERIALS AND METHODS: L929 cells were infected with Orientia tsutsugamushi Gilliam. Dexamethasone was added to the cells at final concentrations of 10(1) and 10(7) pg/mL. Cultures were incubated at 35degrees C and processed for flow cytometry on the 6th day after addition of dexamethasone. RESULTS: Observation on the 6th day after treatment with dexamethasone in infected cultures revealed that there was no difference in fluorescence intensity among the treatment wells. Treatment of the cells with dexamethasone at concentrations of 10(1) and 10(7) pg/mL showed no influence on the growth of Orientia tsutsugamushi. CONCLUSION: Our results to show that isolated corticosteroid does not enhance the replication of Orientia tsutsugamushi in vitro. Concurrent use of anti-inflammatory or immunosuppressive doses of corticosteroids in conjunction with antibiotics may not have detrimental effects on the course of scrub typhus.