Scrub typhus and pregnancy: a case report and literature review.

Scrub typhus is still prevalent on Penghu Islands. We herein report a case in a pregnant woman who had been to Yi-Lan County in Taiwan. The patient responded well to Minocycline (Minocin) therapy without complication. Her newborn baby was found not complicated with the disease. The relative literature is reviewed.

[Leukopenia and hypoxemia induced by hemodialysis].

Patients with uremia usually develop hypoxemia during hemodialysis therapy. It has been thought by most of the investigators that the development of hypoxemia is related to the impropriety of biocompatibility of the dialyzer membranes. Besides, acetate dialysate through metabolism may cause a decrease of respiratory quotient and some amount of CO2 may be lost during hemodialysis. The decrease of CO2 in the blood may induce hypoventilation and therefore develop hypoxemia. A total of 32 patients who received hemodialysis therapy were studied. They were divided into group A and group B. In group A, there were 14 males and 8 females. They were hemodialyzed with cuprophan dialyzer membrane for 22 times totally. In group B, there were 6 males and 4 females. They were hemodialyzed with PMMA dialyzer membrane for 16 times totally. In both groups, acetate dialysate was used. Arterial blood gas analyses were hemodialyzed with PMMA dialyzer membrane for 16 times totally. In both groups, acetate dialysate was used. Arterial blood gas analyses were performed before hemodialysis as the baseline and at 15, 30, 45, 60, 120, 180, 240, and 300 minutes during hemodialysis. White blood cell counts (WBC) were done at the same time when arterial blood gas analyses were performed. The results showed that in group A, a marked decrease of WBC at 15 minutes (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Eosinophilic gastroenteritis: report of two cases.

Eosinophilic gastroenteritis is a rare disease, not previously been reported on Taiwan. Two male cases are reported. One was 19 years old and the other one was 54 years old. Both patients responded to corticosteroid therapy.

Studies on lymphocyte subpopulations and lymphocyte transformation in response to phytohemagglutinin, pokeweed mitogen, concanavalin A in systemic lupus erythematosus.

Forty-eight cases of systemic lupus erythematosus (SLE) were studied for lymphocyte subpopulations, and 42 cases were studied for lymphocyte response to mitogen stimulation. A decreased percentage of thymus-derived cells (T cells) and an increased percentage of bursa-equivalent derived cells (B cells), null cells (N cells), double labelled cells (D cells) were found in non-treated cases of SLE. There was no significant difference in these lymphocyte subpopulations in the treated cases in comparison with the normal control. There was an inverted linear relationship between T cells and N cells (p less than 0.001). No such relationship was found between B cells and N cells. The lymphocyte transformation in response to phytohemagglutinin (PHA), pokeweed mitogen (PWM) and concanavalin A (Con A) was expressed in three ways: (1) the net count of transformed data, (2) the difference between the square roots of the isotope incorporation in the stimulated and the non-stimulated cultures (Dsq), and (3) the stimulation index (SI). There were significantly decreased lymphocyte transformation in response to PHA, PWM stimulation in both the non-treated and the treated cases of SLE when results were expressed as net count and Dsq. But decreased counts in response to Con A was only found in non-treated cases. In contrast, no significantly lowered response to all three mitogens was found when data were expressed as stimulation index. Simultaneous study of the percentages of T cells, B cells, N cells, and D cells might be helpful in assessing the clinical activity of SLE and monitoring the effect of therapy. In the study of lymphocyte response to mitogen stimulation, Con A response was a more sensitive indicator of disease activity. The stimulation index was not a good method to demonstrate the result of lymphocyte response to mitogen stimulation in cases of SLE.

A proposed criteria for diagnosis of systemic lupus erythematosus used in Veterans General Hospital.

An eight-point diagnostic criteria for SLE was proposed and evaluated at the Veterans General Hospital (VGH), Taipei. It consists of 8 points and 12 items, 3 points being required for an accurate diagnosis. All of 94 cases of SLE whether they could or could not be diagnosed with the ARA criteria fulfilled 3 or more points of the VGH criteria. None of the 17 cases of rheumatoid arthritis fulfilled 3 or more points of the VGH criteria.

Population indices of chiggers (Leptotrombidium deliense) and incidence of scrub typhus in Chinese military personnel, Pescadores Islands of Taiwan, 1976-77.

Larval Leptotrombidium deliense were recovered from live-trapped Suncus murinus, Rattus rattus and R. norvegicus captured in the Pescadores Islands of Taiwan during 1976 and 1977. Weekly and monthly indices of chigger infestation expressed as a percentage of hosts infested and the number of chiggers per host for S. murinus and Rattus spp. were calculated. Close correlations were observed between monthly indices of L. deliense measured for S. murinus and Rattus spp. and the number of laboratory-confirmed cases of scrub typhus per month. Weekly indices from S. murinus correlated more closely with number of cases than did weekly indices from Rattus spp. The critical level of chigger infestation necessary for a single case of scrub typhus in a month was estimated at 0.69 chigger per S. murinus and 0.68 chigger per Rattus spp. The weekly index of chigger infestation necessary for a single case of scrub typhus during a week was calculated at 0.47 chiggers per shrew. Critical levels of chigger infestations expressed as percentages of hosts infested were not calculated.

Prevention of scrub typhus. Prophylactic administration of doxycycline in a randomized double blind trial.

We conducted a prospective randomized double blind study on the effects of doxycycline as a prophylactic antibiotic against scrub typhus. A total of 1,125 military subjects was followed for periods as long as 5 months of exposure in a hyperendemic focus in the Pescadores Islands of Taiwan. Oral 200 mg doses of doxycycline (Vibramycin) or placebo were given once each week throughout the trial. The incidence rate of scrub typhus in the placebo group was 2.5 times greater than that of the group taking doxycycline (P = 0.11). When subjects who failed to comply with scheduled administration of doxycycline were removed from the analysis, the incidence rate of scrub typhus in the control group was five times greater than that in the drug group (P = 0.04). The rates of infection with Rickettsia tsutsugamushi and of sick call reports were the same in experimental and control groups. The drug was well tolerated in pretrial tests and complaints were negligible during the conduct of the trial. Doxycycline appears to be an excellent antibiotic for the prevention of scrub typhus among personnel exposed to high risk of infection with R. tsutsugamushi.

Serological studies on systemic lupus erythematosus.

Serum samples from 73 cases of Systemic lupus erythematosus (SLE) were studied for proteins, immunoglobulins, complement components and anti-nuclear antibodies. In fresh cases of SLE, low serum albumin, high alpha-1, alpha-2, and gamma-globulins were found. Marked elevation of serum levels of IgG was found at the time of diagnosis, but this returned to normal after regular treatment. Over 71% of SLE had serum levels of C3 and C4 lower than normal (mean - 2SD). The more severe the disease, the lower the serum levels of these two components of complement. Fluorescent anti-nuclear antibody (FANA) was found in 98.6% of the cases studied. Most (85.1%) cases and anti-double stranded deoxyribonucleic acid (anti-ds DNA) antibody levels higher than normal control (mean + 2 SD). We may conclude that FANA, C3, C4 and anti-ds DNA anatibody are immunological parameters sensitive in the early diagnosis of SLE. FANA is the most sensitive, and can be used as a screening test in SLE. The serum C3 and C4 levels correlate well with the severity of the disease.

Epidemiological and serological study of scrub typhus among Chinese military in the Pescadores islands of Taiwan.

An outbreak of 69 cases of scrub typhus occurred among Chinese military personnel stationed in the Pescadores Islands, Taiwan Province, Republic of China between May and November 1975. A retrospective epidemiological study of this outbreak indicated that military personnel over 40 were more likely to have scrub typhus than those under 40. High risk groups included the Garrison Force (home guard), anti-aircraft gunners and infantry and armoured units stationed at Hsing-jen. The onset of symptoms in 69% occurred within one year of residence in the Pescadores. The clinical course of scrub typhus and the serological response to infection were also studied. Eschar formation, fever, headache chills and lymph node enlargement were the predominant clinical manifestations noted. The indirect immunofluorescent antibody test (IFAT) demonstrated diagnostic (four-fold) rises in antibody titres to Rickettsia tsutsugamushi reference strains in 36 of 41 paired sera tested. 11 of 19 patients from whom only single sera were obtained had IFA titres presumptive of scrub typhus (greater than or equal to 1:160). Of 19 patients experiencing possible primary infections, 13 (68%) responded with antibodies directed against more than one reference strain of R. tsutsugamushi. These results suggest that several antigenically diverse strains of R. tsutsugamushi may be active in the Pescadores.

Clinical observations of scrub typhus on Penghu (the Pescadores Islands).

Between May and September 1973, 68 cases of scrub typhus in Chinese military personnel on the Pescadores Islands were studied. The common symptoms and signs were fever, chills, headache, eschar, myalgia, and lymph node enlargement. Most eschars were located in the axilla, waist, groin and genitals, and neck. These lesions were painless and not noticed by the patients themselves. Regional lymph node enlargement at the site of eschar drainage was common. Relative bradycardia with fever was observed in 40%, a skin rash in 35% of the patients. Leucopenia was noted more frequently in the febrile than in the convalescent stage, but more than half of the patients had a normal count. Lymphocytosis was prominent, especially during the convalescent period. An acceleration of ESR was noted. Instead of depression of the erythroid series in the marrow which was reported previously, 47% of examined patients were found to have erythroid hyperplasia. Two patients showed marked hypocellularity of the marrow in the acute febrile stage; later on became normocellular. Albuminuria was present in 15 and BUN increased in 12 patients. Elevation of serum bilirubin and SGOT was also noted. Biologic false positive VDRL tests were observed in nine patients. In 30 tests elevation of Proteus OX-K titres between 1:160 and 1:640 was noted. A geometric mean OX-K titre rise in the patients is presented; the mean titre reached a peak in the third week of illness, and then fell off. Most of the patients were treated with tetracycline 500 mg every six hours for about nine days. The fever usually subsided within 36 hours. Complications or mortality were not encountered.