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LABORATORY DIAGNOSIS OF TWO SCRUB TYPHUS OUTBREAKS AT CAMP FUJI, JAPAN IN 2000 AND 2001 BY ENZYME-LINKED IMMUNOSORBENT ASSAY, RAPID FLOW ASSAY, AND WESTERN BLOT ASSAY USING OUTER MEMBRANE 56-KD RECOMBINANT PROTEINS

Two scrub typhus outbreaks occurred among U.S. Marines training at Camp Fuji, Japan, between October 25 and November 3, 2000 and October 17 and November 30, 2001. Nine cases in approximately 800 Marines in 2000 and eight cases in approximately 900 Marines in 2001 (approximate attack rates = 1.1% and 0.9%, respectively) reported with signs and symptoms of fever, rash, headache, lymphadenopathy, myalgia, and eschar. Serologies and rapid response to doxycycline treatment indicated they had scrub typhus. Sixty-four convalescent serum samples (18 suspected cases and 46 negative controls) from U.S. Marines training at Camp Fuji during the outbreaks were assessed by enzyme-linked immunosorbent assay (ELISA), rapid flow assay (RFA), and Western blot assay for evidence of infection with Orientia tsutsugamushi, the causative agent of scrub typhus. All but one suspected case had serologic evidence of scrub typhus and all 46 control sera were non-reactive to O. tsutsugamushi antigens. The recombinant 56-kD antigen (r56) from the Karp, Kato and Gilliam strains of O. tsutsugamushi in an ELISA format provided better results than Karp r56 alone (ELISA and RFA) or whole cell antigen preparation from Karp, Kato and Gilliam (ELISA).

Received December 19, 2002. Accepted for publication April 26, 2003.

Acknowledgments: We thank Dr. Shaun Peterson (3rd Battalion/3rd Marine Infantry Division, Marine Corps Base, Hawaii); Hospital Corpsman First Class Petty Officer Marcos Bordonado (3rd Battalion/3rd Marine Infantry Division, Marine Corps Base, Hawaii); and Chief Hospital Corpsman Bonnie D. O’Mara (Preventive Medicine Department, Naval Hospital, Yokosuka, Japan) for help during the 2000 Outbreak Investigation, and Hospital Corpsman First Class Petty Officer Andrew Barker; Hospital Corpsman Second Class Petty Officer Richard Cabitet; Hospital Corpsman Third Class Petty Officer Alvin Jules (1st Battalion/3rd Marine Infantry Division, Marine Corps Base, Hawaii); Lieutenant Alfredo Fernandez; Chief Hospital Corpsman Bonnie D. O’Mara (Preventive Medicine Department, Naval Hospital, Yokosuka, Japan); and Lieutenant Debra Baker (Laboratory Services, Naval Hospital, Okinawa Japan) for help during the 2001 Outbreak Investigation.

Financial support: This study was supported by Naval Medical Research Center (Work Unit no. 61102AS13JA006).

Disclaimer: The opinion and assertions contained herein are those of the authors and are not to be construed as official of reflecting the views of the U.S. Navy or the Department of Defense.

Authors’ addresses: Ju Jiang, Rickettsial Diseases Department, Naval Medical Research Center 503 Robert Grant Avenue, Room 3N66, Silver Spring, MD 20910-7500, Telephone: 301-319-7249. Karen J. Marienau, Navy Environmental and Preventive Medicine Unit 6, 1215 North Road, Pearl Harbor, HI 96860-4477, Telephone: 808-473-0555, Fax: 808-473-2754. Laurel A. May, Navy Medical Clinic, 480 Central Avenue, Pearl Harbor, HI 96860-4477. H. James Beecham III, Naval Medical Research Unit No. 2, American Embassy, Jakarta, Indonesia FPO AP 96520-8132, Telephone: 62-21-425-6966, Fax: 62-21-424-4507. Ray Wilkinson, PANBIO Limited, 116 Lutwyche Road, Windsor, Brisbane, Queensland 4030, Australia, Telephone: 61-7-3357-1177, Fax: 61-7-3357-1222. Wei-Mei Ching, Rickettsial Diseases Department, Naval Medical Research Center 503 Robert Grant Avenue, Room 3N85, Silver Spring, MD 20910-7500, Telephone: 301-319-7438. Allen L. Richards, Rickettsial Diseases Department, Naval Medical Research Center 503 Robert Grant Avenue, Room 3A19, Silver Spring, MD 20910-7500.

Reprint requests: Allen L. Richards, Rickettsial Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Room 3A19, Silver Spring, MD 20910-7500, Telephone: 301-319-7668, Fax: 301-319-7460, E-mail: RichardsA{at}nmrc.navy.mil.

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