1921
Volume 102, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Scrub typhus is a life-threatening zoonotic disease, which is caused by , an obligatory intracellular Gram-negative bacterium. It is transmitted by mites in endemic regions of Southeast Asia. So far, data on imported scrub typhus cases to non-endemic areas and immunological descriptions are rare. Eleven scrub typhus cases that had been diagnosed by the German National Reference Center for Tropical Pathogens between 2010 and 2018 were retrospectively reviewed for clinical symptoms, laboratory changes, and travel destinations. Patient sera were included if follow-up samples showed simultaneous seroconversion for IgM and IgG antibody responses by immunofluorescence assays or concurrence with the first serum sample. The median of seroconversion was week 2 after symptom onset. Cytokine levels were measured over time, demonstrating simultaneously upregulated major Th1, Th2, and Th17 cytokines in the acute phase of infection followed by normalization during convalescence. This study underlines the complex mixed cytokine response elicited by scrub typhus and highlights clinical and diagnostic aspects of imported infections with .

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. Xu G, Walker DH, Jupiter D, Melby PC, Arcari CM, , 2017. A review of the global epidemiology of scrub typhus. PLoS Negl Trop Dis 11: e0006062. [Google Scholar]
  2. Weitzel T, Dittrich S, Lopez J, Phuklia W, Martinez-Valdebenito C, Velasquez K, Blacksell SD, Paris DH, Abarca K, , 2016. Endemic scrub typhus in South America. N Engl J Med 375: 954961. [Google Scholar]
  3. Izzard L, 2010. Isolation of a novel Orientia species (O. chuto sp. nov.) from a patient infected in Dubai. J Clin Microbiol 48: 44044409. [Google Scholar]
  4. Horton KC, Jiang J, Maina A, Dueger E, Zayed A, Ahmed AA, Pimentel G, Richards AL, , 2016. Evidence of Rickettsia and Orientia infections among abattoir workers in Djibouti. Am J Trop Med Hyg 95: 462465. [Google Scholar]
  5. Maina AN, Farris CM, Odhiambo A, Jiang J, Laktabai J, Armstrong J, Holland T, Richards AL, O’Meara WP, , 2016. Q fever, scrub typhus, and rickettsial diseases in children, Kenya, 201–2012. Emerg Infect Dis 22: 883886. [Google Scholar]
  6. Kramme S, An le V, Khoa ND, Trin le V, Tannich E, Rybniker J, Fleischer B, Drosten C, Panning M, , 2009. Orientia tsutsugamushi bacteremia and cytokine levels in Vietnamese scrub typhus patients. J Clin Microbiol 47: 586589. [Google Scholar]
  7. Weitzel T, Aylwin M, Martinez-Valdebenito C, Jiang J, Munita JM, Thompson L, Abarca K, Richards AL, , 2018. Imported scrub typhus: first case in South America and review of the literature. Trop Dis Travel Med Vaccines 4: 10. [Google Scholar]
  8. Jensenius M, Montelius R, Berild D, Vene S, , 2006. Scrub typhus imported to Scandinavia. Scand J Infect Dis 38: 200202. [Google Scholar]
  9. Hendershot EF, Sexton DJ, , 2009. Scrub typhus and rickettsial diseases in international travelers: a review. Curr Infect Dis Rep 11: 6672. [Google Scholar]
  10. Vliegenthart-Jongbloed K, de Mendonca Melo M, Slobbe L, Beersma MF, van Genderen PJ, , 2013. Imported scrub typhus in The Netherlands. Travel Med Infect Dis 11: 197199. [Google Scholar]
  11. Suzuki Y, Shimanuki M, Seto J, Yahagi K, Mizuta K, , 2016. A case of scrub typhus imported from South Korea to Yamagata, Japan. Jpn J Infect Dis 69: 454456. [Google Scholar]
  12. Paris DH, Shelite TR, Day NP, Walker DH, , 2013. Unresolved problems related to scrub typhus: a seriously neglected life-threatening disease. Am J Trop Med Hyg 89: 301307. [Google Scholar]
  13. Thipmontree W, Tantibhedhyangkul W, Silpasakorn S, Wongsawat E, Waywa D, Suputtamongkol Y, , 2016. Scrub typhus in northeastern Thailand: eschar distribution, abnormal electrocardiographic findings, and predictors of fatal outcome. Am J Trop Med Hyg 95: 769773. [Google Scholar]
  14. Kim DM, 2007. Distribution of eschars on the body of scrub typhus patients: a prospective study. Am J Trop Med Hyg 76: 806809. [Google Scholar]
  15. Silpapojakul K, Chupuppakarn S, Yuthasompob S, Varachit B, Chaipak D, Borkerd T, Silpapojakul K, , 1991. Scrub and murine typhus in children with obscure fever in the tropics. Pediatr Infect Dis J 10: 200203. [Google Scholar]
  16. Wei Y, Ma Y, Luo L, Wu X, Huang Y, Li X, Yang Z, , 2017. Differences in clinical and laboratory features for different genotypes of Orientia tsutsugamushi in Guangzhou, southern China. Vector Borne Zoonotic Dis 17: 260267. [Google Scholar]
  17. Kim DM, Kim SW, Choi SH, Yun NR, , 2010. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis 10: 108. [Google Scholar]
  18. Yasunaga H, Horiguchi H, Kuwabara K, Hashimoto H, Matsuda S, , 2011. Delay in tetracycline treatment increases the risk of complications in tsutsugamushi disease: data from the Japanese diagnosis procedure combination database. Intern Med 50: 3742. [Google Scholar]
  19. Rajapakse S, Weeratunga P, Sivayoganathan S, Fernando SD, , 2017. Clinical manifestations of scrub typhus. Trans R Soc Trop Med Hyg 111: 4354. [Google Scholar]
  20. Kumar M, Krishnamurthy S, Delhikumar CG, Narayanan P, Biswal N, Srinivasan S, , 2012. Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. J Infect Public Health 5: 8288. [Google Scholar]
  21. Narayanasamy DK, Arunagirinathan AK, Kumar RK, Raghavendran VD, , 2016. Clinico–laboratory profile of scrub typhus–an emerging rickettsiosis in India. Indian J Pediatr 83: 13921397. [Google Scholar]
  22. Blacksell SD, Bryant NJ, Paris DH, Doust JA, Sakoda Y, Day NP, , 2007. Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to a lot of confusion. Clin Infect Dis 44: 391401. [Google Scholar]
  23. Janardhanan J, Trowbridge P, Varghese GM, , 2014. Diagnosis of scrub typhus. Expert Rev Anti Infect Ther 12: 15331540. [Google Scholar]
  24. Koh GC, Maude RJ, Paris DH, Newton PN, Blacksell SD, , 2010. Diagnosis of scrub typhus. Am J Trop Med Hyg 82: 368370. [Google Scholar]
  25. Kim DM, Kim HL, Park CY, Yang TY, Lee JH, Yang JT, Shim SK, Lee SH, , 2006. Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study. Clin Infect Dis 43: 12961300. [Google Scholar]
  26. Mansueto P, Vitale G, Cascio A, Seidita A, Pepe I, Carroccio A, di Rosa S, Rini GB, Cillari E, Walker DH, , 2012. New insight into immunity and immunopathology of rickettsial diseases. Clin Dev Immunol 2012: 967852. [Google Scholar]
  27. Koh Y-S, Yun J-H, Seong S-Y, Choi M-S, Kim I-S, , 2004. Chemokine and cytokine production during Orientia tsutsugamushi infection in mice. Microbial Pathogenesis 36: 5157. [Google Scholar]
  28. Palmer BA, Hetrick FM, Jerrells TJ, , 1984. Production of gamma interferon in mice immune to Rickettsia tsutsugamushi. Infect Immun 43: 5965. [Google Scholar]
  29. Iwasaki H, Mizoguchi J, Takada N, Tai K, Ikegaya S, Ueda T, , 2010. Correlation between the concentrations of tumor necrosis factor-alpha and the severity of disease in patients infected with Orientia tsutsugamushi. Int J Infect Dis 14: e328-33. [Google Scholar]
  30. Chung Y, 2009. Critical regulation of early Th17 cell differentiation by interleukin-1 signaling. Immunity 30: 576587. [Google Scholar]
  31. Annunziato F, Cosmi L, Liotta F, Maggi E, Romagnani S, , 2009. Human Th17 cells: are they different from murine Th17 cells? Eur J Immunol 39: 637640. [Google Scholar]
  32. Wei L, Laurence A, Elias KM, O'Shea JJ, , 2007. IL-21 is produced by Th17 cells and drives IL-17 production in a STAT3-dependent manner. J Biol Chem 282: 3460534610. [Google Scholar]
  33. Aujla SJ, 2008. IL-22 mediates mucosal host defense against gram-negative bacterial pneumonia. Nat Med 14: 275281. [Google Scholar]
  34. Chen K, McAleer JP, Lin Y, Paterson DL, Zheng M, Alcorn JF, Weaver CT, Kolls JK, , 2011. Th17 cells mediate clade-specific, serotype-independent mucosal immunity. Immunity 35: 9971009. [Google Scholar]
  35. Khader SA, Gaffen SL, Kolls JK, , 2009. Th17 cells at the crossroads of innate and adaptive immunity against infectious diseases at the mucosa. Mucosal Immunol 2: 403411. [Google Scholar]
  36. Steinman L, , 2007. A brief history of T(H)17, the first major revision in the T(H)1/T(H)2 hypothesis of T cell-mediated tissue damage. Nat Med 13: 139145. [Google Scholar]
  37. Yoon HJ, Lee MS, Ki M, Ihm C, Kim D, Kim Y, Yoo SM, , 2010. Does IL-17 play a role in hepatic dysfunction of scrub typhus patients? Vector Borne Zoonotic Dis 10: 231235. [Google Scholar]
  38. Astrup E, 2014. Cytokine network in scrub typhus: high levels of interleukin-8 are associated with disease severity and mortality. PLoS Negl Trop Dis 8: e2648. [Google Scholar]
  39. Colic M, Gazivoda D, Vucevic D, Vasilijic S, Rudolf R, Lukic A, , 2009. Proinflammatory and immunoregulatory mechanisms in periapical lesions. Mol Immunol 47: 101113. [Google Scholar]
  40. Araujo-Pires AC, Francisconi CF, Biguetti CC, Cavalla F, Aranha AM, Letra A, Trombone AP, Faveri M, Silva RM, Garlet GP, , 2014. Simultaneous analysis of T helper subsets (Th1, Th2, Th9, Th17, Th22, Tfh, Tr1 and Tregs) markers expression in periapical lesions reveals multiple cytokine clusters accountable for lesions activity and inactivity status. J Appl Oral Sci 22: 336346. [Google Scholar]
  41. Paris DH, 2012. Coagulation and inflammation in scrub typhus and murine typhus--a prospective comparative study from Laos. Clin Microbiol Infect 18: 12211228. [Google Scholar]
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  • Received : 02 Jul 2019
  • Accepted : 09 Oct 2019
  • Published online : 25 Nov 2019

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