Volume 69, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 , 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 antigens. The recombinant 56-kD antigen (r56) from the Karp, Kato and Gilliam strains of 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).


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Rapmund G, 1984. Rickettsial diseases of the Far East: new perspectives. J Infect Dis 149 : 330–338. [Google Scholar]
  2. Brown GW, Shirai A, Jegathesan M, Burke DS, Twartz JC, Saunders JP, Huxsoll DL, 1984. Febrile illness in Malaysia-an analysis of 1,629 hospitalized patients. Am J Trop Med Hyg 33 : 311–315. [Google Scholar]
  3. Brown GW, Robinson DM, Huxsoll DL, Ng TS, Lim KJ, Sannasey G, 1976. Scrub typhus: a common cause of illness in indigenous populations. Trans R Soc Trop Med Hyg 70 : 444–448. [Google Scholar]
  4. Berman SJ, Kundin WD, 1973. Scrub typhus in South Vietnam. Ann Intern Med 79 : 26–30. [Google Scholar]
  5. Richards AL, Teik OC, Lockman JL, Rahardjo E, Wignall FS, 1997. Scrub typhus in an American living in Jakarta, Indonesia: a case report. Infect Dis Clin Pract 6 : 268–273. [Google Scholar]
  6. Philip CB, 1948. Tsutsugamushi disease (scrub typhus) in World War II. J Parasitol 34 : 169–191. [Google Scholar]
  7. Olson JG, Bourgeois AL, 1977. Rickettsia tsutsugamushi infection and scrub typhus incidence among Chinese military personnel in the Pescadores Islands. Am J Epidemiol 106 : 172–175. [Google Scholar]
  8. Kelly DJ, Richards AL, Temenak JJ, Strickman D, Dasch GA, 2002. The past and present threat of rickettsial diseases to military medicine and international public health. Clin Infect Dis 34 (Suppl 4): s145–s169. [Google Scholar]
  9. Gormley TS, 1996. A diagnosis of scrub typhus. Navy Med 87 : 20–22. [Google Scholar]
  10. Marienau KJ, May LA, Beecham HJ, 2001. Scrub Typhus Among U.S. Marines at Camp Fuji, Japan. Pearl Harbor, HI: U.S. Navy Environmental and Preventive Medicine Unit No. 6 Epidemiological Investigative Report.
  11. Marienau KJ, 2002. Scrub Typhus Revisited: A Second Outbreak Among U.S. Marines at Camp Fuji, Japan. Pearl Harbor, HI: U.S. Navy Environmental and Preventive Medicine No. 6, Epidemiological Investigative Report.
  12. Dasch GA, Halle S, Bourgeosis AL, 1979. Sensitive microplate enzyme-linked immunosorbent assay for detection of antibodies against scrub typhus rickettsia, Rickettsia tsutsugamushi. J Clin Microbiol 9 : 38–48. [Google Scholar]
  13. Ching W-M, Wang H, Eamsila, Kelly DJ, Dasch GA, 1998. Expression and refolding of truncated recombinant major outer membrane protein antigen (r56) of Orientia tsutsugamushi and its use in enzyme-linked immunosorbent assays. Clin Diagn Lab Immunol 5 : 519–526. [Google Scholar]
  14. Ching W-M, Rowland D, Zhang Z, Bourgeois AL, Kelly D, Dasch GA, Devine PL, 2001. Early diagnosis of scrub typhus with a rapid flow assay using recombinant major outer membrane protein antigen (R56) of Orientia tsutsugamusi. Clin Diagn Lab Immunol 8 : 409–414. [Google Scholar]
  15. Wilkinson R, Rowland D, Ching W-M, 2003. Development of an improved rapid lateral flow assay for the detection of Orientia tsutsugamushi specific IgG/IgM antibodies. Ann N Y Acad Sci 990 : 386–390. [Google Scholar]
  16. Kim I-S, Seong S-Y, Woo S-G, Choi M-S, Kang J-S, Chang W-H, 1993. Rapid diagnosis of scrub typhus by a passive hemagglutination assay using recombinant 56-kilodalton polypeptides. J Clin Microbiol 31 : 2057–2060. [Google Scholar]
  17. Kim I-S, Seong S-Y, Woo S-G, Choi M-S, Chang W-H, 1993. High-level expression of a 56-kilodalton protein gene (bor56) of Rickettsia tsutsugamushi Boryong and its application to enzyme-linked immunosorbent assays. J Clin Microbiol 31 : 598–605. [Google Scholar]
  18. Coleman RE, Sangkasuwan V, Suwanabun N, Ching W-M, Sat-tabongkot J, Eamsila C, Richards AL, Rowland D, Devine P, Lerdthusnee K, 2002. Comparative evaluation of selected diagnostic assays for the detection of IgG and IgM antibody to Orientia tsutsugamushi in Thailand. Am J Trop Med Hyg 67 : 497–503. [Google Scholar]
  19. Elisberg BL, Sangkasuvana V, Campbell JM, Bozeman FM, Bodhidatta P, 1967. Physiogeographic distribution of scrub typhus in Thailand. Acta Med Biol (Niigata) 15 : 61–67. [Google Scholar]
  20. Tamura A, Takahashi K, Tsuruhara T, Urakami H, Miyamura S, Sekikawa H, Kenmotsu M, Shibata M, Abe S, Nezu H, 1984. Isolation of Rickettsia tsutsugamushi antigenically different from Kato, Karp, and Gilliam strains from patients. Microbiol Immunol 28 : 873–882. [Google Scholar]
  21. Richards AL, Soeatmandji DW, Widodo MA, Sardjono TW, Yanuwiadi B, Hernowati TE, Baskoro AD, Roebiyoso, Hakim L, Soendoro M, Rahardjo E, Putri MP, Saragih JM, Strickman D, Kelly DJ, Dasch GA, Olson JG, Church CJ, Corwin AL, 1997. Seroepidemiological evidence for murine and scrub typhus in Malang, Indonesia. Am J Trop Med Hyg 57 : 91–95. [Google Scholar]
  22. Watt G, Strickman D, 1994. Life-threatening scrub typhus in a traveler returning from Thailand. Clin Infect Dis 18 : 624–626. [Google Scholar]
  23. Eamsila C, Singsawat P, Duangvaraporn A, Strickman D, 1996. Antibodies to Orientia tsutsugamushi in Thai soldiers. Am J Trop Med Hyg 55 : 556–559. [Google Scholar]
  24. Ohashi N, Tamura A, Suto T, 1988. Immunoblotting analysis of anti-rickettsial antibodies produced in patients of Tsutsugamushi disease. Microbiol Immunol 32 : 1085–1092. [Google Scholar]

Data & Media loading...

  • Received : 19 Dec 2002
  • Accepted : 26 Apr 2003

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error