Case Report: Coinfection with Rickettsia monacensis and Orientia tsutsugamushi

Seok Won Kim Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Republic of Korea;

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Choon-Mee Kim Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea;

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Dong-Min Kim Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Na Ra Yun Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Rickettsia monacensis and Orientia tsutsugamushi are bacteria of the family Rickettsiaceae, which causes fever, rash, and eschar formation; outdoor activities are a risk factor for Rickettsiaceae infection. A 75-year-old woman presented with fever, rash, and eschar and was confirmed as being scrub typhus based on a nested-polymerase chain reaction (N-PCR) test for a 56-kDa gene of O. tsutsugamushi; the genome was identified as the Boryong genotype. In addition, a pan-Rickettsia real-time PCR test was positive and a N-PCR test using a Rickettsia-specific partial outer membrane protein A (rOmpA) confirmed R. monacensis. This is the first case wherein a patient suspected of having scrub typhus owing to the presence of rash and eschar was also found to be coinfected with O. tsutsugamushi and R. monacensis based on molecular testing.

Author Notes

Address correspondence to Dong-Min Kim, Department of Internal Medicine, School of Medicine, Chosun University, 588 Seosuk-dong, Dong-gu, Gwangju 501-717, Republic of Korea. E-mail: drongkim@chosun.ac.kr

Financial support: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2016R1D1A1B03930956).

Disclosure: The authors do not have any commercial interests or other associations that might pose a conflict of interest.

Authors’ addresses: Seok Won Kim, Chosun University College of Medicine, Departments of Neurosurgery Chosun University College of Medicine, Gwangju, Republic of Korea, E-mail: chosunns@chosun.ac.kr. Choon-Mee Kim, College of Medicine, Premedical Science, Gwangju, Republic of Korea, E-mail: choonmee@chosun.ac.kr. Dong-Min Kim and Na Ra Yun, Chosun University College of Medicine, Departments of Internal Medicine Chosun University College of Medicine, Gwang-Ju, Republic of Korea, E-mails: drongkim@chosun.ac.kr and shine@chosun.ac.kr.

These authors contributed equally to this work.

  • 1.

    Pretorius AM, Jensenius M, Birtles RJ, 2004. Update on spotted fever group Rickettsiae in South Africa. Vector Borne Zoonotic Dis 4: 249260.

    • Search Google Scholar
    • Export Citation
  • 2.

    Lee HJ, Park CY, Park SG, Yoon NR, Kim DM, Chung CH, 2017. Activation of the coagulation cascade in patients with scrub typhus. Diagn Microbiol Infect Dis 89: 16.

    • Search Google Scholar
    • Export Citation
  • 3.

    Kim YS, Choi YJ, Lee KM, Ahn KJ, Kim HC, Klein T, Jiang J, Richards A, Park KH, Jang WJ, 2017. First isolation of Rickettsia monacensis from a patient in South Korea. Microbiol Immunol 61: 258263.

    • Search Google Scholar
    • Export Citation
  • 4.

    Choi SH, Kim DM, Lee J, Yun NR, 2017. Endoscopic characteristics of infection-associated peptic ulcers. Helicobacter 2017 Dec;22(6). doi: 10.1111/hel.12427.

    • Search Google Scholar
    • Export Citation
  • 5.

    Park JW et al. 2018. Molecular epidemiology of an Orientia tsutsugamushi gene encoding a 56-kDa type-specific antigen in chiggers, small mammals, and patients from the southwest region of Korea. Am J Trop Med Hyg 98: 616624.

    • Search Google Scholar
    • Export Citation
  • 6.

    Kato CY, Chung IH, Robinson LK, Austin AL, Dasch GA, Massung RF, 2013. Assessment of real-time PCR assay for detection of Rickettsia spp. and Rickettsia rickettsii in banked clinical samples. J Clin Microbiol 51: 314317.

    • Search Google Scholar
    • Export Citation
  • 7.

    Jeung YS, Kim CM, Yun NR, Kim SW, Han MA, Kim DM, 2016. Effect of latitude and seasonal variation on scrub typhus, South Korea, 2001-2013. Am J Trop Med Hyg 94: 2225.

    • Search Google Scholar
    • Export Citation
  • 8.

    Simser JA, Palmer AT, Fingerle V, Wilske B, Kurtti TJ, Munderloh UG, 2002. Rickettsia monacensis sp. nov., a spotted fever group Rickettsia, from ticks (Ixodes ricinus) collected in a European city park. Appl Environ Microbiol 68: 4 5594566.

    • Search Google Scholar
    • Export Citation
  • 9.

    Jado I et al. 2007. Rickettsia monacensis and human disease, Spain. Emerg Infect Dis 13: 1405140 7.

  • 10.

    Madeddu G, Mancini F, Caddeo A, Ciervo A, Babudieri S, Maida I, Fiori ML, Rezza G, Mura MS, 2012. Rickettsia monacensis as cause of Mediterranean spotted fever-like illness, Italy. Emerg Infect Dis 18: 702704.

    • Search Google Scholar
    • Export Citation
  • 11.

    Lee KM, Choi YJ, Shin SH, Choi MK, Song HJ, Kim HC, Klein TA, Richards AL, Park KH, Jang WJ, 2013. Spotted fever group rickettsia closely related to Rickettsia monacensis isolated from ticks in South Jeolla Province, Korea. Microbiol Immunol 57: 487495.

    • Search Google Scholar
    • Export Citation
  • 12.

    Tijsse-Klasen E, Sprong H, Pandak N, 2013. Co-infection of Borrelia burgdorferi sensu lato and Rickettsia species in ticks and in an erythema migrans patient. Parasit Vectors 6: 347.

    • Search Google Scholar
    • Export Citation
  • 13.

    Miťková K, Berthová L, Kalúz S, Kazimírová M, Burdová L, Kocianová E, 2015. First detections of Rickettsia helvetica and R. monacensis in ectoparasitic mites (Laelapidae and Trombiculidae) infesting rodents in south-western Slovakia. Parasitol Res 114: 24652472.

    • Search Google Scholar
    • Export Citation
  • 14.

    Huang Y et al. 2017. Detection of a novel Rickettsia from Leptotrombidium scutellare mites (Acari: Trombiculidae) from Shandong of China. J Med Entomol 54: 544549.

    • Search Google Scholar
    • Export Citation
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