Rickettsial Infections in Southeast Asia: Implications for Local Populace and Febrile Returned Travelers

Ar Kar Aung Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia

Search for other papers by Ar Kar Aung in
Current site
Google Scholar
PubMed
Close
,
Denis W. Spelman Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia

Search for other papers by Denis W. Spelman in
Current site
Google Scholar
PubMed
Close
,
Ronan J. Murray Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia

Search for other papers by Ronan J. Murray in
Current site
Google Scholar
PubMed
Close
, and
Stephen Graves Department of Infectious Diseases and Microbiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia; New South Wales Health Pathology, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia

Search for other papers by Stephen Graves in
Current site
Google Scholar
PubMed
Close
Restricted access

Rickettsial infections represent a major cause of non-malarial febrile illnesses among the residents of Southeast Asia and returned travelers from that region. There are several challenges in recognition, diagnosis, and management of rickettsioses endemic to Southeast Asia. This review focuses on the prevalent rickettsial infections, namely, murine typhus (Rickettsia typhi), scrub typhus (Orientia tsutsugamushi), and members of spotted fever group rickettsiae. Information on epidemiology and regional variance in the prevalence of rickettsial infections is analyzed. Clinical characteristics of main groups of rickettsioses, unusual presentations, and common pitfalls in diagnosis are further discussed. In particular, relevant epidemiologic and clinical aspects on emerging spotted fever group rickettsiae in the region, such as Rickettsia honei, R. felis, R. japonica, and R. helvetica, are presented. Furthermore, challenges in laboratory diagnosis and management aspects of rickettsial infections unique to Southeast Asia are discussed, and data on emerging resistance to antimicrobial drugs and treatment/prevention options are also reviewed.

Author Notes

* Address correspondence to Ar Kar Aung, Department of Infectious Diseases and Microbiology, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia. E-mail: a.aung@alfred.org.au

Authors' addresses: Ar Kar Aung, Department of Infectious Diseases and Microbiology, The Alfred Hospital, Melbourne, Australia, E-mail: a.aung@alfred.org.au. Denis W. Spelman, Department of Infectious Diseases and Microbiology, The Alfred Hospital and Microbiology Unit, Monash University, Melbourne, Victoria, Australia, E-mail: d.spelman@alfred.org.au. Ronan J. Murray, Department of Infectious Diseases and Microbiology and Pathwest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia, and School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia, E-mail: ronan.murray@health.wa.gov.au. Stephen Graves, Australian Rickettsial Reference Laboratory Foundation, Geelong Hospital, Geelong, Victoria, Australia, and New South Wales Health Pathology, University of Newcastle, Newcastle, New South Wales, Australia, E-mail: stephen.graves@hnehealth.nsw.gov.au.

  • 1.

    Acestor N, Cooksey R, Newton PN, Menard D, Guerin PJ, Nakagawa J, Christophel E, Gonzalez IJ, Bell D, 2012. Mapping the aetiology of non-malarial febrile illness in Southeast Asia through a systematic review: terra incognita impairing treatment policies. PLoS ONE 7: e44269.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Cowan G, 2000. Rickettsial diseases: the typhus group of fevers: a review. Postgrad Med J 76: 269272.

  • 3.

    Parola P, Miller RS, McDaniel P, Telford III Sr., Rolain J-M, Wongsrichanalai C, Raoult D, 2003. Emerging rickettsioses of the Thai-Myanmar border. Emerg Infect Dis 9: 592595.

  • 4.

    McGready R, Ashley EA, Wuthiekanun V, Tan SO, Pimanpanarak M, Viladpai-Nguen SJ, Jesadapanpong W, Blacksell SD, Peacock SJ, Paris DH, 2010. Arthropod borne disease: the leading cause of fever in pregnancy on the Thai-Burmese border. PLoS Negl Trop Dis 4: e888.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Bottieau E, Clerinx J, Schrooten W, Van den Enden E, Wouters R, Van Esbroeck M, Vervoort T, Demey H, Colebunders R, Van Gompel A, 2006. Etiology and outcome of fever after a stay in the tropics. Arch Intern Med 166: 16421648.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Wilson ME, Weld LH, Boggild A, Keystone JS, Kain KC, von Sonnenburg F, Schwartz E, 2007. Fever in returned travelers: results from the GeoSentinel Surveillance Network. Clin Infect Dis 44: 15601568.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    O'Brien D, Tobin S, Brown GV, Torresi J, 2001. Fever in returned travelers: review of hospital admissions for a 3-year period. Clin Infect Dis 33: 603609.

  • 8.

    Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F, Keystone JS, Pandey P, Cetron MS, 2006. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 354: 119130.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Phommasone K, Paris DH, Anantatat T, Castonguay-Vanier J, Keomany S, Souvannasing P, Blacksell SD, Mayxay M, Newton PN, 2013. Concurrent infection with murine typhus and scrub typhus in southern Laos: the mixed and the unmixed. PLoS Negl Trop Dis 7: e2163.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Tay S, Rohani M, 2002. The use of the indirect immunoperoxidase test for the serodiagnosis of rickettsial diseases in Malaysia. Southeast Asian J Trop Med Public Health 33: 314320.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Hendershot EF, Sexton DJ, 2009. Scrub typhus and rickettsial diseases in international travelers: a review. Curr Infect Dis Rep 11: 6672.

  • 12.

    Civen R, Ngo V, 2008. Murine typhus: an unrecognized suburban vectorborne disease. Clin Infect Dis 46: 913918.

  • 13.

    Izzard L, Fuller A, Blacksell SD, Paris DH, Richards AL, Aukkanit N, Nguyen C, Jiang J, Fenwick S, Day NP, 2010. Isolation of a novel Orientia species (O. chuto sp. nov.) from a patient infected in Dubai. J Clin Microbiol 48: 44044409.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Jensenius M, Davis X, von Sonnenburg F, Schwartz E, Keystone JS, Leder K, Lopéz-Véléz R, Caumes E, Cramer JP, Chen L, 2009. Multicenter GeoSentinel analysis of rickettsial diseases in international travelers, 1996–2008. Emerg Infect Dis 15: 17911798.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Jensenius M, Han PV, Schlagenhauf P, Schwartz E, Parola P, Castelli F, von Sonnenburg F, Loutan L, Leder K, Freedman DO, 2013. Acute and potentially life-threatening tropical diseases in western travelers: a GeoSentinel Multicenter Study, 1996–2011. Am J Trop Med Hyg 88: 397404.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Ong A, Tambyah P, Ooi S, Kumarasinghe G, Chow C, 2001. Endemic typhus in Singapore: a re-emerging infectious disease? Singapore Med J 42: 549552.

  • 17.

    Chen M, Chua J, Lee C, Leo Y, Kumarasinghe G, 2001. Epidemiological, clinical and laboratory characteristics of 19 serologically confirmed rickettsial disease in Singapore. Singapore Med J 42: 553558.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Wong S, Lam M, 2001. Rickettsioses: the new and old diseases. Singapore Med J 42: 546548.

  • 19.

    Sekhar W, Devi S, 2000. The increasing prevalence of endemic typhus in Kuala Lumpur and an evaluation of a diagnostic ELISA dot test for the detection of antibodies to Rickettsia typhi. Singapore Med J 41: 226231.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Tay S, Ho T, Rohani M, Devi S, 2000. Antibodies to Orientia tsutsugamushi, Rickettsia typhi and spotted fever group rickettsiae among febrile patients in rural areas of Malaysia. Trans R Soc Trop Med Hyg 94: 280284.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Tay S, Kamalanathan M, Rohani M, 2003. Antibody prevalence of Orientia tsutsugamushi, Rickettsia typhi and TT118 spotted fever group rickettsiae among Malaysian blood donors and febrile patients in the urban areas. Southeast Asian J Trop Med Public Health 34: 165170.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Tay S, Rohani M, Ho T, Devi S, 2002. Isolation and PCR detection of rickettsiae from clinical and rodent samples in Malaysia. Southeast Asian J Trop Med Public Health 33: 772779.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Tay ST, Kamalanathan M, Suan KA, Chun SS, Ming HT, Yasin RM, Devi S, 1999. Seroepidemiologic survey of Orientia tsutsugamushi, Rickettsia typhi, and TT118 spotted fever group rickettsiae in rubber estate workers in Malaysia. Am J Trop Med Hyg 61: 7377.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Vallée J, Thaojaikong T, Moore CE, Phetsouvanh R, Richards AL, Souris M, Fournet F, Salem G, Gonzalez J-PJ, Newton PN, 2010. Contrasting spatial distribution and risk factors for past infection with scrub typhus and murine typhus in Vientiane City, Lao PDR. PLoS Negl Trop Dis 4: e909.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Thitivichianlert S, Suthee Panichkul M, Boonmee P, Ketupanya A, 2009. Incidence of rickettsial infection in patients with acute fever in provincial Thai Army hospitals. J Med Assoc Thai 92: S39S46.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Suttinont C, Losuwanaluk K, Niwatayakul K, Hoontrakul S, Intaranongpai W, Silpasakorn S, Suwancharoen D, Panlar P, Saisongkorh W, Rolain J, 2006. Causes of acute, undifferentiated, febrile illness in rural Thailand: results of a prospective observational study. Ann Trop Med Parasitol 100: 363370.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Suputtamongkol Y, Suttinont C, Niwatayakul K, Hoontrakul S, Limpaiboon R, Chierakul W, Losuwanaluk K, Saisongkork W, 2009. Epidemiology and clinical aspects of rickettsioses in Thailand. Ann N Y Acad Sci 1166: 172179.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Rodkvamtook W, Gaywee J, Kanjanavanit S, Ruangareerate T, Richards AL, Sangjun N, Jeamwattanalert P, Sirisopana N, 2013. Scrub typhus outbreak, northern Thailand, 2006–2007. Emerg Infect Dis 19: 774777.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Richards AL, Ratiwayanto S, Rahardjo E, Kelly DJ, Dasch GA, Fryauff DJ, Bangs MJ, 2003. Serologic evidence of infection with ehrlichiae and spotted fever group rickettsiae among residents of Gag Island, Indonesia. Am J Trop Med Hyg 68: 480484.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Brown G, Robinson D, Huxsoll D, Ng T, Lim K, Sannasey G, 1976. Scrub typhus: a common cause of illness in indigenous populations. Trans R Soc Trop Med Hyg 70: 444448.

  • 32.

    Ibrahim IN, Okabayashi T, Lestari EW, Yanase T, Muramatsu Y, Ueno H, Morita C, 1999. Serosurvey of wild rodents for rickettsioses (spotted fever, murine typhus and Q fever) in Java Island, Indonesia. Eur J Epidemiol 15: 8993.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Richards AL, Rahardjo E, Rusjdi AF, Kelly DJ, Dasch GA, Church CJ, Bangs MJ, 2002. Evidence of Rickettsia typhi and the potential for murine typhus in Jayapura, Irian Jaya, Indonesia. Am J Trop Med Hyg 66: 431434.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Okabayashi T, Tsutiya K, Muramatsu Y, Ueno H, Morita C, 1996. Serological survey of spotted fever group Rickettsia in wild rats in Thailand in the 1970s. Microbiol Immunol 40: 895898.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Jiang J, Soeatmadji DW, Henry KM, Ratiwayanto S, Bangs MJ, Richards AL, 2006. Rickettsia felis in Xenopsylla cheopis, Java, Indonesia. Emerg Infect Dis 12: 12811283.

  • 36.

    Kernif T, Socolovschi C, Wells K, Lakim MB, Inthalad S, Slesak G, Boudebouch N, Beaucournu J-C, Newton PN, Raoult D, 2012. Bartonella and Rickettsia in arthropods from the Lao PDR and from Borneo, Malaysia. Comp Immunol Microbiol Infect Dis 35: 5157.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Barbara KA, Farzeli A, Ibrahim IN, Antonjaya U, Yunianto A, Winoto I, Perwitasari D, Widjaya S, Richards AL, Williams M, 2010. Rickettsial infections of fleas collected from small mammals on four islands in Indonesia. J Med Entomol 47: 11731178.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Mokhtar AS, Tay ST, 2011. Molecular detection of Rickettsia felis, Bartonella henselae, and B. clarridgeiae in fleas from domestic dogs and cats in Malaysia. Am J Trop Med Hyg 85: 931933.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Hirunkanokpun S, Kittayapong P, Cornet J-P, Gonzalez J-P, 2003. Molecular evidence for novel tick-associated spotted fever group rickettsiae from Thailand. J Med Entomol 40: 230237.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Walker DH, 2007. Rickettsiae and rickettsial infections: the current state of knowledge. Clin Infect Dis 45: S39S44.

  • 41.

    Walker DH, 2003. Rickettsial diseases in travelers. Travel Med Infect Dis 1: 3540.

  • 42.

    Paris D, Chansamouth V, Nawtaisong P, Löwenberg E, Phetsouvanh R, Blacksell S, Lee S, Dondorp A, van der Poll T, Newton P, 2012. Coagulation and inflammation in scrub typhus and murine typhus: a prospective comparative study from Laos. Clin Microbiol Infect 18: 12211228.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Chierakul W, de Fost M, Suputtamongkol Y, Limpaiboon R, Dondorp A, White NJ, van der Poll T, 2004. Differential expression of interferon-γ and interferon-γ-inducing cytokines in Thai patients with scrub typhus or leptospirosis. Clin Immunol 113: 140144.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Feng H-M, Whitworth T, Popov V, Walker DH, 2004. Effect of antibody on the Rickettsia-host cell interaction. Infect Immun 72: 35243530.

  • 45.

    Feng H-M, Whitworth T, Olano JP, Popov VL, Walker DH, 2004. Fc-dependent polyclonal antibodies and antibodies to outer membrane proteins A and B, but not to lipopolysaccharide, protect SCID mice against fatal Rickettsia conorii infection. Infect Immun 72: 22222228.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Pickard AL, McDaniel P, Miller RS, Uthaimongkol N, Buathong N, Murray CK, Telford SR, Parola P, Wongsrichanalai C, 2004. A study of febrile illnesses on the Thai-Myanmar border: predictive factors of rickettsioses. Southeast Asian J Trop Med Public Health 35: 657663.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Nachega JB, Bottieau E, Zech F, Van Gompel A, 2007. Travel-acquired scrub typhus: emphasis on the differential diagnosis, treatment, and prevention strategies. J Travel Med 14: 352355.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Raby E, Dyer JR, 2013. Endemic (murine) typhus in returned travelers from Asia, a case series: clues to early diagnosis and comparison with dengue. Am J Trop Med Hyg 88: 701703.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Syhavong B, Rasachack B, Smythe L, Rolain J-M, Roque-Afonso A-M, Jenjaroen K, Soukkhaserm V, Phongmany S, Phetsouvanh R, Soukkhaserm S, 2010. The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos. Trans R Soc Trop Med Hyg 104: 475483.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Azad AF, Radulovic S, Higgins JA, Noden B, Troyer JM, 1997. Flea-borne rickettsioses: ecologic considerations. Emerg Infect Dis 3: 319327.

  • 51.

    Azad AF, Sacci JB, Nelson WM, Dasch GA, Schmidtmann ET, Carl M, 1992. Genetic characterization and transovarial transmission of a typhus-like Rickettsia found in cat fleas. Proc Natl Acad Sci USA 89: 4346.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Ericsson CD, Jensenius M, Fournier P-E, Raoult D, 2004. Rickettsioses and the international traveler. Clin Infect Dis 39: 14931499.

  • 53.

    Loh K, Leo Y, Heng M, Goh B, 1996. Murine typhus: a forgotten cause of febrile illness in Singapore. Singapore Med J 37: 3943.

  • 54.

    Silpapojakul K, Chayakul P, Krisanapan S, 1993. Murine typhus in Thailand: clinical features, diagnosis and treatment. QJM 86: 4347.

  • 55.

    Stockdale AJ, Weekes MP, Kiely B, Lever AM, 2011. Case report: severe typhus group rickettsiosis complicated by pulmonary edema in a returning traveler from Indonesia. Am J Trop Med Hyg 85: 11211123.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    Parola P, Vogelaers D, Roure C, Janbon F, Raoult D, 1998. Murine typhus in travelers returning from Indonesia. Emerg Infect Dis 4: 677680.

  • 57.

    Takeshita N, Imoto K, Ando S, Yanagisawa K, Ohji G, Kato Y, Sakata A, Hosokawa N, Kishimoto T, 2010. Murine typhus in two travelers returning from Bali, Indonesia: an underdiagnosed disease. J Travel Med 17: 356358.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Azuma M, Nishioka Y, Ogawa M, Takasaki T, Sone S, Uchiyama T, 2006. Murine typhus from Vietnam, imported into Japan. Emerg Infect Dis 12: 14661468.

  • 59.

    Sakamoto N, Nakamura-Uchiyama F, Kobayashi K, Takasaki T, Ogasawara Y, Ando S, Iwabuchi S, Ohnishi K, 2013. Severe murine typhus with shock and acute respiratory failure in a Japanese traveler after returning From Thailand. J Travel Med 20: 5053.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60.

    Kueh Y, Ti T, Heptonstall J, 1988. Murine typhus infection complicated by dengue haemorrhagic fever. Ann Acad Med Singapore 17: 595599.

  • 61.

    McDonald JC, MacLean JD, McDade JE, 1988. Imported rickettsial disease: clinical and epidemiologic features. Am J Med 85: 799805.

  • 62.

    Watt G, Parola P, 2003. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis 16: 429436.

  • 63.

    Phongmany S, Rolain J-M, Phetsouvanh R, Blacksell SD, Soukkhaseum V, Rasachack B, Phiasakha K, Soukkhaseum S, Frichithavong K, Chu V, 2006. Rickettsial infections and fever, Vientiane, Laos. Emerg Infect Dis 12: 256262.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 64.

    Kim D-m, Won KJ, Park CY, Yu KD, Kim HS, Yang TY, Lee JH, Kim HK, Song H-J, Lee S-H, 2007. Distribution of eschars on the body of scrub typhus patients: a prospective study. Am J Trop Med Hyg 76: 806809.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 65.

    Sirisanthana V, Puthanakit T, Sirisanthana T, 2003. Epidemiologic, clinical and laboratory features of scrub typhus in thirty Thai children. Pediatr Infect Dis J 22: 341345.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66.

    Watt G, Strickman D, 1994. Life-threatening scrub typhus in a traveler returning from Thailand. Clin Infect Dis 18: 624626.

  • 67.

    Cracco C, Delafosse C, Baril L, Lefort Y, Morelot C, Derenne J-P, Bricaire F, Similowski T, 2000. Multiple organ failure complicating probable scrub typhus. Clin Infect Dis 31: 191192.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 68.

    Kurup A, Issac A, Jimmy LJP, Lee TB, Chua R, Bist P, Chao C-C, Lewis M, Gubler DJ, Ching WM, 2013. Scrub typhus with sepsis and acute respiratory distress syndrome: a case report. J Clin Microbiol 51: 27872790.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 69.

    Wang C-C, Liu S-F, Liu J-W, Chung Y-H, Su M-C, Lin M-C, 2007. Acute respiratory distress syndrome in scrub typhus. Am J Trop Med Hyg 76: 11481152.

  • 70.

    Tsay RW, Chang FY, 2002. Acute respiratory distress syndrome in scrub typhus. QJM 95: 126128.

  • 71.

    Pérez-Osorio CE, Zavala-Velázquez JE, León JJA, Zavala-Castro JE, 2008. Rickettsia felis as emergent global threat for humans. Emerg Infect Dis 14: 10191023.

  • 72.

    Robertson RG, Wisseman CL, 1973. Tick-borne rickettsiae of the spotted fever group in west Pakistan ii. serological classification of isolates from west pakistanan and thailand: evidence for two new species. Am J Epidemiol 97: 5564.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 73.

    Graves S, Stenos J, 2003. Rickettsia honei. Ann N Y Acad Sci 990: 6266.

  • 74.

    Jiang J, Sangkasuwan V, Lerdthusnee K, Sukwit S, Chuenchitra T, Rozmajzl PJ, Eamsila C, Jones JW, Richards AL, 2005. Human infection with Rickettsia honei, Thailand. Emerg Infect Dis 11: 14731475.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 75.

    Sangkasuwan V, Chatyingmongkol T, Sukwit S, Eamsila C, Chuenchitra T, Rodkvamtook W, Jiang J, Richards AL, Lerdthusnee K, Jones JW, 2007. Description of the first reported human case of spotted fever group rickettsiosis in urban Bangkok. Am J Trop Med Hyg 77: 891892.