Raoult D, 2010. Orientia tsutsugamushi (scrub typhus). Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. Seventh edition. Philadelphia, PA: Churchill Livingstone, 2529–2530.
Kelly DJ, Marana D, Stover C, Oaks E, Carl M, 1990. Detection of Rickettsia tsutsugamushi by gene amplification using polymerase chain reaction techniques. Ann N Y Acad Sci 590: 564–571.
Park JS, Jee YK, Lee KY, Kim KY, Myong NH, Seo PW, 2000. Acute respiratory distress syndrome associated with scrub typhus: diffuse alveolar damage without pulmonary vasculitis. J Korean Med Sci 15: 343–345.
Thap LC, Supanaranond W, Treeprasertsuk S, Kitvatanachai S, Chinprasatsak S, Phonrat B, 2002. Septic shock secondary to scrub typhus: characteristics and complications. Southeast Asian J Trop Med Public Health 33: 780–786.
Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, Abraham OC, Abraham AM, Thomas K, 2010. Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Trop Doct 40: 129–133.
Kelly DJ, Fuerst PA, Ching WM, Richards AL, 2009. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis 48 (Suppl 3): S203–S230.
Shiga K, Ogawa M, Ono T, Tachibana N, 1997. Analysis of clinical severity of tsutsugamushi disease according to the serotype of pathogenic Rickettsia. Kansenshogaku Zasshi 71: 299–306.
Liu YX, Feng D, Suo JJ, Xing YB, Liu G, Liu LH, Xiao HJ, Jia N, Gao Y, Yang H, Zuo SQ, Zhang PH, Zhao ZT, Min JS, Feng PT, Ma SB, Liang S, Cao WC, 2009. Clinical characteristics of the autumn-winter type scrub typhus cases in south of Shandong province, northern China. BMC Infect Dis 9: 82.
Sonthayanon P, Chierakul W, Wuthiekanun V, Phimda K, Pukrittayakamee S, Day NP, Peacock SJ, 2009. Association of high Orientia tsutsugamushi DNA loads with disease of greater severity in adults with scrub typhus. J Clin Microbiol 47: 430–434.
Kim IH, Lee HB, Hwang JH, Kwon KS, Lee CS, 2010. Scrub typhus in patients with liver cirrhosis: a preliminary study. Clin Microbiol Infect 16: 419–424.
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: 37–42.
Chanta C, Triratanapa K, Ratanasirichup P, Mahaprom W, 2007. Hepatic dysfunction in pediatric scrub typhus: role of liver function test in diagnosis and marker of disease severity. J Med Assoc Thai 90: 2366–2369.
Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, Mathai E, 2006. Scrub typhus among hospitalized patients with febrile illness in South India: magnitude and clinical predictors. J Infect 52: 56–60.
Lee CS, Min IS, Hwang JH, Kwon KS, Lee HB, 2010. Clinical significance of hypoalbuminemia in outcome of patients with scrub typhus. BMC Infect Dis 10: 216.
Kim DM, Kim SW, Choi SH, Yun NR, 2010. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis 10: 108.
Seong SY, Choi MS, Kim IS, 2001. Orientia tsutsugamushi infection-overview and immune responses. Microbes Infect 3: 11–21.
Rollo EE, Laskin DL, Denhardt DT, 1996. Osteopontin inhibits nitric oxide production and cytotoxicity by activated RAW264.7 macrophages. J Leukoc Biol 60: 397–404.
Takahashi F, Takahashi K, Shimizu K, Cui R, Tada N, Takahashi H, Soma S, Yoshioka M, Fukuchi Y, 2004. Osteopontin is strongly expressed by alveolar macrophages in the lungs of acute respiratory distress syndrome. Lung 182: 173–185.
Inomata S, Shijubo N, Kon S, Maeda M, Yamada G, Sato N, Abe S, Uede T, 2005. Circulating interleukin 18 and osteopontin are useful to evaluate disease activity in patients with tuberculosis. Cytokine 30: 203–211.
Wong CK, Lit LC, Tam LS, Li EK, Lam CW, 2005. Elevation of plasma osteopontin concentration is correlated with disease activity in patients with systemic lupus erythematosus. Rheumatology (Oxford) 44: 602–606.
Groves MG, Rosenstreich DL, Taylor BA, Osterman JV, 1980. Host defenses in experimental scrub typhus-mapping the gene that controls natural resistance in mice. J Immunol 125: 1395–1399.
Patarca R, Freeman GJ, Singh RP, Wei FY, Durfee T, Blattner F, Regnier DC, Kozak CA, Mock BA, Morse HC, 1989. Structural and functional studies of the early T lymphocyte activation 1 (Eta-1) gene. Definition of a novel T cell-dependent response associated with genetic resistance to bacterial infection. J Exp Med 170: 145–161.
Groves MG, Osterman JV, 1978. Host defenses in experimental scrub typhus: genetics of natural resistance to infection. Infect Immun 19: 583–588.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE, 1985. APACHE II: a severity of disease classification system. Crit Care Med 13: 818–829.
Ewig S, Ruiz M, Mensa J, Marcos MA, Martinez JA, Arancibia F, Miederman MS, Torres A, 1998. Severe community-acquired pneumonia: assessment of severity criteria. Am J Respir Crit Care Med 158: 1102–1108.
Park SW, Lee CK, Kwak YG, Moon CS, Kim BN, Kim ES, Kang JM, Lee CS, 2010. Antigenic drift of Orientia tsutsugamushi in South Korea as identified by the sequence analysis of a 56-kDa protein-encoding gene. Am J Trop Med Hyg 83: 930–935.
Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, Yoo HS, Park O, 2009. Rapid increase of scrub typhus, South Korea, 2001–2006. Emerg Infect Dis 15: 1127–1129.
Chang WH, 1995. Current status of tsutsugamushi disease in Korea. J Korean Med Sci 10: 227–238.
Hanson B, 1991. Comparative susceptibility to mouse interferons of Rickettsia tsutsugamushi strains with different virulence in mice and of Rickettsia rickettsii. Infect Immun 59: 4134–4141.
Tamura A, Ohashi N, Urakami H, Miyamura S, 1995. Classification of Rickettsia tsutsugamushi in a New Genus, Orientia gen. nov., as Orientia tsutsugamushi comb. nov. Int J Syst Bacteriol 45: 589–591.
Cho NH, Seong SY, Choi MS, Kim IS, 2001. Expression of chemokine genes in human dermal microvascular endothelial cell lines infected with Orientia tsutsugamushi. Infect Immun 69: 1265–1272.
Watt G, Strickman D, 1994. Life-threatening scrub typhus in a traveler returning from Thailand. Clin Infect Dis 18: 624–626.
Tamura A, Yamamoto N, Koyama S, Makisaka Y, Takahashi M, Urabe K, Takaoka M, Nakazawa K, Urakami H, Fukuhara M, 2001. Epidemiological survey of Orientia tsutsugamushi distribution in field rodents in Saitama prefecture, Japan, and discovery of a new type. Microbiol Immunol 45: 439–446.
Iwasaki H, Hashimoto K, Takada N, Nakayama T, Ueda T, Nakamura T, 1994. Fulminant Rickettsia tsutsugamushi infection associated with hemophagocytic syndrome. Lancet 343: 1236.
Iwasaki H, Takada N, Nakamura T, Ueda T, 1997. Increased levels of macrophage colony-stimulating factor, gamma interferon, and tumor necrosis factor alpha in sera of patients with Orientia tsutsugamushi infection. J Clin Microbiol 35: 3320–3322.
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–e333.
Chung DR, Lee YS, Lee SS, 2008. Kinetics of inflammatory cytokines in patients with scrub typhus receiving doxycycline treatment. J Infect 56: 44–50.
Ashkar S, Weber GF, Panoutsakopoulou V, Sanchirico ME, Jansson M, Zawaideh S, Rittling SR, Denhardt DT, Glimcher MJ, Cantor H, 2000. Eta-1 (osteopontin): an early component of type-1 (cell-mediated) immunity. Science 287: 860–864.
Nau GJ, Liaw L, Chupp GI, Berman JS, Hogan BI, Young RA, 1999. Attenuated host resistance against Mycobacterium bovis BCG infection in mice lacking osteopontin. Infect Immun 67: 4223–4230.
Maeno Y, Nakazawa S, Dao LD, Tuan NV, Giang ND, Hanh TV, Taniguchi K, 2006. Osteopontin is involved in Th1-mediated immunity against Plasmodium falciparum infection in a holoendemic malaria region in Vietnam. Acta Trop 98: 305–310.
Moron CG, Popov VL, Feng HM, Wear D, Walker DH, 2001. Identification of the target cells of Orientia tsutsugamushi in human cases of scrub typhus. Mod Pathol 14: 752–759.
Kim YS, Yun HJ, Shim SK, Koo SH, Kim SY, Kim S, 2004. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin Infect Dis 39: 1329–1335.
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Abstract Views | 944 | 827 | 311 |
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We prospectively evaluated severity predictors in terms of host, microorganism, and treatment factors in 153 eschar-positive scrub typhus patients. Severity was assessed with the Acute Physiology and Chronic Health Evaluation (APACHE) II score (< 10 versus ≥ 10) and predefined criteria of severe complications. Genotypes of Orientia tsutsugamushi were determined. Independent risk factors for severity (APACHE II score ≥ 10) were old age, diabetes mellitus, serum osteopontin > 100 ng/mL, and a group of underlying diseases (congestive heart failure, cerebrovascular disease, chronic liver disease, bronchial asthma, and chronic obstructive lung diseases). Anemia (≤ 10 g/dL) and C-reactive protein > 10 mg/dL were indicators of current severity. Neither the delay in antibiotics administration nor strain types (Boryong, Taguchi, or Kanda/Kawasaki) contributed to the severity. The risk factors for severe complications were similar. Serum osteopontin > 100 ng/mL had a negative predictive value of 96% for severe complications. This marker can be used to rule out severe disease status.
Financial support: This study was supported by grant 04-2009-610 from the Seoul National University Hospital (SNUH) Research Fund.
Authors' addresses: Sang-Won Park, Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea, E-mail: hswon1@snu.ac.kr. Chang-Seop Lee, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea, E-mail: lcsmd@chonbuk.ac.kr. Chi Kug Lee, Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea, E-mail: na25pro@hotmail.com. Yee Gyung Kwak, Chisook Moon, and Baek-Nam Kim, Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea, E-mails: philmed202@hanmail.net, duomon@hanmail.net, and griuni@chol.com. Eu Suk Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea, E-mail: yonathan@hanafos.com. Jae Myung Kang, Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea, E-mail: joshuakang@hanmail.net. Myoung-don Oh, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea, E-mail: mdohmd@snu.ac.kr.
Raoult D, 2010. Orientia tsutsugamushi (scrub typhus). Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. Seventh edition. Philadelphia, PA: Churchill Livingstone, 2529–2530.
Kelly DJ, Marana D, Stover C, Oaks E, Carl M, 1990. Detection of Rickettsia tsutsugamushi by gene amplification using polymerase chain reaction techniques. Ann N Y Acad Sci 590: 564–571.
Park JS, Jee YK, Lee KY, Kim KY, Myong NH, Seo PW, 2000. Acute respiratory distress syndrome associated with scrub typhus: diffuse alveolar damage without pulmonary vasculitis. J Korean Med Sci 15: 343–345.
Thap LC, Supanaranond W, Treeprasertsuk S, Kitvatanachai S, Chinprasatsak S, Phonrat B, 2002. Septic shock secondary to scrub typhus: characteristics and complications. Southeast Asian J Trop Med Public Health 33: 780–786.
Chrispal A, Boorugu H, Gopinath KG, Prakash JA, Chandy S, Abraham OC, Abraham AM, Thomas K, 2010. Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Trop Doct 40: 129–133.
Kelly DJ, Fuerst PA, Ching WM, Richards AL, 2009. Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi. Clin Infect Dis 48 (Suppl 3): S203–S230.
Shiga K, Ogawa M, Ono T, Tachibana N, 1997. Analysis of clinical severity of tsutsugamushi disease according to the serotype of pathogenic Rickettsia. Kansenshogaku Zasshi 71: 299–306.
Liu YX, Feng D, Suo JJ, Xing YB, Liu G, Liu LH, Xiao HJ, Jia N, Gao Y, Yang H, Zuo SQ, Zhang PH, Zhao ZT, Min JS, Feng PT, Ma SB, Liang S, Cao WC, 2009. Clinical characteristics of the autumn-winter type scrub typhus cases in south of Shandong province, northern China. BMC Infect Dis 9: 82.
Sonthayanon P, Chierakul W, Wuthiekanun V, Phimda K, Pukrittayakamee S, Day NP, Peacock SJ, 2009. Association of high Orientia tsutsugamushi DNA loads with disease of greater severity in adults with scrub typhus. J Clin Microbiol 47: 430–434.
Kim IH, Lee HB, Hwang JH, Kwon KS, Lee CS, 2010. Scrub typhus in patients with liver cirrhosis: a preliminary study. Clin Microbiol Infect 16: 419–424.
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: 37–42.
Chanta C, Triratanapa K, Ratanasirichup P, Mahaprom W, 2007. Hepatic dysfunction in pediatric scrub typhus: role of liver function test in diagnosis and marker of disease severity. J Med Assoc Thai 90: 2366–2369.
Varghese GM, Abraham OC, Mathai D, Thomas K, Aaron R, Kavitha ML, Mathai E, 2006. Scrub typhus among hospitalized patients with febrile illness in South India: magnitude and clinical predictors. J Infect 52: 56–60.
Lee CS, Min IS, Hwang JH, Kwon KS, Lee HB, 2010. Clinical significance of hypoalbuminemia in outcome of patients with scrub typhus. BMC Infect Dis 10: 216.
Kim DM, Kim SW, Choi SH, Yun NR, 2010. Clinical and laboratory findings associated with severe scrub typhus. BMC Infect Dis 10: 108.
Seong SY, Choi MS, Kim IS, 2001. Orientia tsutsugamushi infection-overview and immune responses. Microbes Infect 3: 11–21.
Rollo EE, Laskin DL, Denhardt DT, 1996. Osteopontin inhibits nitric oxide production and cytotoxicity by activated RAW264.7 macrophages. J Leukoc Biol 60: 397–404.
Takahashi F, Takahashi K, Shimizu K, Cui R, Tada N, Takahashi H, Soma S, Yoshioka M, Fukuchi Y, 2004. Osteopontin is strongly expressed by alveolar macrophages in the lungs of acute respiratory distress syndrome. Lung 182: 173–185.
Inomata S, Shijubo N, Kon S, Maeda M, Yamada G, Sato N, Abe S, Uede T, 2005. Circulating interleukin 18 and osteopontin are useful to evaluate disease activity in patients with tuberculosis. Cytokine 30: 203–211.
Wong CK, Lit LC, Tam LS, Li EK, Lam CW, 2005. Elevation of plasma osteopontin concentration is correlated with disease activity in patients with systemic lupus erythematosus. Rheumatology (Oxford) 44: 602–606.
Groves MG, Rosenstreich DL, Taylor BA, Osterman JV, 1980. Host defenses in experimental scrub typhus-mapping the gene that controls natural resistance in mice. J Immunol 125: 1395–1399.
Patarca R, Freeman GJ, Singh RP, Wei FY, Durfee T, Blattner F, Regnier DC, Kozak CA, Mock BA, Morse HC, 1989. Structural and functional studies of the early T lymphocyte activation 1 (Eta-1) gene. Definition of a novel T cell-dependent response associated with genetic resistance to bacterial infection. J Exp Med 170: 145–161.
Groves MG, Osterman JV, 1978. Host defenses in experimental scrub typhus: genetics of natural resistance to infection. Infect Immun 19: 583–588.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE, 1985. APACHE II: a severity of disease classification system. Crit Care Med 13: 818–829.
Ewig S, Ruiz M, Mensa J, Marcos MA, Martinez JA, Arancibia F, Miederman MS, Torres A, 1998. Severe community-acquired pneumonia: assessment of severity criteria. Am J Respir Crit Care Med 158: 1102–1108.
Park SW, Lee CK, Kwak YG, Moon CS, Kim BN, Kim ES, Kang JM, Lee CS, 2010. Antigenic drift of Orientia tsutsugamushi in South Korea as identified by the sequence analysis of a 56-kDa protein-encoding gene. Am J Trop Med Hyg 83: 930–935.
Kweon SS, Choi JS, Lim HS, Kim JR, Kim KY, Ryu SY, Yoo HS, Park O, 2009. Rapid increase of scrub typhus, South Korea, 2001–2006. Emerg Infect Dis 15: 1127–1129.
Chang WH, 1995. Current status of tsutsugamushi disease in Korea. J Korean Med Sci 10: 227–238.
Hanson B, 1991. Comparative susceptibility to mouse interferons of Rickettsia tsutsugamushi strains with different virulence in mice and of Rickettsia rickettsii. Infect Immun 59: 4134–4141.
Tamura A, Ohashi N, Urakami H, Miyamura S, 1995. Classification of Rickettsia tsutsugamushi in a New Genus, Orientia gen. nov., as Orientia tsutsugamushi comb. nov. Int J Syst Bacteriol 45: 589–591.
Cho NH, Seong SY, Choi MS, Kim IS, 2001. Expression of chemokine genes in human dermal microvascular endothelial cell lines infected with Orientia tsutsugamushi. Infect Immun 69: 1265–1272.
Watt G, Strickman D, 1994. Life-threatening scrub typhus in a traveler returning from Thailand. Clin Infect Dis 18: 624–626.
Tamura A, Yamamoto N, Koyama S, Makisaka Y, Takahashi M, Urabe K, Takaoka M, Nakazawa K, Urakami H, Fukuhara M, 2001. Epidemiological survey of Orientia tsutsugamushi distribution in field rodents in Saitama prefecture, Japan, and discovery of a new type. Microbiol Immunol 45: 439–446.
Iwasaki H, Hashimoto K, Takada N, Nakayama T, Ueda T, Nakamura T, 1994. Fulminant Rickettsia tsutsugamushi infection associated with hemophagocytic syndrome. Lancet 343: 1236.
Iwasaki H, Takada N, Nakamura T, Ueda T, 1997. Increased levels of macrophage colony-stimulating factor, gamma interferon, and tumor necrosis factor alpha in sera of patients with Orientia tsutsugamushi infection. J Clin Microbiol 35: 3320–3322.
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–e333.
Chung DR, Lee YS, Lee SS, 2008. Kinetics of inflammatory cytokines in patients with scrub typhus receiving doxycycline treatment. J Infect 56: 44–50.
Ashkar S, Weber GF, Panoutsakopoulou V, Sanchirico ME, Jansson M, Zawaideh S, Rittling SR, Denhardt DT, Glimcher MJ, Cantor H, 2000. Eta-1 (osteopontin): an early component of type-1 (cell-mediated) immunity. Science 287: 860–864.
Nau GJ, Liaw L, Chupp GI, Berman JS, Hogan BI, Young RA, 1999. Attenuated host resistance against Mycobacterium bovis BCG infection in mice lacking osteopontin. Infect Immun 67: 4223–4230.
Maeno Y, Nakazawa S, Dao LD, Tuan NV, Giang ND, Hanh TV, Taniguchi K, 2006. Osteopontin is involved in Th1-mediated immunity against Plasmodium falciparum infection in a holoendemic malaria region in Vietnam. Acta Trop 98: 305–310.
Moron CG, Popov VL, Feng HM, Wear D, Walker DH, 2001. Identification of the target cells of Orientia tsutsugamushi in human cases of scrub typhus. Mod Pathol 14: 752–759.
Kim YS, Yun HJ, Shim SK, Koo SH, Kim SY, Kim S, 2004. A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus. Clin Infect Dis 39: 1329–1335.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 944 | 827 | 311 |
Full Text Views | 478 | 7 | 1 |
PDF Downloads | 110 | 6 | 1 |