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Dong-min Kim - One of the best experts on this subject based on the ideXlab platform.
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Scrub Typhus and Abnormal Electrocardiography.
The American journal of tropical medicine and hygiene, 2019Co-Authors: Seo-won Choi, Na Ra Yun, Dong-hyun Choi, Seok Won Kim, Choon-mee Kim, Dong-min KimAbstract:This study compared the frequency of abnormal electrocardiogram (ECG) types between Scrub Typhus patient group and age- and gender-matched health checkup group and their associations with disease severity in Scrub Typhus patient. Demographic characteristics and ECG and laboratory findings of patients with Scrub Typhus admitted to Chosun University Hospital, and normal subjects visiting the hospital for health checkup from January 2008 to December 2012 were retrospectively studied. Electrocardiogram abnormalities at admission were observed in 72 of 165 (43.6%) Scrub Typhus confirmed patients. The following ECG abnormalities were observed: arrhythmic group (31 cases, 18.8%), ischemic change group (25 cases, 15.1%), prolonged QT group (32 cases, 19.4%).Compared with the age and gender-matched health checkup group, ECG abnormalities were more commonly observed in Scrub Typhus patient group (13.9% versus 43.6%, P < 0.001). In addition, when compared with the normal ECG group, Scrub Typhus in the abnormal ECG group showed greater disease severity and this phenomenon was particularly prominent in the prolonged QT group. Based on our study prolonged QT observed in approximately 20% of patients with Scrub Typhus, clinicians should pay additional attention to drugs that affect QT interval.
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Indicators of severe prognosis of Scrub Typhus: prognostic factors of Scrub Typhus severity
BMC, 2019Co-Authors: Hyun Lee Kim, Na Ra Yun, Choon-mee Kim, Hye Rim Park, Youn Jung Cha, Dong-min KimAbstract:Abstract Background Scrub Typhus is an acute disease, characterized by symptoms of fever, which occurs due to infection by Orientia tsutsugamushi. In most cases, patients recover from the disease with appropriate treatment, but serious and fatal complications may occur. The present study examined laboratory findings and tumor necrosis factor-alpha (TNF-α) levels of Scrub Typhus patients to identify the prognostic predictors of disease severity. Method Patients whose Scrub Typhus diagnosis was confirmed by elevated indirect fluorescent antibody (IFA) levels and positive polymerase chain reaction (PCR) results were classified according to disease severity into one of three groups; i.e., deceased (n = 7), severe (n = 15), and mild (n = 15) retrospectively registered. Additionally, the usefulness of modified Acute Physiology and Chronic Health Evaluation II (APACHE II) score, C-reactive protein (CRP) level, white blood cell (WBC) count, and TNF-α level as prognostic predictors were examined. Result The mean TNF-α levels of the deceased, severe, and mild groups were 53.5 (range: 7.8–147.8), 26.0 (1.7–64.4), and 8.8 pg/mL (4.6–16.0), respectively. The results of Kruskal-Wallis tests showed statistically significant differences between the deceased and severe groups versus the mild group (p = 0.005). CRP level and Modified APACHE II score also differed significantly among the groups (p = 0.046 and 0.007, respectively); however, WBC count did not (p = 0.196). Conclusion An elevated serum TNF-α level in patients with Scrub Typhus could predict a severe condition or death and may be useful in predicting patient prognosis
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Scrub Typhus meningitis or meningoencephalitis.
The American journal of tropical medicine and hygiene, 2013Co-Authors: Dong-min Kim, Na Ra Yun, Seok Won Kim, Jong Hoon Chung, Jun Young Lee, Mi Ah Han, Yong-bok LeeAbstract:Orientia tsutsugamushi induces vasculitis leading to symptoms of systemic organ invasion including meningitis and meningoencephalitis. We conducted a retrospective case-control study of Scrub Typhus patients to investigate the clinical and laboratory features of patients with Scrub Typhus meningitis or meningoencephalitis, and the therapeutic outcomes, and to determine the predictor factors. Cases were 22 patients with Scrub Typhus meningitis or meningoencephalitis, and controls were 303 patients without meningitis or meningoencephalitis. Multivariate analysis showed that the presence of pneumonitis was associated with the occurrence of Scrub Typhus meningitis and meningoencephalitis (odds ratio [OR] 8.9; P < 0.001; confidence interval [CI] 2.9-27.2). Although appropriate antimicrobials such as doxycycline agents were administered at an early stage, meningitis or meningoencephalitis still occurred in some cases. Physicians should be aware that meningitis or meningoencephalitis may develop during appropriate drug therapy such as doxycycline. Close observation and great care are essential for patients with risk factors, particularly pneumonitis.
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Clinical Features and Diagnosis of Scrub Typhus
Infection and Chemotherapy, 2009Co-Authors: Dong-min KimAbstract:Scrub Typhus is the most common rickettsial disease in Korea. Scrub Typhus is an acute febrile illness with characteristic findings such as high fever, rash, headache, and eschar. It is caused by intracellular gram-negative bacteria Orientia tsutsugamushi. Infection occurs when larvae of thrombiculi...
Jienwei Liu - One of the best experts on this subject based on the ideXlab platform.
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Coinfection with leptospirosis and Scrub Typhus in Taiwanese patients.
The American journal of tropical medicine and hygiene, 2007Co-Authors: Chen-hsiang Lee, Jienwei LiuAbstract:We retrospectively analyzed patients with leptospirosis (n = 35), Scrub Typhus (n = 45), and coinfection (leptospirosis and Scrub Typhus [n = 7]) to facilitate the detection of coinfection. Our data showed that factors favoring these disease entities included animal contact, an aspartate aminotransferase/alanine aminotransferase ratio > 2 (for leptospirosis); outdoor exposure, lymphadenopathy, splenomegaly, eschar, and elevated alkaline phosphatase levels (for Scrub Typhus and coinfection); calf tenderness, conjunctival suffusion, jaundice, oliguria, elevated total bilirubin levels and serum creatinine levels (for leptospirosis and coinfection); and maculopapular rash (for Scrub Typhus). Patients at risk for leptospirosis are often at increased risk for Scrub Typhus and vice versa. Lack of knowledge of coinfection may jeopardize the health of affected patients. Our study serves as a reminder of potential coinfection and provides clues for its detection.
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acute respiratory distress syndrome in Scrub Typhus
American Journal of Tropical Medicine and Hygiene, 2007Co-Authors: Chinchou Wang, Shihfeng Liu, Jienwei Liu, Yuhsiu Chung, Maochang Su, Mengchih LinAbstract:Scrub Typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi. Acute respiratory distress syndrome (ARDS) is a serious complication of Scrub Typhus. This study retrospectively reviewed the medical records of 72 patients diagnosed with Scrub Typhus from January 1998 to August 2006 in Kaohsiung Chang Gung Memorial Hospital in Taiwan. Eight of 72 Scrub Typhus patients with ARDS were included in the study; the other patients without ARDS were used as controls. The mortality rate for the Scrub Typhus patients with ARDS was 25%. The eight patients seldom had underlying diseases. Initial presentations of dyspnea and cough, white blood cell count, hematocrit, total bilirubin, and delayed used of appropriate antibiotics use were significant predictors of ARDS. Multivariate analysis showed that albumin, prothrombin time, and delayed use of appropriate antibiotics were independent predictors of ARDS. Identification of these relative risk factors may help clinicians evaluate clinical cases of Scrub Typhus with ARDS.
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ABNORMAL LIVER FUNCTION IN Scrub Typhus
The American journal of tropical medicine and hygiene, 2005Co-Authors: Jienwei Liu, Shue-shian Chiou, Chung-huang Kuo, Seng-kee Chuah, Jing-houng Wang, King-wah ChiuAbstract:Scrub Typhus is one kind of rickettsial disease and may cause fever, cough, and skin rashes in infected humans. Regarding liver involvement, it was uncommon to be reported in previous medical literature from Western countries. This study observes the relationship between Scrub Typhus and liver function. From January 1998 to August 2003 in Kaohsiung Chang Gung Memorial Hospital in Taiwan, we observed 30 patients with Scrub Typhus, and 29 of them had liver function abnormality. In these patients, we found 89.3% with elevated aspartate aminotransferase (AST) levels, 91.7% with elevated alanine aminotransferase (ALT) levels, 84.2% with elevated alkaline phosphatase (ALP) levels, and 38.5% with elevated total bilirubin levels. In our study, there is a close relationship between Scrub Typhus and impaired liver function tests. Therefore, if patients are found with fever of unknown origin and abnormal liver function, we should take Scrub Typhus into consideration.
Chang-seop Lee - One of the best experts on this subject based on the ideXlab platform.
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Acute Cholecystitis in Patients with Scrub Typhus
Journal of Korean medical science, 2015Co-Authors: Hyun Lee, Jeong-hwan Hwang, Ja Yeon Lee, Ju-hyung Lee, Kyung Min Chung, Chang-seop LeeAbstract:Acute cholecystitis is a rare complication of Scrub Typhus. Although a few such cases have been reported in patients with Scrub Typhus, the clinical course is not well described. Of 12 patients, acute cholecystitis developed in 66.7% (8/12) of patients older than 60 yr. The Scrub Typhus group with acute cholecystitis had marginal significant longer hospital stay and higher cost than the group without cholecystitis according to propensity score matching. Scrub Typhus should be kept in mind as a rare etiology of acute cholecystitis in endemic areas because the typical signs of Scrub Typhus such as skin rash and eschar can present after the abdominal pain.
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Peritonitis in patients with Scrub Typhus.
The American journal of tropical medicine and hygiene, 2012Co-Authors: Chang-hun Lee, Jae Hoon Lee, Ki Jung Yoon, Jeong-hwan Hwang, Chang-seop LeeAbstract:Various complications have been reported in Scrub Typhus cases including acute respiratory distress syndrome, encephalitis, pneumonia, pericarditis, acute renal failure, and acute hepatic failure. Few studies have reported on the gastrointestinal manifestations of Scrub Typhus. Typical gastrointestinal manifestations in patients with Scrub Typhus include abdominal pain, nausea, vomiting, hematemesis, melena, and diarrhea. The two cases presented in this study are the first reported cases of peritonitis associated with Scrub Typhus. This study shows that Scrub Typhus should also be included in the differential diagnosis of peritonitis in areas where Orientia tsutsugamushi is endemic.
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risk factors leading to fatal outcome in Scrub Typhus patients
American Journal of Tropical Medicine and Hygiene, 2009Co-Authors: Chang-seop Lee, Jeong-hwan Hwang, Heungbum Lee, Keunsang KwonAbstract:Scrub Typhus is a potentially fatal infectious disease. However, to this date, no epidemiologic study on mortality of complicated Scrub Typhus has been reported. We reviewed the clinical records of 302 patients with diagnosis of Scrub Typhus who were admitted to our institute between January 2000 and December 2006. In total, 297 patients with Scrub Typhus were analyzed and the mortality rate of this study group was 6.1%. Multivariate logistic regression analysis revealed absence of eschar, event of intensive care unit admission and higher APACHE II score were independent predictive variables. Identification of these risk factors leading to fatal outcome may help physicians to start early intensive management of complicated Scrub Typhus.
Daniel H Paris - One of the best experts on this subject based on the ideXlab platform.
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Scrub Typhus
Oxford Textbook of Medicine, 2020Co-Authors: Daniel H Paris, Nicholas P.j. DayAbstract:Orientia spp. are obligate intracellular Gram-negative bacteria that cause Scrub Typhus, historically known as ‘tsutsugamushi disease’, a febrile illness characterized by early non-specific ‘flu-like’ symptoms, and sometimes a diffuse, macular, or maculopapular rash and/or a necrotic lesion eschar at the inoculation site. Leptotrombidium mites transmit Orientia spp. to humans via the bite of the larval stage, while all mite stages act as bacterial reservoirs through vertical transovarial and transstadial transmission. Scrub Typhus is a leading cause of treatable undifferentiated febrile illness in many regions of Asia, and unfortunately remains an underappreciated neglected disease, mainly due to diagnostic difficulties and lack of awareness among medical staff. Complications include meningo-encephalitis, respiratory and renal failure, and severe multiorgan failure. Scrub Typhus can be treated effectively with tetracyclines, macrolides, and chloramphenicol. Humans are dead-end hosts and do not participate in the Orientia life cycle, hence treatment does not affect overall disease incidence.
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estimating the burden of Scrub Typhus a systematic review
PLOS Neglected Tropical Diseases, 2017Co-Authors: Ana Bonell, Paul N. Newton, Yoel Lubell, John A Crump, Daniel H ParisAbstract:Background Scrub Typhus is a vector-borne zoonotic disease that can be life-threatening. There are no licensed vaccines, or vector control efforts in place. Despite increasing awareness in endemic regions, the public health burden and global distribution of Scrub Typhus remains poorly known. Methods We systematically reviewed all literature from public health records, fever studies and reports available on the Ovid MEDLINE, Embase Classic + Embase and EconLit databases, to estimate the burden of Scrub Typhus since the year 2000. Findings In prospective fever studies from Asia, Scrub Typhus is a leading cause of treatable non-malarial febrile illness. Sero-epidemiological data also suggest that Orientia tsutsugamushi infection is common across Asia, with seroprevalence ranging from 9.3%–27.9% (median 22.2% IQR 18.6–25.7). A substantial apparent rise in minimum disease incidence (median 4.6/100,000/10 years, highest in China with 11.2/100,000/10 years) was reported through passive national surveillance systems in South Korea, Japan, China, and Thailand. Case fatality risks from areas of reduced drug-susceptibility are reported at 12.2% and 13.6% for South India and northern Thailand, respectively. Mortality reports vary widely around a median mortality of 6.0% for untreated and 1.4% for treated Scrub Typhus. Limited evidence suggests high mortality in complicated Scrub Typhus with CNS involvement (13.6% mortality), multi-organ dysfunction (24.1%) and high pregnancy miscarriage rates with poor neonatal outcomes. Interpretation Scrub Typhus appears to be a truly neglected tropical disease mainly affecting rural populations, but increasingly also metropolitan areas. Rising minimum incidence rates have been reported over the past 8–10 years from countries with an established surveillance system. A wider distribution of Scrub Typhus beyond Asia is likely, based on reports from South America and Africa. Unfortunately, the quality and quantity of the available data on Scrub Typhus epidemiology is currently too limited for any economical, mathematical modeling or mapping approaches.
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endemic Scrub Typhus in south america
The New England Journal of Medicine, 2016Co-Authors: Thomas Weitzel, Daniel H Paris, Stuart D. Blacksell, Sabine Dittrich, Javier Lopez, Weerawat Phuklia, Constanza Martinezvaldebenito, Katia Velasquez, Katia AbarcaAbstract:Scrub Typhus is a life-threatening zoonosis caused by Orientia tsutsugamushi organisms that are transmitted by the larvae of trombiculid mites. Endemic Scrub Typhus was originally thought to be confined to the so called “tsutsugamushi triangle” within the Asia–Pacific region. In 2006, however, two individual cases were detected in the Middle East and South America, which suggested that the pathogen was present farther afield. Here, we report three autochthonous cases of Scrub Typhus caused by O. tsutsugamushi acquired on Chiloe Island in southern Chile, which suggests the existence of an endemic focus in South America. (Funded by the Chilean Comision Nacional de Investigacion Cientifica y Tecnologica and the Wellcome Trust.)
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Diagnosis of Scrub Typhus
The American journal of tropical medicine and hygiene, 2010Co-Authors: Gavin C. K. W. Koh, Daniel H Paris, Paul N. Newton, Richard J. Maude, Stuart D. BlacksellAbstract:Scrub Typhus is transmitted by trombiculid mites and is endemic to East and Southeast Asia and Northern Australia. The clinical syndrome classically consists of a fever, rash, and eschar, but Scrub Typhus also commonly presents as an undifferentiated fever that requires laboratory confirmation of the diagnosis, usually by indirect fluorescent antibody (IFA) assay. We discuss the limitations of IFA, debate the value of other methods based on antigen detection and nucleic acid amplification, and outline recommendations for future study.
Siddalingana Gouda Thaplar Gurusiddana - One of the best experts on this subject based on the ideXlab platform.
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Pancreatitis in Scrub Typhus
Journal of global infectious diseases, 2014Co-Authors: Alok Bhatt, Aravind A. Menon, Rama Bhat, Siddalingana Gouda Thaplar GurusiddanaAbstract:Scrub Typhus is a rickettsial infection prevalent in most parts of India. Acute pancreatitis with pseudocyst formation is a rare complication of this condition. This paper reports acute renal failure, pancreatitis and pseudocyst formation in a 48-year-old female with Scrub Typhus. Ultrasonography of the abdomen revealed a bulky pancreas with fluid seen along the body of the pancreas in the lesser sac. The infection was successfully treated with doxycycline and supportive treatment. Pancreatitis was managed conservatively. This case report highlights the importance of identifying and managing uncommon complications of a common tropical disease for optimum outcome.
