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Purpose: Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced-scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced-Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever-serologically proven Indian tick typhus (Rickettsia conorii)-has been reported. We report for the first time ocular manifestations of serologically proven R. conorii infection in a cluster of patients.Methods: In this retrospective study, case records patients with serologically proven Indian tick typhus (Rickettsia conorii) were reviewed for clinical manifestations and treatment outcomes.Results:: In the months of February to April 2016, a cluster of 12 patients (23 eyes) visited us with defective vision. Examination showed multifocal retinitis; mostly bilateral; patients had a history of fever approximately 4 weeks prior to onset of symptoms. After excluding other causes of multifocal retinitis, a diagnosis of rickettsial retinitis was made after Weil-Felix test (WFT) was significantly positive, and enzyme-linked immunosorbent assay was positive for R. conorii. Course of the disease, visual outcome, and investigations are discussed. Doxycycline along with oral corticosteroids was effective in treating the condition.Conclusion:: Systematic fundus examination should be part of the routine evaluation of any patient who presents with fever and/or skin rash living in or returning from a specific endemic area. Clinical clues to diagnosing ocular rickettsiosis could be multifocal retinitis predominantly involving the posterior pole and macular involvement in the form of serous macular detachment or macular hard exudates. A positive WFT still serves as a useful and cheap diagnostic tool for laboratory diagnosis of rickettsial disease. Doxycycline along with oral corticosteroids was effective in treating the condition. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 11-year-old female presented to the hospital with a 7-day history of fever, 5-day history of rash, as well as headache, emesis, and joint pain. It mentions that a chest radiograph was notable for left basilar airspace opacity, possibly representing pneumonia versus pleural effusion. It states that the patient’s antibiotic coverage was transitioned to oral cefdinir and azithromycin.

Infectious retinitis postfebrile illness is known to be caused by chikungunya, dengue, West Nile virus, Bartonella, Lyme's disease, Rift Valley fever, rickettsia, Herpes viruses etc. Rickettsia is Gram-negative bacteria transmitted by arthropods vectors. Ocular involvement is common including conjunctivitis, keratitis, anterior uveitis, panuveitis, retinitis, retinal vascular changes, and optic nerve involvement. Retinitis lesions in rickettsia can occur because of an immunological response to the bacteria or because of direct invasion and proliferation of bacteria in the inner retina. We report such a case of bilateral rickettsial retinitis proven by serology which worsened on systemic steroids and responded dramatically to therapy with oral doxycycline and steroid taper. We thus believe that direct bacterial invasion plays a major role in the pathogenesis of rickettsial retinitis. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus is a rickettsiosis which is caused by Orientia tsutsugamushi and occurs throughout the Asia-Pacific region. Molecular diagnosis of rickettsioses using eschar swabs has recently emerged, and may be very useful for the diagnosis of these diseases in tropical settings. Methodology/Principal findings: Quantitative polymerase chain reaction (qPCR) was used to detect O. tsutsugamushi DNA in whole blood and eschar swab specimens of 67 patients who were clinically suspected of scrub typhus in Quang Nam province, Vietnam. Among the 20 patients for whom both eschar and whole blood were obtained, 17 (85%) of the eschar specimens and 5 (25%) of the whole blood specimens tested positive for O. tsutsugamushi. Genetic analysis of the 56-kDa TSA gene sequences demonstrated that the 14 sequences obtained in this study, including 12 eschar swabs and 2 whole blood specimens, were related to 4 groups: Karp, Kawasaki, Gilliam (JG-v and TG-v) and TA716. The majority (9/14; 64.4%) of contemporary O. tsutsugamushi genotypes in Quang Nam province were related to the Karp group. Conclusions: These results suggest that polyclonal antigen pools used for serological testing in the future should contain at least Karp, Kawasaki, Gilliam and TA716 antigens for Vietnamese patients, as well as patients who have traveled to Vietnam. qPCR after eschar swabbing should be considered for molecular diagnosis of scrub typhus in endemic patients as well as in travelers, since it is easy to perform and appears very useful for the rapid detection of Orientia tsutsugamushi in the early phase of infection. [ABSTRACT FROM AUTHOR]

Introduction: Rickettsioses represent a group of emerging infectious diseases in Europe. Climate changes and the anthropization of rural environment have favored vectors' biological cycle and geographic spread. In Sardinia, Mediterranean spotted fever (MSF) is endemic and represents an important public health problem. Purpose: We investigated the etiology and the clinical presentation of MSF-like illness in northern Sardinia by enrolling patients admitted to the Infectious Disease Unit of the University of Sassari. Results: Diagnostic tests included ELISA, Indirect immunofluorescence (IFI), DNA isolation from blood and from eschar samples with real-time PCR and genotyping. Eighty-seven patients with a mean age of 53 ± 14 years, of whom 65 (75 %) males, were included in the study. The most common diagnosis was MSF (79 %), followed by Q fever (8 %), and anaplasmosis (2 %). A tache noire was found in 58 % of rickettioses and 28 % of Coxiella burnetii infections. MSF was confirmed in 47 % of the cases by IFI and 43 % by ELISA antibody tests. The isolation of rickettsial DNA from the eschar was positive in 10/13 (77 %) of the cases due to Rickettsia conorii. Using this method, we identified the first case of R. monacensis infection in Italy. Conclusions: In conclusion, antibody-based tests confirmed the diagnosis in less than 50 % of the cases, whereas DNA isolation confirmed the diagnosis in 77 % of tested cases and allowed the identification of a new pathogenic species in Italy. Therefore, DNA isolation should be implemented to better identify the etiology of MSF-like illnesses and help the clinician in the management of patients. [ABSTRACT FROM AUTHOR]

Background: Human infection with Candidatus Rickettsia tarasevichiae (CRT) was first reported in northeastern China in 2012.Objective: To describe the clinical spectrum and laboratory findings of patients infected with CRT in eastern central China.Design: Case series.Setting: A sentinel hospital for severe fever with thrombocytopenia syndrome (SFTS) in eastern central China in 2014.Participants: Hospitalized patients with SFTS-like illness.Measurements: Molecular and serologic tests were performed to diagnose CRT infection. Data about clinical manifestations and laboratory findings were retrieved from medical records.Results: 56 of 733 assessed patients had CRT based on polymerase chain reaction and sequencing. All patients presented with nonspecific manifestations, including fever (96%), malaise (88%), myalgia (57%), cough (25%), and dizziness (14%). Only 2 patients had rash. Further, 16% had eschar, 29% had lymphadenopathy, 100% had gastrointestinal symptoms, 34% had neurologic symptoms, 43% had hemorrhagic manifestations, and 23% had signs of plasma leakage. Thrombocytopenia was observed in 70%, leukopenia in 59%; lymphopenia in 45%; and elevated levels of lactate dehydrogenase in 82%, aspartate aminotransferase in 70%, alanine aminotransferase in 54%, and creatinine kinase in 46%. Co-infection with SFTS virus was documented in 66% patients, and 8 of the 56 patients died.Limitations: Patients with CRT were not treated for infection because they were retrospectively identified. This was not a population-based study, and the results cannot be generalized to all patients with CRT.Conclusion: Candidatus R tarasevichiae infection should be considered in the differential diagnosis of febrile patients with SFTS-like illness in endemic areas.Primary Funding Source: National Natural Science Foundation of China. [ABSTRACT FROM AUTHOR]

Rodents are important reservoirs of many human pathogens transmitted via arthropod vectors. Arthropod-borne bacteria belonging to the family Rickettsiaceae cause acute febrile diseases in humans worldwide, but the real burdens of rickettsial diseases appear to be underestimated in Hanoi, Vietnam, because differential diagnosis on the basis of clinical signs and symptoms is confounded by the presence of other tropical infectious diseases with similar signs and symptoms. To know the prevalence of bacteria of the family Rickettsiaceae among small mammals in Hanoi, 519 animals thriving in the public places were captured and examined for the presence of bacterial sequences using duplex PCR. Nucleotide sequences specific for Orientia tsutsugamushi were detected in seven samples (1.3%). Out of seven animals, two were captured in a market, whereas five were in hospitals. None of the captured small mammals tested positive for the genus Rickettsia. The nucleotide sequence analysis of the genes encoding the 47-kDa high-temperature requirement A (47-kDa HtrA) and 56-kDa type-specific antigen (TSA) showed that these seven isolates were indistinguishable from each other. O. tsutsugamushi isolated in this study was closely related phylogenetically to the Gilliam strain, which was originally isolated at the border of Assam and Burma, rather than to those isolated in the central to southern part of Vietnam. It should be emphasized that Vietnamese hospitals were heavily infested by small rodents and some of them harbored O. tsutsugamushi. Strict hygienic control should be implemented to mitigate the potential risk posed by O. tsutsugamushi in hospital settings. [ABSTRACT FROM AUTHOR]

This study proposed the use of satellite hyperspectral imagery to support tick-borne infectious diseases surveillance based on monitoring the variation in amplifier hosts food sources. To verify this strategy, we used the data of the human rickettsiosis occurrences in southeastern Brazil, region in which the emergence of this disease is associated with the rising capybara population. Spatio-temporal analysis based on Monte Carlo simulations was used to identify risk areas of human rickettsiosis and hyperspectral moderate-resolution imagery was used to identify the increment and expansion of sugarcane crops, main food source of capybaras. In general, a pixel abundance associated with increment of sugarcane crops was detected in risk areas of human rickettsiosis. Thus, the hypothesis that there is a spatio-temporal relationship between the occurrence of human rickettsiosis and the sugarcane crops increment was verified. Therefore, due to the difficulty of monitoring locally the distribution of infectious agents, vectors and animal host’s, satellite hyperspectral imagery can be used as a complementary tool for the surveillance of tick-borne infectious diseases and potentially of other vector-borne diseases. [ABSTRACT FROM AUTHOR]

We report an unusual case of myopericarditis caused by Rickettsia sibirica mongolitimonae. Because of increasing reports of Rickettsia spp. as etiologic agents of acute myopericarditis and the ease and success with which it was treated in the patient reported here, rickettsial infection should be included in the differential diagnosis for myopericarditis. [ABSTRACT FROM AUTHOR]

Rickettsioses present a threat to human health worldwide, but relatively little is known on their epidemiology and ecology in Oceania. These bacteria are the cause of potentially fatal febrile illnesses in humans (categorized into scrub typhus, typhus group and spotted fever group rickettsioses). They are transmitted by arthropod vectors such as ticks, mites, fleas and lice, which are associated with vertebrate host animals including rodents and companion animals. We conducted a search in the scientific and grey literature of Rickettsia spp. and Orientia tsutsugamushi within the Oceania region. Human case reports, human serosurveys and PCR-based testing of vectors and host animals reviewed here highlight the widespread distribution of these pathogens in the region, with the majority of human serological and vector surveys reporting positive results. These findings suggest that rickettsioses may have a significantly higher burden of disease in Oceania than is currently appreciated due to diagnostic challenges. Furthermore, consideration of the ecology and risk factors for rickettsioses reported for Oceania suggests that their importance as a cause of undifferentiated acute febrile illness may grow in the future: environmental and social changes driven by predicted climate change and population growth have the potential to lead to the emergence of rickettsioses as a significant public health problem in Oceania. [ABSTRACT FROM AUTHOR]

Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi, one of the most common infectious diseases in the Asia-Pacific region. It has been reported from northern, eastern, and southern India, and its presence has been documented in at least 11 Indian states. However, scrub typhus meningoencephalitis has not been well documented in Kerala. We report two cases of scrub typhus meningoencephalitis from northern Kerala. The diagnosis was made based on the clinical pictures, presence of eschar, and a positive Weil-Felix test with a titer of > 1:320. The first patient succumbed to illness due to respiratory failure and the second patient improved well. [ABSTRACT FROM AUTHOR]

This is a first report of 20 adult cases describing clinical feature, epidemiological profile and treatment outcome of clinically diagnosed scrub typhus confirmed by test for antibodies (IgM) to O.tsutsugamushi using ELISA kit. Majority of the cases belonged to the district Rajouri (45%) froming hilly & rural belts.Outbreak was Autumn Winter type as all cases reported in month of September and October. The common clinical features were fever 100%, myalgia 50%, headache 30%, conjunctival congestion 30%, eschar 35%, rash 25%, lymphadenopathy 45%, splenomegaly 40%, hepatomegaly 40%, edema 25%, ARDS 35%, altered sensorium 10%, hypotension 20% & metrorrhagia in 5% of patients. Use of Immunological test helped to establish diagnosis of scrub typhus.Thus all the cases were managed successfully without any mortality with doxycycline and or azithromycine & one with addition of rifampicin. [ABSTRACT FROM AUTHOR]

Physicians may encounter unfamiliar diseases as a result of international travel. Fever with rash is an important sign that usually represents initial manifestation of infectious disorders. A 62-year-old Taiwanese woman presented with multiple eschars, a papulovesicular rash, and fever 5 days after returning from South Africa. A biopsy specimen of an eschar had wedge-shaped tissue necrosis, hemorrhage, necrotizing vasculitis of the small venules and arterioles, and a dense perivascular lymphocytic infiltrate in the dermis. Serologically, there was cross reaction with both Rickettsia conorii and R. rickettsii. DNA sequencing demonstrated R. africae, confirming the diagnosis of African tick bite fever. The patient responded well to minocycline. Recognition of the symptoms and signs, and diagnostic tools for different types of rickettsiosis are essential for correct diagnosis and treatment. [Copyright &y& Elsevier]

The article focuses on a study done to evaluate the diagnosis of Coxiella burnetii pericarditis by using a systematic prescription kit tests in the cases of pericardial effusion. It describes how the diagnostic procedure included a questionnaire with items underlying conditions and epidemiological factors and a list of tests to be performed systematically. It mentions that the inclusion of systematic testing in the kit can result in unexpected diagnosis of the cases of Q fever.

Background: Spotted fever group of rickettsial infections are emerging in Sri Lanka. We describe a patient with rapidly progressing ARDS and myocarditis secondary to spotted fever caused by Rickettsia conorii. ARDS and myocarditis are rare complications of Rickettsia conorii infections and only a few cases are reported to date.Case Presentation: A 53 years old manual worker presented with fever for 5 days and a skin rash. He was in circulatory failure on admission and developed severe hypoxaemia with gross changes in chest radiograph by next day requiring assisted ventilation. He had myocarditis causing left ventricular failure and acute respiratory distress syndrome. He was confirmed to have spotted fever rickettsial infection with rising titre of indirect immunofluorescence antibodies to Ricketssia conorii and made a complete recovery with appropriate antibiotic therapy and supportive care.Conclusion: Rickettsial infections can present with diverse manifestations. Even the patients with severe organ involvements such as myocarditis and ARDS can be completely cured if timely identified and treated. [ABSTRACT FROM AUTHOR]

The authors ponder on the right diagnostic test for Rickettsial diseases. Topics covered include the Guidelines for Management of Rickettsial diseases published by the Department of Health Research and Indian Council for Medical Research in 2015, the results of studies conducted on the different tests used for diagnosing the disease, and the factors contributing to the interpretation of test results.

The article discusses cases of two patients with eschar caused by scrub typhus infection. Scrub typhus refers to a mite-borne infectious disease caused by Orienta tsutsugamushi, with symptoms such as a short duration fever, headache and myalgia. Particular focus is given to the results of examination and tests for malarial parasites done on the patients. The cases found that eschar can also occur in atypical sites like the eyelid and lips.

Three patients with fever, exanthem, headache, and central-nervous-system involvement were diagnosed with Rickettsia felis infection by specific PCR of blood or skin and seroconversion to surrogate Rickettsia antigens. Although R felis's relationship to other Rickettsia species is known and the pathogenic potential of this clade is well documented, R felis's role as a pathogen has not been fully understood. [ABSTRACT FROM AUTHOR]

The article discusses research on the neurological manifestations of scrub typhus. It references the study "Neurological Manifestations of Scrub Typhus" by U. K. Misra published in the "Journal of Neurology and Neurosurgical Psychiatry" in June 2015. Topics covered include rickettsial diseases as well as the typical presentation, signs, diagnostic testing and prognosis of patients.