Search

Background and Aims: Scrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain‐Barré syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus. Methods: Patients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS‐associated clinical and electrophysiological characteristics, outcomes, and scrub typhus‐associated features were collected. Results: Of the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2–14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1–4) points. Interpretation: Patients with scrub typhus‐associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS. [ABSTRACT FROM AUTHOR]

Health challenges of communities are often assessed using biomedical or individual risk-based frameworks which are often inadequate for understanding their full extent. We use observations from the global South to demonstrate the usefulness of structural assessment to evaluate a public health problem and spur action. Following newspaper reports of excessive deaths in the marginalised indigenous or Adivasi community of the Pando people in Northern Chhattisgarh in central India, we were asked by the state government's public health authorities to identify root causes of these deaths. In this rapidly evolving situation, we used a combination of public health, social medicine, and structural vulnerability frameworks to conduct biomedical investigation, social inquiry, and structural assessment. After biomedical investigations, we identified scrub typhus, a neglected tropical disease, as the most likely cause for some of the deaths which was unrecognised by the treating physicians. In the social inquiry, the community members identified the lack of Adivasi status certificates, education, and jobs as the three major social factors leading to these deaths. During the structural assessment of these deaths, we inductively identified the following ten structures– political, administrative, legal, economic, social, cultural, material, technical, biological, and environmental. We recommended improving the diagnosis and treatment of scrub typhus, making the hospitals more friendly for Adivasi people, and tracking the health status of the Adivasi communities as some of the measures. We suggest that a combination of biomedical, social,and structural assessments can be used to comprehensively evaluate a complex public health problem to spur action.. [ABSTRACT FROM AUTHOR]

Typhus is an acute febrile disease caused by a series of bacteria called Rickettsia that is transmitted by insects such as lice, fleas, and ticks. This disease has appeared several times in Iran and caused many casualties. There were some therapeutic measures taken by European physicians in Tehran and medical graduates of the Dar al-Fonun school or expatriates who had studied medical courses in Western countries, even though the taken steps were not enough. Due to the lack of sanitation and cleaning products after the outbreak of World War I in March 1917 and its synchronization with the swift outbreak of Typhus in 1918, heavy casualties followed. In this study, we first examine the prevalence of Typhus in the Qajar dynasty in Iran, and will then focus on the pathological importance of this disease history in Iran. After that, we will study the role of Typhus prevalence and World War I in the Persian famine, malnutrition, and food poverty. Moreover, we investigated the role that this great war had in strengthening the spread of this disease and its role in the death of many Iranian people. [ABSTRACT FROM AUTHOR]

The exposure of a research team to chigger mites in southern Chile allowed the first identification of a trombiculid species as vector and reservoir of scrub typhus outside the tsutsugamushi triangle, providing unique insights into the ecology and transmission of this recently discovered rickettsial infection in South America. [ABSTRACT FROM AUTHOR]

The article discusses how Guillain Barre Syndrome is associated with Scrub Typhus infection, a a zoonotic disease, caused by Rickettsia, Orientia tsutsugamushi (OT). Topics include Treatment given including intravenous immunoglobulin (IVIG) or Plasma exchange (PE); and temporal association in the present study supports the notion that GBS might have been triggered by humoral immune response against ST.

Rickettsial illnesses, comprising mainly spotted fever group, typhus group and scrub typhus, are vector-borne re-emerging or newly emerging febrile illnesses where humans are an accidental dead-end host. They are a major cause of non-malarial febrile illnesses among returned travellers. They commonly present as an acute febrile illness and carry a characteristic entry wound (eschar) or a discrete erythematous maculo-popular rash based on the organism and the region. The illness severity is mainly dependent on the virulence of the rickettsial organism and delay in the diagnosis is known to cause severe illness with multi-organ involvement carrying high mortality. Almost all rickettsial infections respond to anti-rickettsial antibiotics such as doxycycline within 48--72 hours. Awareness of rickettsial illnesses and their various clinical presentations helps in early diagnosis and institution of appropriate treatment and hence prevent morbidity and mortality. [ABSTRACT FROM AUTHOR]

Sphingobacterium spiritivorum is a rare cause of human infections worldwide. After reviewing the literature, we could find only eight case reports to date. The majority of cases were of cellulitis and septicemia. Most of these patients were immunocompromised and the recovery rate was lesser. We present a case of a young female diagnosed with scrub typhus complicated by acute respiratory distress syndrome who developed septicemia and septic shock due to S. spiritivorum. She was managed with sensitive antibiotic levofloxacin, clinically improved, and discharged in satisfactory condition. [ABSTRACT FROM AUTHOR]

Background: A clinical risk-scoring algorithm (CRSA) to forecast the scrub typhus severity was developed from two general hospitals in Thailand where patients were classified into three groups--nonsevere, severe, and fatal. In this study, an attempt was made to validate the risk-scoring algorithm for prognostication of scrub typhus severity in India. Materials and methods: This prospective study was conducted at a hospital in South India between November 2017 and March 2019. Patients of scrub typhus were categorized into nonsevere, severe, and fatal according to the CRSA. The patients were also grouped into severe and nonsevere according to the definition of severe scrub typhus which was used as a gold standard. The obtained CRSA score was validated against the classification based on the definition of severe scrub typhus. Receiver operating characteristics (ROC) curve for the scores was plotted and the Youden's index for optimal cutoff was used. Results: A total of 198 confirmed cases of scrub typhus were included in the study. According to the ROC curve, at a severity score ≥7, an optimal combination of sensitivity of 75.9% and specificity of 77.5% was achieved. It correctly predicted 76.77% (152 of 198) of patients as severe, with an underestimation of 10.61% (21 patients) and an overestimation of 12.63% (25 patients). Conclusion: In the present study setting, a cutoff of ≥7 for severity prediction provides an optimum combination of sensitivity and specificity. These findings need to be validated in further studies. [ABSTRACT FROM AUTHOR]

Scrub typhus most commonly presents as febrile illness, myalgia, headache, lymphadenopathy and rash. There can be diverse clinical presentations ranging from subclinical presentation to sepsis leading to multiorgan failure. The patient can also present with features of acute abdominal pain which is usually managed conservatively. Scrub typhus cases are commonly reported from rural areas of Indonesia, China, Southeast Asia, Japan and India. Most common lesion is an eschar which starts as a vesicular lesion at the mite bite site. It further forms an ulcer with black necrotic centre. Secondary bacterial infection can also be present at the eschar site forming an abscess at a later stage. The case reported here is one of the rarest presentations where the patient presented with eschar and abscess formation over the previous scar site. Incision and drainage were done for the scar site abscess. ELISA for IgM antibodies to Orientia tsutsugamushi in view of multiple eschars which turned out to be positive. She improved with medical management. [ABSTRACT FROM AUTHOR]

This article explores three epidemic episodes in 1950s Bolivia: a typhus outbreak in Oruro in September 1954, a typhoid outbreak in Cochabamba in January 1956, and a polio outbreak along the Bolivia-Argentine border in March 1956. Each case discusses state-imposed quarantine and sanitation measures, using newspaper reports and editorials, letters to health officials, and government publications to document institutional responses to these epidemic episodes and people's reactions. Through press coverage, the article analyzes praise and critiques of government responses to these epidemics to assess what measures public health authorities implemented, how effective they were, and how Bolivians felt about their political and medical leadership during these crises. These case studies evidence that Bolivians did not respond uniformly to government containment policies, and responses varied by region and disease. They also demonstrate that quarantines are effective even if not always popular, and that the public's perception of the measures' efficacy and implementation impact their feelings about state legitimacy. Finally, they show that disease outbreaks create opportunities for citizens to critique government officials and push for improvements to public health. [ABSTRACT FROM AUTHOR]

Scrub typhus, a neglected infectious disease caused by the obligate intracellular bacterium Orientia tsutsugamushi , is a major cause of fever across the Asia Pacific region with more than a billion people at risk. Treatment with antibiotics such as doxycycline or chloramphenicol is effective for the majority of patients. In the 1990s, reports from northern Thailand raised a troubling observation; some scrub typhus patients responded poorly to doxycycline, which investigators attributed to doxycycline resistance. Despite the controversial nature of these reports, independent verification was neglected, with subsequent studies speculating on the role of doxycycline resistance in contributing to failure of treatment or prophylaxis. In this review, we have outlined the evidence for drug-resistant Orientia tsutsugamushi , assessed the evidence for doxycycline resistance, and highlight more recent findings unsupportive of doxycycline resistance. We conclude that doxycycline resistance is a misconception, with treatment outcome likely to be determined by other bacterial, host, and pharmacological factors. [ABSTRACT FROM AUTHOR]

Introduction: Children with scrub typhus may present with one or more organ failures. Identifying the predictors of severe disease and need for pediatric intensive care unit (PICU) admission would help clinicians during outbreak seasons. Materials and methods: This observational study included 160 children admitted to the emergency department (ED) with scrub typhus confirmed by polymerase chain reaction (PCR) between January 2013 and December 2015. Demographic, clinical, and laboratory data were collected and predictors for PICU admission were identified. Results: There was a seasonal trend with peak presentation in post-monsoon months between August and October. Mean (SD) age at presentation was 6.8 (3.2) years. Fever was present in all with a median (IQR) duration of 9 (6-11) days. Respiratory distress (42%), altered sensorium (24%), hepatomegaly (93%), splenomegaly (57%), and lymphadenopathy (54%) were other features. Rash and eschar were noted in 24% each. Thrombocytopenia (83%), hypoalbuminemia (63%), and hyponatremia (62%) were common laboratory abnormalities. Meningoencephalitic presentation was noted in 29%; acute kidney injury (AKI) (16%), acute respiratory distress syndrome (ARDS) (11%), and myocarditis (3%) were other organ dysfunctions. Sixty-six (41%) children required PICU admission. Intensive care needs include invasive ventilation (n = 27, 17%), vasoactive drugs therapy for hemodynamic support (n = 43, 27%), osmotherapy to treat raised intracranial pressure (n = 27, 17%), and renal replacement therapy (n = 3, 2%). Mortality was 8.8%. On multivariable analysis, lymphadenopathy, respiratory distress, shock, elevated lactate, and meningoencephalitis predicted the requirement of PICU admission. Conclusion: Scrub typhus presents with organ dysfunction during post-monsoon months. We identified predictors of intensive care in children with scrub typhus admitted to ED. Clinical significance: Our results would help clinicians identify severe cases and prioritize resources. [ABSTRACT FROM AUTHOR]

One of the historical periods of Iran that can be studied for contagious diseases and how they spread, is the late Qajar period. The city of Mashhad, after Tehran and Tabriz, had a special place among Russian and English governments in the Qajar period as one of the significant religious, political and economic centers in Iran due to Imam Reza's holy shrine, a large population and great geographical scale. The central governments' incompetence in preventing the outbreak of contagious diseases and lack of essential amenities, caused many lives to be lost all over Iran and especially Mashhad during the Qajar period. Hence, the neighbor governments such as Russia, ordered for quarantines to be set up at the borders and dispatched doctors to stop diseases' from reaching Russian lands. However, these attempts did not prevent the deaths of people in the border areas, especially in Mashhad, from diseases such as cholera, plague, smallpox, typhus, flu and other diseases. In this study, we investigate and explain the subjects: disease outbreaks, the problem of commerce, quarantine and its outcomes at the end of Qajar period, between the years 1892 and 1921 AD in Mashhad, with the help of historical and documentary sources using an analytical and medical historiography method. [ABSTRACT FROM AUTHOR]

The objectives of this paper are to locate documentation to study the morbidity and mortality caused by exanthematous typhus in Jerez de la Frontera (1941-1942); to study the sanitary measures that were carried out in this city against this disease, and to point out other problems of morbidity and mortality in the 1940s. [ABSTRACT FROM AUTHOR]

Rickettsia are obligate intracellular bacteria often associated with ticks and best known for causing human diseases (rickettsiosis), including typhus fever and sporadic cases of serious infection. In this study, we conducted a large survey of ticks in French Guiana to understand the overall diversity of Rickettsia in this remote area largely covered by dense rainforests. Out of 819 individuals (22 tick species in six genera), 252 (30.8%) samples were positive for Rickettsia infection. Multilocus typing and phylogenetic analysis identified 19 Rickettsia genotypes, but none was 100% identical to already known Rickettsia species or strains. Among these 19 genotypes, we identified two validated Rickettsia species, Rickettsia amblyommatis (spotted fever group) and Rickettsia bellii (bellii group), and characterized a novel and divergent Rickettsia phylogenetic group, the guiana group. While some tick hosts of these Rickettsia genotypes are among the most common ticks to bite humans in French Guiana, their potential pathogenicity remains entirely unknown. However, we found a strong association between Rickettsia genotypes and their host tick species, suggesting that most of these Rickettsia genotypes may be nonpathogenic forms maintained through transovarial transmission. [ABSTRACT FROM AUTHOR]

This article examines Mexico City's typhus epidemic of 1915-16 and makes three central claims. First, the federal response to the outbreak, while laudable in light of the grim circumstances, was disjointed and excessively bureaucratic. Second, the epidemic drew out long-standing stereotypes of poor indigenous populations, leading people to make misguided linkages between the high incidence of typhus within those populations and their supposed moral or intellectual shortcomings. Third, the typhus epidemic prompted fundamental reforms to the nation's public health system. As a delegate to the constitutional convention of 1917, the nation's chief public health officer, general and doctor José Marıá Rodríguez, successfully promoted his vision of a "sanitary dictatorship" that would operate according to strict authoritarian principles for the sake of efficiency. The epidemic thus shaped not only the human experience in that moment but also the course of revolutionary political reform in the years to come. [ABSTRACT FROM AUTHOR]

Background Substantial outbreaks of scrub typhus, coupled with the discovery of this vector-borne disease in new areas, suggest that the disease remains remarkably neglected. The objectives of this study were to map the contemporary and potential transmission risk zones of the disease and to provide novel insights into the health burden imposed by scrub typhus in southern China. Methods Based on the assembled data sets of annual scrub typhus cases and maps of environmental and socioeconomic correlates, a boosted regression tree modeling procedure was used to identify the environmental niche of scrub typhus and to predict the potential infection zones of the disease. Additionally, we estimated the population living in the potential scrub typhus infection areas in southern China. Results Spatiotemporal patterns of the annual scrub typhus cases in southern China between 2007 and 2017 reveal a tremendous, wide spread of scrub typhus. Temperature, relative humidity, elevation, and the normalized difference vegetation index are the main factors that influence the spread of scrub typhus. In southern China, the predicted highest transmission risk areas of scrub typhus are mainly concentrated in several regions, such as Yunnan, Guangxi, Guangdong, Hainan, and Fujian. We estimated that 162 684 million people inhabit the potential infection risk zones in southern China. Conclusions Our results provide a better understanding of the environmental and socioeconomic factors driving scrub typhus spread, and estimate the potential infection risk zones beyond the disease's current, limited geographical extent, which enhances our capacity to target biosurveillance and help public health authorities develop disease control strategies. [ABSTRACT FROM AUTHOR]

The article focuses on Uzbekistan's rural communities experienced ocharchilik and shortages of food convinced some them to eat potatoes and plant potatoes. It mentions oral history accounts tell about drought, and subsequent grain shortfall, across most of Uzbekistan in the spring of 1933; about deaths from starvation and typhus. It mentions Amartya Sen's question about entitlements and Uzbeks struggled to find sustenance in famine conditions.

Scrub typhus, a mite-borne zoonotic disease, is endemic in several parts of India. It may cause multisystemic disease involving lungs, heart, spleen, liver, hematological system, and nervous system. Neurological involvement may include meningoencephalitis, cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, muscle dysfunction, neuroleptic malignant syndrome, parkinsonian syndrome, and Guillain–Barre syndrome. Here, we report a rare patient of scrub typhus, who developed meningoencephalitis followed by long-segment myelitis and axonal polyneuropathy, with hepatic, renal, hematological, and pulmonary involvement, following acute febrile illness with associated neurocysticercosis. He gained consciousness with a resolution of almost all of his complaints, with the exception of muscular power, which showed partial improvement following treatment with doxycycline, azithromycin, and steroids. What needs to be explored is whether the existence of neurological scrub typhus with neurocysticercosis is the coincidental price paid for living in the tropics or there is something more to it as in case of Japanese encephalitis and neurocysticercosis co-infection. [ABSTRACT FROM AUTHOR]

Context: Opsoclonus, a rare neurological manifestation in scrub typhus, causes significant distress and disability. There is a paucity of clinical data and outcomes in these patients. Aim: This study aims to describe the clinical and laboratory profile and longitudinal outcomes in a scrub typhus patient cohort with opsoclonus. Settings and Design: This retrospective study was conducted in a 2700-bed teaching hospital in South India, in scrub typhus patients with opsoclonus over a 5-year period. Patients and Methods: Clinical, laboratory, and radiological data and outcomes at discharge and 6- and 12-weeks postdischarge were documented. Results: Of 1650 scrub typhus patients, 18 had opsoclonus. 17 had opsoclonus at presentation, while one patient developed opsoclonus on the 5th admission day, 1-day postdefervescence. Opsoclonus was first noted after a median interval of 11 (7–18) days from fever onset. It was associated with myoclonus in 94% (17/18), cerebellar dysfunction in 67% (12/18), extrapyramidal syndrome (EPS) in 33% (6/18), and aseptic meningitis in 17% (3/18) patients. Mean cerebrospinal fluid (CSF) white blood cell (WBC) count was 9 ± 2.7 cells/cumm, with mean CSF protein 118.5 ± 53.9 mg% and mean CSF glucose 97 ± 13 mg% in 1l/15 patients. Brain magnetic resonance imaging was unremarkable in 75% (9/12). Case-fatality rate was 5.5% (1/18). Complete resolution of the index neurological syndrome occurred at 12-week postdischarge. Conclusions: Opsoclonus is a rare neurological manifestation in scrub typhus, usually occurring in association with myoclonus, cerebellar dysfunction, or EPS. It appears to occur during the resolving febrile phase, with neurological deficits completely resolving at 12 weeks. [ABSTRACT FROM AUTHOR]

Abstract Ethnopharmacological relevance The Sephardic or Judeo-Spanish communities kept a cultural heritage extremely relevant which is recognizable through the peculiar form of their language and practices. Medicine was one of the main professional activities among Jews of Spain before their expulsion in 1492. We expected to find ingredients and recipes in the Sephardic traditional medicine related to classical medicine and to modern ethnopharmacology of Spain, but also influenced by the host countries. Recipes for specific diseases could be compared with modern ethnopharmacology. Although the basic language of the recipes is Judeo-Spanish, it presents local variants and names which are not only dialectal Spanish, but also Turkish, Hebrew or Bosnian. Methods The main source of information for Sephardic folk medicine are the specimens of the " Livro de Milizinas" printed in Thessaloniki and Smyrna (Izmir) during the 19th century. Others are some documents on pharmacy conserved in Bosnia associated to the Papo family of Sephardic Aktars or Attars (Ottoman herbalists) and the oral tradition in the Sephardic communities of Asia, Europe and the Americas. In order to analyze these formularies, we have studied the recipes in eleven different sources systematized in an Excel® 2010 book. We focused on formulas that are not merely rituals instead contain specific ingredients and pathologies. Specific dictionaries were generated in Excel® 2010, to standardize names of ingredients and pathologies. Results In the 502 complete recipes and variants studied, 107 pathologies and 154 different ingredients appear. Among ingredients, 93 are plants, 38 animals and 23 mineral substances. The most common pathologies in the recipes correspond to infectious diseases, headache, epistaxis, parasites and the " espanto ". These ingredients received 397 different vernacular names, being prevalent those in Spanish (303) followed by those in Turkish. Preparations recorded are simple, easily made at home, not requiring special tools or hardware. In studies dated 1845 in Bulgaria the forms of preparation and administration are similar. Topic preparations externally applied are prevalent in numbers doubling the oral administration on the contrary of modern ethnopharmacology studies in Thessaloniki where dominate internal uses over external ones. The books of medicines of Smyrna and Thessaloniki are very similar, if not almost identical. The " Livro de Milizinas" constitute a peculiar Sephardic text within the Ottoman style of medicine. The proximity in the analyses with Ottoman sources (Ottoman pharmacopoeias, Turkish Aktar shops and Medieval Cairo Jewish pharmacopoeia) is due to the high proportion of ingredients in common. After excluding animal and mineral ingredients of the analyses, modern ethnobotanical records from Greece and Turkey appear closer to the Sephardic main sources. The rest of Sephardic sources with notably smaller lists of ingredients represent fragments of mostly oral transmitted tradition and treat pathologies such as evil eye or " espanto ". The recipes of the Sephardic of Bosnia comprise pathologies such as plague, cholera, typhus or gastroenteritis. Ingredients, largely of plant origin, to 93, are still in use in phytotherapy and/or local medical-pharmaceutical ethnobotany in Turkey or Greece. Conclusions The Sephardic materia medica presented in the " Livro de Milizinas " is eclectic, adapted to an urban environment and to the prevalent pathologies of the second half of the 19th century, within the main cultural framework of the Ottoman Empire but with peculiarities characteristic of Sephardic Culture. These can be traced back to the period immediately after the expulsion of Sephardic from Spain. Their relationships with other modern sources are scarce, even in terms of pathologies. Graphical abstract fx1 [ABSTRACT FROM AUTHOR]

Scrub typhus is associated with outbreaks of acute encephalitis syndrome in Uttar Pradesh, India. A case-control study indicated that children residing, playing, or visiting fields; living with firewood stored indoors; handling cattle fodder; and practicing open defecation were at increased risk for scrub typhus. Communication messages should focus on changing these behaviors. [ABSTRACT FROM AUTHOR]

We evaluated formalin-fixed paraffin-embedded tissue specimens from 7 patients who died with encephalitic typhus in Hamburg, Germany, during World War II. The archived specimens included only central nervous system tissues >70 years old that had been stored at room temperature. We demonstrated successful detection of Rickettsia typhi DNA by a nested qPCR specific to prsA in 2 patients. These results indicate that R. typhi infections contributed to typhus outbreaks during World War II. Immunohistochemical analyses of brain tissue specimens of R. typhi DNA-positive and -negative specimens showed perivascular B-cell accumulation. Around blood vessels, nodular cell accumulations consisted of CD4-positive and CD8-positive T cells and CD68-positive microglia and macrophages; neutrophils were found rarely. These findings are similar to those of previously reported R. prowazekii tissue specimen testing. Because R. typhi and R. prowazekii infections can be clinically and histopathologically similar, molecular analyses should be performed to distinguish the 2 pathogens. [ABSTRACT FROM AUTHOR]

Background: In sub-Saharan Africa, where there is the scarcity of proper diagnostic tools, febrile illness related symptoms are often misdiagnosed as malaria. Information on causative agents of febrile illness related symptoms among pastoral communities in Ethiopia have rarely been described. Methods: In this a community based cross-sectional survey, we assessed the prevalence of typhoid fever, typhus, brucellosis and malaria among individuals with a set of given symptoms in Amibara district, Afar Region, Ethiopia. Blood samples were collected from 650 study participants, and examined by Widal and Weilfelix direct card agglutination test (DCAT) as well as test tube based titration test for Salmonella enterica serotype Typhi (S. Typhi) and Rickettsia infections. Rose Bengal Plate Test (RBPT) and Complement Fixation Test (CFT) were used to screen Brucella infection. Thin and thick blood smears were used to diagnosis malaria. Results: Out of 630 sera screened by DCAT, 83 (13.2%) were reactive to H and/or O antigens for S. Typhi infection. Among these, 46 (55.4%) were reactive by the titration test at the cut off value ≥ 1:80. The combined sero-prevalence for S. Typhi by the two tests was 7.3% (46/630). The seroprevalence for Rickettsia infection was 26.2% (165/630) by DCAT and 53.3% (88/165) by the titration test at the cut off value ≥ 1:80. The combined sero-prevalence for Rickettsia infection by the two tests was 14.0% (88/630). The sero-prevalence for Brucella infection was 12.7% (80/630) by RBPT, of which 28/80 (35%) were positive by CFT. The combined sero-prevalence for Brucella infection by the two tests was 4.4% (28/630). Out 650 suspected individuals for malaria, 16 (2.5%) were found positive for P. falciparum infection. Conclusion: In this study, typhoid fever, typhus, brucellosis and malaria were observed among symptomatic individuals. The study also highlighted that brucellosis cases can be misdiagnosed as malaria or other disease based solely on clinical diagnosis. Therefore, efforts are needed to improve disease awareness and laboratory services for the diagnosis of brucellosis and other zoonotic diseases to identify other causes of febrile illness in this pastoral setting. [ABSTRACT FROM AUTHOR]

Background and Aim: Scrub typhus (ST) is an acute infectious disease of variable severity caused by Orientia (formerly Rickettsia) tsutsugamushi. The disease can be complicated by organ dysfunctions and the case fatality rate (CFR) is approximately 15%, which further rises with the development of severe complications. We studied the clinical features of the ST and the performance of critical illness scoring systems (CISSs) – Acute Physiology and Chronic Health Evaluation (APACHE) II, sequential organ failure assessment (SOFA), and quick SOFA (qSOFA) in predicting the clinical outcomes in complicated ST (cST) patients admitted to the emergency department. Study Design and Methods: A prospective observational study was done in 50 patients diagnosed to have cST with one or more organ dysfunctions. Clinical features and laboratory parameters were recorded and the patients were followed up until the end of their stay in the hospital. APACHE II, SOFA, and qSOFA scores at admission were calculated and were analyzed in predicting the clinical outcomes. Results: The median SOFA, APACHE II, and qSOFA scores of the cohort were 7 (interquartile range [IQR] = 13–22), 8 (IQR = 5–11), and 2 (IQR = 1–3), respectively. The median duration of in-hospital stay was 9 (IQR 5–11) days and overall CFR was 8%. On bivariate analysis, both SOFA (P = 0.031) and qSOFA (P = 0.001) predicted mortality. However, only SOFA score correlated with the in-hospital stay duration (Pearson's correlation = 0.311, P = 0.028). Conclusion: Among the three CISSs studied, the SOFA score correlated with in-hospital stay duration and mortality, whereas the qSOFA score formed a simple as well as a convenient tool in predicting the mortality in patients of cST with organ dysfunction. [ABSTRACT FROM AUTHOR]

A century has passed since the epidemic typhus in 1914/15, but the answer if the Serbian people were led to fight against the typhus has not been given yet. If so, was the fight successful? Did the doctors' reaction for not taking into consideration the activity of the State Committee for the suppression of communicable diseases was appropriate? Were there any steps which should be remembered by the citizens of Serbia, especially medical professionals? The Committee was in charge in 1915, and its decisions represent the official attitudes of Serbia, the ones that should be analyzed at first, while the after war historical-medical analyses are in the second place. As the president of the Committee, Velisav Vulovic was the coordinator of this body, and so had an influence on working of Serbian Military Medical Corps in 1915. The lack of factory autoclaves resulted in the scientific problem how to replace them. Vulovic is a forerunner of sanitary engineers in our country and improved the prototype of "a dry warm air chamber". "The disinfecting central" was built in Niš and started working before Hunter's mission. Its function was to act offensively by depediculation in suppressing epidemics of transmission diseases. It was used by army, hospitals, prisoners, and civilians. With the consent of dr Gencic, the chamber was applied in basic military units on the battling field. The successful action of Serbian medical staff in 1915 on suppressing epidemics was the beginning of the significant fight against typhus and its recurrence, and not only Serbian people but the world medicine owes them a debt of gratitude. [ABSTRACT FROM AUTHOR]

A century has passed since the epidemic typhus in 1914/15, but the answer if the Serbian people were led to fight against the typhus has not been given yet. If so, was the fight successful? Did the doctors' reaction for not taking into consideration the activity of the State Committee for the suppression of communicable diseases was appropriate? Were there any steps which should be remembered by the citizens of Serbia, especially medical professionals? The Committee was in charge in 1915, and its decisions represent the official attitudes of Serbia, the ones that should be analyzed at first, while the after war historical-medical analyses are in the second place. As the president of the Committee, Velisav Vulovic was the coordinator of this body, and so had an influence on working of Serbian Military Medical Corps in 1915. The lack of factory autoclaves resulted in the scientific problem how to replace them. Vulovic is a forerunner of sanitary engineers in our country and improved the prototype of "a dry warm air chamber". "The disinfecting central" was built in Niš and started working before Hunter's mission. Its function was to act offensively by depediculation in suppressing epidemics of transmission diseases. It was used by army, hospitals, prisoners, and civilians. With the consent of dr Gencic, the chamber was applied in basic military units on the battling field. The successful action of Serbian medical staff in 1915 on suppressing epidemics was the beginning of the significant fight against typhus and its recurrence, and not only Serbian people but the world medicine owes them a debt of gratitude. [ABSTRACT FROM AUTHOR]

Scrub typhus has reemerged with a different geographical distribution and varied clinical presentation like acute encephalitis syndrome (AES), which is a less known entity in scrub typhus. In this case series, we studied the clinical profile and outcome of eight patients who presented with AES and a positive scrub serology without any other identifiable cause of encephalopathy. All these patients had fever, altered sensorium, and nuchal rigidity, while seizures were present in six (75%) patients and papilledema in two (25%) patients. Complications like shock, pulmonary edema, and gastrointestinal (GI) bleed were observed in three (37%) patients. All patients except for one responded well to the treatment and recovered completely. Scrub typhus should be suspected early in patients presenting with AES. [ABSTRACT FROM AUTHOR]

A clinical quiz about two siblings who were presented with complement activation, thrombotic microangiopathy and gangrene is presented.

Introduction: In this study, we undertook a retrospective analysis of the epidemiological aspects and risk factors of murine typhus (MT) in Korea in the last decade (2006–2015). Materials and Methods: MT infections in Korea using a total of 411 cases obtained from the Diseases Web Statistical System of the Korea Center for Disease Control and Prevention. Results: In a total of 411 MT infection cases, the cumulative incidence rate was 0.08/100,000 populations. Men were slightly more infected by MT as compared to women (51.3% vs. 48.7%), and a higher incidence of MT was observed in people aged over 40 years (93.4%; P < 0.01). The seasonal pattern of outbreaks revealed that most infections occurred from October to November (69.1% of the total cases) (P < 0.01). Significantly more outbreaks occurred in the southern part (53.5%) of the Korean peninsula as compared to its northern (33.3%) and central (10.7%) parts, as well as the Jeju Island (1.0%) (P < 0.01). In addition, the number of MT infections was significantly higher in rural and sea-village (87.6%) than in urban areas (12.4%; P < 0.01). Conclusion: In conclusion, the rapid reemergence of MT outbreaks can be minimized through health education, and a strong enforcement of control measures against rats and their ectoparasites could markedly reduce the transmission of this infection to humans in high-risk areas. [ABSTRACT FROM AUTHOR]

We developed a scoring system to differentiate severe fever with thrombocytopenia syndrome (SFTS) in 21 patients with SFTS and 91 with scrub typhus; it provided 100% sensitivity and 97% specificity (score > 1). Criteria included altered mental status, leukopenia, prolonged activated partial thromboplastin time, and normal C-reactive protein (1-point each). [ABSTRACT FROM AUTHOR]

Aim of the Study: Scrub typhus has been globally recognized as an emerging infectious disease contributing significantly to pyrexia of unknown origin (PUO) and a potential cause of multiorgan dysfunction syndrome (MODS). We studied the incidence of scrub typhus as a cause of pediatric intensive care unit (PICU) admission and MODS in our hospital and its clinical and laboratory characteristics to measure the incidence of MODS caused by scrub typhus. Materials and Methods: This study was done in a pediatric teaching hospital in Kolkata, India. Records of patients admitted with PUO from March 2012 to December 2015 were reviewed. Rathi-Goodman-Aghai scoring system was used to identify potential ST patients and confirmed by serological testing. Clinical characteristics, laboratory findings, and treatment response were noted of those needing PICU admissions. Results: Ninety-seven cases of scrub typhus have been identified during that period. PICU admission was needed in 30 of them (31%) which contributed 8.43% of total PICU admissions. Among these 30 patients, 16 (53%) developed MODS which contributed 18.29% of total MODS admitted in PICU. Septic shock was the most common manifestation in as many as 18 (60%) patients followed by encephalopathy in 13 (43%). Patients were treated with either doxycycline alone or in combination with azithromycin. Mean time to complete defervescence was 32 h after first dose of doxycycline. The outcome was excellent without a single mortality. Conclusion: Scrub typhus is an important cause of MODS in this part of the world, especially in fevers associated with features as identified and not responding to conventional antibiotics. [ABSTRACT FROM AUTHOR]

An increase in typhus group rickettsiosis and an expanding geographic range occurred in Texas, USA, over a decade. Because this illness commonly affects children, we retrospectively examined medical records from 2008-2016 at a large Houston-area pediatric hospital and identified 36 cases. The earliest known cases were diagnosed in 2011. [ABSTRACT FROM AUTHOR]

Renal involvement and acute kidney injury (AKI) are common clinical manifestations seen in scrub typhus, a vector-borne tropical disease. There are no data on renal manifestation in scrub typhus in Nepal. We conducted a prospective study to analyze the incidence, urinary abnormalities, course, severity, outcome, and the predictors of AKI in patients with scrub typhus during a major outbreak in Central Nepal. Total 1398 patients admitted with acute febrile illness were subjected for Scrub Typhus Detect™ Immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) test, of which 502 (35.90%) patients tested positive and were included in the study. Mean age of the patients was 30.37 ± 18.81 years (range, 1-79 years) with 26.29% in the pediatric age group. Female-to-male ratio was 1.26:1. Mean duration of fever was 6.8 ± 3.1 days. Mean IgM ELISA value for scrub typhus was 2.17 ± 1.70 without difference in AKI and non-AKI groups (2.17 ± 1.76 vs. 2.16 ± 1.62; P = 0.94). Urinary abnormalities were seen in 42.3% of patients. Mean serum creatinine was 1.37 ± 0.69 mg/dl with significant difference in two groups (1.85 ± 0.87 vs. 1.03 ± 0.17; P = 0.003). AKI was seen in 35.8% of patients with majority having Stage 1 AKI (68.3%) followed by Stage 2 (34.1%) and Stage 3 (1.2%). Hemodialysis was required for 3.94% of patients. In 54% of patients, AKI occurred in fifth and sixth day of fever. ICU admission was required for 18.73% of patients and 8.57% required ventilator support. Mortality rate was 1.79%, which was higher among patients with AKI (2.96% vs. 1.0%; P = 0.106). Multivariate analysis revealed that the presence of pneumonia, shock, and acute respiratory distress syndrome predicted the development of AKI. [ABSTRACT FROM AUTHOR]

Background: Undifferentiated febrile illness (UFI) includes typhoid and typhus fevers and generally designates fever without any localizing signs. UFI is a great therapeutic challenge in countries like Nepal because of the lack of available point-of-care, rapid diagnostic tests. Often patients are empirically treated as presumed enteric fever. Due to the development of high-level resistance to traditionally used fluoroquinolones against enteric fever, azithromycin is now commonly used to treat enteric fever/UFI. The re-emergence of susceptibility of Salmonella typhi to co-trimoxazole makes it a promising oral treatment for UFIs in general. We present a protocol of a randomized controlled trial of azithromycin versus co-trimoxazole for the treatment of UFI.Methods/design: This is a parallel-group, double-blind, 1:1, randomized controlled trial of co-trimoxazole versus azithromycin for the treatment of UFI in Nepal. Participants will be patients aged 2 to 65 years, presenting with fever without clear focus for at least 4 days, complying with other study criteria and willing to provide written informed consent. Patients will be randomized either to azithromycin 20 mg/kg/day (maximum 1000 mg/day) in a single daily dose and an identical placebo or co-trimoxazole 60 mg/kg/day (maximum 3000 mg/day) in two divided doses for 7 days. Patients will be followed up with twice-daily telephone calls for 7 days or for at least 48 h after they become afebrile, whichever is later; by home visits on days 2 and 4 of treatment; and by hospital visits on days 7, 14, 28 and 63. The endpoints will be fever clearance time, treatment failure, time to treatment failure, and adverse events. The estimated sample size is 330. The primary analysis population will be all the randomized population and subanalysis will be repeated on patients with blood culture-confirmed enteric fever and culture-negative patients.Discussion: Both azithromycin and co-trimoxazole are available in Nepal and are extensively used in the treatment of UFI. Therefore, it is important to know the better orally administered antimicrobial to treat enteric fever and other UFIs especially against the background of fluoroquinolone-resistant enteric fever.Trial Registration: ClinicalTrials.gov, ID: NCT02773407 . Registered on 5 May 2016. [ABSTRACT FROM AUTHOR]

Scrub typhus is caused by Orientia tsutsugamushi (formerly Rickettsia) and is transmitted to humans by an arthropod vector of the Trombiculidae family (Leptotrombidium deliense and L. akamushi). It is the most common re-emerging Rickettsial infection in India and many other South East Asian countries. In fact, scrub typhus is confined geographically to the Asia Pacific region, a billion people are at risk and nearly a million cases are reported every year. Scrub typhus appears particularly to be distributed in the tsutsugamushi triangle which is distributed over a very wide area of 13 million km² bound by Japan in the east, through China, the Philippines, tropical Australia in the south, and west through India, Pakistan, possibly to Tibet to Afghanistan, and southern parts of the USSR in the north. Eschar is the characteristic lesion that starts as a vesicular lesion at the site of mite feeding. Later, an ulcer forms with black necrotic center and an erythematous border along with regional lymphadenopathy. Other features are fever, maculopapular rash starting from the trunk, and spreading to the limbs. It may affect the central nervous system, cardiovascular system, renal, respiratory, and gastrointestinal systems. Serious complication in the form of myocarditis, pneumonia, meningoencephalitis, acute renal failure, gastrointestinal bleeding, and even acute respiratory distress syndrome may develop. Tetracycline or chloramphenicol remains the main stay of therapy. [ABSTRACT FROM AUTHOR]

We report five cases of Rickettsia australis infection from southern coastal New South Wales, Australia. All patients presented with a cutaneous eruption of erythematous papules and pustules and systemic features of malaise, headache, lymphadenopathy and myalgia. Acute kidney injury ( AKI) was present in two of five cases and one of five cases had acute delirium. Improvement was only seen after treatment with doxycycline 100 mg b.i.d. Positive serology for R. australis was present in four of five cases and a positive polymerase chain reaction ( PCR) was seen in one of five cases. Histology showed varying features, from neutrophilic vasculitis to Sweet's syndrome and lymphocytic vasculitis. Recent significant advances in the diagnosis of R. australis infection include an eschar swab or biopsy PCR and isolation of specific Rickettsia on serology. These investigations should be considered in the presence of any of the following features: eschar at site of a tick bite or lymphadenopathy and fever with an eruption of erythematous papules and pustules. [ABSTRACT FROM AUTHOR]

Rickettsial diseases are some of the most covert reemerging infections of the present times. They are generally incapacitating and notoriously difficult to diagnose; untreated cases can have fatality rates as high as 30%-35%, but when diagnosed properly, they are often easily treated but lack of definite diagnostic tools and the hazards of handling these microorganisms aggravate the difficulties of diagnosis and treatment. [ABSTRACT FROM AUTHOR]

To determine prevalence of severe fever with thrombocytopenia syndrome in South Korea, we examined serum samples from patients with fever and insect bite history in scrub typhus-endemic areas. During the 2013 scrub typhus season, prevalence of this syndrome among patients suspected of having scrub typhus was high (23.0%), suggesting possible co-infection. [ABSTRACT FROM AUTHOR]

The present article provides a concise historical review on classical epidemic typhus (exanthemata typhus) in the world as well its outbreaks in Iran mainly during the 19th and 20th centuries. Typhus is still a potential public health threat under certain conditions, despite the feet that nowadays, efficient antibiotics are accessible and sanitary conditions which lead to typhus outbreaks have improved significantly. [ABSTRACT FROM AUTHOR]

The article discusess the diagnosis of hemophagocytic lymphohistiocytosis in a young child with fever and unexplained acute kidney injury. It mentions involvement of a multisystem involvement including renal parenchymal infiltration and inflammation in the same; and use of pulse steroids followed by oral prednisolone for treating the same.

Frosted branch angiitis (FBA), a rare form of retinal vasculitis presenting as bilateral perivascular sheathing, resembling the appearance of frosted tree branches in winter, was first reported by Ito et al.1 in 1976, in a young immunocompetent boy. FBA predominantly affects healthy young patients, the youngest reported in an 11-month-old infant2 and oldest in a 42-year-old patient.3 Classical symptoms include sudden onset of blurred vision with floaters and photopsiae. Fundus examination shows widespread perivascular translucent sheathing affecting both arterioles and venules, more commonly latter. Fluorescein angiography shows late staining of vessels with no obstruction of blood flow. Electroretinogram shows reduced amplitude and visual fields show generalized constriction. Medline search did not show any case of frosted branch angiitis in a patient with typhoid fever. [ABSTRACT FROM AUTHOR]