Abstract
Rickettsial diseases, particularly vector-borne rickettsioses (VBR), have a long history in Taiwan, with studies on scrub typhus and murine typhus dating back over a century. The climatic and geographic diversity of Taiwan’s main island and its offshore islands provide many ecological niches for the diversification and maintenance of rickettsiae alike. In recent decades, scrub typhus has re-emerged as the most prevalent type of rickettsiosis in Taiwan, particularly in eastern Taiwan and its offshore islands. While murine typhus has also re-emerged on Taiwan’s western coast, it remains neglected. Perhaps more alarming than the re-emergence of these rickettsioses is the emergence of newly described VBR. The first case of human infection with Rickettsia felis was confirmed in 2005, and undetermined spotted fever group rickettsioses have recently been detected. Taiwan is at a unique advantage in terms of detecting and characterizing VBR, as it has universal health coverage and a national communicable disease surveillance system; however, these systems have not been fully utilized for this purpose. Here, we review the existing knowledge on the eco-epidemiology of VBR in Taiwan and recommend future courses of action.
Highlights
Taiwan is located in East Asia off the southeastern coast of China, intersected by the Tropic of Cancer, which divides the coastal lowlands into subtropical and tropical climates
In 1995, Tamura et al [69] proposed the reclassification of Rickettsia tsutsugamushi to a novel genus, Orientia, where O. tsutsugamushi remained the sole species until the discovery of a divergent species, Orientia chuto, isolated from an Australian tourist infected in the United Arab Emirates (UAE) in 2006 and described by Izzard et al [70] in 2010, no human cases have since been reported
Scrub typhus and murine typhus were studied in Taiwan amidst their discovery in the early twentieth century by Japanese scholars; murine typhus has remained largely neglected in Taiwan since WWII, even to this day
Summary
Taiwan is located in East Asia off the southeastern coast of China, intersected by the Tropic of Cancer, which divides the coastal lowlands into subtropical and tropical climates. Most of Taiwan’s population is concentrated in metropolitan areas in the north (Taipei basin) and southward along the western coast It is Taiwan’s offshore islands and eastern region that have historically been, and remain, the hyperendemic foci of vector-borne rickettsioses (VBR). More representative studies such as those of Su et al [40] and Chang et al [50], who described 187 cases in southern Taiwan from 2002 to 2011, reported lower rates of ARF (2–3%), ARDS (1–3%), DIC (0–3%), septic shock (1–2%), and acute pancreatitis (0–2%) Together, these studies suggest a mortality rate of approximately 1% for patients with scrub typhus in Taiwan (5 deaths among 569 cases), representing 22% of those who developed ARDS [30,39,40,43,50]. Favorable clinical outcome in patients with scrub typhus relies on physician vigilance, ensuring rapid diagnosis and effective treatment
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