Orientia Tsutsugamushi Research Articles

Molecular detection of Anaplasma phagocytophilum, Borrelia theileri and Severe fever with thrombocytopenia syndrome virus (SFTSV) in military working dogs and ticks collected from the Republic of Korea Army garrisons in Gangwon Province in 2021–2022

AbstractTick‐borne pathogens (TBPs) are an emerging concern to humans and animals in the Republic of Korea, especially within the military zones of Gangwon Province, a mountainous region abundant with wild fauna and ticks. This study aimed to detect six TBPs in military working dogs (MWDs) and ticks in this region using Nested polymerase chain reaction (nested PCR) and sequencing. The targeted pathogens included Anaplasma phagocytophilum, Bartonella henselae, Borrelia spp., Orientia tsutsugamushi, Severe fever with thrombocytopenia syndrome virus (SFTSV) and tick‐borne encephalitis virus (TBEV). A total of 164 serum samples from MWDs were collected at the Korean Army Military working dog training center and 1418 ticks were collected at various training sites between June 2021 and August 2022. Haemaphysalis longicornis was identified as the predominant species (98.3%, n = 1394), followed by Haemaphysalis flava (1.6%, n = 22) and Ixodes nipponensis (0.1%, n = 2). This study detected A. phagocytophilum and Borrelia theileri in 1.4% (1/72) of the tick pools and detected SFTSV in 0.6% (1/164) of MWD serum samples. The MWD found to be infected with SFTS was a German Shepherd, but showed no significant clinical signs, with a normal complete blood count (CBC). In the phylogenetic analysis, three sequences were acquired. One sequence (OR865211) exhibited 100% homology with 16S rRNA of A. phagocytophilum identified from animals and human patients in the Republic of Korea. Another sequence (OR865152) displayed 99.34%–100% sequence similarity with 16S rRNA of B. theileri fragments. The third sequence (OR865115), which belongs to the SFTS B‐1 genotype, showed 94.7% sequence similarity to a strain identified in the Republic of Korea (KY789441).

Scrub typhus with hemorrhagic stroke: a case report

BackgroundScrub typhus, caused by Orientia tsutsugamushi, rarely leads to central nervous system involvement. Although intracerebral bleeding is rare due to endemicity and a significant proportion of underdiagnoses, it should be considered a noteworthy differential diagnosis in endemic regions in patients with relevant history and clinical findings.Case presentationWe present the case of a 40-year-old Nepali woman who visited the emergency department with complaints of left-sided weakness for 6 hours and an acute febrile illness with an eschar for 7 days and was diagnosed with scrub typhus by immunoglobulin M enzyme-linked immunosorbent assay of the serum. Imaging revealed a right-sided frontotemporal hematoma, and further examination revealed pulmonary edema with multiple organ dysfunction syndrome. The patient was mechanically ventilated and was treated with antibiotics, steroids, vasopressors, and antipyretics. However, the hematoma was treated conservatively, with ongoing neurological recovery at the 6-month follow-up.ConclusionAlthough neurological complications and intracranial hemorrhage are uncommon, physicians must be cautious when making differential diagnoses and initiating appropriate therapies to avoid serious or fatal complications.

The Prevalence of Rickettsial and Rickettsial-Like Diseases in Patients with Undifferentiated Febrile Illness - Hainan Province, China, 2018-2021.

Rickettsial and Rickettsial-like diseases, resulting from obligate intracellular Gram-negative bacteria, pose a growing public health threat in China. To assess the current prevalence of these diseases on Hainan Island, a study was conducted on 9 bacterial pathogens found in patients with undifferentiated febrile illness (UFI) treated in Haikou between 2018 and 2021 using a TaqMan Polymerase Chain Reaction (TaqMan PCR) array. Blood samples (n=503) were collected from patients with UFI between 2018 and 2021. The samples were screened for Rickettsia spp., Orientia tsutsugamushi (O. tsutsugamushi), Anaplasma. phagocytophilum (A. phagocytophilum), Ehrlichia chaffeensis, Coxiella burnetii, Chlamydia psittaci, Brucella spp., Burkholderia pseudomallei, and Borrelia burgdorferi using a TaqMan PCR array. Positive samples (Ct<35) underwent confirmation through nested PCR, sequencing, and phylogenetic analysis. O. tsutsugamushi and A. phagocytophilum were detected in the patients at positive rates of 14.51% (73/503) and 5.57% (28/503), respectively. Co-infection of O. tsutsugamushi and A. phagocytophilum was identified in scrub typhus (ST) positive populations from Hainan (10.96%, 8/73), Guangxi (61.54%, 8/13), and Yunnan (5.36%, 3/56) provincial-level administrative divisions (PLADs) of China. An increased prevalence rate of ST and a decreased prevalence of rickettsioses were observed in patients with UFI in Hainan compared to a decade ago. The co-infection of O. tsutsugamushi and A. phagocytophilum poses a current public health threat in China.

Coinfection of Leptospirosis with Scrub Typhus: A Case Report

Leptospirosis and scrub typhus are common zoontic illnesses in tropical countries. Leptospira, a spirochaete, can cause leptospirosis when a patient comes in contact with contaminated water. Following a period of bacteraemic illness, leptospirosis may progress to a more severe form. Weil’s disease is a severe form of leptospirosis characterised by jaundice, haemorrhage and acute kidney injury. Scrub typhus, a rickettsial disease, common in South-East Asia is caused by Orientia tsutsugamushi occurs due to bite of Trombicula mite. An eschar forms at the site of the bite. Here we present a case of a 60-year-old gentleman, hailing from Savar who was diagnosed as a case of coinfection of scrub typhus and leptospirosis. Patient presented with an eschar, high grade fever and features of Weil’s disease. He didn’t initially respond to Ceftriaxone and then Doxycycline was added after which he became afebrile. J MEDICINE 2024; 25: 187-190

Seroprevalence and Clinical Profile of Leptospirosis and Scrub Typhus in Clinically Suspected Patients at a Tertiary Care Center: A Retrospective Study from Theni, Tamil Nadu

Abstract Background: Leptospirosis and Scrub typhus are zoonotic illnesses that are found worldwide. Scrub typhus is a rickettsial infection caused by Orientia tsutsugamushi and spread through the biting of a mite’s chigger. Leptospirosis is an anthropozoonotic illness that can be found anywhere but is most common in tropical and subtropical areas. In this study, we report the seroprevalence of Scrub typhus and Leptospirosis with relation to demographic factors in clinically suspected patients attending a tertiary care hospital in Theni, Tamil Nadu. Methods: This is a retrospective study in which 9574 serum samples from clinically suspected cases were collected from January 2018 to December 2023 and tested for immunoglobulin M (IgM) antibodies for Scrub typhus using the enzyme-linked immunosorbent assay (ELISA) and rapid test. A blood sample was taken from each patient, and an IgM ELISA was performed to make the diagnosis. The ELISA cut-off was determined. Results: In this study, 9574 probable cases, 4306 were examined for Leptospira IgM ELISA and 5268 for Scrub typhus IgM ELISA. Out of 4306 suspected Leptospira cases, 167 (3.8%) were positive and 485 (9.2%) were positive in 5268 suspected Scrub typhus cases. The bulk of Leptospirosis and Scrub typhus cases were in the 21–40 years’ age range, followed by the 0–20 years’ age range. Males were found to have higher seroprevalence (57.1%) than females (42.9%). Conclusions: Scrub typhus and leptospirosis are developing infections, and prompt treatment can save many lives. It is strongly advised to take a programmatic approach to the prevention, control, and management of these developing diseases.

Correlation between genotypes of Orientia tsutsugamushi and clinical characteristics of patients with scrub typhus in Guangzhou, China

Objective: To explore the correlation between genotypes of Orientia (O.) tsutsugamushi and clinical characteristics of scrub typhus patients. Methods: Clinical data of patients with scrub typhus admitted to different types of medical institutions in Guangzhou from September 2012 to December 2016 were collected using medical records. Demographic data, clinical manifestations, as well as hematological and biochemical indicators of patients infected with different genotypes were analyzed and compared. Results: A total of 192 patients were included in this study, including 121 patients with Karp genotype of O. tsutsugamushi infection (63.0%), 36 patients with Gilliam genotype (19.0%), 23 patients with Kato genotype (12.0%), and 12 patients with TA763 genotype (6.0%) infection. The median value of albumin in patients with Karp genotype infection was significantly lower than that of Gilliam-infected patients (P=0.032). Patients with Karp genotype infection had a significantly longer hospital stay (9 days) than those with Gilliam genotype (7 days) (P=0.009) and Kato genotype infection (6 days) (P=0.005). Karp-infected patients also represented for the largest number of patients with complicated organ involvement (88/133, 66.2%). Furthermore, Karp-infected patients had higher risk of developing multiple organ dysfunction syndrome (18.2%) and requiring intensive care unit treatment (15.9%). Besides, patients with Gilliam genotype (8 days) and TA763 genotype infection (7.5 days) had shorter fever duration than those with Karp genotype (9 days) and Kato genotype (9 days) infection, respectively. Conclusions: Genotypes of Orientia tsutsugamushi were associated with varying clinical manifestations, organ involvement, and treatment outcomes, suggesting that genotypes ranged in virulence.

Orientia tsutsugamushi: An Unusual Intracellular Bacteria-Adaptation Strategies, Available Antibiotics, and Alternatives for Treatment.

During evolution Orientia tsutsugamushi became a smarter obligate bacterium to establish as intracellular pathogens. O. tsutsugamushi is a human pathogenic bacterium responsible for 1 billion infections of scrub typhus. Several novel mechanisms make this bacterium unique (cell wall, genetic constitutions, secretion system, etc.). In 2007, O. tsutsugamushi Boryong was pioneer strain for whole-genome sequencing. But the fundamental biology of this bacterial cell is a mystery till date. The unusual biology makes this organism as model for host cell interaction. Only a few antibiotics are effective against this intracellular pathogen but emergence of less susceptibility toward antibiotics make the situation alarming. The review was captivated to highlight the unusual aspects of adaptation, antibiotics, and drugs beyond antibiotics.

A case of scrub typhus with meningitis as the onset: Case report and literature review.

Scrub typhus is a naturally occurring acute febrile disease caused by Orientia tsutsugamushi. Although it can cause multiple organ dysfunction, central nervous system infections are uncommon. A 17-year-old male presented with a 5-day history of fever and headaches. The MRI of the head revealed thickness and enhancement of the left temporal lobe and tentorium cerebelli, indicating potential inflammation. The patient was diagnosed with a central nervous system infection. Ceftriaxone and acyclovir were administered intravenously to treat the infection, reduce fever, restore acid-base balance, and manage electrolyte disorders. Despite receiving ceftriaxone and acyclovir as infection therapy, there was no improvement. Additional multipathogen metagenomic testing indicated the presence of O tsutsugamushi infection, and an eschar was identified in the left axilla. The diagnosis was changed to scrub typhus with meningitis and the therapy was modified to intravenous doxycycline. Following a 2-day therapy, the body temperature normalized, and the fever subsided. The patient was diagnosed with scrub typhus accompanied by meningitis, and doxycycline treatment was effective. Rarely reported cases of scrub typhus with meningitis and the lack of identifiable symptoms increase the chance of misdiagnosis or oversight. Patients with central nervous system infections presenting with fever and headache unresponsive to conventional antibacterial and antiviral treatment should be considered for scrub typhus with meningitis. Prompt multipathogen metagenomic testing is recommended to confirm the diagnosis and modify the treatment accordingly.

Tick-borne pathogens isolated from ticks, rodents, and a shrew in Gangwon and Gyeonggi provinces in the Republic of Korea.

The prevalence of tick-borne pathogens (TBP), Orientia tsutsugamushi, Rickettsia and Borrelia spp. in wild small animals, namely wild rodents, is now widely investigated. This study is to present the prevalence and distribution of O. tsutsugamushi, Rickettsia and Borrelia spp. in wild small animals and ticks collected from Gyeonggi and Gangwon provinces, Republic of Korea (ROK) in 2014. A total of 131 wild small animals, rodents and shrews, and 2,954 ticks were collected from Gyeonggi and Gangwon provinces from May to November 2014. The wild small animals (KR1-9) and ticks (K1-17) were grouped in accordance with capture dates and locations. Among the wild small animals, a total of 393 tissues and blood samples were extracted from six selected small animal series (KR1-3, KR6-8). Also, each date and location-grouped ticks were identified for its species and pooled according to the stage of development. Molecular identification for Rickettsia, Orientia, and Borrelia species was performed using polymerase chain reaction (PCR). To detect TBPs among wild small animals and ticks, primer sets targeting the 56 kDa protein encoding gene of Orientia spp., outer membrane protein B gene (OmpB) of Rickettsia spp., and 5S-23S intergenic spacer region (IGS) gene of Borrelia spp. were used. Of the 393 wild small animals' blood and tissue samples, 199 (50.6%) were positive for Orientia spp., 158 (40.2%) were positive for Borrelia spp., and 55 (14.0%) were positive for Rickettsia spp. Moreover, a total of 14 tick pools (n = 377) was positive for Rickettsia spp. (n=128, 34.0%) and Borrelia spp. (n=33, 8.8%). High prevalence of Orientia spp. and Rickettsia spp. in rodents and shrews were observed. This study presents significant insights by presenting data collected in 2014 that the prevalence of TBP was already high in mid 2010s. This study highlights the sustainable routine surveillance model for TBP.

Unravelling the Enigma of Scrub Typhus: A Critical Review and Insights Into Epidemiology, Clinical Features, Diagnostic Advances, and Emerging Trends.

Scrub typhus (ST) is caused by the bacterium Orientia tsutsugamushi, which exhibits significant antigenic diversity and is prevalent in the Asia-Pacific region. Its clinical presentation is characterized by non-specific symptoms such as headache, myalgia, sweating, and vomiting, along with the abrupt onset of fever and chills. An eschar is often visible in the axilla, groin, or inguinal area and is present in around half of the confirmed cases. The Weil-Felix test is the earliest detection technique, though it is not highly specific. Diagnostic procedures include biopsy, culture, serology, and PCR. The molecularly detectable amount of Orientiaein the bloodstreamoccasionally reaches levels that are identified during acute illness and vanish after the first round of appropriate antibiotic treatment. This study offers a thorough review of ST, a disease carried by vectors caused by Orientia tsutsugamushi.We emphasize on the significance of monitoring and awareness campaigns, diagnostic problems, and geographical differences. It is essential to use multidisciplinary techniques combining epidemiologists, public health authorities, and doctors. Sustained observation and research are essential for developing successful preventative and control measures. When participating in outdoor activities in areas known for such infections or at particular times of the year when ticks or mites carrythe rickettsia infection, people should take great precautions to prevent getting bitten by ticks or mites. Prompt medical evaluation is advised if suspicious symptoms or signs appear, especially in elderly individuals.

Novel Drug Repurposing Strategy as an Alternative Therapeutic Concept for Scrub Typhus Using Computational Studies

Scrub typhus is one of the most underdiagnosed and unreported febrile illnesses caused by an obligate intracellular bacterium named Orientia tsutsugamushi and the antibiotics were the commonly prescribed drugs to treat the condition. Due to the widespread development of antimicrobial resistance to the standard drugs, the new therapeutic approach is warranted. The drug repurposing approach plays a novel concept in identifying alternative therapies to fight against pathogens. To investigate the anti-scrub typhus activity of nine newly FDA-approved antibiotics from 2018-2019 against Orientia tsutsugamushi deubiquitylase (OtDUB) compared with standard drugs. The structure of ligands was retrieved from the PubChem database and the crystal structure of target OtDUB (PDB ID: 6UPU) with a resolution of 2.2 Ao was retrieved from the Protein data bank. Molecular docking studies were performed using PyRx version 0.8 and the amino acid interactions were visualized using BIOVIA Discovery studio and the pharmacokinetic properties of the drugs were analysed by SWISS ADME software. The binding affinity of the drugs to deubiquitylase and amino acids was determined using the In silico approach, the drug Omadacycline shows superior activity when compared with other drugs. Based on our preliminary in-silico docking studies, we conclude that Omadacycline may be repurposed for the treatment of scrub typhus as it shows a higher binding affinity of -8.6 kcal/mol when compared to the standard drugs. For the further advancement of the study, in vitro and in vivo studies should be performed.

A Multi-epitope Subunit Vaccine Identification and Development Against Scrub Typhus (Orientia tsutsugamushi) Using Immunoinformatics Approaches.

Background The pathogen Orientia tsutsugamushi, which causes scrub typhus, is rapidlyspreading throughout the tropics. As a measure to improve public health, the development of a vaccine for human use is essential. Scrub typhus is listed as one of the underdiagnosed and underreported febrile infections. This vector-borne zoonotic infection appears as eschar on the patient's skin. Methods Immunoinformaticswas employed to predict the multi-epitope subunit vaccine that will activate both B and T cells. The final vaccine includes lipoprotein LprA as an adjuvant at the N-terminus along with B-cell, helperTlymphocyte (HTL), and cytotoxic T lymphocyte (CTL)-binding epitopes to boost immunogenicity. Assessing the vaccine's physiochemistry demonstrates that it is both antigenic and non-allergic. The vaccine structure was developed, enhanced, confirmed, and disulfide-engineered to provide the best possible model. Using molecular docking, the interaction of the produced vaccine with toll-like receptor 2 (TLR2) was analyzed, and the vaccine-receptor complex was stabilized by molecular dynamics (MD) simulation. According to in silico cloning, Escherichia coli can efficiently produce the recommended vaccine. Additionally, the efficacy of the in silico-developed vaccine must be evaluated in an in vitro and in vivo experiment. Results The developed vaccine successfully stimulates cellular and humoral immune responses. The vaccine, which has three B-cell epitopes, three HCL epitopes, and nine CTL epitopes, can bind firmly to immunological receptors. Dynamic investigations of the vaccine-receptor complex show a strong interaction and stable conformation. Conclusion In this study, the vaccine candidate demonstrated strong antigenicity, stability, and solubility while also being non-allergenic to host cells. The vaccine candidate's stability with the TLR2 immune receptor is established by binding studies, and in silico cloning verifies efficient and stable expression in the bacterial system.

A molecular survey of zoonotic pathogens of public health importance in rodents/shrews and their ectoparasites trapped in Puducherry, India.

Globally, India has a high zoonotic disease burden and lacks surveillance data in humans and animals. Rodents are known reservoirs for many zoonotic diseases and their synanthropic behavior poses a great public health threat. In this study, trapped rodents/shrews from randomly selected villages within Puducherry, India, and their ectoparasites were screened for zoonotic pathogens, namely, Orientia tsutsugamushi, other pathogenic rickettsiae, Leptospira spp., Cryptosporidium spp., Coxiella burnetii and methicillin-resistant Staphylococcus aureus (MRSA) using conventional PCR. A total of 58 rodents/shrews were trapped from 11 villages. The species trapped were Suncus murinus (49/58, 84.48%), Rattus rattus (8/58, 13.79%) and Rattus norvegicus (1/58, 1.72%). All ectoparasites collected were identified as mites and its infestation rate was 46.55% (27/58). Real-time PCR targeting the 47 kDa gene of O. tsutsugamushi revealed positivity in one rodent and one shrew (3.45%) and two mite pools (7.41%). Conventional PCR targeting the 56 kDa gene revealed positivity in one shrew and two mite pools and the phylogenetic analysis of all three amplicons indicated the circulation of the Gilliam-related serotype. MRSA was detected in the alimentary tract of a shrew (1/32, 3.13%). Leptospira spp., Rickettsia, Cryptosporidium spp. and Co. burnetii tested negative. The detection of zoonotic pathogens within reservoir hosts and vectors poses a risk of transmission to humans. This study signifies the need for zoonotic pathogen surveillance in synanthropic rodents/shrews.

SEROPREVALENCE AND CLINICAL FEATURES OF SCRUB TYPHUS AMONG FEBRILE PATIENTS IN A TERTIARY CARE HOSPITAL

Objective: Rickettsial infections is the most neglected and underdiagnosed tropical diseases in developing countries. The most common rickettsial disease, which is caused by the obligate intracellular gram-negative bacteria Orientia tsutsugamushi, is Scrub Typhus. Scrub typhus can prove to an important diagnosis in pyrexia of unknown origin (PUO) patients and is transmitted by a species of trombiculid mites (“chiggers”). Aim of this study is to find seroprevalence and clinical features of scrub typhus among febrile patients from a tertiary care hospital in North India. Methods: This study was undertaken for a period of 1 y. All the patients attending the outpatient department or admitted indoors suspected of PUO were included in the study. Serum samples of suspected cases were tested for IgM Scrub typhus. Results: During the study period, a total of 755 cases were tested for scrub typhus, out of which 223 were positive so, the seroprevlance of Scrub typhus is 29.5%. Out of 223 positive patients, 105 (47%) were males and 118 (53%) were females. Maximum no. of patients was from age group 21 to 40 y of age and maximum number of cases is in autumn season. Most common clinical feature is fever, followed by myalgia, headache, ocular pain, dyspnoea, cough and eschar, respectively. Conclusion: Scrub typhus is an emerging tropical rickettsial disease in the Indian subcontinent. The present study highlights the importance of screening of PUO cases for Scrub typhus as timely institution of simple empirical treatment can prove to be lifesaving in such cases.

Lack of the IFN-γ signal leads to lethal Orientia tsutsugamushi infection in mice with skin eschar lesions.

Scrub typhus is an acute febrile disease due to Orientia tsutsugamushi (Ot) infection and can be life-threatening with organ failure, hemorrhage, and fatality. Yet, little is known as to how the host reacts to Ot bacteria at early stages of infection; no reports have addressed the functional roles of type I versus type II interferon (IFN) responses in scrub typhus. In this study, we used comprehensive intradermal (i.d.) inoculation models and two clinically predominant Ot strains (Karp and Gilliam) to uncover early immune events. Karp infection induced sequential expression of Ifnb and Ifng in inflamed skin and draining lymph nodes at days 1 and 3 post-infection. Using double Ifnar1-/-Ifngr1-/- and Stat1-/- mice, we found that deficiency in IFN/STAT1 signaling resulted in lethal infection with profound pathology and skin eschar lesions, which resembled to human scrub typhus. Further analyses demonstrated that deficiency in IFN-γ, but not IFN-I, resulted in impaired NK cell and macrophage activation and uncontrolled bacterial growth and dissemination, leading to metabolic dysregulation, excessive inflammatory cell infiltration, and exacerbated tissue damage. NK cells were found to be the major cellular source of innate IFN-γ, contributing to the initial Ot control in the draining lymph nodes. In vitro studies with dendritic cell cultures revealed a superior antibacterial effect offered by IFN-γ than IFN-β. Comparative in vivo studies with Karp- and Gilliam-infection revealed a crucial role of IFN-γ signaling in protection against progression of eschar lesions and Ot infection lethality. Additionally, our i.d. mouse models of lethal infection with eschar lesions are promising tools for immunological study and vaccine development for scrub typhus.

Co-circulation of Hantavirus, Pathogenic Leptospira spp., and Bartonella spp. in Rodents in the Wanzhou Section of the Three Gorges Reservoir Region, 2021-2023.

Background: Rodent is a reservoir of various zoonotic pathogens. Wanzhou section of the Three Gorges reservoir region (TGRR) is a superior habitat for rodents, and the situation of rodent-borne zoonotic pathogens in this region has not been surveyed in recent years. Materials and Methods: Rodents were night trapped with mousecage or mousetrap in urban and surrounding towns' indoor or outdoor areas of the Wanzhou section of the TGRR, and nucleic acid was extracted from their lung or a mixture of liver, spleen, and kidney. Commercialized qPCR kits for pathogenic Leptospira spp., Rickettsia typhi, Anaplasma phagocytophilum, Bartonella spp., Orientia tsutsugamushi, and Francisella tularensis and qRT-PCR kits for hantavirus (HV), and severe fever with thrombocytopenia syndrome virus (SFTSV) were used for the detection of associated pathogens in collected rodents. Results: From 2021 to 2023, 604 rodents belonging to 10 species were collected. HV and pathogenic L. spp. were detected positive, with infection rates of 0.66% (4/604) and 1.32% (8/604), respectively. B. spp. were detected positive with an infection rate of 4.73% (19/402) in the rodents trapped in 2022 and 2023. Other five pathogens were all detected negative. Conclusion: This study showed that the Wanzhou section of the TGRR had HV, pathogenic L. spp., and B. spp. co-circulation in rodents. Hence, more attention should be paid to the prevention and control of associated rodent-borne diseases.

Relevance Of Orientia Tsutsugamushi Antibodies In Elevated Levels Of Liver Enzymes And Thrombocytopenia Among Patients In Tertiary Care Hospital

Relevance Of Orientia Tsutsugamushi Antibodies In Elevated Levels Of Liver Enzymes And Thrombocytopenia Among Patients In Tertiary Care Hospital

The Spectrum of Neurological Manifestations in Scrub Typhus.

Scrub typhus is a mite-borne zoonotic disease caused by Orientia tsutsugamushi and commonly presents with fever, rash, and eschar. Systemic complications develop later in the illness including, meningoencephalitis, pericardial effusion, myocarditis, and pneumonitis. In this article, we will be presenting different neurological manifestations of scrub typhus along with functional outcomes studied at a tertiary care center in New Delhi. This ambispective observational study was conducted at Army Hospital Research and Referral, New Delhi, during January 2018- January 2020. Febrile illness, serologically confirmed as scrub typhus and developing neurological complications were included. A predesigned clinical proforma was recorded for demographics, clinical features, neurological examination, supported with laboratory and/or radiology evaluation, and functional outcomes using the modified Rankin Scale (mRS). In our cohort of 7 patients' majority were male (71%) with mean age at presentation being 42.5 years. Eschar was present in only 2 cases (28%) and a syndromic clinical diagnosis of meningoencephalitis was made in 3 (43%), acute flaccid quadriparesis in 2 (28%); and symptomatic seizure and parkinsonism in 1 patient each (14%). CSF showed lymphocytic pleocytosis with protein elevation in 57% cases. Systemic dysfunction was noted in the form of thrombocytopenia (57%), hyponatremia (42%), elevated transaminases (57%). Symptoms resolved with Doxycycline ± Rifampicin therapy in all cases, with good functional outcomes in majority of (89%) cases. Neurological complications in scrub typhus have a wide spectrum involving meninges, encephalon, basal ganglia, cranial, and peripheral nerves. High index of suspicion with early serological testing (ELISA) is a must in undifferentiated fevers. Timely initiation of appropriate therapy leads to good clinical outcomes, in majority of cases with neurological involvement.

Prominent early adulthood hyperferritinemia in scrub typhus

Background: Scrub typhus is an acute infectious disease, caused by Orientia tsutsugamushi. It is endemic to a geographically distinct region of Japan, Taiwan, China, and South Korea, known as the tsutsugamushi triangle, as well as in Nepal, Pakistan, and Papua New Guinea. In India, the incidence of this disease varies from 4-46% with high morbidity and mortality. Methods: In this cross-sectional study at a tertiary care hospital in Kolkata, India we analysed ferritin blood levels along with different demographic and laboratory test parameters of 60 suspected scrub typhus patients who were also scrub typhus IgM antibody positive during a one-year study period. Results: It was found that serum ferritin levels were unusually high in 21-40 years age group patients along with mildly increased urea and creatinine levels. Other important findings were below 40 years of age males were mostly affected, but above 40 years of age, females were generally affected. Haemoglobin and platelet levels were normal in all age groups. Although WBC count and neutrophils were normal in the 21-40 years age group, in other age groups increased levels were observed. CRP, SGPT, and SGOT levels were uniformly high above 20 years of age. Electrolytes were mildly decreased. Conclusions: It appears that oxidative stress-induced acute kidney injury may be an important reason for the rising ferritin levels in the 21-40 years age group. These important findings may be helpful to clinicians in management of these patients.

Guillain–Barre syndrome following scrub typhus: a case report and literature review

BackgroundScrub typhus is an acute infectious disease caused by Orientia tsutsugamushi. Guillain–Barre syndrome (GBS) is an autoimmune-mediated peripheral neuropathy with a frequent history of prodromal infections, but GBS associated with scrub typhus is very rare.Case presentationWe report a 51-year-old male patient who developed dysarthria and peripheral facial paralysis following the cure of scfrub typhus. CSF examination and electrophysiological findings suggested a diagnosis of GBS. After treatment with intravenous immunoglobulin, the patient’s neurological condition improved rapidly.ConclusionsScrub typhus infection is likely to be a potential predisposing factor in GBS, while scrub typhus-associated GBS has a favorable prognosis.