A Case of Scrub Typhus Imported from South Korea to Yamagata, Japan

Suzuki, Yuichi; Shimanuki, Miwa; Seto, Junji; Yahagi, Kazue; Mizuta, Katsumi

doi:10.7883/yoken.jjid.2016.121

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…7 The overall majority of published data describe imported infections from the traditional area of the tsutsugamushi triangle. [7][8][9][10][11] In line with these reports, all infections with O. tsutsugamushi in our study were acquired in countries located in Southeast Asia and in Nepal. In contrast to the few reported cases in travelers, at least one million cases of scrub typhus occur in the Asian-Pacific region annually.…”

Section: Discussionsupporting

confidence: 89%

Complex Cytokine Responses in Imported Scrub Typhus Cases, Germany, 2010–2018

Eisermann

Rauch

Reuter

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Scrub typhus is a life-threatening zoonotic disease, which is caused by Orientia tsutsugamushi, an obligatory intracellular Gram-negative bacterium. It is transmitted by Leptotrombidium mites in endemic regions of Southeast Asia. So far, data on imported scrub typhus cases to non-endemic areas and immunological descriptions are rare. Eleven scrub typhus cases that had been diagnosed by the German National Reference Center for Tropical Pathogens between 2010 and 2018 were retrospectively reviewed for clinical symptoms, laboratory changes, and travel destinations. Patient sera were included if follow-up samples showed simultaneous seroconversion for IgM and IgG antibody responses by immunofluorescence assays or concurrence with the first serum sample. The median of seroconversion was week 2 after symptom onset. Cytokine levels were measured over time, demonstrating simultaneously upregulated major Th1, Th2, and Th17 cytokines in the acute phase of infection followed by normalization during convalescence. This study underlines the complex mixed cytokine response elicited by scrub typhus and highlights clinical and diagnostic aspects of imported infections with O. tsutsugamushi.

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Section: Discussionsupporting

confidence: 89%

Complex Cytokine Responses in Imported Scrub Typhus Cases, Germany, 2010–2018

Eisermann

Rauch

Reuter

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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“…The GeoSentinel network reported only five confirmed cases among 47,915 ill travelers between 1996 and 2008 [ 20 ]. Most of these patients were diagnosed by serological tests of single (mostly convalescent) samples and only few were molecularly confirmed (mostly in endemic countries) [ 18 , 19 ]. In contrast, many experts postulate an increased risk of travel-associated scrub typhus due to the emergence of ecotourism (camping, trekking, rafting) in endemic areas [ 8 , 21 , 22 ], which is in accordance with experiences during military operations during World War II and the Vietnam and Korea conflicts, when scrub typhus affected thousands of soldiers [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Imported scrub typhus: first case in South America and review of the literature

Weitzel

Aylwin

Martínez-Valdebenito

et al. 2018

Trop Dis Travel Med Vaccines

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BackgroundScrub typhus is a neglected vector-borne zoonosis causing life-threatening illnesses, endemic in the Asian-Pacific region and, as recently discovered, in southern Chile. Scrub typhus is rarely reported in travelers, most probably due to the lack of clinical experience and diagnostic tests in non-endemic countries. We report the first case of imported scrub typhus in South America.Case presentationA 62-year-old tourist from South Korea presented severely ill with fever, rash, and eschar in Santiago, Chile. Laboratory exams showed thrombocytopenia and elevated inflammation parameters, hepatic enzymes, and LDH. With the clinical suspicion of scrub typhus, empirical treatment with doxycycline was initiated and the patient recovered rapidly and without complications. The diagnosis was confirmed by IgM serology and by real-time PCR, which demonstrated infection with Orientia tsutsugamushi (Kawasaki clade).ConclusionsOnly due to the emerging clinical experience with endemic South American scrub typhus and the recent implementation of appropriate diagnostic techniques in Chile, were we able to firstly identify and adequately manage a severe case of imported scrub typhus in South America. Physicians attending febrile travelers need to be aware of this rickettsiosis, since it requires prompt treatment with doxycycline to avoid complications.

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