Differences in Clinical Features According to Boryoung and Karp Genotypes of Orientia tsutsugamushi

Kim, Dong-Min; Yun, Na Ra; Neupane, Ganesh Prasad; Shin, Sung Heui; Ryu, So Yeon; Yoon, Hee Jung; Wie, Seong Heon; Kim, Woo Jin; Lee, Chang Youl; Choi, Jong Soo; Yang, Tae Young

doi:10.1371/journal.pone.0022731

Cited by 47 publications

(44 citation statements)

References 25 publications

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“…It is possible that the patients missed the optimal time for physical examination, and patients infected with some genotypes or low loads of O. tsutsugamushi that did not form eschar were reported. 17,18 Additional research is needed to clarify the relationship between clinical features and genotypes and loads of the pathogen. The distribution pattern of eschar in scrub typhus patients in this study was different from the pattern in Mengyin County, but it was very similar to the pattern reported in South Korea.…”

Section: Discussionmentioning

confidence: 99%

Scrub Typhus: Surveillance, Clinical Profile and Diagnostic Issues in Shandong, China

Zhao

Zhao²,

Wang³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. To elucidate the epidemic status, clinical profile, and current diagnostic issues of scrub typhus in Shandong Province, we analyzed the surveillance data of scrub typhus from 2006 to 2011 and conducted a hospital-based disease survey in 2010. Scrub typhus was clustered in mountainous and coastal areas in Shandong Province, with an epidemic period from September to November. The most common manifestations were fever (100%), eschar or skin ulcer (86.3%), fatigue (71.6%), anorexia (71.6%), and rash (68.6%). Predominant complications included bronchopneumonia, toxic hepatitis, and acute cholecystitis in 21.6%, 3.9%, and 2.9% of the cases, respectively. Severe complications including toxic myocarditis, heart failure, pneumonedema, pleural effusion, and emphysema were first reported in Shandong. Missed and delayed diagnosis of scrub typhus was common in local medical institutions. Alarm should be raised for changes of clinical features and current diagnostic issues of scrub typhus in newly developed endemic areas.

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Section: Discussionmentioning

confidence: 99%

Scrub Typhus: Surveillance, Clinical Profile and Diagnostic Issues in Shandong, China

Zhao

Zhao²,

Wang³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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“…Another report on the genotypic distribution of O. tsutsugamushi strains that cause human infections in South Korea listed Boryong (68.6z), Taguchi (19.6z), Kanda/Kawasaki (9.2z), Jecheon (1.3z), and UAP7 (1.3z) (19). A clinical report that compared the Boryong and Karp genotypes of O. tsutsugamushi revealed no significant differences in disease severity between the 2 strains (20). An experimental study on animals demonstrated a correlation between the fatality rates of O. tsutsugamushi and differences in serotypes and virulence genes of Daejeon03-1 and Muju03-01 (Boryong strains) (21).…”

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confidence: 99%

Dynamics of Clinical Symptoms in Patients with Scrub Typhus

Lee

Chung

et al. 2013

Jpn J Infect Dis

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SUMMARY:The clinical manifestations and complications of scrub typhus are variable. Few studies have examined the timeline of clinical symptoms after the appropriate antimicrobial agents have been administered. The most prevalent clinical manifestations are fever and cough, followed by headache, myalgia, eschar, skin rash, and nausea. Systemic symptoms are most severe during the early stages of illness (i.e., the first 5 days), but resolve slowly within 2 weeks. The associated skin rash is most severe during the first 8 days of infection, but it resolves slowly within 21 days.Scrub typhus is a potentially fatal infectious disease caused by the organism Orientia tsutsugamushi (1). Typical signs include eschar formation and acute febrile illness with symptoms that include abrupt fever, chills, rash, lymphadenopathy, abdominal pain, and myalgia (2,3). The clinical manifestations and complications of scrub typhus vary; most symptoms are mild but severe complications have been reported, including acute respiratory distress syndrome, encephalitis, interstitial pneumonia, myocarditis and pericarditis, acute renal failure, and acute hepatic failure (4-10). Very few reports describe the clinical course beyond the occurrence of fever after the appropriate antimicrobial agents have been administered (11). An established timeline of the clinical symptoms may help physicians manage patients with scrub typhus more effectively.This study was conducted in 5 university medical centers in Korea between October and December 2010. In the current study, we used several diagnostic criteria for scrub typhus. First, a diagnosis of scrub typhus was made according to the World Health Organization criteria in 4 out of 5 hospitals when specific IgM antibody titers were equal to or greater than 1:10, or IgG titers were either equal to or greater than 1:256, or a 4-fold increase in titer was demonstrated using paired serum samples in an indirect immunofluorescence antibody (IFA) test (11,12). The O. tsutsugamushi strains used in the IFA test included Gilliam, Karp, Kato, and Boryong. Second, in the remaining hospital, O. tsutsugamushi was detected in passive hemagglutination assay (PHA) against O. tsutsugamushi with an antibody titer of 1:80 or greater in a single serum sample or 4-fold increase or greater during follow-up (13,14). The PHA was conducted using the Genedia Tsutsu PHA II test kit (Green Cross Corp., Yongin, Korea), which provides qualitative and quantitative detection of serum antibodies against O. tsutsugamushi. Sheep erythrocytes for the PHA were sensitized with the Karp and Gilliam strains, including the Boryong strain found in Korea (11,12).Respiratory symptoms included cough and dyspnea. Systemic symptoms included subjective fever, chills, headache, weight loss, and myalgia. Gastrointestinal symptoms included nausea, vomiting, diarrhea, and abdominal pain (15). Neurologic symptoms included mental confusion and delirium. Moreover, a skin rash was also observed. Symptom severity was scored using a 4-point scale: no symptoms...

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“…Patients infected with the Boryong genotype were found to present with significantly more generalized weakness, conjunctival injection and skin rash than in the group infected with Karp genotype [10]. Studies conducted in mice model also demonstrated differences in the virulence among strains of O tsutsugamushi, and the strains were classified into a high virulence group (Karp, Kato and KN-3 genotypes), an intermediate virulence group (Gilliam genotype) and a low virulence group (Kuroki, Kawasaki and KN-2) [13,14].…”

Section: Introductionmentioning

confidence: 91%

“…Among these, Karp, Gilliam and Kato are considered as protoypes of Orientia, while there are genotypes such as Kuroki, Shimokoshi, Irie, Hirano, Kawasaki, Boryong etc. [9][10][11]. Information on the clinical presentations of these prototypes/ serotypes/genotypes is scanty.…”

Section: Introductionmentioning

confidence: 99%

Occurrence of Orientia Tsutsugamushi Genotypes in Areas of Union Territory of Puducherry and Tamil Nadu State, India

K¹,

Sl²,

Kanungo³

et al. 2017

J Emerg Infect Dis

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Scrub typhus, caused by the proteobacterium, Orientia tsutsugamushi, is re-emerging in several regions of Asia, particularly in India. Severity of infection and clinical presentations are known to vary with the infecting prototype/ genotype. Hence genotypic characterization and distribution of various genotypes is of clinical and epidemiological importance. One hundred and forty five suspected scrub typhus cases, reporting to a tertiary care centre in Puducherry, India were investigated for O. tsutsugamushi specific IgM antibodies by ELISA out of which, 135 (93%) were positive. Most cases occurred post-monsoon, peaking in September, and there was a preponderance in young adults. Forty samples tested positive by Nested PCR based on 56kDa gene of O. tsutsugamushi and amplicons from PCR positive samples were sequenced. Phylogenetic tree constructed using 35 sequences (from nt 20 to nt 130) obtained in the study, along with those retrieved from NCBI site, formed two major branches; one comprising 15 sequences from this study, which aligned with Karp genotype, and the other containing 6 sequences which aligned with a sequence from Vellore, India. The second major branch had 12 sequences, which formed an independent group from the Gilliam prototype. Analysis of association of clinical manifestations with genotypes obtained in the present study showed that the sequences that formed an independent group, were associated with a wide spectrum of clinical manifestations involving multiple organs and more severe manifestations like ARDS and hypotension. The sequences, which branched with Karp prototype were associated with hepatitis, meningitis and Multi-organ disorder syndrome (MODS). The present study thus indicated that different genotypes of O. tsutsugamushi occur in southern regions of India, which were associated with various clinical manifestations. Studies on the occurrence of genotypes will help in development of diagnostic methods and vaccines to curtail the infection.

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Differences in Clinical Features According to Boryoung and Karp Genotypes of Orientia tsutsugamushi

Cited by 47 publications

References 25 publications

Scrub Typhus: Surveillance, Clinical Profile and Diagnostic Issues in Shandong, China

Scrub Typhus: Surveillance, Clinical Profile and Diagnostic Issues in Shandong, China

Dynamics of Clinical Symptoms in Patients with Scrub Typhus

Occurrence of Orientia Tsutsugamushi Genotypes in Areas of Union Territory of Puducherry and Tamil Nadu State, India

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