Dual Genotype <i>Orientia tsutsugamushi</i> Infection in Patient with Rash and Eschar, Vietnam, 2016

Le-Viet, Nhiem; Phan, Duc-Tuan; Le-Viet, Nho; Trinh, Sinh; To, Muoi; Raoult, Didier; Parola, Philippe

doi:10.3201/eid2408.171622

Cited by 8 publications

(10 citation statements)

References 15 publications

(22 reference statements)

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“…Here, among 16 AUF patients with rash, four patients had rickettsial infections (three cases of murine typhus and one case of scrub typhus), one had leptospirosis, one was coinfected with scrub typhus and leptospirosis, and 10 patients had an undetected cause. The appearance of rash in scrub typhus varies depending on the O. tsutsugamushi genotype and might be less frequent in Vietnamese patients with scrub typhus [25,26]. Among the patients with scrub typhus, eschar was present in 47.4% of patients, similar to the proportion observed in our previous study [26].…”

Section: Discussionsupporting

confidence: 76%

“…Diagnosis of rickettsial infections may be difficult in clinical practice due to the diversity of manifestations, particularly in developing countries where diagnostic tests are usually lacking. Typical clinical signs, including eschar and skin rash, were rarely observed in a patient with dual genotype of O. tsutsugamushi infection [25]. In most cases, typical clinical signs of rickettsial infections might be absent or missed, resulting in the misdiagnosis of patients as having AUF.…”

Section: Discussionmentioning

confidence: 99%

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Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam

Le-Viet

Chung

et al. 2019

Emerging Microbes & Infections

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Acute undifferentiated fever (AUF) is frequently observed in tropical settings, but diagnosing the cause of AUF is often a challenge for local physicians and the physicians treating returning travellers. We conducted a case-control study in central Vietnam in 2016. A total of 378 febrile adult patients (AUFs) with a fever for ≤21 days, no evidence of localized infection and negative screening tests for dengue and malaria, and 384 afebrile adult patients (Controls) were prospectively enrolled. Whole blood, plasma, eschar swab, throat swab and urine specimens were collected and analysed. Quantitative PCR and RT-PCR were used to test for 55 bacteria, viruses and their subtypes. Serological tests were also used to test for rickettsial agents. The most common aetiology was influenza virus (20.9% in AUFs vs. 0% in Controls), followed by rickettsial agents (mainly Orientia tsutsugamushi and Rickettsia typhi ) (10.8% vs. 0.3%), dengue virus (7.7% vs. 0.5%), Leptospira (4.8% vs. 0.8%), adenovirus (4.8% vs. 1.0%), and enterovirus (2.1% vs. 0%) ( p < .05). The real proportion of dengue in AUF cases was underestimated because patients with dengue-positive rapid diagnosis tests were excluded from the study. The emerging agent Rickettsia felis , which had not been previously observed in Vietnam, was detected in this study. In total, 216 patients (57.1%) were given causative diagnoses, comprising 143 (66.2%) monoinfections and 73 (33.8%) coinfections. The infections caused by these agents should be considered in clinical practice and further studies. Additionally, agents susceptible to doxycycline were detected in 15.6% of AUFs; thus, this drug should be included in the panel used to treat AUF patients.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam

Le-Viet

Chung

et al. 2019

Emerging Microbes & Infections

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“…These data align with other reports ( 11 ). Rapid clinical improvement after using effective antimicrobial drugs is reported to back up clinical diagnoses of rickettsioses ( 37 – 39 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Manifestations and Molecular Diagnosis of Scrub Typhus and Murine Typhus, Vietnam, 2015–2017

Trung¹,

Hoi²,

Dien³

et al. 2019

Emerg. Infect. Dis.

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“…It has been found that mixed or coinfection may be incurred in patients by evidence of different pathogens existing in tissue specimens (eschar and whole blood) assayed by the sequencing of PCR clones [ 30 , 31 ]. In fact, we are interested in this important issue.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology of scrub typhus in Taiwan during 2006–2016

et al. 2022

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Scrub typhus is the most common endemic vector-borne disease in Taiwan. We identified a total of 4,857 laboratory-confirmed cases during 2006–2016 with hyperendemic foci on offshore islands, including Penghu (778 cases, 16.0%) and Kinmen (716 cases, 14.7%), and eastern Taiwan, including Taitung (628 cases, 12.9%) and Hualien (508 cases, 10.5%). Scrub typhus cases occur year-round throughout Taiwan, with a summer peak in June and July. A total of 545 O. tsutsugamushi isolates were successfully obtained from patients infected in diverse geographic areas, including Taiwan and three offshore islands, and the complete open reading frame of the 56 kDa type-specific antigen gene (tsa56) sequence of these isolates was examined. High phylogenetic diversity was found in these isolates, which could be grouped into 36 distinct sequence types. Most isolates belonged to the Karp (49.9%; 272/545), followed by the TW-22 (17.8%; 97/454) and Kawasaki (14.7%; 80/545) genotypes. In conclusion, our data indicate the widespread presence of tsa56 genotypes closely related to Thailand and Korean strains and the presence of the unique endemic strains TW-12, TW-22, TW-29, and TW-36 in Taiwan.

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Dual Genotype Orientia tsutsugamushi Infection in Patient with Rash and Eschar, Vietnam, 2016

Cited by 8 publications

References 15 publications

Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam

Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam

Clinical Manifestations and Molecular Diagnosis of Scrub Typhus and Murine Typhus, Vietnam, 2015–2017

Molecular epidemiology of scrub typhus in Taiwan during 2006–2016

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