Unusual Genotypic Distribution of Orientia tsutsugamushi Strains Causing Human Infections on Jeju Island

Yoo, Jeong Rae; Heo, Sang Taek; Koh, Young‐Sang; Kim, Young Ho; Kim, Seok

doi:10.4269/ajtmh.13-0511

Cited by 6 publications

(8 citation statements)

References 13 publications

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“…30,31 A maculopapular rash, as a presenting feature, was seen in 9% of our patients, as compared with 22% patients from Vellore, 20% patients from the Himalayan region of north India, 30% patients in Thailand, and 55.7% patients from Jeju Islands, South Korea. [23][24][25][26][27][28][29][30][31][32] In the present study, splenomegaly was present in 45% of patients. Another study from north India has reported a higher splenomegaly rate of 59%.…”

Section: Discussionmentioning

confidence: 80%

“…[12][13][14][15][16][17][18][19][20][21][22] The pathognomonic eschar was present in 14% patients (Table 3), a figure considerably higher than a previous study from the Himalayan region (9.5% patients), but lesser than that reported from south India (43.5%) and Jeju Island in South Korea (75.8%). 26,28,29 This variation in the presence of eschar may be explained by the geographic distribution of different strains of the organism. Lymphadenopathy, present in a nearly 11% third of our patients, was also lesser than in the studies from Vietnam and Thailand.…”

Section: Discussionmentioning

confidence: 99%

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Scrub Typhus in a Tertiary Care Hospital in North India

Sharma

Biswal

Kumar

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Scrub typhus, a zoonotic disease caused by the bacterium Orientia tsutsugamushi, has become endemic in many parts of India. We studied the clinical profile of this infection in 228 patients that reported to this tertiary care center from July 2013 to December 2014. The median age of patients was 35 years (interquartile range = 24.5-48.5 years), and 111 were males and 117 females. A high-grade fever occurred in 85%, breathlessness in 42%, jaundice in 32%, abdominal pain in 28%, renal failure in 11%, diarrhea in 10%, rashes in 9%, and seizures in 7%. Common laboratory abnormalities at presentation were a deranged hepatic function in 61%, anemia in 54%, leukopenia in 15%, and thrombocytopenia in 90% of our patients. Acute kidney injury (32%), acute respiratory distress syndrome (ARDS) (25%), and disseminated intravascular coagulation (DIC) (16%) were the commonest complications. A hepatorenal syndrome was seen in 38% and multiple organ dysfunction syndrome (MODS) in 20% patients. The overall case fatality rate was 13.6%. In univariate analysis, ARDS requiring mechanical ventilation, acute kidney injury requiring hemodialysis, hypotension requiring inotropic support, central nervous system dysfunction at presentation, and MODS were inversely associated with survival.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Scrub Typhus in a Tertiary Care Hospital in North India

Sharma

Biswal

Kumar

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…In the present cases, death and serious complications including pneumonia, acute kidney injury, and encephalitis were not observed. The previous study at a university hospital that was located in Jeju-si also reported that death among the 138 patients was not observed [33]. Furthermore, the low mortality was achieved in the present patients that included a large number of elderly patients and patients with comorbid conditions.…”

Section: Discussionmentioning

confidence: 55%

The Eschar Size and Early Inoculation Lesion of Tsutsugamushi Disease on Jeju Island, Korea

Kim¹,

Hyun²,

Kim³

et al. 2019

Infect Chemother

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BackgroundTsutsugamushi disease, or scrub typhus, is an acute febrile illness caused by Orientia tsutsugamushi, which is followed by chronic latent infection. People who reside in areas endemic of tsutsugamushi disease may be frequently reinfected with this organism. Volunteers who are experimentally reinfected with O. tsutsugamushi manifest various systemic and local reactions, including the presence of small-sized eschar. The present study recorded the morphology and size of eschars in patients with tsutsugamushi disease on Jeju Island, Korea.Materials and MethodsFrom March 2018 to February 2019, 23 patients manifesting clinical characteristics and epidemiologic features of tsutsugamushi disease on Jeju Island were investigated. For comparison of eschar sizes between the two regions, 12 patients with tsutsugamushi disease in Incheon were similarly examined.ResultsThree patients, two on the first day and one on the fourth day of fever, presented with papules of 2 – 5 mm in diameter. Another three patients, one on the second day and two on the fourth day, presented with ruptured vesicles of 5 – 8 mm in diameter. Thirteen patients presented with eschars covered with dark scabs, with a median diameter of 5 (95% confidence interval [CI], 5 – 7.5) × 4 (95% CI, 3 – 5) mm. The medians of the eschar sizes did not differ between the two cities (P = 0.46 by Mann-Whitney U test), but eschars ≥10 mm in diameter were more frequent in Incheon than in Seogwipo-si (4 of 12 vs. 0 of 13 patients, P = 0.04 by Fisher's exact test). One patient presented with multiple eschars, and no eschar was detected in the remaining three patients. Among 11 Jeju Island patients with positive IgG and IgM antibodies, seven patients revealed higher IgG than IgM antibody titers during the acute phase of the illness, i.e., the IgG antibody response, two patients had equal IgG and IgM titers, and two patients presented the IgM antibody response. Life-threatening complications and death were not observed in this study.ConclusionThe patients in Seogwipo-si had small-sized eschars and occasionally exhibited non-necrotic lesions. Many patients had serologically reinfected tsutsugamushi disease. Further studies are needed to investigate the association between these findings.

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“…Physicians may not consider Q fever in the differential diagnosis in patients with acute febrile illness because the symptoms and signs of Q fever are nonspecific; acute fever is common due to severe fever with thrombocytopenia syndrome (in the spring and the summer) and scrub typhus (in the autumn) in individuals who participate in outdoor activity [ 23 , 24 , 25 , 26 ], and most infected individuals have no history of animal contact or occupational exposure [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Seroreactivity to Coxiella burnetii in an Agricultural Population and Prevalence of Coxiella burnetii Infection in Ticks of a Non-Endemic Region for Q Fever in South Korea

et al. 2021

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Coxiella burnetii infects humans and wild and domesticated animals. Although reported cases on Jeju Island, off the coast of South Korea, are rare, the region is considered to have a high potential for Q fever. We investigated the seroprevalence of antibodies to C. burnetii in 230 farmers living in ten rural areas on Jeju Island between January 2015 and December 2019. Blood samples were collected and examined for C. burnetii Phase I/II IgM and IgG antibodies. Trained researchers collected ticks from rural areas. Clone XCP-1 16S ribosomal RNA gene sequencing was performed to identify Coxiella species from the collected ticks. The overall seroprevalence of antibodies to C. burnetii in farmers was 35.7%. The seroprevalence was significantly higher in fruit farmers. Of the collected ticks, 5.4% (19/351) of the Haemaphysalis longicornis ticks harbored C. burnetti. A high seroprevalence of antibodies to C. burnetii was observed in this region of Jeju Island, confirming that C. burnetti is endemic. Physicians should thus consider Q fever in the differential diagnosis of patients that present with acute fever after participating in outdoor activities.

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Unusual Genotypic Distribution of Orientia tsutsugamushi Strains Causing Human Infections on Jeju Island

Cited by 6 publications

References 13 publications

Scrub Typhus in a Tertiary Care Hospital in North India

Scrub Typhus in a Tertiary Care Hospital in North India

The Eschar Size and Early Inoculation Lesion of Tsutsugamushi Disease on Jeju Island, Korea

Seroreactivity to Coxiella burnetii in an Agricultural Population and Prevalence of Coxiella burnetii Infection in Ticks of a Non-Endemic Region for Q Fever in South Korea

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