OBJECTIVES: This study aimed to assess the status of Scrub typhus, Leptospirosis and HFRS(hemorrhagic fever with renal syndrome) among farmers with febrile illness. METHODS: We involved a total of 841 farmers who had febrile illness(508 and 333 village residents were, respectively, three and four district of Gyeongju city) selected during autumn of 2014 and 2015. Data were collected by survey questionnaires and blood sample examination. RESULTS: Serum response rate for Scrub typhus and Leptospirosis was 1.5% each and 1.9% for HFRS. Serum response rate for Scrub typhus was significantly higher for tick-bite cases(38.5%), while Leptospirosis was significantly higher for those who were in fruit–planting work(23.1%). Similarly, serum response rate was significantly higher for HFRS who were working in venyl green house work(25.0%). CONCLUSIONS: Government authority should develop effective and efficient preventive strategies to create awareness of infectious diseases among farmers. Extending information, education and communication be reached to farmers that could change their perception and help early diagnosis and treatment and reduce the disease burden and its complication.
Communicable Diseases ; Early Diagnosis ; Education ; Farmers ; Fever ; Gyeongsangbuk-do ; Hemorrhagic Fever with Renal Syndrome ; Leptospirosis ; Risk Factors ; Scrub Typhus

BACKGROUND: Scrub typhus, severe fever with thrombocytopenia syndrome (SFTS) and human granulocytic anaplasmosis (HGA) are important arthropod-borne infectious diseases in Korea and share a common point that they are transmitted by arthropod bites mostly during outdoor activities and there are considerable overlaps of epidemiologic and clinical features at presentation. We investigated the co-infection of these infections. METHODS: The study subjects were patients with laboratory-confirmed scrub typhus who were enrolled retrospectively in 2006. SFTS virus (SFTSV) infection was confirmed by a reverse transcriptase polymerase chain reaction (PCR) to amplify partial L segment of SFTSV for molecular diagnosis. HGA was confirmed by a nested PCR to amplify 16S rRNA gene of Anaplasma phagocytophilum. Direct sequencing of the positive PCR products was performed. Clinical features of co-infected subjects were described. RESULTS: One-hundred sixty-seven patients with scrub typhus were included in the analysis. Co-infection of A. phagocytophilum was identified in 4.2% of scrub typhus patients (7/167). The route of co-infection was uncertain. The co-infected patients had not different clinical manifestations compared to the patients with scrub typhus only. All the study subjects were negative for SFTSV. CONCLUSION: We found retrospective molecular evidence of the co-infection of scrub typhus and HGA in Korea. HGA may be more prevalent than expected and need to be considered as an important differential diagnosis of febrile patients in Korea.
Anaplasma phagocytophilum ; Anaplasmosis ; Animals ; Arthropods ; Coinfection ; Communicable Diseases ; Diagnosis ; Diagnosis, Differential ; Fever ; Genes, rRNA ; Humans ; Korea ; Polymerase Chain Reaction ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Scrub Typhus ; Thrombocytopenia

OBJECTIVE: To explore the feasibility of difference between hematocrit and albumin (HCT-ALB) to evaluate the severity in patients with severe scrub typhus (Tsutsugamushi disease). METHODS: The clinical data of 408 patients with scrub typhus in 37 hospitals located in 15 prefectures of Yunnan Province from January 1st, 2017 to December 31st, 2018 were retrospectively collected. The patients were divided into the non-severe scrub typhus disease group (n = 265) and the severe scrub typhus disease group (n = 143) according to the diagnostic criteria. Volunteers attending Kunming City Medical Center in Yunnan Province for routine physical examination were enrolled as healthy control group (n = 230). HCT, ALB, lactate dehydrogenase (LDH), uric acid (UA), and acute physiology and chronic health evaluations II (APACHE II) and sequential organ failure assessment (SOFA) within 24 hours after admission were collected. HCT-ALB difference was calculated. Pearson method was used to analyze the correlation between HCT-ALB difference and LDH, UA, APACHE II and SOFA scores in patients with severe scrub typhus disease; the receiver operating characteristic (ROC) curve was used to analyze the value of HCT-ALB difference in the diagnosis of severe scrub typhus disease. RESULTS: (1) There was no significant difference in gender composition between patients with non-severe scrub typhus disease group and severe scrub typhus disease group, but the age of the severe scrub typhus disease group was significantly higher than that of the non-severe scrub typhus disease group (years old: 53.57±15.23 vs. 35.03±23.47, P < 0.01). (2) Compared with the healthy control group, the HCT, ALB of the non-severe scrub typhus disease group and severe scrub typhus disease group were significantly decreased [HCT: (36.54±6.82)%, (38.13±7.60)% vs. (46.20±4.42)%; ALB (g/L): 35.53±5.87, 26.90±6.10 vs. 47.75±4.28, all P < 0.01], and the HCT-ALB difference was significantly increased (5.28±3.90, 11.26±6.62 vs. 1.55±5.32, both P < 0.01). Compared with the non-severe scrub typhus disease group, the HCT of the severe scrub typhus disease group was significantly increased [(38.13±7.60)% vs. (36.54±6.82)%, P < 0.01], the ALB was significantly decreased (g/L: 26.90±6.10 vs. 35.53±5.87, P < 0.01), and the HCT-ALB difference was significantly increased (11.26±6.62 vs. 5.28±3.90, P < 0.01). (3) Pearson correlation analysis showed that HCT-ALB difference was positively correlated with LDH and UA in patients with severe scrub typhus disease (r values were 0.316 and 0.284, respectively, both P < 0.01), and negatively correlated with APACHE II score and SOFA score (r values were -0.229 and -0.198, respectively, both P < 0.05). (4) ROC curve analysis showed that the area under the curve (AUC) of HCT-ALB difference in the diagnosis of severe scrub typhus disease was 0.786, standard error was 0.024, P = 0.000, and 95% confidence interval (95%CI) was 0.739-0.832. When the best diagnostic value was 8.56, the sensitivity was 81.1%, the specificity was 60.8%, and the Youden index was 0.419. CONCLUSIONS HCT-ALB difference is an indicator to evaluate the severe scrub typhus disease. When HCT-ALB difference is above 8.56, it can be used as an indicator to identify severe scrub typhus disease.
Albumins ; China ; Feasibility Studies ; Hematocrit ; Humans ; Prognosis ; ROC Curve ; Retrospective Studies ; Scrub Typhus/diagnosis*

The incidence of mite- and tick-borne infectious disease is increasing with climate change and the development of diagnostic tools. Tick-borne infectious diseases include Lyme disease, anaplasmosis, ehrlichiosis, severe fever with thrombocytopenia syndrome (SFTS), and Japanese spotted fever. Rickettsial pox and scrub typhus are mite-borne infectious diseases. Scrub typhus and SFTS are the most common mite- and tick-borne infectious diseases in Korea, respectively. They are often difficult to diagnose at an early stage of disease. To make a definite diagnosis of mite- and tick-borne infectious disease, polymerase chain reaction (PCR) tests or serologic testing for antibodies during the acute and convalescent periods are necessary. If patients with nonspecific symptoms, such as fever, headache, nausea, and vomiting, have a history of outdoor activity or a tick bite, it is reasonable to consider the possibility of mite- or tick-borne infectious diseases clinically. There are no vaccinations against mite- and tick-borne infectious diseases. Therefore, preventing mite or tick bites is the best way to prevent the diseases.
Anaplasmosis ; Animals ; Antibodies ; Asian Continental Ancestry Group ; Climate Change ; Communicable Diseases* ; Diagnosis ; Ehrlichiosis ; Fever* ; Headache ; Humans ; Incidence ; Korea* ; Lyme Disease ; Mites ; Nausea ; Phlebovirus ; Polymerase Chain Reaction ; Scrub Typhus* ; Serologic Tests ; Thrombocytopenia* ; Tick Bites ; Tick-Borne Diseases ; Vaccination ; Vomiting

The incidence of vector-borne infectious diseases is increasing due to developments in diagnostic techniques, as well as due to economic, environmental, and ecological factors such as global warming, increased rainfall, globalization, and urbanization. Tick-borne infectious diseases occurring in Korea include severe fever with thrombocytopenia syndrome, Lyme disease, anaplasmosis, and Japanese spotted fever. Various skin lesions, such as erythema migrans, tick bite sites, rash, and eschar, are associated with tick-borne infectious diseases. It is necessary to remove ticks immediately to prevent transmission of these tick-borne infectious diseases. Especially for conditions such as Lyme disease, at least 24 to 48 hours of tick attachment to the host is required for transmission of the causative pathogens to the host. Tick-borne diseases are acquired after outdoor activities and have nonspecific symptoms such as fever, headache, and chills, which make them difficult to identify without a diagnostic test. Rapid diagnosis and early treatment can reduce the otherwise significant morbidity and mortality associated with these conditions; therefore, therapy should not be delayed until laboratory confirmation is received.
Anaplasmosis ; Animals ; Asian Continental Ancestry Group ; Chills ; Communicable Diseases* ; Diagnosis ; Diagnostic Tests, Routine ; Erythema ; Exanthema ; Fever ; Global Warming ; Headache ; Humans ; Incidence ; Internationality ; Korea* ; Lyme Disease ; Mortality ; Rickettsia Infections ; Scrub Typhus ; Skin ; Thrombocytopenia ; Tick Bites ; Tick-Borne Diseases ; Ticks ; Urbanization

BACKGROUND: An infection known to be a major cause of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Rapidly progressive dementia is a neurological condition in which dementia progresses in a short period of time. CASE REPORT: We report on a 78-year-old woman presenting with a rapid decline in cognitive function resulting from a scrub typhus infection. Diffusion weighted images showed a signal intensity at the splenium, and subcortical white matter of both hemispheres suggesting MERS. On the neuropsychological test, the patient showed frontal executive dysfunction. CONCLUSIONS: This case suggests that diagnosticians should consider the possibility that a MERS patient with a rapidly cognitive decline could have a scrub typhus infection because early diagnosis of scrub typhus is very important in this aspect of the treatment.
Aged ; Brain Diseases* ; Cognition ; Dementia* ; Diffusion ; Early Diagnosis ; Female ; Humans ; Neuropsychological Tests ; Scrub Typhus* ; White Matter

In Korea, scrub typhus usually occurs in October and November. Hemophagocytic lymphohistiocytosis (HLH) is a distinct clinical entity characterized by a high fever, pancytopenia, hepatosplenomegaly, histiocyte proliferation, and hemophagocytosis. We encountered a summertime case of severe scrub typhus presenting as HLH. A 49-year-old female complained of abdominal pain and fever 3 days in duration. On hospital day 3 she was transferred to the intensive care unit because of clinical deterioration accompanied by severe sepsis. As an eschar was evident on the right shoulder, we commenced doxycycline. Her condition improved dramatically and she was discharged on day 14. Although the indirect immunofluorescence antibody test (IFA) for Orientia tsutsugamushi was negative on admission, a repeat IFA test was positive; the antibody titer was 1:5,120 on hospital day 10. Scrub typhus should be considered during differential diagnosis in a patient with severe sepsis in any season except the fall.
Abdominal Pain ; Diagnosis, Differential ; Doxycycline ; Female ; Fever ; Fluorescent Antibody Technique, Indirect ; Histiocytes ; Humans ; Intensive Care Units ; Korea ; Lymphohistiocytosis, Hemophagocytic* ; Middle Aged ; Orientia tsutsugamushi ; Pancytopenia ; Scrub Typhus* ; Seasons ; Sepsis ; Shoulder

Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus.
Antibodies, Bacterial/blood ; Enzyme-Linked Immunosorbent Assay ; Fluorescent Antibody Technique, Indirect ; Humans ; Immunoglobulin G/blood ; Immunoglobulin M/blood ; Orientia tsutsugamushi/immunology ; Reagent Kits, Diagnostic ; Retrospective Studies ; Scrub Typhus/*diagnosis/microbiology ; Sensitivity and Specificity

There have been a small number of cases of scrub typhus-associated hemophagocytic syndrome (HPS), most of which were treated successfully using adequate antibiotics. Here, we report a case of Epstein-Barr virus (EBV)-associated HPS after scrub typhus infection that was not improved using antirickettsial treatment. A 73-year-old male who had been diagnosed with scrub typhus according to an eschar and a positive serology was transferred to our institution because of a persistent fever despite 7-day doxycycline therapy. Physical and laboratory data showed hepatosplenomegaly, bicytopenia, hyperferritinemia, and hypofibrinogenemia. A bone marrow examination (BM) revealed hypercellular marrow with hemophagocytosis and histiocyte infiltration. EBV was detected in BM aspirates using polymerase chain reaction. After a diagnosis of HPS was made, the patient was treated successfully using high-dose steroids.
Aged ; Anti-Bacterial Agents ; Bone Marrow ; Bone Marrow Examination ; Diagnosis ; Doxycycline ; Epstein-Barr Virus Infections ; Fever ; Herpesvirus 4, Human* ; Histiocytes ; Humans ; Lymphohistiocytosis, Hemophagocytic* ; Male ; Polymerase Chain Reaction ; Scrub Typhus* ; Steroids

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The main symptoms of scrub typhus are fever, eschar, generalized rash, and swelling of the lymph nodes. Complications include pneumonia, myocarditis, meningitis, hepatitis, acute renal failure, and hearing loss. We report a rare case of Tsutsugamushi disease with acute bilateral hearing loss in a 65-year-old woman. The antibodies against O. tsutsugamushi were detected which led to the diagnosis of scrub typhus. She was treated immediately with oral doxycycline for 9 days and had a rapid and complete recovery. Scrub typhus can be associated with hearing loss, which is present in approximately one-third of the cases, but it is rare in Korea, therefore it is easy to misdiagnose scrub typhus as any other otological abnormalities. When patients present with fever, rash, and sensorineural hearing loss, clinicians should suspect scrub typhus and consider empirical antibiotic therapy.
Acute Kidney Injury ; Aged ; Antibodies ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Fever ; Hearing Loss ; Hearing Loss, Bilateral* ; Hearing Loss, Sensorineural ; Hepatitis ; Humans ; Korea ; Lymph Nodes ; Meningitis ; Myocarditis ; Orientia tsutsugamushi ; Pneumonia ; Scrub Typhus*