Antibodies to typhus in Eastern Nepal

Brown, G.W.; Shirai, Akira; Gan, Elsie; Bernthall, P.

doi:10.1016/0035-9203(81)90210-8

Cited by 24 publications

(23 citation statements)

References 5 publications

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“…The results of this and other (11,12) studies indicate that murine typhus is an important endemic infection in Nepal. Although our study did not extend throughout the full year, murine typhus was more common in winter than in summer.…”

Section: Discussionsupporting

confidence: 60%

Murine Typhus and Febrile Illness, Nepal

Zimmerman¹,

Murdoch²,

Rozmajzl³

et al. 2008

Emerg. Infect. Dis.

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Murine typhus was diagnosed by PCR in 50 (7%) of 756 adults with febrile illness seeking treatment at Patan Hospital in Kathmandu, Nepal. Of patients with murine typhus, 64% were women, 86% were residents of Kathmandu, and 90% were unwell during the winter. No characteristics clearly distinguished typhus patients from those with blood culture-positive enteric fever.I n 2001, we found Salmonella enterica serotype Typhi and S. enterica serotype Paratyphi A to be the most common causes of bloodstream infections among adults with febrile illness who sought treatment at Patan Hospital in Kathmandu, Nepal (1). Another important fi nding was the relatively high percentage of patients (11%) who had immunoglobulin (Ig) M antibodies against Rickettsia typhi in peripheral blood. Because most testing was performed on unpaired acute-phase sera, and a high percentage of seropositive results were found in a group of healthy study participants, we were uncertain whether these participants had acute murine typhus or more distant past infection.Recent studies have shown the value of PCR for diagnosing scrub typhus (2-4), and a real-time assay for R. typhi has recently been validated (5). In our study, we tested archived blood samples from our febrile adult cohort (1) with this R. typhi PCR to better characterize the incidence of murine typhus and to determine whether clinical features could help distinguish murine typhus from enteric (typhoid) fever. The StudyWe studied consecutive adult patients with fever (axillary temperature >38°C; >13 years of age) who sought treatment at Patan Hospital from January 15 through March 15, 2001 (winter) and July 2 through August 10, 2001 (summer), as detailed elsewhere (1). The study was approved by the Nepal Health Research Council and the Institutional Review Board of the Centers for Disease Control and Prevention. Blood from each patient was injected into blood culture bottles and serum samples were tested for R. typhi IgM antibodies (INDX Multi-Test Dip-S-Ticks SDLST; Integrated Diagnostics, Inc., Baltimore, MD, USA). In addition, whole blood samples (stored at −80ºC) were tested by real-time PCR for R. typhi at the Naval Medical Research Center, Silver Spring, MD (NMRC) and at Canterbury Health Laboratories, Christchurch, New Zealand (CHL). Details of the assay have been described elsewhere (5). We extracted DNA from 200 μL of whole blood and used primers and probes specifi c to a portion of the outer membrane protein B (ompB) unique to R. typhi to amplify and detect the target sequence in a SmartCycler (Cepheid, Sunnyvale, CA, USA) at NMRC and in a LightCycler (Roche Diagnostics, Mannheim, Germany) thermocycler at CHL. Thermocycling parameters included an initial denaturation step (2 min at 9°C) followed by 45 cycles of denaturation (94°C for 5 s) and annealing/ elongation (60°C for 30 s) steps. Positive samples were defi ned as those that demonstrated fl uorescence above background levels. Template-free controls assayed at the same time and under the same conditions as the experimental a...

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Section: Discussionsupporting

confidence: 60%

Murine Typhus and Febrile Illness, Nepal

Zimmerman¹,

Murdoch²,

Rozmajzl³

et al. 2008

Emerg. Infect. Dis.

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“…8 In Nepal, first study to detect scrub typhus was done in 1981 in eastern part of the country where 10% of study population were found to have antibodies to scrub-typhus rickettsiae, indicating that the infection occurred widely in eastern Nepal. 3 In another study, up to 3% of in-hospital patients in central Nepal were found to be infected with the scrub typhus. 4 However, till date there had not been such a large outbreak and clinical study of scrub typhus in the country.…”

Section: Discussionmentioning

confidence: 96%

“…2 Scrub typhus as a cause of acute febrile illness in Nepal was first reported in 1981. 3 Hospital based study conducted in 2004 in central Nepal found scrub typhus as a cause of acute febrile illness in 3% of patients. 4 Since then the disease has been considered to be endemic in different parts of the country, though it did not cause significant problems.…”

Section: Introductionmentioning

confidence: 99%

Clinical presentation of scrub typhus during a major outbreak in central Nepal

Sedhain

Bhattarai²

2017

Asian J Med Sci

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Background: Scrub typhus, an emerging rickettsial disease caused by the organism Orientiatsutsugamushi, is associated with multi-organ involvement. We prospectively studied the clinical manifestations of the disease during a major outbreak in central part of Nepal. Aims and Objective: This study was carried out with an aim to analyze the clinical presentations, laboratory parameters, complications and outcomes of scrub typhus. Materials and Methods: A prospective observational study was conducted in the Department of Medicine in a tertiary teaching hospital. A total of 1398 patients admitted with acute febrile illness were subjected for Scrub Typhus Detect™ IgM ELISA test, among which 502 (35.90%) patients tested positive and were included in the study. Acute kidney injury was defined according to KDIGO guideline. Statistical analysis was done with SAS University Studio package using t-test for continuous variables and chi-square test for categorical variables. Results: Mean age of the patients was 30.37±18.81 years with 26.29% in the pediatric age group (<14 years). Females comprised of 55.98% of the patients. Majority (97.98%) of the patients were seen between July to November. Clinical presentations in the descending order of frequency were anorexia (55.18%), headache (53.39%), lymphadenopathy (15.73%), jaundice (13.35) and eschar (6.57%). Mean scrub typhus IgM ELISA value was 2.17. Leukocytosis was seen in 5.78% and thrombocytopenia in 66.73% of patients. Transaminitis was found in 80.68% of patients. Urinary abnormalities were recorded in 42.3% of patients. Acute kidney injury (AKI) was seen in 35.8% of patients followed by acute respiratory distress syndrome (24.1%), pneumonia (22.1%), shock (14.74%), neurologic manifestation (6.37%) and cardiac manifestations (4.38%). ICU admission was required for 18.73% of patients and 8.57% required ventilator support. Mortality rate was 1.79%. Conclusion: Scrub typhus, being an emerging vector borne infectious disease in Nepalese context, is associated with multiple organ involvement.

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“…Since, various parts of Nepal appeared to be suitable hubs for Scrub typhus, the clinical suspicion of scrub typhus in the differential diagnosis of FUO is of utmost importance to prevent mortality and morbidity. 17 Scrub typhus, which has been growing as an epidemic threat in various parts of the country, has indicated laboratory confirmation as essential tool to prevent and restrict the spread of disease. Currently, serology continues to be the mainstay for diagnosis of Scrub typhus.…”

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confidence: 99%

Threat of scrub typhus in post-earthquake Nepal

2017

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Scrub typhus is a potentially fatal zoonotic infection, reported from many parts of Asia including Nepal. There is increasing reports of outbreak of Scrub typhus, after the earthquake hit Nepal on April 25, 2015. The recent outbreak of Scrub typhus posed problems in diagnosis and treatment of the disease. It may be related to poor awareness of the disease or lack of suspicion for Scrub typhus which often presents with clinical features indistinguishable from typhoid fever. Since, various parts of Nepal appeared to be suitable hubs for Scrub typhus, the clinical suspicion of Scrub typhus in the differential diagnosis of fever of unknown origin (FUO) is of utmost importance to prevent mortality and morbidity. This is a prospective study conducted in Chitwan Medical College (CMC), Chitwan, Nepal. This study was carried out over a period of 4 months extending from June 2016 to September 2016. A total of 410 serum samples were collected from all patients visiting CMC, clinically suspected of having Scrub typhus infection. The samples were processed for the detection of IgM antibodies for Scrub typhus by ELISA. Results: A total of 410 samples from patients suspected with Scrub typhus infection were processed which included 200 males and 210 females. Out of total 410 samples tested, 181 (44.1%) were seropositive for Scrub typhus. Seropositivity was highest 25.9% among the age group 11-20 years of age. Females were infected more than males. This study implies the re-emergence of Scrub typhus in different regions of Nepal. Although the disease is endemic in our country, it is grossly underdiagnosed owing to non-specific clinical presentation and lack of diagnostic facilities. It is thus suggested that high index of suspicion should be maintained for cases presenting with febrile illness. Infection with Scrub typhus was found high and this calls for an urgent need to introduce vaccine against Scrub typhus.

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Antibodies to typhus in Eastern Nepal

Cited by 24 publications

References 5 publications

Murine Typhus and Febrile Illness, Nepal

Murine Typhus and Febrile Illness, Nepal

Clinical presentation of scrub typhus during a major outbreak in central Nepal

Threat of scrub typhus in post-earthquake Nepal

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