P1523 Diagnosis of scrub typhus by immunohistochemical staining of Orientia tsutsugamushi in cutaneous lesions

Kim, Dong-Min; Lee, S.H.; Lim, Siew-Lin

doi:10.1016/s0924-8579(07)71362-6

Cited by 3 publications

(3 citation statements)

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“…33,34 Weil-Felix OX-K agglutination reaction is the only test generally available for detecting scrub typhus in hospitals in Shandong Province, but low sensitivity hampers its clinical application. Methods of higher sensitivity and specificity, including indirect immunofluorescence assay, 35 PCR, [36][37][38] and immunohistochemistry, 39 are limited in primary medical institutions, because they require expensive equipment or well-trained staff. A gold conjugate-based rapid diagnostic test was recommended in rural areas for its high sensitivity and convenient usage.…”

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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“…Because it takes > 3-4 weeks for eschars to fall off and new healthy skin to form, it is possible to observe eschars for a considerable period. 13 Polymerase chain reaction (PCR) testing of eschars is more sensitive than that of other tissues; therefore, identifying common eschar sites could enable rapid diagnosis 14,15 and treatment. 16 Ticks tend to prefer specific hosts, such as vertebrate hosts, including humans, and wild and domestic animals, depending on the species and lifecycle stage.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Preferred Bite Sites Between Mites and Ticks on Humans in Korea

Jang

Kim

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Identification of mite and tick bite sites provides important clinical information. The predominant mite species in Korea associated with scrub typhus are Leptotrombidium pallidum and Leptotrombidium scutellare The most abundant tick species is Haemaphysalis longicornis To date, there has been no comparative study on preferred bite sites between mites and ticks in humans. This study included a review of medical records and a field study. For mite bite sites, eschars were checked on 506 patients with scrub typhus, confirmed by indirect immunofluorescence assay or nested polymerase chain reaction on the 56-kDa type-specific antigen gene of Orientia tsutsugamushi Tick bite sites were identified and marked on a diagram for 91 patients who experienced tick bites within the previous year through a field epidemiological investigation. The mite and tick bite sites in Koreans were compared. The most frequently observed mite bite sites were the anterior chest, including the axillae (29.1%) and the abdominal region, including the inguinal area (26.1%). Tick bite sites were most frequent on the lower extremities (33.0%), followed by the abdominal region, including the inguinal area (26.4%), and upper extremities (26.4%). The distribution was significantly different between mite and tick bite sites (P < 0.001). There was a statistically significant difference in the mite bite (P = 0.001), but not tick bite sites (P = 0.985), between men and women. This is the first report on the differences between tick and mite bite sites, and may help clinicians reach a rapid diagnosis of mite- or tick-borne infection.

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“…The net result is necrotizing vasculitis and end-organ damage which is also seen in other eschar-like lesions (such as ecthyma gangrenosum). 10 Prolonged fever can be the only manifestation in scrub typhus. Scrub typhus was the cause of fever in 7.5% of children in a Thai study.…”

Section: Discussionmentioning

confidence: 99%

Eschar or Ecthyma or Both?

Arunachalam

Thoon

Nagarajan

et al. 2015

J Pediatr Infect Dis

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We report a case of scrub typhus with coexistent Pseudomonas aeruginosa skin infection in the same patient. A 6-year-old Chinese boy presented with 5 days of fever, 2 days of right thigh swelling, and an insect bite mark over the swelling. A full blood count had been performed prior to hospital consultation, and showed neutropenia and thrombocytopenia. Initial clinical examination revealed a tender erythematous induration with a central punctum on his right thigh, which progressed to form a rolled-up papule with black central necrosis. The clinical suspicion was of an eschar, although ecthyma gangrenosum could not be ruled out. He had recently returned from a recreational trip in the United States 3 weeks earlier, and had travelled to Wisconsin and Las Vegas. He was treated initially for right thigh cellulitis with parenteral ampicillin and cloxacillin, but after infectious disease consultation, he was commenced on intravenous ciprofloxacin. A wound culture grew P. aeruginosa, while rickettsial serology was positive for Orientia tsutsugamushi. He responded clinically to ciprofloxacin and was discharged well, and an outpatient review showed significant improvement of his cutaneous lesion.

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P1523 Diagnosis of scrub typhus by immunohistochemical staining of Orientia tsutsugamushi in cutaneous lesions

Cited by 3 publications

References 0 publications

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

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

Comparison of Preferred Bite Sites Between Mites and Ticks on Humans in Korea

Eschar or Ecthyma or Both?

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