Rickettsioses in Australia

Graves, Stephen; Unsworth, Nathan B.; Stenos, John

doi:10.1111/j.1749-6632.2009.04530.x

Cited by 55 publications

(45 citation statements)

References 41 publications

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“…The diagnosis of scrub typhus is based on the patient's exposure history, the clinical features, and the results of serologic testing (4,5). It occurs in persons who engage in occupational or recreational behavior that brings them into contact with mite-infested habitats such as brush and grass (3,(6)(7)(8)(9)(10). In such environments, trombiculid mite larvae can be found in any location that is suitable for rodent populations and has ground moisture sufficient to nourish the mite vectors (11).…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of Drug Treatment for Scrub Typhus in Asia

Fang

Huang²,

Tu³

et al. 2012

Intern. Med.

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Objective Scrub typhus is an important febrile disease in Asia, and antibiotics have been used to treat this disease. The purpose of this study was to generate large-scale evidence of the efficacy of different antibiotic regimens for treating scrub typhus using a meta-analysis. Methods PubMed, Elsevier ScienceDirect, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. The data from eligible citations were extracted by two reviewers. All analyses were performed using the Cochrane Collaboration Review Manager 4.2 and Stata 10.0 software programs. Results We conducted a meta-analysis of 17 separate studies that evaluated the efficacy of treatment with the different antibiotic regimens for scrub typhus. The median time (h) to clearance of fever in the azithromycin-treated group was longer than that in the chloramphenicol-treated group (weighted mean difference [WMD] = 12.66, 95% confidence interval [CI]: 2.26,23.06). Adverse events were 2.95 (95%CI: 1.32, 6.61) times more likely to occur in the azithromycin-treated group than in the chloramphenicol-treated group. The clearance time (days) for the main symptoms (including fever, headache, rash and lymphadenectasis) in the doxycycline-treated group was shorter than that in the chloramphenicol-treated group (WMD = -0.4, 95%CI: -0.53, -0.26) in five trials. Adverse drug events occurred significantly less frequently in the azithromycin-treated group than in the doxycycline-treated group (relative risk [RR] = 0.47, 95%CI: 0.31,0.71). Conclusion Doxycycline was found to act more quickly, but more adverse drug events occur when using this regimen compared to azithromycin and chloramphenicol.

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Section: Introductionmentioning

confidence: 99%

Meta-analysis of Drug Treatment for Scrub Typhus in Asia

Fang

Huang²,

Tu³

et al. 2012

Intern. Med.

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“…Scrub typhus is seen in several parts of South-East Asia including India [4][5][6][7][8][9][10][11] , Bangladesh [12] , China [13] , Taiwan [14] , South Korea [15] , Japan [16] and Northern Australia [17] . Although scrub typhus has been reported from isolated parts of these countries [2,5,9,13,14] , it is likely that this disease is ubiquitous.…”

Section: Distribution Of Diseasementioning

confidence: 99%

Severe scrub typhus infection: Clinical features, diagnostic challenges and management

Peter

Sudarsan

Prakash

et al. 2015

WJCCM

139

121

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Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay (IFA) for the detection of IgM antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%.

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“…Human cases and flea vectors infected with Rickettsia typhi have commonly been reported in subtropical or temperate areas in Australia (Jones et al, 2004;Graves and Stenos, 2009) and the north island of New Zealand (Roberts et al, 2001;Gray et al, 2007;Irwin et al, 2013;Lim et al, 2012;Roberts et al, 2001;Lim et al, 2012) (Table 2). However, murine typhus is also considered endemic to tropical regions of Australia (ARRL, 2014).…”

Section: Typhus Group Rickettsioses In Oceaniamentioning

confidence: 95%

Distribution of rickettsioses in Oceania: Past patterns and implications for the future

et al. 2015

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Rickettsioses present a threat to human health worldwide, but relatively little is known on their epidemiology and ecology in Oceania. These bacteria are the cause of potentially fatal febrile illnesses in humans (categorized into scrub typhus, typhus group and spotted fever group rickettsioses). They are transmitted by arthropod vectors such as ticks, mites, fleas and lice, which are associated with vertebrate host animals including rodents and companion animals. We conducted a search in the scientific and grey literature of Rickettsia spp. and Orientia tsutsugamushi within the Oceania region. Human case reports, human serosurveys and PCR-based testing of vectors and host animals reviewed here highlight the widespread distribution of these pathogens in the region, with the majority of human serological and vector surveys reporting positive results. These findings suggest that rickettsioses may have a significantly higher burden of disease in Oceania than is currently appreciated due to diagnostic challenges. Furthermore, consideration of the ecology and risk factors for rickettsioses reported for Oceania suggests that their importance as a cause of undifferentiated acute febrile illness may grow in the future: environmental and social changes driven by predicted climate change and population growth have the potential to lead to the emergence of rickettsioses as a significant public health problem in Oceania.

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Rickettsioses in Australia

Cited by 55 publications

References 41 publications

Meta-analysis of Drug Treatment for Scrub Typhus in Asia

Meta-analysis of Drug Treatment for Scrub Typhus in Asia

Severe scrub typhus infection: Clinical features, diagnostic challenges and management

Distribution of rickettsioses in Oceania: Past patterns and implications for the future

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