The Past and Present Threat of Rickettsial Diseases to Military Medicine and International Public Health

Abstract

Morbidity and mortality caused by rickettsioses have had a major influence on military activities and public health for >2000 years. The threat posed by the rickettsioses is reviewed, focusing on the impact and epidemiology of those that have adversely influenced wartime operations and the current challenges posed by these diseases. With their uneven worldwide distribution, the discovery of drug-refractory strains of Orientia tsutsugamushi, the increased threat of their use in acts of bioterrorism, frequent deployment of troops to regions of endemicity, and exposures due to increased humanitarian missions, these diseases continue to be a threat to military personnel in the field. Effective strategies to reduce the impact of these diseases include development of effective vaccines, enhanced surveillance, and development of new safe, effective, and odorless repellants. The continuation of a proven, highly productive military infectious disease research program is essential for providing solutions to these daunting tasks.

Rickettsial neglected zoonoses: prevalence of scrub typhus at central Karnataka

“…10,11 The common clinical features include fever, headache, rash, lymphadenopathy and in some presence of an eschar could be pathognomonic, but it is typically unnoticed or misdiagnosed. [12][13][14] In very few cases pulmonary involvement could occur and it is the principal cause of death in complicated disease. 10,11 In the present study fever was the commonest symptom followed by myalgia, headache, hepatomegaly and splenomegaly.…”

“…Our finding is in correlation with other studies. 7,8,12,15 The sharing of antigens between rickettsia and Proteus is the basis of Weil Felix test. It demonstrates antibodies to Proteus vulgaris strain OX 19, OX2 and OX K. Most of the Western research has advised against performing this test for diagnosis of rickettsial infections.…”

Isolation and Characterization of Orientia tsutsugamushi from Rodents Captured following a Scrub Typhus Outbreak at a Military Training Base, Bothong District, Chonburi Province, Central Thailand

“…16 Mortality rates for scrub typhus range from < 1% to 50% depending upon proper antibiotic treatment, health status of the patient, and virulence of the infected strain of O. tsutsugamushi encountered. 17 Antigenic differences among isolates of O. tsutsugamishi were clearly demonstrated in 1962. 18 Originally, there were three distinctive antigen prototype strains of O. tsutsugamishi described: Karp, Kato, and Gilliam.…”

Rickettsiosis as Threat for the Traveller

“…. Some cases of louse-borne typhus in travellers have been published (Zanetti et al, 1998;Kelly et al, 2002). Endemic typhus or murine typhus is associated with the presence of fleas.…”

“…In severe cases mainly associated with epidemic typhus, evolution to a multiple-organ dysfunction syndrome and coagulation disorders may appear. Some references related to travellers are: Zanetti et al, 1998;Niang et al, 1999;Kelly et al, 2002;Jensenius et al, 2004;Azuma et al, 2006;Angelakis et al, 2010;Walter et al, 2011. …”