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Volume 9, Number 5—May 2003

Dispatch

Emerging Rickettsioses of the Thai-Myanmar Border1

Philippe Parola*†‡, R. Scott Miller*, Philip McDaniel§, Sam R. Telford‡, Jean-Marc Rolain†, Chansuda Wongsrichanalai*, and Didier Raoult†Comments to Author 
Author affiliations: *Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand; †Unité de Médecine, Marseille, France; ‡Harvard School of Public Health, Boston, Massachusetts, USA; §Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi, Thailand

Main Article

Table

Clinical and laboratory data of patients with rickettsioses on the Thai-Myanmar border.

Patient no. Age/sex A.
bite Clinical signs accompanying fever Immunofluorescence serologic testinga
IgG/IgM early
IgG/IgM late



R
E
N
Other
SFG rickettsia antigens
R. typhi antigen
Orientia tsutsugamushi







Rh
Rc
Rjap
Rhon
Rslo
AT1
Rheil
Rfel

G
Kw
Kp
K
Scrub typhus


















1
29/M
Not noticed
No
No
Yes
Headache, stupor, meningism, thrombocytopenia,
↑ALT
0/16
0/16
0/0
0/0
0/16
0/16
0/8
0/8
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/32
256/32
0/8
0/8
0/8
256/32
0/0
0/0
2
50/F
Yes
Yesb
Yes
No
Chills, myalgia, vomiting, thrombocytopenia,
↑GGT ↑ALT
0/32
0/32
0/0
0/0
0/32
0/32
0/16
0/16
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
128/64
128/16
0/0
0/0
0/0
0/0
0/0
0/0
3
32/M
Yes
No
No
Yes
Headache, myalgia, cough, thrombocytopenia,
↑GGT ↑ALT
0/16
16/16
0/0
0/0
0/0
16/16
0/8
0/8
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
512/128
0/0
0/0
0/0
512/0
0/0
0/0
Murine typhus


















4
28/F

No
No
No
Chills, headache, vomiting, myalgia, cough, thrombocytopenia
16/128e
16/64e
16/64
16/64
16/8
0/0
16/16
16/64
16/16
16/8
0/0
0/0
0/32
0/8
0/0
0/0
64/128e32/32e
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
5
35/M
Not noticed
No
No
No
Chills, headache,
↑ALT
0/64
16/128
0/64
16/256
0/8
0/8
0/64
0/64
0/0
0/0
0/0
0/0
0/32
0/128
0/0
0/0
16/256512/256
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
6
37/F
Not noticed
No
No
No
Chills, headache, myalgia, vomiting, thrombocytopenia,
↑GGT ↑ALT
16/64
128/64
32/8
32/0
0/0
32/0
16/0
128/0
16/0
128/8
0/0
32/8
0/0
32/0
0/0
0/0
64/8512/256
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
7
20/F
Not noticed
No
No
No
Headache, back pain
0/128
16/64
0/64
0/64
0/0
0/64
0/32
0/64
0/0
0/164
0/0
0/8
0/0
0/0
0/0
0/0
0/64128/256
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
SFG rickettsioses


















8
70/F

No
No
No
Chills, headache, vomiting, hepatomegaly, leukopenia
0/32
32/32
0/32
32/32
0/0
0/0
0/8
16/8
0/0
0/0
0/0
0/0
0/0
0/0
0/01024/256d
0/0
0/256d
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
9
50/M
Not noticed
Yesc
Yes
Yes
Chills, abdominal
pain, confusion, thrombocytopenia
64/8d
64/16
128/16d128/16
32/0d
32/0
32/0d
64/0
32/0d
128/0
0/0
0/0
16/0d
32/8
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
10
45/M

No
No
Yes
Vomiting, diarrhea, hepato-splenomegaly
16/32d
64/32
64/32d64/32
16/32d
32/16
16/0d
32/16
16/16d
16/16
0/0
0/0
16/8d
32/16
0/0
0/0
0/16d
16/32
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
11
35/M
Tick bite
No
Yes
No
Chills, headache, vomiting, myalgia, cough, splenomegaly,
↑GGT ↑ALT
64/25616/128
0/16
16/32
16/8
0/8
16/256
16/128
0/64
0/64
0/32
16/8
32/32
0/16
0/0
0/0
0/256
0/256
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
12
37/F
A. removed from ear
No
No
No
Chills, headache, vomiting, myalgia, cough, ↑GGT ↑ALT
0/16128/32
0/0
0/0
0/0
64/0
0/0
32/16
0/0
16/32
0/8
0/0
0/8
32/16
0/0
0/0
0/32
0/64
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
13
20/F
Tick bite
No
Yes
No
Headache, chills, myalgia
32/16d64/16
32/0d
32/0
32/0d
64/0
64/0d
128/0
32/8d
64/8
0/0
0/0
0/0
0/0
32/0d
64/0
0/0
512/0
512/0
0/0
0/0
0/0
14
55/F

No
No
No
Chills, headache, myalgia, diarrhea, thrombocytopenia
16/32128/16
16/16
16/16
16/16
16/16
16/16
16/16
16/16
64/0
16/16
16/16
16/0
64/0
32/0
64/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
0/0
15 29/M Yesb No No Chills, headache, myalgia, cough, thrombocytopenia,
↑GGT ↑ALT 16/1664/64d 16/16
32/32d 32/16
32/32d 32/16
32/32d 16/0
64/64d 32/16
32/32d 16/0
64/64d 16/16
64/64d 0/0
0/0 256/0
256/0 256/0
256/0 0/0
0/0 0/0
0/0

Abbreviations: A., arthropod; Ig, immunoglobulin; R, rash; E, eschar; N, nodes; Rh, Rickettsia helvetica; Rc, R. conorii Indian; Rjap, R. japonica; Rhon, R. honei; Rslo, R. slovaca; AT1, Rickettsia strain AT1 from Japan; Rheil, “R. heilongjiangii”; Rfel, R. felis; G, strain Gilliam; Kw, strain Kawazaki; Kp, strain Karp; Ko, strain Kato.
aImmunofluorescence assay was completed by Western blot and cross-adsorption as described in the text. For typhus and spotted fever group antigens, the rickettsia considered potentially responsible for the infection are in bold type.
bMaculopapular over chest and back.
cVesiculous on the legs.
dAntigens and sera used for Western blot assays.
eAntigens and sera used for Western blot and cross-adsorption assays.

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1These results were presented in part at the 3rd International Conference on Emerging Infectious Diseases, March 24–27, 2002, Atlanta, Georgia, USA.

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