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Volume 25, Number 4—April 2019
CME ACTIVITY - Synopsis

Clinical Manifestations and Molecular Diagnosis of Scrub Typhus and Murine Typhus, Vietnam, 2015–2017

Nguyen Vu Trung, Le Thi Hoi, Vu Minh Dien, Dang Thi Huong, Tran Mai Hoa, Vu Ngoc Lien, Phan Van Luan, Sonia Odette Lewycka, Marc Choisy, Juliet E. Bryant, Behzad Nadjm, H. Rogier van Doorn, Allen L. RichardsComments to Author , and Nguyen Van Kinh
Author affiliations: National Hospital for Tropical Diseases, Hanoi, Vietnam (N.V. Trung, L.T. Hoi, V.M. Dien, D.T. Huong, T.M. Hoa, V.N. Lien, N.V. Kinh); Hanoi Medical University, Hanoi (N.V. Trung, L.T. Hoi, P.V. Luan, N.V. Kinh); Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi (S.O. Lewycka, M. Choisy, J.E. Bryant, B. Nadjm, H.R. van Doorn); University of Oxford, UK (S.O. Lewycka, B. Nadjm, H.R. van Doorn); Institute of Research for Development, Marseille, France (M. Choisy); Merieux Foundation, Lyon, France (J.E. Bryant); Naval Medical Research Center, Silver Spring, Maryland, USA (A.L. Richards); Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (A.L. Richards)

Main Article

Table 2

Comparison of signs and symptoms for patients with scrub typhus from Hanoi Province with patients from other provinces, northern Vietnam, March 2015–March 2017*

Sign or symptom p value
Noncorrected Corrected
Headache 0.7041 0.9071
Myalgia 0.8773 0.9071
Eye pain 0.7745 0.9071
Nausea 0.7295 0.9071
Vomiting 0.5109 0.9071
Diarrhea 0.8530 0.9071
Abdominal pain 0.2053 0.6676
Throat pain 0.8128 0.9071
Cough 0.0158 0.2194
Rash 0.8683 0.9071
Eschar 0.0219 0.2194
Skin hyperemia 0.3239 0.8098
Congestive conjuctiva 0.9071 0.9071
Lymphadenopathy 0.0590 0.3479
Edema 0.0696 0.3479
Rales 0.6423 0.9071
Resonance from lungs 0.5542 0.9071
Liver enlargement 0.2089 0.6676
Spleen enlargement 0.5725 0.9071
Convulsions 0.2336 0.6676

*n = 115; results use Fisher exact test, expressed in p values and corrected using multiple comparisons and the Benjamini and Hochberg method (20).

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References
  1. Jensenius  M, Fournier  PE, Raoult  D, Raoult  D. Rickettsioses and the international traveler. Clin Infect Dis. 2004;39:14939. DOIPubMed
  2. Blanton  LS, Dumler  JS, Walker  DH. Rickettsia typhi (murine typhus). In: Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier Inc.; 2014. p. 2221–4.e2.
  3. Day  NPJ, Newton  PN. Scrub typhus and other tropical rickettsioses. In: Cohen J, Powderly WG, Opal SM, eds. Infectious diseases. 4th ed. Amsterdam: Elsevier Inc.; 2017. p. 1091–1097.e1.
  4. Duong  V, Mai  TT, Blasdell  K, Lo  V, Morvan  C, Lay  S, et al. Molecular epidemiology of Orientia tsutsugamushi in Cambodia and Central Vietnam reveals a broad region-wide genetic diversity. Infect Genet Evol. 2013;15:3542. DOIPubMed
  5. Liu  D. Rickettsia. In: Tang Y-W, Sussman M, Dongyou L, Poxton I, Schwartzman J, eds. Molecular medical microbiology. 2nd ed. Boston: Academic Press; 2015. p. 2043–2056.
  6. Miller  MB, Blankenship  R, Bratton  JL, Lohr  DC, Hunt  J, Reynolds  RD. Murine typhus in Vietnam. Mil Med. 1974;139:1846. DOIPubMed
  7. Lim  C, Paris  DH, Blacksell  SD, Laongnualpanich  A, Kantipong  P, Chierakul  W, et al. How to determine the accuracy of an alternative diagnostic test when it is actually better than the reference tests: A re-evaluation of diagnostic tests for scrub typhus using Bayesian LCMs. PLoS One. 2015;10:e0114930. DOIPubMed
  8. Berman  SJ, Kundin  WD. Scrub typhus in South Vietnam. A study of 87 cases. Ann Intern Med. 1973;79:2630. DOIPubMed
  9. Aung  AK, Spelman  DW, Murray  RJ, Graves  S. Rickettsial infections in Southeast Asia: implications for local populace and febrile returned travelers. Am J Trop Med Hyg. 2014;91:45160. DOIPubMed
  10. Azuma  M, Nishioka  Y, Ogawa  M, Takasaki  T, Sone  S, Uchiyama  T. Murine typhus from Vietnam, imported into Japan. Emerg Infect Dis. 2006;12:14668. DOIPubMed
  11. Hamaguchi  S, Cuong  NC, Tra  DT, Doan  YH, Shimizu  K, Tuan  NQ, et al. Clinical and epidemiological characteristics of scrub typhus and murine typhus among hospitalized patients with acute undifferentiated fever in Northern Vietnam. Am J Trop Med Hyg. 2015;92:9728. DOIPubMed
  12. Nadjm  B, Thuy  PT, Trang  VD, Ha  D, Kinh  NV, Wertheim  HF. Scrub typhus in the northern provinces of Vietnam: an observational study of admissions to a national referral hospital. Trans R Soc Trop Med Hyg. 2014;108:73940. DOIPubMed
  13. Le Viet  N, Laroche  M, Thi Pham  HL, Viet  NL, Mediannikov  O, Raoult  D, et al. Use of eschar swabbing for the molecular diagnosis and genotyping of Orientia tsutsugamushi causing scrub typhus in Quang Nam province, Vietnam. PLoS Negl Trop Dis. 2017;11:e0005397. DOIPubMed
  14. Graf  PC, Chretien  JP, Ung  L, Gaydos  JC, Richards  AL. Prevalence of seropositivity to spotted fever group rickettsiae and Anaplasma phagocytophilum in a large, demographically diverse US sample. Clin Infect Dis. 2008;46:707. DOIPubMed
  15. Trung  NV, Hoi  LT, Thuong  NTH, Toan  TK, Huong  TTK, Hoa  TM, et al. Seroprevalence of scrub typhus, typhus, and spotted fever among rural and urban populations of northern Vietnam. Am J Trop Med Hyg. 2017;96:10847. DOIPubMed
  16. Henry  KM, Jiang  J, Rozmajzl  PJ, Azad  AF, Macaluso  KR, Richards  AL. Development of quantitative real-time PCR assays to detect Rickettsia typhi and Rickettsia felis, the causative agents of murine typhus and flea-borne spotted fever. Mol Cell Probes. 2007;21:1723. DOIPubMed
  17. Jiang  J, Chan  T-C, Temenak  JJ, Dasch  GA, Ching  W-M, Richards  AL. Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi. Am J Trop Med Hyg. 2004;70:3516. DOIPubMed
  18. Jiang  J, Stromdahl  EY, Richards  AL. Detection of Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Gulf Coast ticks collected from humans in the United States. Vector Borne Zoonotic Dis. 2012;12:17582. DOIPubMed
  19. Wright  CL, Nadolny  RM, Jiang  J, Richards  AL, Sonenshine  DE, Gaff  HD, et al. Rickettsia parkeri in gulf coast ticks, southeastern Virginia, USA. Emerg Infect Dis. 2011;17:8968. DOIPubMed
  20. Benjamini  Y, Hochberg  Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B. 1995;57:289300. DOI
  21. Strickman  D, Tanskul  P, Eamsila  C, Kelly  DJ. Prevalence of antibodies to rickettsiae in the human population of suburban Bangkok. Am J Trop Med Hyg. 1994;51:14953. DOIPubMed
  22. Kramme  S, An  V, Khoa  ND, Trin  V, Tannich  E, Rybniker  J, et al. Orientia tsutsugamushi bacteremia and cytokine levels in Vietnamese scrub typhus patients. J Clin Microbiol. 2009;47:5869. DOIPubMed
  23. Luce-Fedrow  A, Mullins  K, Kostik  AP, St John  HK, Jiang  J, Richards  AL. Strategies for detecting rickettsiae and diagnosing rickettsial diseases. Future Microbiol. 2015;10:53764. DOIPubMed
  24. Phongmany  S, Rolain  JM, Phetsouvanh  R, Blacksell  SD, Soukkhaseum  V, Rasachack  B, et al. Rickettsial infections and fever, Vientiane, Laos. Emerg Infect Dis. 2006;12:25662. DOIPubMed
  25. Silpapojakul  K, Varachit  B, Silpapojakul  K. Paediatric scrub typhus in Thailand: a study of 73 confirmed cases. Trans R Soc Trop Med Hyg. 2004;98:3549. DOIPubMed
  26. Sonthayanon  P, Chierakul  W, Wuthiekanun  V, Blacksell  SD, Pimda  K, Suputtamongkol  Y, et al. Rapid diagnosis of scrub typhus in rural Thailand using polymerase chain reaction. Am J Trop Med Hyg. 2006;75:1099102. DOIPubMed
  27. Kim  DM, Kim  HL, Park  CY, Yang  TY, Lee  JH, Yang  JT, et al. Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study. Clin Infect Dis. 2006;43:1296300. DOIPubMed
  28. Liu  Y-X, Feng  D, Zhang  Q, Jia  N, Zhao  Z-T, De Vlas  SJ, et al. Key differentiating features between scrub typhus and hemorrhagic fever with renal syndrome in northern China. Am J Trop Med Hyg. 2007;76:8015. DOIPubMed
  29. Taylor  AJ, Paris  DH, Newton  PN. A systematic review of mortality from untreated scrub typhus (Orientia tsutsugamushi). PLoS Negl Trop Dis. 2015;9:e0003971. DOIPubMed
  30. Weng  SC, Lee  HC, Chen  JJ, Cheng  YJ, Chi  H, Lin  CY. Eschar: a stepping stone to scrub typhus. J Pediatr 2017;181:320–320 e1.
  31. Jamil  M, Lyngrah  KG, Lyngdoh  M, Hussain  M. Clinical manifestations and complications of scrub typhus: a hospital based study from North Eastern India. J Assoc Physicians India. 2014;62:1923.PubMed
  32. Ogawa  M, Hagiwara  T, Kishimoto  T, Shiga  S, Yoshida  Y, Furuya  Y, et al. Scrub typhus in Japan: epidemiology and clinical features of cases reported in 1998. Am J Trop Med Hyg. 2002;67:1625. DOIPubMed
  33. Silpapojakul  K, Chupuppakarn  S, Yuthasompob  S, Varachit  B, Chaipak  D, Borkerd  T, et al. Scrub and murine typhus in children with obscure fever in the tropics. Pediatr Infect Dis J. 1991;10:2003. DOIPubMed
  34. Tsay  RW, Chang  FY. Serious complications in scrub typhus. J Microbiol Immunol Infect. 1998;31:2404.PubMed
  35. Tsay  RW, Chang  FY. Acute respiratory distress syndrome in scrub typhus. QJM. 2002;95:1268. DOIPubMed
  36. Hu  M-L, Liu  J-W, Wu  K-L, Lu  S-N, Chiou  S-S, Kuo  C-H, et al. Short report: Abnormal liver function in scrub typhus. Am J Trop Med Hyg. 2005;73:6678. DOIPubMed
  37. Tsai  CC, Lay  CJ, Ho  YH, Wang  LS, Chen  LK. Intravenous minocycline versus oral doxycycline for the treatment of noncomplicated scrub typhus. J Microbiol Immunol Infect. 2011;44:338. DOIPubMed
  38. Watt  G, Chouriyagune  C, Ruangweerayud  R, Watcharapichat  P, Phulsuksombati  D, Jongsakul  K, et al. Scrub typhus infections poorly responsive to antibiotics in northern Thailand. Lancet. 1996;348:869. DOIPubMed
  39. Le-Viet  N, Phan  DT, Le-Viet  N, Trinh  S, To  M, Raoult  D, et al. Dual genotype Orientia tsutsugamushi infection in patient with rash and eschar, Vietnam, 2016. Emerg Infect Dis. 2018;24:15203. DOIPubMed

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Page created: March 16, 2019
Page updated: March 16, 2019
Page reviewed: March 16, 2019
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