Comparison of the Efficacy and Safety between Doxycycline and Moxifloxacin in the Treatment of Tsutsugamushi Disease

Objective: To explore the efficacy and safety of doxycycline and moxifloxacin in the treatment of tsutsugamushi disease. Methods: There was a total of 80 cases of tsutsugamushi disease that were treated in Jiangsu Sihong Fenjinting Hospital from January 2017 to August 2020. The patients were divided into group A and group B, with 40 cases in each group. The patients in group A were treated with moxifloxacin whereas those in group B were treated with doxycycline. The efficacy and safety of the clinical treatment between the two groups were compared. Results: The effective rate was 72.5% in group A and 95.0% in group B. Compared with group A, group B was better (p < 0.05). The time taken for the resolution of clinical symptoms, the detection indexes of liver function, and the incidence of adverse reactions were also compared between the two groups, in which group B was significantly better than group A (p < 0.05). Conclusion: In the clinical treatment of tsutsugamushi disease, doxycycline has better therapeutic effect and higher safety compared to moxifloxacin. It can significantly improve the patient’s liver function, reduce the probability of adverse reactions, and accelerate the patient’s physical recovery.

Clinical Features of Severe Tsutsugamushi Disease Complicated with Hemophagocytic Lymphohistiocytosis

The article discusses a case of severe tsutsugamushi disease complicated with hemophagocytic syndrome in Guangdong Maternal and Child Health Hospital and concludes that blood purification technology has significant therapeutic effect among children with severe HLH complicated with multiple organ dysfunction.

Nationwide Incidence of Chigger Mite Populations and Molecular Detection of Orientia tsutsugamushi in the Republic of Korea, 2020

The Korea Disease Control and Prevention Agency has established regional centers at 16 locations to monitor vectors and pathogens. We investigated the geographical and temporal distribution of chigger mite populations to understand tsutsugamushi disease epidemiology in 2020. To monitor weekly chigger mite populations, 3637 chigger mites were collected from sticky chigger mite traps in autumn. Chigger mites appeared from the first week of October to the third week of December, peaking in the fourth week of October. The predominant species were Leptotrombidium scutellare, Leptotrombidium palpale, Neotrombicula kwangneungensis, Neotrombicula tamiyai, and Leptotrombidium pallidum. To monitor Orientia tsutsugamushi infection in chigger mites, 50,153 chigger mites were collected from 499 trapped wild rodents in spring and autumn, with a chigger index of 100.5. Approximately 50% of chigger mites were pooled into 998 pools, and the minimum infection rate (MIR) of O. tsutsugamushi was 0.1%. Jeongeup had the highest MIR for O. tsutsugamushi (0.7%). The Kato-related genotype was the most common (52.2%), followed by the Karp-related (17.4%), Boryong (13.0%), JG-related (8.7%), Shimokoshi (4.3%), and Kawasaki (4.3%) genotypes. Ecological and geographical studies focusing on the basic ecology and pathology of mites will improve our understanding of tsutsugamushi disease risks in the Republic of Korea.

Monitoring Chigger Mites for Orientia tsutsugamushi in Field Small Mammals in Hwaseong-si, Gyeonggi-do, Korea, 2019-2020

Incidence of tsutsugamushi disease (scrub typhus) caused by Orientia tsutsugamushi, is steadily increasing. It is a mite-borne disease transmitted by chigger mites. In this study, the chigger mites were collected from field small mammals in Hwaseong-si (city), Gyeonggi-do (province), Korea, 2019 and 2020. The field small mammals captured were 56 Apodemus agrarius (94.9%) and 3 Crocidura lasiura (5.1%). A total of 7,531 chigger mites were collected from the captured small mammals. Using PCR test, 153 chigger mite pools were examined and 17 pools were reported positive for O. tsutsugamushi. The O. tsutsugamushi were identified to 5 strains; Jecheon strain was most prevalent, followed by Boryong strain. The other strains were OI011, Taguchi, and Shimokoshi. Collectively, these results provide essential regional information on mite-borne tsutsugamushi disease in the Hwaseong-si, and further contribute to bring awareness and rapid diagnosis for the tsutsugamushi disease.

Surveillance of Chigger Mite Vectors for Tsutsugamushi Disease in the Hwaseong Area, Gyeonggi-do, Republic of Korea, 2015

Owing to global climate change, the global resurgence of vector-borne infectious diseases and their potential to inflict widespread casualties among human populations has emerged as a pivotal burden on public health systems. Tsutsugamushi disease (scrub typhus) in the Republic of Korea is steadily increasing and was designated as a legal communicable disease in 1994. The disease is a mite-borne acute febrile disease most commonly contracted from October to December. In this study, we tried to determine the prevalence of tsutsugamushi disease transmitted by chigger mites living on rodents and investigated their target vector diversity, abundance, and distribution to enable the mapping of hotspots for this disease in 2015. A total of 5 species belonging to 4 genera (109 mites): Leptotrombidium scutellare 60.6%, L. pallidum 28.4% Neotrombicula tamiyai 9.2%, Euschoengastia koreaensis/0.9%), and Neoschoengastia asakawa 0.9% were collected using chigger mite collecting traps mimicking human skin odor and sticky chigger traps from April to November 2015. Chigger mites causing tsutsugamushi disease in wild rodents were also collected in Hwaseong for the zoonotic surveillance of the vector. A total of 77 rodents belonging to 3 genera: Apodemus agrarius (93.5%), Crocidura lasiura (5.2%), and Micromys minutus (1.3%) were collected in April, October, and November 2015. The most common mite was L. pallidum (46.9%), followed by L. scutellare (18.6%), and L. orientale (18.0%). However, any of the chigger mite pools collected from rodent hosts was tested positive for Orientia tsutsugamushi, the pathogen of tsutsugamushi disease, in this survey.

Kawasaki disease with tsutsugamushi disease: two case reports

A number of microorganisms were hypothesised as an aetiology of the Kawasaki disease. Unfortunately, no specific agent that provides reproducible evidence has yet been reported. We report two cases of extremely rare Kawasaki disease with tsutsugamushi disease. These case reports suggest that Kawasaki disease can rarely occur concurrently or immediately after a rickettsial illness such as tsutsugamushi disease.

Scrub typhus

Orientia spp. are obligate intracellular Gram-negative bacteria that cause scrub typhus, historically known as ‘tsutsugamushi disease’, a febrile illness characterized by early non-specific ‘flu-like’ symptoms, and sometimes a diffuse, macular, or maculopapular rash and/or a necrotic lesion eschar at the inoculation site. Leptotrombidium mites transmit Orientia spp. to humans via the bite of the larval stage, while all mite stages act as bacterial reservoirs through vertical transovarial and transstadial transmission. Scrub typhus is a leading cause of treatable undifferentiated febrile illness in many regions of Asia, and unfortunately remains an underappreciated neglected disease, mainly due to diagnostic difficulties and lack of awareness among medical staff. Complications include meningo-encephalitis, respiratory and renal failure, and severe multiorgan failure. Scrub typhus can be treated effectively with tetracyclines, macrolides, and chloramphenicol. Humans are dead-end hosts and do not participate in the Orientia life cycle, hence treatment does not affect overall disease incidence.