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The winter soldier
\"Vienna, 1914. Lucius is a twenty-two-year-old medical student when World War I explodes across Europe. Enraptured by romantic tales of battlefield surgery, he enlists, expecting a position at a well-organized field hospital. But when he arrives--at a commandeered church tucked away high in a remote valley of the Carpathian Mountains--he discovers a freezing outpost ravaged by typhus. The other doctors have fled, and only a single mysterious nurse named Sister Margarete remains. But Lucius has never lifted a surgeon's scalpel. And as the war rages across the winter landscape, he finds himself falling in love with the woman from whom he must learn a brutal makeshift medicine. Then one day, an unconscious soldier is brought in from the snow, his uniform stuffed with strange drawings. He seems beyond rescue, until Lucius makes a fateful decision that will change the lives of doctor, patient, and nurse forever\"--Provided by publisher.
Book
A review of the global epidemiology of scrub typhus
Scrub typhus is a serious public health problem in the Asia-Pacific area. It threatens one billion people globally, and causes illness in one million people each year. Caused by Orientia tsutsugamushi, scrub typhus can result in severe multiorgan failure with a case fatality rate up to 70% without appropriate treatment. The antigenic heterogeneity of O. tsutsugamushi precludes generic immunity and allows reinfection. As a neglected disease, there is still a large gap in our knowledge of the disease, as evidenced by the sporadic epidemiologic data and other related public health information regarding scrub typhus in its endemic areas. Our objective is to provide a systematic analysis of current epidemiology, prevention and control of scrub typhus in its long-standing endemic areas and recently recognized foci of infection.
Journal Article
DHR-ICMR Guidelines for diagnosis & management of Rickettsial diseases in India
Rickettsial diseases, caused by a variety of obligate intracellular, gram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma, belonging to the Alphaproteobacteria, are considered some of the most covert emerging and re-emerging diseases and are being increasingly recognized. Among the major groups of rickettsioses, commonly reported diseases in India are scrub typhus, murine flea-borne typhus, Indian tick typhus and Q fever. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45 per cent with multiple organ dysfunction, if not promptly diagnosed and appropriately treated. The vast variability and non-specific presentation of this infection have often made it difficult to diagnose clinically. Prompt antibiotic therapy shortens the course of the disease, lowers the risk of complications and in turn reduces morbidity and mortality due to rickettsial diseases. There is a distinct need for physicians and health care workers at all levels of care in India to be aware of the clinical features, available diagnostic tests and their interpretation, and the therapy of these infections. Therefore, a Task Force was constituted by the Indian Council of Medical Research (ICMR) to formulate guidelines for diagnosis and management of rickettsial diseases. These guidelines include presenting manifestations, case definition, laboratory criteria (specific and supportive investigations) and treatment.
Journal Article
A spatio-temporal analysis of scrub typhus and murine typhus in Laos; implications from changing landscapes and climate
Scrub typhus (ST) and murine typhus (MT) are common but poorly understood causes of fever in Laos. We examined the spatial and temporal distribution of ST and MT, with the intent of informing interventions to prevent and control both diseases.
This study included samples submitted from 2003 to 2017 to Mahosot Hospital, Vientiane, for ST and MT investigation. Serum samples were tested using IgM rapid diagnostic tests. Patient demographic data along with meteorological and environmental data from Laos were analysed. Approximately 17% of patients were positive for either ST (1,337/8,150 patients tested) or MT (1,283/7,552 patients tested). While both diseases occurred in inhabitants from Vientiane Capital, from the univariable analysis MT was positively and ST negatively associated with residence in Vientiane Capital. ST was highly seasonal, with cases two times more likely to occur during the wet season months of July-September compared to the dry season whilst MT peaked in the dry season. Multivariable regression analysis linked ST incidence to fluctuations in relative humidity whereas MT was linked to variation in temperature. Patients with ST infection were more likely to come from villages with higher levels of surface flooding and vegetation in the 16 days leading up to diagnosis.
The data suggest that as cities expand, high risk areas for MT will also expand. With global heating and risks of attendant higher precipitation, these data suggest that the incidence and spatial distribution of both MT and ST will increase.
Journal Article
Human rickettsial infections in India - A review
Rickettsial infections are emerging and/or re-emerging disease that poses a serious global threat to humans and animals. Transmission to humans and animals is through the bite of the ectoparasites including ticks, fleas and chigger mites. Most of the rickettsial diseases are endemic in India, but underdiagnosed. This review is aimed at analyzing the prevalence of rickettsiosis in India and the advancement of rickettsial diagnosis. We have conducted a systematic review on the prevalence of rickettsial disease in India ranging from 1.3% to 46.6% for spotted fever, 2.4% to 77.8% for scrub typhus and 1% to 46.4% for Q fever, based on the literature published with the evidence of isolation, serological, and molecular diagnostics. Search engines Medline/PubMed, Science Direct, ProQuest, and EBSCO were used to retrieve the articles from electronic databases by using appropriate keywords to track the emergence of these rickettsial diseases in India for the period of 1865 to till date. We retrieved 153 published rickettsial articles on hospital-based studies from India that were purely made on the basis of prevalence and the laboratory parameters viz., Weil-Felix test (WF) and Rapid Immunochromatographic tests (RICT) with reference to the gold standard IFA and ELISA. More epidemiological studies are required for epidemic typhus to know the exact prevalence status of this louse-borne rickettsiosis in India. Currently, there is no confirmed specific inflammatory marker for rickettsial diseases. Moreover, serological cross-reactivity is an important aspect, and it should be investigated in endemic areas, there is also a need to include molecular diagnostic techniques for further confirmation in healthcare settings.
Journal Article
Endemic Scrub Typhus in South America
Scrub typhus, caused by
Orientia tsutsugamushi,
has been thought to be geographically restricted to the “tsutsugamushi triangle” in the Asia–Pacific region. In this report, a potential focus in southern Chile is identified.
Scrub typhus is a vector-borne zoonosis caused by
Orientia tsutsugamushi
. The infection is transmitted by “chiggers” (i.e., the larvae of trombiculid mites of the genus leptotrombidium). Although chiggers feed on various vertebrates, the main reservoir is the vector itself, which maintains orientia organisms through transstadial and transovarial transmission.
1
After the bite of an infective chigger, a characteristic necrotic inoculation lesion, termed eschar, can develop, which typically contains high bacterial loads. The microorganism then spreads through the lymphatic fluid and blood, causing systemic manifestations that include fever, rash, and laboratory abnormalities such as elevated levels of C-reactive protein and liver . . .
Journal Article
Nonnegligible Seroprevalence and Predictors of Murine Typhus, Japan
To elucidate the epidemiology of murine typhus, which is infrequently reported in Japan, we conducted a cross-sectional study involving 2,382 residents of rickettsiosis-endemic areas in Honshu Island during August-November 2020. Rickettsia typhi seroprevalence rate was higher than that of Orientia tsutsugamushi, indicating that murine typhus is a neglected disease.
Journal Article
Correction: Use of eschar swabbing for the molecular diagnosis and genotyping of Orientia tsutsugamushi causing scrub typhus in Quang Nam province, Vietnam
[This corrects the article DOI: 10.1371/journal.pntd.0005397.].
Journal Article
Specter of Epidemic Typhus
Typhus fevers—including scrub typhus, murine typhus, and epidemic typhus—are vectorborne rickettsial diseases spread to humans by chiggers, fleas, and lice, respectively. Epidemic typhus, sometimes called louse-borne typhus, is caused by the bacterium Rickettsia prowazekii, and this form of typhus is transmitted to humans by the body louse Pediculus humanus humanus.Though now considered an uncommon disease, epidemic typhus outbreaks resulted in millions of deaths during previous centuries in Europe, Mexico, South America, and Central America. Such outbreaks were prevalent among people living in poverty, displaced and homeless populations, prisoners, and military troops. According to infectious disease researchers Emmanouil Angelakis, Yassina Bechah, and Didier Raoult, “Epidemic typhus has accompanied disasters that impact humanity and has arguably determined the outcome of more wars than have soldiers and generals.” Now, new concerns exist about possible outbreaks of epidemic typhus in war-torn areas, such as parts of Ukraine.
Journal Article
Association of Scrub Typhus in Children with Acute Encephalitis Syndrome and Meningoencephalitis, Southern India
Scrub typhus is an established cause of acute encephalitis syndrome (AES) in northern states of India. We systematically investigated 376 children with AES in southern India, using a stepwise diagnostic strategy for the causative agent of scrub typhus, Orientia tsutsugamushi, including IgM and PCR testing of blood and cerebrospinal fluid (CSF) to grade its association with AES. We diagnosed scrub typhus in 87 (23%) children; of those, association with AES was confirmed in 16 (18%) cases, probable in 55 (63%), and possible in 16 (18%). IgM detection in CSF had a sensitivity of 93% and specificity of 82% compared with PCR. Our findings suggest scrub typhus as an emerging common treatable cause of AES in children in southern India and highlight the importance of routine testing for scrub typhus in diagnostic algorithms. Our results also suggest the potential promise of IgM screening of CSF for diagnosis of AES resulting from scrub typhus.
Journal Article