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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
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
Charles Nicolle, Pasteur's Imperial Missionary
This book examines the biomedical research of Nobel Prize-winning bacteriologist Charles Nicolle during his tenure as director of the Pasteur Institute of Tunis. Using typhus as its lens, it demonstrates how the complexities of early twentieth century bacteriology, French imperial ideology, the \"Pastorian mission,\" and conditions in colonial Tunisia blended to inform the triumphs and disappointments of Nicolle's fascinating career. It illuminates how these diverse elements shaped Nicolle's personal identity, the identity of his institute, and his innovative conception of the \"birth, life, and death\" -- or, the emergence and eradication -- of infectious disease. Kim Pelis blends exhaustive archival research with a close reading of Nicolle's written work -- scientific papers, philosophical treatises, and literary contributions -- to explore the complex relations between biomedical ideas and sociocultural context. The result is a study that will be of interest not only to students of French history, colonial medicine, and the history of the biomedical sciences but also to anyone seeking to understand how individuals have attempted to deal creatively with complex times and ambiguous knowledge. Kim Pelis, a medical historian by training, is a writer for the director of the National Institutes of Health.
eBook
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
A review of Rickettsial diseases other than scrub typhus in India
Rickettsial diseases (RD) are widely reported all over the world. Scrub typhus (ST) is a major tropical infection which is well documented all over India. Therefore, the index of suspicion of scrub typhus is high among physicians with regard to patients presenting with acute febrile illness (AFI) and acute undifferentiated febrile illness (AUFI) in India. Rickettsial diseases other than ST (non-ST RDs), which include spotted fever group (SFG) rickettsioses and typhus group (TG) rickettsioses are not uncommon in India, but the index of suspicion is not as high as ST unless there is a history of the presence of fever with rashes and/or recent arthropod bites. This review aims to look into the Indian scenario on the epidemiology of non-ST RDs, especially the SFG and TG rickettsioses based on various investigations, spectrum of clinical presentation, challenges and gaps in knowledge to suspect and diagnose these infections.
Journal Article
Incidence of scrub typhus according to changes in geographic and demographic characteristic in the Chungcheong region of Korea
To ascertain the incidence trends of scrub typhus in the Chungcheong region, we analyzed the epidemiological survey information of 14,379 cases of scrub typhus reported to the integrated disease health management system of the Korea Centers for Disease Control and Prevention be- tween 2012 and 2022, along with demographic data from the Korean Statistics Information Service. Geographical analyses were performed to confirm the correlation between high-risk areas and the proportion of elderly people. The average age, proportion of elderly people, and changes in the agricultural population were statistically associated with incidence. The incidence of scrub typhus, and the agricultural population, in the Chungcheong region has decreased compared with that in 2012-2013. However, recent trends indicate a resurgence linked to increased outdoor activity, with higher risks observed in older age groups. Additionally, advancing age correlates with a heightened probability of reinfection and additional infections with other febrile diseases. The incidence of scrub typhus in the Chungcheong region (2012-2022) is changing according to age and route of infection, highlighting the need for revised prevention and promotion policies.
Journal Article
Serological evidence of spotted fever group rickettsiosis in and around Puducherry, south India-A three years study
Background & objectives: Rickettsial diseases are important re-emerging infections that mostly go unnoticed or are misdiagnosed. Though few case reports of Indian tick typhus have been reported in Indian literature in the past 10 yr, prevalence surveys are few and far between. The objective of this research was to study the seroprevalence of spotted fever (SF) group rickettsiosis and its coinfection with scrub typhus (ST) in Puducherry region of south India, as these two diseases may show similar clinical presentations.
Methods: During 2012-2015, paired sera of 320 febrile patients were examined for Rickettsia conorii IgM/IgG by ELISA and OX19 and OX2 agglutinins by Weil-Felix test. Additionally, patients were screened for ST IgM ELISA. Statistical analysis was performed for clinical and laboratory parameters in children and adults using Fisher's exact test and chi-square test with Yates correction.
Results: Out of 320 patients, 142 (44.38%) had R. conorii IgM and/or IgG antibodies. Only IgM was present in 72 (22.5%) patients, while 36 patients were positive for IgG only and 34 were positive for both IgG and IgM. A total of 68 patients (21.25%) showed only OX19 and/or OX2 antibodies (titres ≥ 1 : 80). SF and ST coinfection was observed in 47 cases (14.69%).
Interpretation & conclusion: Seroprevalence of SF in Puducherry was found to be quite high (44.38%). ST and SF coinfection was observed in 34.50% of the SG IgG positive patients, however, this require further evaluation by PCR to rule out cross-reaction or false positivity. At present ELISA seems to be an affordable alternative to highly subjective and technically demanding immunofluorescence assay (IFA) for serodiagnosis of SF.
Journal Article
A use of 56-kDa recombinant protein of orientia tsutsugamushi karp serotype in serodiagnosis of scrub typhus by enzyme-linked immunosorbent assay in Thais
Scrub typhus is a mite-borne disease caused by a Gram-negative obligately intracellular bacillus, Orientia tsutsugamushi. The disease is endemic in the Asia-Australia-Pacific region, including Thailand. Scrub typhus generally manifests as acute undifferentiated febrile fever along with myalgia, rash, and lymphadenopathy. An eschar can be a valuable diagnostic clue, but this skin lesion may be missed in some patients. The disease symptoms resemble those of other febrile illnesses such as leptospirosis, typhoid, murine typhus, malaria, and dengue fever, making a laboratory diagnosis necessary for the definitive diagnosis. In this study, we expressed a recombinant protein derived from 56-kDa type-specific antigen of O. tsutsugamushi Karp serotype and tested its ability to detect and differentiate scrub typhus infection. IgM and IgG antibodies were determined in sera from scrub typhus (n = 92) and other febrile illness patients (murine typhus (n = 25), melioidosis (n = 36), leptospirosis (n = 42), and dengue (n = 35)) from Thailand. Sensitivities of 87.0% and 59.8% with a specified assay cut-off were obtained for IgM and IgG indirect ELISAs, respectively, with a specificity of 100% in both tests. The sensitivity was increased to 95.7% when a combination of IgM and IgG ELISAs results was considered. Our study suggested a potential of the 56-kDa recombinant protein for further development and evaluation for use in scrub typhus serodiagnosis.
Journal Article
Spotted Fever and Typhus Group Rickettsiae in Dogs and Humans, Mexico, 2022
We found serologic evidence of spotted fever group Rickettsia in humans and dogs and typhus group Rickettsia in dogs in Reynosa, Mexico. Our investigation revealed serologic samples reactive to spotted fever group Rickettsia in 5 community members, which highlights a potential rickettsial transmission scenario in this region.
Journal Article