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      Endemic Scrub Typhus–like Illness, Chile

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          Abstract

          TOC Summary: Rickettsiae closely related to the scrub typhus agent are present in the Western Hemisphere.

          Abstract

          We report a case of scrub typhus in a 54-year-old man who was bitten by several terrestrial leeches during a trip to Chiloé Island in southern Chile in 2006. A molecular sample, identified as related to Orientia tsutsugamushi based on the sequence of the16S rRNA gene , was obtained from a biopsy specimen of the eschar on the patient’s leg. Serologic analysis showed immunoglobulin G conversion against O. tsutsugamushi whole cell antigen. This case and its associated molecular analyses suggest that an Orientia-like agent is present in the Western Hemisphere that can produce scrub typhus–like illness. The molecular analysis suggests that the infectious agent is closely related, although not identical, to members of the Orientia sp. from Asia.

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          Scrub typhus: the geographic distribution of phenotypic and genotypic variants of Orientia tsutsugamushi.

          John Kelly, John Fuerst, Terence Han-Wei Ching … (2009)
          Orientia tsutsugamushi is the etiological agent of scrub typhus, an acute, mite-borne, febrile illness that occurs in the Asia-Pacific region. Historically, strain characterization used serological analysis and revealed dramatic antigenic diversity. Eyeing a recommendation of potential vaccine candidates for broad protection, we review geographic diversity and serological and DNA prevalences. DNA analysis together with immunological analysis suggest that the prototype Karp strain and closely related strains are the most common throughout the region of endemicity. According to serological analysis, approximately 50% of isolates are seroreactive to Karp antisera, and approximately one-quarter of isolates are seroreactive to antisera against the prototype Gilliam strain. Molecular methods reveal greater diversity. By molecular methods, strains phylogenetically similar to Karp make up approximately 40% of all genotyped isolates, followed by the JG genotype group (Japan strains serotypically similar to the Gilliam strain but genetically non-Gilliam; 18% of all genotyped isolates). Three other genotype groups (Kato-related, Kawasaki-like, and TA763-like) each represent approximately 10% of genotyped isolates. Strains genetically similar to the Gilliam strain make up only 5% of isolates. Strains from these groups should be included in any potential vaccine.
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            Isolation of a novel Orientia species (O. chuto sp. nov.) from a patient infected in Dubai.

            Alexander L. Richards, Richard Fuller, Daniel Paris … (2010)
            In July 2006, an Australian tourist returning from Dubai, in the United Arab Emirates (UAE), developed acute scrub typhus. Her signs and symptoms included fever, myalgia, headache, rash, and eschar. Orientia tsutsugamushi serology demonstrated a 4-fold rise in antibody titers in paired serum collections (1:512 to 1:8,192), with the sera reacting strongest against the Gilliam strain antigen. An Orientia species was isolated by the in vitro culture of the patient's acute blood taken prior to antibiotic treatment. The gene sequencing of the 16S rRNA gene (rrs), partial 56-kDa gene, and the full open reading frame 47-kDa gene was performed, and comparisons of this new Orientia sp. isolate to previously characterized strains demonstrated significant sequence diversity. The closest homology to the rrs sequence of the new Orientia sp. isolate was with three strains of O. tsutsugamushi (Ikeda, Kato, and Karp), with a nucleotide sequence similarity of 98.5%. The closest homology to the 47-kDa gene sequence was with O. tsutsugamushi strain Gilliam, with a nucleotide similarity of 82.3%, while the closest homology to the 56-kDa gene sequence was with O. tsutsugamushi strain TA686, with a nucleotide similarity of 53.1%. The molecular divergence and geographically unique origin lead us to believe that this organism should be considered a novel species. Therefore, we have proposed the name "Orientia chuto," and the prototype strain of this species is strain Dubai, named after the location in which the patient was infected.
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              Development of a quantitative real-time polymerase chain reaction assay specific for Orientia tsutsugamushi.

              Alexander L. Richards, Terence Han-Wei Ching, Andrew T. Chan … (2004)
              Two specific and sensitive polymerase chain reaction (PCR) assays were developed to detect and quantitate Orientia tsutsugamushi, the agent of scrub typhus, using a portion of the 47-kD outer membrane protein antigen/ high temperature requirement A gene as the target. A selected 47-kD protein gene primer pair amplified a 118-basepair fragment from all 26 strains of O. tsutsugamushi evaluated, but it did not produce amplicons when 17 Rickettsia and 18 less-related bacterial nucleic acid extracts were tested. Similar agent specificity for the real-time PCR assay, which used the same primers and a 31-basepair fluorescent probe, was demonstrated. This sensitive and quantitative assay determination of the content of O. tsutsugamushi nucleic acid used a plasmid containing the entire 47-kD gene from the Kato strain as a standard. Enumeration of the copies of O. tsutsugamushi DNA extracted from infected tissues from mice and monkeys following experimental infection with Orientia showed 27-5552 copies/microL of mouse blood, 14448-86012 copies/microL of mouse liver/spleen homogenate, and 3-21 copies/microL of monkey blood.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (iso-abbrev): Emerging Infect. Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): September 2011
                Volume: 17
                Issue: 9
                Pages: 1659-1663
                Affiliations
                [1]Author affiliations: School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile (M.E. Bacells, R. Rabagliati, P. García, H. Poggi, D. Oddó, M. Concha, K. Abarca);
                [2]Naval Medical Research Center, Silver Spring, Maryland, USA (J. Jiang, A.L. Richards);
                [3]The Ohio State University, Columbus, Ohio, USA (D.J. Kelly, P.A. Fuerst)
                Author notes
                Address for correspondence: Daryl J. Kelly, Department of Evolution, Ecology, and Organismal Biology, The Ohio State University, 388 Aronoff Laboratory, 318 West 12th Ave, Columbus, OH 43210, USA; email: kelly.350@ 123456osu.edu
                Article
                Publisher ID: 10-0960
                DOI: 10.3201/eid1709.100960
                PMC ID: 3322051
                PubMed ID: 21888791
                SO-VID: 8685159e-1442-4292-9ccd-5d34b2b6a9d0
                History
                Categories
                Subject: Research

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: 16s rrna,scrub typhus,rickettsia,chile,research,scrub typhus–like illness,orientia tsutsugamushi,parasites
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: 16s rrna, scrub typhus, rickettsia, chile, research, scrub typhus–like illness, orientia tsutsugamushi, parasites

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