Dataset Information

Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses.

ABSTRACT: Scrub typhus and spotted fever rickettsioses (SFR) are understudied, vector-borne diseases of global significance. Over 1 billion individuals are at risk for scrub typhus alone in an endemic region, spanning across eastern and southern Asia to Northern Australia. While highly treatable, diagnostic challenges make timely antibiotic intervention difficult for these diseases. Delayed therapy may lead to severe outcomes affecting multiple organs, including the central nervous system (CNS), where infection and associated neuroinflammation may be lethal or lead to lasting sequelae. Meningitis and encephalitis are prevalent in both scrub typhus and SFR. Additionally, case reports detailing focal neurological deficits have come to light, with attention to both acute and chronic sequelae of infection. Despite the increasing number of clinical reports outlining neurologic consequences of these diseases, relatively little research has examined underlying mechanisms of neuroinflammation. Animal models of scrub typhus have identified cerebral T-cell infiltration and vascular damage associated with endothelial infection and neuropathogenesis. Differential gene expression analysis of brain tissues during murine scrub typhus have revealed selective increases in CXCR3 ligands, proinflammatory and type-1 cytokines and chemokines, and cytotoxicity molecules, as well as alterations in the complement pathway. In SFR, microglial expansion and macrophage infiltration contribute to neurological disease progression. This narrative Review highlights clinical neurologic features of scrub typhus and SFR and evaluates our current understanding of basic research into neuroinflammation for both diseases in animal models. Further investigation into key mediators of neuropathogenesis may yield prognostic markers and treatment regimens for severe patients.

SUBMITTER: Fisher J

PROVIDER: S-EPMC7580963 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses.

Fisher James J Card Galen G Soong Lynn L

PLoS neglected tropical diseases 20201022 10

Scrub typhus and spotted fever rickettsioses (SFR) are understudied, vector-borne diseases of global significance. Over 1 billion individuals are at risk for scrub typhus alone in an endemic region, spanning across eastern and southern Asia to Northern Australia. While highly treatable, diagnostic challenges make timely antibiotic intervention difficult for these diseases. Delayed therapy may lead to severe outcomes affecting multiple organs, including the central nervous system (CNS), where inf ...[more]

PMID: 33091013

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Project description:BACKGROUND:Ecological determinants of most emerging vector-borne diseases are understudied, particularly for neglected tropical disease. Moreover, although socioeconomic impacts can have significant downstream effects on human risks to vector-borne diseases via a change in land cover, particularly facilitating the invasion of exotic plants, related studies remains very scarce. Scrub typhus and spotted fever are neglected diseases emerging around the globe and are transmitted by chigger mites and ticks infective of Orientia tsutsugamushi and Rickettsia spp., respectively, with small mammals as the primary hosts of both vectors. METHODOLOGY/PRINCIPAL FINDINGS:We investigated how invasions of the plant Leucaena leucocephala caused by widespread abandonment of farmlands driven by industrialization affected abundance of chiggers and ticks in Penghu Island, Taiwan. We determined ectoparasite abundance by trapping small mammals in three types of habitats (invasion site, agricultural field, human residential) every two months for a year. Based on ectoparasite burdens, invasion sites harbored more chiggers and ticks than the other two habitats. Furthermore, hosts maintained higher burdens of both vectors in early winter and burdens of chiggers were more stable across seasons in invasion sites, suggesting that sites with invasive plants could be a temporary refuge for both vectors and might help mitigate the negative influence of unfavorable climate. Infective rates of O. tsutsugamushi in chiggers and Rickettsia in ticks were also consistently not lower in invasion sites. Top soil temperature and relative humidity were similar across the three habitats, but invasion sites contained more of the rat Rattus losea, on which chiggers and ticks were more engorged than those from the most commonly trapped species (Suncus murinus shrew), indicating that abundance of the host R. losea instead of microclimate might better determine the abundance of both vectors. CONCLUSIONS/SIGNIFICANCE:This study highlights an important but largely neglected issue that socioeconomic change can have unexpected consequences for human health induced particularly by invasive plants, which could become a hotspot for emerging infectious diseases but usually are very hard to be eradicated. In the future, a more comprehensive approach that integrates socio-economics, land use, exotic species, and human health should be considered to fully understand potential emergence of vector-borne diseases.

Project description:Introduction Purpura fulminans is an acute and fatal condition presenting with acute progressive hemorrhagic infarction of the skin and disseminated intravascular coagulation. Scrub typhus, is an emerging disease of Nepal, despite being a rickettsioses has been rarely associated with Purpura fulminans. The non-specific clinical presentation and limited diagnostic facility make it difficult for clinicians to diagnose the disease. Knowing the prevalence of the disease, suspecting the disease early and treatment with appropriate antibiotics can limit the course of the disease. Case presentation A 46-year-old female with no comorbidity presented with febrile illness and generalized weakness in the emergency department. During the course in hospital, she developed purpura followed by painful hemorrhagic bullae in bilateral lower limb with bluish discoloration in bilateral feet. IgM antibodies against the Orientia Tsutsugamushi antigen came out to be positive making diagnosis of purpura fulminans secondary to scrub typhus. She recovered with anti rickettsial therapy. Discussion Purpura fulminans is an emergency condition. Scrub typhus, one of the rare cause, is diagnosed with Rickettsial DNA by PCR or by Indirect Immunofluorescence Assay (IFA) or Indirect Immunoperoxidase Assay (IPA). Medical management includes Doxycycline, fluid therapy, antipyretics and surgical management includes escharotomies and fasciotomies if required. Conclusion We feel that clinicians should be aware of rickettsia as a differential of acute febrile illness, especially when the patient presents from endemic areas. In addition to it, they should be aware of rare presentations such as purpura fulminans which can help with early suspicion of the disease and appropriate antibiotic therapy. Highlights • Purpura fulminans is an acute condition with skin changes and disseminated intravascular coagulation.• Rarely, acute infectious purpura fulminans, can be caused by Orientia Tsutsugamushi, a common rickettsioses of Nepal.• Clinical suspicion of the disease with appropriate antibiotic therapy can limit the disease course or prevent complication.

Dataset Information

Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses.

Publications

Neuroinflammation associated with scrub typhus and spotted fever group rickettsioses.

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