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Copyright of China Tropical Medicine is the property of China Tropical Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Here, utilizing of microneedle roller as a physical enhancer of drug permeation through third-degree burn eschar has been investigated. This study was also conducted to investigate the effect of physicochemical properties of different drugs on permeation through perforated and unperforated eschar. Method: 1000 μm and 1500 μm height microneedle rollers were used to study the effect of microneedle pretreatment on permeation of diclofenac sodium, vancomycin hydrochloride, and sirolimus through human third-degree burn eschar. Optical microscopy and histological sectioning were used to visualize perforation and characterize the penetration depth, respectively. Franz-diffusion cells were utilized to study the permeation over 10 h. Results: There were visible pores in eschar after treatment for both microneedle heights. Despite different physicochemical properties of drug models, microneedle rollers enhanced the permeation percentage through eschar in the range of 1.4 to 3.7 times for 1000 μm and 3.3 to 5.53 times for 1500 μm microneedle. Diclofenac as a molecule with the lowest MW and moderate log P had the highest permeation percentage in unperforated and perforated conditions. In the control condition, despite the higher MW of vancomycin compared to sirolimus, a higher percentage of vancomycin (about 2.7 times) permeated through eschar, indicating the higher permeability of hydrophilic drug in unperforated eschar. This behavior was also observed after eschar treatment with both heights of microneedle rollers. Conclusion: Commercially available microneedle rollers enhance the drug permeation through eschar. Microneedle pretreatment has the potential to be used for burn management in situations where early eschar removal is not possible. [ABSTRACT FROM AUTHOR]

Objectives: To study epidemiological characteristics, clinical features, laboratory findings, and clinical outcomes in cases of scrub typhus. Additionally, the study aims to identify the predictors of disease severity. Methods: This cross-sectional study was conducted in the Department of General Medicine at Dr PDM Medical College in Amaravati, India. The study duration was 6 months, from July 2023 to December 2023. All clinically confirmed patients with scrub typhus were evaluated through history, clinical examination, and appropriate laboratory investigations. The clinical and laboratory profiles, hospital course, and outcomes were analyzed. Organ dysfunction upon admission was assessed using the sequential organ failure assessment (SOFA) score. Results: A total of 200 cases were included in the study. The majority of the cases were in the age range of 31-40 years, and most of them were males. The highest number of scrub typhus cases occurred in September. The most common presenting symptoms were fever (81%), followed by nausea (37.5%), generalized weakness (34%), abdominal pain, eschar (21.5%), breathlessness, and cough (21% each), headache (19%), vomiting (15%), and altered sensorium (4.5%). The majority of patients (72.5%) did not experience any complications, while 55 patients (27.5%) developed multi-organ dysfunction syndrome (MODS) as a complication. The mortality rate was 1%. Conclusion: Scrub typhus is a significant cause of acute febrile illness in the Vidarbha region of Maharashtra. It can present with various clinical manifestations, with or without an eschar. Early diagnosis and appropriate treatment of these cases can lead to minimal complications.

Background: Scrub typhus is a mite-borne zoonotic disease caused by Orientia tsutsugamushi and commonly presents with fever, rash, and eschar. Systemic complications develop later in the illness including, meningoencephalitis, pericardial effusion, myocarditis, and pneumonitis. In this article, we will be presenting different neurological manifestations of scrub typhus along with functional outcomes studied at a tertiary care center in New Delhi. Methods: This ambispective observational study was conducted at Army Hospital Research and Referral, New Delhi, during January 2018-January 2020. Febrile illness, serologically confirmed as scrub typhus and developing neurological complications were included. A predesigned clinical proforma was recorded for demographics, clinical features, neurological examination, supported with laboratory and/or radiology evaluation, and functional outcomes using the modified Rankin Scale (mRS). Results: In our cohort of 7 patients' majority were male (71%) with mean age at presentation being 42.5 years. Eschar was present in only 2 cases (28%) and a syndromic clinical diagnosis of meningoencephalitis was made in 3 (43%), acute flaccid quadriparesis in 2 (28%); and symptomatic seizure and parkinsonism in 1 patient each (14%). CSF showed lymphocytic pleocytosis with protein elevation in 57% cases. Systemic dysfunction was noted in the form of thrombocytopenia (57%), hyponatremia (42%), elevated transaminases (57%). Symptoms resolved with Doxycycline ± Rifampicin therapy in all cases, with good functional outcomes in majority of (89%) cases. Conclusion: Neurological complications in scrub typhus have a wide spectrum involving meninges, encephalon, basal ganglia, cranial, and peripheral nerves. High index of suspicion with early serological testing (ELISA) is a must in undifferentiated fevers. Timely initiation of appropriate therapy leads to good clinical outcomes, in majority of cases with neurological involvement. [ABSTRACT FROM AUTHOR]

Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3–30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P <.001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P <.001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P <.001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P <.0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring. [ABSTRACT FROM AUTHOR]

Scrub typhus (ST) is a re-emerging zoonotic disease caused by Orientia tsutsugamushi and is transmitted by chiggers. Serological tests targeting IgM and/or IgG antibodies play a major role in the detection of ST cases. Orientia 56kDa genome is common target for the molecular diagosis of ST to identify the prevalence of specific serotypes of O. tsutsugamushi in and around Puducherry by targeting 56kDa gene with the application of phylogenetic analysis. This prospective laboratory-based study was conducted in a tertiary care teaching hospital, from November 2105 to March 2018. Blood samples were collected from out-patients/in-patients, and those tested positive for ST IgM ELISA (n=140) and an equal number of negative samples were archived and anonymized. Genomic DNA was extracted and analyzed by using Nested PCR and LAMP assay. The positive products were purified and sequenced. Phylogenetic tree was constructed based on the sequences. Among 280 samples, 45 (16.1%) N-PCR and 102 LAMP (36.43%) positivity was observed for 56kDa gene. Forty-one N-PCR positive products were sequenced and accession numbers were obtained (MG601875 to MG601917) for the isolates. Phylogenetic analysis was done by Maximum Likelihood methods and this study has showed that 32.3% are similar to the Karp isolates. Molecular diagnosis of Scrub typhus has become essential in case of doubtful serology and early acute phase of illness. Gene sequencing result indicates that most of them were different from the existing ones, which may belong to the newer strains. The identification of newer strains will be helpful in future for development of scrub typhus vaccine.

Scrub typhus is one of the important vector borne illness which is largely underdiagnosed, particularly in children. It causes mild febrile illness to severe complications. More than 20 genotypic clusters are documented from various geographical regions based on sequence variations of 56kDa type specific antigen gene of Orientia tsutsugamushi, the causative agent of scrub typhus. Adequate knowledge about epidemiology and genetic diversity in endemic regions is an important tool for clinical management, development of diagnostic kit and vaccines. Limited studies are available based on genotypic characterization of Orientia tsutsugamushi in children. The present study determined the prevalence and genotypic characterization of Orientia tsutsugamushi in febrile pediatric patients admitted in tertiary care hospital of Chennai, South India. Both serum and blood samples were collected from 239 scrub typhus suspected febrile pediatric patient’s aged between 6 months to 12 years. IgM ELISA and 56kDa nested PCR were performed on all the patient samples. Nested PCR positive samples were sequenced and analyzed for genotypic differences. Among 239 samples, 103 were positive for IgM ELISA and 35 were positive for nPCR analysis. Out of the 108 scrub typhus positive cases, 45.31% (58/128) were male and 45.05% (50/111) were female. Eschar was positive in 56.48% of patients. Pneumonia (4/108), hypotensive shock (3/108), and myocarditis (1/108) were the most common clinical complications associated with scrub typhus positive children. Karp (56.6%) was the most common genotypic cluster found in our study, followed by TA716 (33.33%), TA763 (2/30), and Gilliam (1/30).

Mediterranean spotted fever (MSF) has been diagnosed clinically in the Crimean Peninsula since the 1930s. We describe the recent illness of an elderly patient from Crimea who had developed a classic triad of MSF symptoms consisting of fever, maculopapular rash, and eschar. Clinical diagnosis of rickettsiosis was confirmed using real-time PCR and sequencing of 4 Rickettsia protein genes. The strain causing clinical illness was characterized as Rickettsia conorii subspecies conorii Malish 7. This report corroborates the utility of eschar swab material as a source of DNA for PCR-based diagnostics that enables timely patient treatment and management.

Copyright of Brazilian Dental Science is the property of Brazilian Dental Science Journal-ICT-UNESP and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Scrub typhus is one of the important vector borne illness which is largely underdiagnosed, particularly in children. It causes mild febrile illness to severe complications. More than 20 genotypic clusters are documented from various geographical regions based on sequence variations of 56kDa type specific antigen gene of Orientia tsutsugamushi, the causative agent of scrub typhus. Adequate knowledge about epidemiology and genetic diversity in endemic regions is an important tool for clinical management, development of diagnostic kit and vaccines. Limited studies are available based on genotypic characterization of Orientia tsutsugamushi in children. The present study determined the prevalence and genotypic characterization of Orientia tsutsugamushi in febrile pediatric patients admitted in tertiary care hospital of Chennai, South India. Both serum and blood samples were collected from 239 scrub typhus suspected febrile pediatric patient's aged between 6 months to 12 years. IgM ELISA and 56kDa nested PCR were performed on all the patient samples. Nested PCR positive samples were sequenced and analyzed for genotypic differences. Among 239 samples, 103 were positive for IgM ELISA and 35 were positive for nPCR analysis. Out of the 108 scrub typhus positive cases, 45.31% (58/128) were male and 45.05% (50/111) were female. Eschar was positive in 56.48% of patients. Pneumonia (4/108), hypotensive shock (3/108), and myocarditis (1/108) were the most common clinical complications associated with scrub typhus positive children. Karp (56.6%) was the most common genotypic cluster found in our study, followed by TA716 (33.33%), TA763 (2/30), and Gilliam (1/30). [ABSTRACT FROM AUTHOR]

Scrub typhus (ST) is a re-emerging zoonotic disease caused by Orientia tsutsugamushi and is transmitted by chiggers. Serological tests targeting IgM and/or IgG antibodies play a major role in the detection of ST cases. Orientia 56kDa genome is common target for the molecular diagosis of ST to identify the prevalence of specific serotypes of O. tsutsugamushi in and around Puducherry by targeting 56kDa gene with the application of phylogenetic analysis. This prospective laboratory-based study was conducted in a tertiary care teaching hospital, from November 2105 to March 2018. Blood samples were collected from out-patients/ in-patients, and those tested positive for ST IgM ELISA (n=140) and an equal number of negative samples were archived and anonymized. Genomic DNA was extracted and analyzed by using Nested PCR and LAMP assay. The positive products were purified and sequenced. Phylogenetic tree was constructed based on the sequences. Among 280 samples, 45 (16.1%) N-PCR and 102 LAMP (36.43%) positivity was observed for 56kDa gene. Forty-one N-PCR positive products were sequenced and accession numbers were obtained (MG601875 to MG601917) for the isolates. Phylogenetic analysis was done by Maximum Likelihood methods and this study has showed that 32.3% are similar to the Karp isolates. Molecular diagnosis of Scrub typhus has become essential in case of doubtful serology and early acute phase of illness. Gene sequencing result indicates that most of them were different from the existing ones, which may belong to the newer strains. The identification of newer strains will be helpful in future for development of scrub typhus vaccine. [ABSTRACT FROM AUTHOR]

Introduction: Orientia tsutsugamushi causes acute febrile illness known as scrub typhus, which is spread by the bite of the trombiculid mite. Doxycycline is the first-line treatment for clinically diagnosed cases of scrub typhus. If not diagnosed and treated early, it can lead to complications such as acute renal failure, meningoencephalitis, gastrointestinal bleeding, and multiple organ failure. However, there have been no trials comparing the effectiveness of oral and Intravenous (i.v.) doxycycline for scrub typhus treatment. Aim: To assess the efficacy of intravenous versus oral doxycycline in managing uncomplicated scrub typhus. Materials and Methods: This prospective interventional research was conducted in the Paediatrics Department at Maharajah’s Institute of Medical Sciences, Vizianagaram, India, from June 2021 to July 2022. Out of a total of 178 children diagnosed with scrub typhus during the study period, 102 children who received either oral or intravenous doxycycline as monotherapy were included. The primary outcome measures studied were the incidence of delayed defervescence and the time of defervescence. The t-test or Mann-Whitney test was applied for continuous data, and the Chi-square test or Fischer’s-exact test was used to compare dichotomous variables. Results: The mean age of children treated with oral doxycycline was 9.5±2.7 years and with i.v. doxycycline was 8.2±2.4 years. Among the 178 children diagnosed with scrub typhus, 102 (57.3%) children treated with doxycycline alone were included in the study. Out of these, 78 (76.4%) cases received oral doxycycline, while 28 (27.4%) cases received intravenous doxycycline. There was no statistically significant difference in the response rate between the two groups. The p-value for time to defervescence was 0.672, and the p-value for the incidence of delayed defervescence was 0.9845. Conclusion: Both oral and intravenous forms of doxycycline demonstrated similar efficacy in the treatment of scrub typhus. Nearly all children in both groups became afebrile within 72 hours after starting treatment.

Background: Scrub typhus is a mite-born disease scrub. It commonly manifests as an acute febrile illness with multi-system involvement. It is regarded as a life-threatening disease in children, with serious complications usually occurring in the 2nd week of illness. Aims and Objectives: The aims of this study were to explore the clinical and laboratory profile of children with scrub typhus. Materials and Methods: All children admitted with scrub typhus over 1-year duration were enrolled in the study. The clinical, laboratory profile, and outcome were observed and analyzed. Results: A total of 47 children were diagnosed with scrub typhus, 17 (36.1%) children had clinical and laboratory evidence of meningitis. The most frequent presenting features were fever (100%), headache (82.4%), vomiting (82.4%), seizures (41.2%), and altered sensorium (70.6%). The mean duration of fever was 6.57 days, eight children (7%) had persistent fever for >14 days duration. Other complications reported were hepatitis 2 (4.3%), hepatosplenomegaly in 18 (38.3%) acute respiratory distress syndrome 2 (4.3%), and shock 31 (66%). The mean cerebrospinal fluid (CSF) protein, glucose, and cell count was 65.75±9.27 mg/dL, 45.00±7.23 mg/dL, and 65.94±52.72 cells/mm3 of CSF, respectively, with lymphocyte count of more than 96% in all cases. Most patients had lymphocytic pleocytosis and the mean lymphocyte percentage was 96.2%±4.5%. Out of all 47 patients, 45 (84.61%) patients recovered with appropriate antibiotics in both groups, while two (15.38%) patients expired in the group without meningitis. Conclusion: A high degree of suspicion and knowledge of the geographical distribution of Rickettsial diseases is crucial for its early diagnosis and favorable outcome. Scrub typhus should be considered in the differential diagnosis of aseptic meningitis.

Introduction: Orientia tsutsugamushi causes acute febrile illness known as scrub typhus, which is spread by the bite of the trombiculid mite. Doxycycline is the first-line treatment for clinically diagnosed cases of scrub typhus. If not diagnosed and treated early, it can lead to complications such as acute renal failure, meningoencephalitis, gastrointestinal bleeding, and multiple organ failure. However, there have been no trials comparing the effectiveness of oral and Intravenous (i.v.) doxycycline for scrub typhus treatment. Aim: To assess the efficacy of intravenous versus oral doxycycline in managing uncomplicated scrub typhus. Materials and Methods: This prospective interventional research was conducted in the Paediatrics Department at Maharajah's Institute of Medical Sciences, Vizianagaram, India, from June 2021 to July 2022. Out of a total of 178 children diagnosed with scrub typhus during the study period, 102 children who received either oral or intravenous doxycycline as monotherapy were included. The primary outcome measures studied were the incidence of delayed defervescence and the time of defervescence. The t-test or Mann-Whitney test was applied for continuous data, and the Chi-square test or Fischer's-exact test was used to compare dichotomous variables. Results: The mean age of children treated with oral doxycycline was 9.5±2.7 years and with i.v. doxycycline was 8.2±2.4 years. Among the 178 children diagnosed with scrub typhus, 102 (57.3%) children treated with doxycycline alone were included in the study. Out of these, 78 (76.4%) cases received oral doxycycline, while 28 (27.4%) cases received intravenous doxycycline. There was no statistically significant difference in the response rate between the two groups. The p-value for time to defervescence was 0.672, and the p-value for the incidence of delayed defervescence was 0.9845. Conclusion: Both oral and intravenous forms of doxycycline demonstrated similar efficacy in the treatment of scrub typhus. Nearly all children in both groups became afebrile within 72 hours after starting treatment. [ABSTRACT FROM AUTHOR]

Background: Covid-19 infection increases the risk of opportunistic infections like mucormycosis. Cutaneous mucormycosis can occur primarily by direct inoculation or secondary to involvement of the underlying structures. Cutaneous manifestations include tender, erythematous, indurated lesions and necrotic plaques. As the disease evolves, cutaneous features manifest progressively. Objectives: To study the manifestations of the cutaneous signs of sinonasal mucormycosis and management of such cases based on severity of involvement. Materials and methods: A retrospective analysis of 21 patients with diagnosis of cutaneous mucormycosis secondary to sinonasal involvement was done with assessment of their skin lesion, area involved and their clinical stage being noted at the time of admission and after 24 h. Treatment consisted of combination of surgical debridement, daily dressing and liposomal amphotericin B. Observations and Results: Out of total 21 patients, there were 10 males and 11 females. Among risk factors, 14 cases had history of covid 19 infection, 5 had history of steroid intake, 6 had history of ICU stay and all had deranged blood sugar levels. Among disease prognosis, excellent outcomes appeared in stage I and stage III showed worst outcome. Conclusion: Since initial clinical presentation is similar to cellulitis and other soft-tissue infections, early recognition is difficult. In this cohort, the prognosis of secondary cutaneous mucormycosis remained poor, especially in ICU patients and those with numerous predisposing factors. Such patients presented in late stages of the disease and mortality rate was very high in such group. [ABSTRACT FROM AUTHOR]

A 17-year-old female patient presented to us with complaints of diffuse swelling in her left upper eyelid with preauricular lymphadenopathy for three days. She was diagnosed with a case of hordeolum externum and was treated on the same line. However, during follow-up, she developed a mild- to moderate-grade fever, which did not subside with treatment. On further investigation, her IgM rapid ELISA for Scrub typhus was positive, which was further confirmed by the Weil–Fellix test (OXK=1:360). She was treated with systemic doxycycline. Within a week, her fever returned to normal baseline, with resolution of local eye lid swelling, and her black scab was also gone. We have reported a case of scrub typhus as a rare manifestation with lid swelling and subsequently eschar formation on the upper eye lid. The patient was promptly treated with oral antibiotics without any morbidity. [ABSTRACT FROM AUTHOR]

Scrub typhus is a rickettsial infection caused by Orientia tsutsugamushi. This is transmitted by trombiculid mite called chiggers. A number of cases of scrub typhus are being reported from North India. However, there has been a steady increase in the number of cases from Southern India, especially Tamil Nadu, Kerala, and Karnataka. The manifestation of the disease is due to the vasculitis and perivasculitic involvement. This vasculitis is responsible for oedema, skin rash and end organ ischaemic injury. A skin lesion called eschar is pathognomic of this condition, which is present in 40% of the cases. It is a close differential diagnosis for other common infectious diseases like-dengue fever, malaria, enteric fever and severe sepsis. Scrub typhus is rare in neonates. Herewith, the authors reported five cases of neonatal scrub typhus with varied clinical manifestations. All the five neonates (2 females and 3 males) had fever and high C-reactive Protein (CRP), two had hepatosplenomegaly, two presented with shock, one had paralytic ileus, one baby had features of aseptic meningitis and one had pericardial and pleural effusion. Two out of five babies had an eschar, which is pathognomonic of scrub typhus. Three babies were treated with doxycycline and two babies required Intravenous (i.v.) azithromycin. All of them recovered completely, except one baby, who succumbed to the illness. A high index of suspicion is required to diagnose scrub typhus in neonates early. Timely intervention will prevent morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus is a mite-born disease scrub. It commonly manifests as an acute febrile illness with multi-system involvement. It is regarded as a life-threatening disease in children, with serious complications usually occurring in the 2nd week of illness. Aims and Objectives: The aims of this study were to explore the clinical and laboratory profile of children with scrub typhus. Materials and Methods: All children admitted with scrub typhus over 1-year duration were enrolled in the study. The clinical, laboratory profile, and outcome were observed and analyzed. Results: A total of 47 children were diagnosed with scrub typhus, 17 (36.1%) children had clinical and laboratory evidence of meningitis. The most frequent presenting features were fever (100%), headache (82.4%), vomiting (82.4%), seizures (41.2%), and altered sensorium (70.6%). The mean duration of fever was 6.57 days, eight children (7%) had persistent fever for >14 days duration. Other complications reported were hepatitis 2 (4.3%), hepatosplenomegaly in 18 (38.3%) acute respiratory distress syndrome 2 (4.3%), and shock 31 (66%). The mean cerebrospinal fluid (CSF) protein, glucose, and cell count was 65.75±9.27 mg/dL, 45.00±7.23 mg/dL, and 65.94±52.72 cells/mm³ of CSF, respectively, with lymphocyte count of more than 96% in all cases. Most patients had lymphocytic pleocytosis and the mean lymphocyte percentage was 96.2%±4.5%. Out of all 47 patients, 45 (84.61%) patients recovered with appropriate antibiotics in both groups, while two (15.38%) patients expired in the group without meningitis. Conclusion: A high degree of suspicion and knowledge of the geographical distribution of Rickettsial diseases is crucial for its early diagnosis and favorable outcome. Scrub typhus should be considered in the differential diagnosis of aseptic meningitis. [ABSTRACT FROM AUTHOR]

The burden of imported rickettsial infection in the UK is not previously described. This retrospective review identifies rickettsial cases diagnosed at the national reference laboratory between 2015 and 2022. Samples testing positive for spotted fever group, typhus group, and scrub typhus IgG/IgM on acute and convalescent blood samples, and/or PCR on tissue/blood were categorized as suspected, confirmed or past infection. 220 patients had rickettsioses, and the commonest import was acute spotted fever group infection (61%, 125/205), 54% (62/114) from South Africa. In acute typhus group cases, 60% (40/67) were from Southeast Asia. One patient with Rickettsia typhi bacteremia died. Scrub typhus group infections (5%, 10/205) were exclusively from Asia and the Western Pacific regions. Overall, 43% of confirmed cases (39/91) had not received doxycycline prior to results. Rickettsial infections are important and under-recognized causes of imported fever in the UK. Thorough history, examination, and timely treatment with doxycycline should be considered if there is suspicion of Rickettsia infection before testing. • Rickettsial infections are a major cause of non-malarial fever. • The UKHSA Rare and Imported Pathogens Laboratory provides rickettsial diagnostics; acute and convalescent serology and PCR. • Timely treatment with doxycycline is encouraged in suspected cases of rickettsial infection. [ABSTRACT FROM AUTHOR]

Scrub typhus is a rickettsial infection caused by Orientia tsutsugamushi. This is transmitted by trombiculid mite called chiggers. A number of cases of scrub typhus are being reported from North India. However, there has been a steady increase in the number of cases from Southern India, especially Tamil Nadu, Kerala, and Karnataka. The manifestation of the disease is due to the vasculitis and perivasculitic involvement. This vasculitis is responsible for oedema, skin rash and end organ ischaemic injury. A skin lesion called eschar is pathognomic of this condition, which is present in 40% of the cases. It is a close differential diagnosis for other common infectious diseases like- dengue fever, malaria, enteric fever and severe sepsis. Scrub typhus is rare in neonates. Herewith, the authors reported five cases of neonatal scrub typhus with varied clinical manifestations. All the five neonates (2 females and 3 males) had fever and high C-reactive Protein (CRP), two had hepatosplenomegaly, two presented with shock, one had paralytic ileus, one baby had features of aseptic meningitis and one had pericardial and pleural effusion. Two out of five babies had an eschar, which is pathognomonic of scrub typhus.Three babies were treated with doxycycline and two babies required Intravenous (i.v.) azithromycin. All of them recovered completely, except one baby, who succumbed to the illness. A high index of suspicion is required to diagnose scrub typhus in neonates early.Timely intervention will prevent morbidity and mortality.

Scrub typhus is an acute febrile illness caused by the bacterium Orientia tsutsugamushi. It usually presents with high-grade fever, body aches, and skin rash. We report the case of a woman who presented with acute febrile illness, bilateral pneumonia, and severe hypoxemia. The presence of a typical eschar on the abdomen, made us suspect scrub typhus. Anti-O. tsutsugamushi Immunoglobulin M (IgM) antibody in the serum was detected in significant titers. She was treated with intravenous doxycycline and supplemental oxygen. Thus, scrub typhus should be considered in the differential diagnosis of febrile illness with acute respiratory distress syndrome.

Scrub typhus (caused by Orientia tsutsugamushi) is a neglected and underdiagnosed disease due to its non-specific clinical presentation and challenging diagnostics. We document the first study of direct diagnosis of scrub typhus from the blood sample of a patient by full-length 16S ribosomal RNA gene amplicon analysis using Oxford Nanopore sequencing.

Introduction: Scrub typhus is transmitted by the bite of the larva (chigger) of a microscopic trombiculidae mite (Leptotrombidium) found in moist areas and vegetation, which serves as both vector and reservoir. Scrub typhus is an often neglected and misdiagnosed febrile illness; clinical suspicion is the only key to diagnosis. Aim: To study clinicolaboratory profile and outcome of serologically confirmed scrub typhus in children from sub Himalayan tribal district of India. Materials and Methods: This cross-sectional observational study was conducted in Department of Paediatrics at Government District Hospital, Chamba, Himachal Pradesh, India, from May 2019 to April 2020. Children upto 18 years admitted with positive Immunoglobulin M (IgM) antibodies for scrub typhus were enrolled. The observational data including detail history and examination, relevant laboratory investigation and treatment was analysed by Statistical Package for Social Sciences (SPSS) software version 18.0 and Chi-square test with p-value

Due to overlapping clinical features, scrub typhus infection may be missed in presence of dengue. Concurrent infection with those two pathogens is rare and creates a diagnostic dilemma. We present a case of a 65-year-old male who was admitted with a high-grade fever and maculopapular rash. A complete hemogram revealed thrombocytopenia with raised hematocrit and positive diagnostic tests for dengue. The patient was treated conservatively with intravenous fluids and antipyretic medications in response to which the hematocrit improved, and the rash disappeared. But fever with thrombocytopenia continued to persist. On further clinical examination, a small eschar was noted on his abdomen. Doxycycline was started upon which the fever subsided, and thrombocytopenia improved. This case illustrates the importance of early recognition of coinfection in unremitting febrile illness in tropical countries to prevent potentially dangerous complications.

Orientia tsutsugamushi causes a zoonotic infection called scrub typhus, which is transmitted by trombiculid mite larvae. The infection is widely distributed throughout the Asia-Pacific region and has also been reported in various parts of India. The disease is an important cause of "tropical sepsis" and could produce severe complications such as encephalitis, pneumonia, myocarditis, cardiac arrhythmia, and acute respiratory distress syndrome (ARDS). A thorough physical examination is required by the physician, as the rash or eschar could sometimes be unnoticed or absent, and finding one could help in early diagnosis and preventing further complications with prompt treatment. Hereby, we present a case of scrub typhus that complicated into ARDS and was diagnosed on the basis of the presence of an eschar, a positive Weil–Felix result, and a positive quick diagnostic kit (immunochromatographic assay). We will also elaborate on the noninvasive management of the patient in the intensive care unit. [ABSTRACT FROM AUTHOR]

Background and aim of study: Scrub typhus, a potentially fatal rickettsial disease, is reported from many Indian states, but mostly from tertiary care centers. This study is distinct as it was undertaken in a primary care center in a rural area. Aim was to observe the age, gender and occupational profile of patients diagnosed with scrub typhus at our center during the period from January 2017-19; to find out about the site and day of appearance of eschar with respect to duration of fever and to note the clinical features and complications of scrub typhus. Methods: Study sample consisted of patients presenting with fever who developed an eschar and positive serology for Ig M on the 10th day. Conclusion: A total of 31cases were seen, of which four were children and eighteen were adult females. The “eschar” was picked up within 5 days of onset of fever in 26(84%) cases. There was no mortality. This study is unique also in the large size of the cases from a rural center and short latency to effective treatment. The study emphasizes the necessity of picking up the eschar by detailed examination in all cases of pyrexia and instituting early specific treatment. [ABSTRACT FROM AUTHOR]

We report a case of rickettsiosis caused by Rickettsia monacensis in an immunocompetent 67-year-old man in Portugal who had eschar, erythematous rash, and an attached Ixodes ricinus tick. Seroconversion and eschar biopsy led to confirmed diagnosis by PCR. Physicians should be aware of this rare rickettsiosis, especially in geographic regions with the vector.

Abstract Objective Nipple-related complications are major factors that prevent breastfeeding for many new mothers. Hence, we tested the effects of aloe arborescens fomentation applied to the nipples as a treatment for nipple-related complications. Results This study included 60 women who breastfed for the first time on day 1 after delivery. Every 24 h, all women breastfed six times and bottle-fed two times (at night). Women were classified into an intervention group (aloe arborescens fomentation) and a control group (no treatment). Aloe fomentation was applied after breastfeeding six times per day. We observed the nipples three times per day for 5 days after delivery. The most common nipple-related complication in this study was redness. A significant decrease was observed for women in the intervention group. Trial Registration Retrospectively Registered to registry: UMIN; Registration no.: UMIN000044514; Registered on: 11th June 2021.

Background: Scrub typhus is a reemerging zoonosis, which presents as acute febrile illness. Very few paediatric prospective studies on this disease are reported from Eastern India. This prospective observational study was carried out to study the clinical presentation, diagnosis, complications and immediate outcome of Scrub typhus in paediatric population in a tertiary care hospital from Eastern India. Material and Methods: Totally 209 cases between 1 month and 18 years of age were included. Clinical manifestations, laboratory parameters and immediate outcome of all patients were recorded. All the data were collected and plotted in Microsoft Excel master chart. Continuous data were presented as mean ± standard deviation (SD) and categorical data as frequency and percentage. All the data analysis was performed using statistical software IBM Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Highest number of cases (41.1%) were found between 1 year and 5 years age group. Fever was the presenting complaint in all cases. Other common symptoms were cough (34%), pain abdomen (23.4%), vomiting (23%), seizure (11.5%) and altered sensorium (9.6%). Hepatomegaly was found in 56.5% and splenomegaly in 39.7% cases. Eschar was found in 27.3% cases. C-reactive protein was elevated (>10 mg/L) in 93.3% children. Other complications were pneumonitis (20.6%), meningoencephalitis (12.4%), septic shock (8.6%), acute respiratory distress syndrome (5.7%), myocarditis (4.8%) and acute kidney injury (4.3%). Mortality was low (1%). Conclusion: Scrub typhus is not uncommon in paediatric population and it must be considered as a close differential diagnosis of any acute febrile illness even when classical clinical presentations are not found. Early treatment results in favourable outcome.

ABSTRACT:Audience: This escharotomy model is designed to instruct emergency medicine residents, medical students, and community physicians.Introduction: Burns account for over 40,000 hospitalizations and 3,400 deaths in the United States each year.1 Circumferential burns commonly lead to constrictive eschar formation, which may cause underlying tissue ischemia and necrosis.2 Escharotomies are a life or limb saving procedure, and therefore proper technique is essential to the training of emergency medicine residents. However, they are an infrequently encountered procedure and consequently are often performed with inadequate tissue decompression as well as incidental damage to the surrounding nerves and vessels.3 Simulation has been demonstrated to be an effective tool in successfully improving resident procedural skills.4Objectives: By the end of this educational session, the learner will be able to: 1) Understand the indications for an escharotomy. 2) List equipment needed to perform an escharotomy. 3) Demonstrate how to perform an escharotomy. 4) Perform an escharotomy and experience the sensation of cutting through simulated burned tissue. 5) Understand post-escharotomy management and referral to specialist.Methods: Attempts have been made previously to build low cost models for teaching escharotomy. We designed a cost-effective model that could be modified to fit any high or low fidelity simulator. A yoga mat is applied to a mannequin torso and extremities to simulate underlying muscle and is then covered with cloth tape and rubber bands. The final stage of building the model includes charring it to simulate the burned tissue. During the simulation session, learners are then able to realistically feel the sensation of incising through the eschar in order to release the compressive effects of the burned tissue. Underlying intravenous tubing provides realistic bleeding from the incised lower tissues.Topics: Escharotomy, burn, eschar, emergency procedure.

Background: An eschar is not always present in all scrub typhus patients. Furthermore, such patients may present to tertiary care hospitals after administration of doxycycline. The present study aimed to determine the usefulness of using the swab from eschar sites in the diagnosis of scrub typhus in patients who present post-doxycycline therapy., Methods: Blood, eschar scraping and swab samples were collected daily until patient discharge/death. Real-time SYBR green PCR targeting the groEl gene, TaqMan probe PCR targeting the 47 kDa gene and nested PCR targeting the 56 kDa gene of Orientia tsutsugamushi were carried out. Partial sequences of the 56 kDa gene of O. tsutsugamushi were sequenced by the Sanger method and phylogenetic analysis was performed using Mega X., Results: In total, 42 samples (19 eschar scraping and 23 eschar swab samples) were collected from 22 patients. A high positivity of eschar scraping samples (89.5%, 17/19) in comparison to blood (63.2%, 12/19) was observed. The nested PCR for eschar swab samples was positive in 10 (43.5%), 47 kDa gene in nine (39.1%) and groEl in three (13%) samples. The swabs remained positive for 1-4 d after doxycycline was started. The majority of the sequences clustered with Karp-like strains., Conclusion: The eschar swab is a good alternative sample for the diagnosis and genotyping of scrub typhus. It also has the added advantage of persistent positivity despite doxycycline administration., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Severe fever with thrombocytopenia syndrome (SFTS) is known to cause gastrointestinal hemorrhaging; however, few reports have so far specified the site of the hemorrhaging or lesion characteristics. A 79-year-old man was admitted to the hospital with fever, anorexia, and diarrhea which was suspected to be due to gastroenteritis. On day 2, the patient developed hematemesis. Esophagogastroduodenoscopy revealed an acute gastric mucosal lesion. Further physical examination revealed an eschar, and the blood test was positive for SFTS virus nucleic acid. This case suggests that SFTS-associated gastrointestinal hemorrhage may be caused by acute gastritis. SFTS should therefore be considered in cases with fever, gastrointestinal symptoms, and thrombocytopenia.

This case report presents an instance of scrub typhus, distinguished by a solitary eschar on the thigh, and explores the application of dermoscopy with 365 nm ultraviolet illumination for real-time monitoring during treatment. Scrub typhus, caused by Orientia tsutsugamushi, typically manifests with eschars that can be easily overlooked due to their painless nature. This case highlights the utility of dermoscopy in improving eschar detection and therapeutic monitoring, offering a novel approach to managing this potentially severe disease., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Scrub typhus is a naturally occurring acute infectious disease that is primarily transmitted through the bites of chiggers or larval mites infected by Orientia tsutsugamushi (O. tsutsugamushi) . Omadacycline, a novel tetracycline, exhibits potent antibacterial efficacy against both typical bacteria and atypical pathogens. However, omadacycline application in the treatment of scrub typhus remains limited., Case Summary: In the present work, we report several cases of scrub typhus, with the main clinical symptoms being fever, the formation of eschars or ulcers, local or systemic lymphadenopathy, headache, myalgia and rash. Blood samples were collected before omadacycline was administered, and O. tsutsugamushi infection was confirmed through targeted next-generation sequencing (tNGS). After two days of treatment, the patients' symptoms, including fever, were alleviated, with no adverse drug reactions., Conclusion: tNGS is an effective method for diagnosing scrub typhus. Omadacycline can be considered an alternative option for antiinfective therapy in patients with O. tsutsugamushi infections., Competing Interests: Conflict-of-interest statement: The authors declare that there are no conflicts of interest regarding the publication of this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background:Despite the elimination of smallpox, other orthopoxviruses, including cowpox virus, still infect humans. Wild rodents are its natural reservoir. Infections in humans are commonly reported from contact with sick domestic cats, rarely directly from rats. Cow pox in humans is a rare zoonotic disease, the diagnosis of which is problematic due to its rarity and thus the lack of clinical experience.Case report:Presented with a summary of the available clinical data on a 15-year-old boy who became infected with cowpox by a domestic cat.The patient developed cutaneous macular changes in the facial area. Within 3 weeks of the onset of symptoms, the lesions progressed through the papular, vesicular and pustular stages before forming a hard black eschars (2 cm in diameter) with erythema and edema and regional lifadenopathy. Differential diagnosis consisting of cat scratch disease, anthrax and brucellosis excluded microbiological examination. The lesions left scars after 8 weeks of continuous topical antiseptic treatment.Conclusions:The clinical course may be complicated, and the improvement takes 4 to 8 weeks. Infection which entered through the skin changes was the cause of antibiotic therapy. Cowpox should be suspected in patients with poorly healing skin lesions accompanied by a painful black eschars with erythema and local lymphadenopathy.

Introduction: Scrub typhus is transmitted by the bite of the larva (chigger) of a microscopic trombiculidae mite (Leptotrombidium) found in moist areas and vegetation, which serves as both vector and reservoir. Scrub typhus is an often neglected and misdiagnosed febrile illness; clinical suspicion is the only key to diagnosis. Aim: To study clinicolaboratory profile and outcome of serologically confirmed scrub typhus in children from sub Himalayan tribal district of India. Materials and Methods: This cross-sectional observational study was conducted in Department of Paediatrics at Government District Hospital, Chamba, Himachal Pradesh, India, from May 2019 to April 2020. Children upto 18 years admitted with positive Immunoglobulin M (IgM) antibodies for scrub typhus were enrolled. The observational data including detail history and examination, relevant laboratory investigation and treatment was analysed by Statistical Package for Social Sciences (SPSS) software version 18.0 and Chi-square test with p-value <0.05 was considered statistically significant. Results: There were total 55 patients with scrub typhus, mean age was 9.2 years, most common age group was 7-12 years, 51% were male. Fever was most common complaint, followed by vomiting (27.3%), abdomen pain (25.4%), respiratory (1.8%), and rash (9%). Clinical examination findings were generalised lymphadenopathy in 46 (83.6%) patients and splenomegaly in 29 (52.7%). Eight patients presented with respiratory signs and tachypnea at the time of admission. Eschar was present in only 3 (5.5%) patients. Sign of meningeal irritation was present in 4 (7.3% cases and low GCS score (below 9) observed in 7 (12.7%) patients. Eight patients required mechanical ventilatory support. Nineteen patients were prescribed doxycycline alone; while 34 were given both azithromycin and doxycycline. There were total five deaths; on multivariate logistic regression, respiratory complaint, need for mechanical ventilation, pain abdomen with liver damage, history of seizures and duration of fever more than 4 days before presentation to hospital were associated with adverse outcome. Conclusion: The prevalence of scrub typhus is considerably high during rainy season, and should be considered as a differential diagnosis of fever among children in this period regardless of the presence of an eschar. Immediate medical care, treatment with doxycycline with early defervescence of fever reduce mortality. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus is a reemerging zoonosis, which presents as acute febrile illness. Very few paediatric prospective studies on this disease are reported from Eastern India. This prospective observational study was carried out to study the clinical presentation, diagnosis, complications and immediate outcome of Scrub typhus in paediatric population in a tertiary care hospital from Eastern India. Material and Methods: Totally 209 cases between 1 month and 18 years of age were included. Clinical manifestations, laboratory parameters and immediate outcome of all patients were recorded. All the data were collected and plotted in Microsoft Excel master chart. Continuous data were presented as mean ± standard deviation (SD) and categorical data as frequency and percentage. All the data analysis was performed using statistical software IBM Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Highest number of cases (41.1%) were found between 1 year and 5 years age group. Fever was the presenting complaint in all cases. Other common symptoms were cough (34%), pain abdomen (23.4%), vomiting (23%), seizure (11.5%) and altered sensorium (9.6%). Hepatomegaly was found in 56.5% and splenomegaly in 39.7% cases. Eschar was found in 27.3% cases. C-reactive protein was elevated (>10 mg/L) in 93.3% children. Other complications were pneumonitis (20.6%), meningoencephalitis (12.4%), septic shock (8.6%), acute respiratory distress syndrome (5.7%), myocarditis (4.8%) and acute kidney injury (4.3%). Mortality was low (1%). Conclusion: Scrub typhus is not uncommon in paediatric population and it must be considered as a close differential diagnosis of any acute febrile illness even when classical clinical presentations are not found. Early treatment results in favourable outcome. [ABSTRACT FROM AUTHOR]

Introduction: Scrub typhus is re-emerging as a common prolonged febrile illness in children with serious complication involving major organ systems. It is easily treatable yet treatment is challenging with respect to early identification of predictors of serious disease that greatly affects the outcome in this vulnerable population. Aim: To study the clinical profile, analyse the complication and outcome of these patients. Materials and Methods: This was a hospital-based, prospective observational study. It was conducted in the Department of Paediatrics, SCB Medical College and Hospital, Cuttack from October 2017 to September 2019. All children with clinical features of scrub typhus were subjected to Immunoglobulin M (IgM) scrub typhus test. All observational data were analysed by IBM Statistical Package for the Social Science (SPSS) software, version 25.0 and Chi-square test was used with p

Background: Scrub typhus is a mite-borne infection caused by the bacterium, Orientia tsutsugamushi. It is re-emerging in many parts of South East Asia, particularly in rural India. Although no age group is immune to this infection, scrub typhus in neonates is rarely suspected and reported. Here, we report a neonate with scrub typhus who was initially misdiagnosed as “late-onset neonatal sepsis.” Clinical Description: A 26-day-old exclusively breastfed infant presented with fever, vomiting, loose stools, abdominal distension, and refusal of feeds for 3 days. Examination revealed an irritable, febrile, and pale infant. She had tachycardia and facial puffiness. On abdominal examination, generalized distension with hepatosplenomegaly was noted. Blood investigations were suggestive of lymphocytic leukocytosis, thrombocytopenia, toxic granules in peripheral smear, and elevated C-reactive protein. Management: The infant was promptly started on empirical antibiotics for “late-onset sepsis.” However, in view of poor response, other possible differential diagnoses were considered. Careful reexamination revealed a necrotic ulcer covered by a yellow scab with erythematous rim on the left lower eyelid. Based on the clinical presentation and an eschar-like lesion, scrub typhus was suspected. The neonate was started on oral azithromycin and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) testing for scrub typhus came back positive. Fever subsided immediately within 48 h and the infant was discharged after 7 days. Conclusion: Acute febrile illness due to scrub typhus can affect newborns. A high index of suspicion is required for early diagnosis. Timely treatment leads to prompt clinical response and reduced complications.

We report the case of a young female suffering from fever and generalized weakness on presentation and was diagnosed to be a case of cryptogenic organizing pneumonia (COP). She developed breathlessness on rest and required oxygen support and on further evaluation diagnosed with Scrub typhus IgM positive status. This case report highlights the importance of a rare presentation of Scrub typhus in a young female presenting with clinically silent chest changes initially and preventable worse outcomes if detected and managed for scrub typhus infection early in the course of disease.

We report a case of rickettsiosis caused by Rickettsia monacensis in an immunocompetent 67-year-old man in Portugal who had eschar, erythematous rash, and an attached Ixodes ricinus tick. Seroconversion and eschar biopsy led to confirmed diagnosis by PCR. Physicians should be aware of this rare rickettsiosis, especially in geographic regions with the vector. [ABSTRACT FROM AUTHOR]

Objective: Nipple-related complications are major factors that prevent breastfeeding for many new mothers. Hence, we tested the effects of aloe arborescens fomentation applied to the nipples as a treatment for nipple-related complications. Results: This study included 60 women who breastfed for the first time on day 1 after delivery. Every 24 h, all women breastfed six times and bottle-fed two times (at night). Women were classified into an intervention group (aloe arborescens fomentation) and a control group (no treatment). Aloe fomentation was applied after breastfeeding six times per day. We observed the nipples three times per day for 5 days after delivery. The most common nipple-related complication in this study was redness. A significant decrease was observed for women in the intervention group. Trial Registration Retrospectively Registered to registry: UMIN; Registration no.: UMIN000044514; Registered on: 11th June 2021. [ABSTRACT FROM AUTHOR]

Scrub typhus is an acute febrile illness caused by the bacterium Orientia tsutsugamushi. It usually presents with high-grade fever, body aches, and skin rash. We report the case of a woman who presented with acute febrile illness, bilateral pneumonia, and severe hypoxemia. The presence of a typical eschar on the abdomen, made us suspect scrub typhus. Anti-O. tsutsugamushi Immunoglobulin M (IgM) antibody in the serum was detected in significant titers. She was treated with intravenous doxycycline and supplemental oxygen. Thus, scrub typhus should be considered in the differential diagnosis of febrile illness with acute respiratory distress syndrome. [ABSTRACT FROM AUTHOR]