|
|
Dispatch
Emerging Rickettsioses of
the Thai-Myanmar Border
Philippe Parola,*†‡ R. Scott Miller,* Philip McDaniel,§ Sam R. Telford
III,‡ Jean-Marc Rolain,† Chansuda Wongsrichanalai,* and Didier Raoult†
*Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok,
Thailand; †Unité de Rickettsies, Marseille, France; ‡Harvard School of
Public Health, Boston, Massachusetts, USA; and §Kwai River Christian Hospital,
Sangkhlaburi, Kanchanaburi, Thailand
| Table. Clinical
and laboratory data of patients with rickettsioses on the Thai-Myanmar
border. |
|
| |
|
|
|
|
|
|
Immunofluorescence serologic testinga
IgG/IgM early IgG/IgM late
|
| |
|
|
|
|
|
|
|
| |
|
|
Clinical signs accompanying fever
|
SFG rickettsia antigens
|
|
Orientia tsutsugamushi
|
| |
|
|
|
|
|
|
| Patient no. |
Age/sex
|
A. bite
|
R
|
E
|
N
|
Other
|
Rh
|
Rc
|
Rjap
|
Rhon
|
Rslo
|
AT1
|
Rheil
|
Rfel
|
R. typhi antigen
|
G
|
Kw
|
Kp
|
K
|
|
|
Scrub typhus
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1
|
29/M
|
Not noticed
|
No
|
No
|
Yes
|
Headache, stupor, meningism, thrombocytopenia,
 ALT
|
0/16
0/16
|
0/0
0/0
|
0/16
0/16
|
0/8
0/8
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/32
256/32
|
0/8
0/8
|
0/8
256/32
|
0/0
0/0
|
|
2
|
50/F
|
Yes
|
Yesb
|
Yes
|
No
|
Chills, myalgia, vomiting, thrombocytopenia,
GGT ALT
|
0/32
0/32
|
0/0
0/0
|
0/32
0/32
|
0/16
0/16
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
128/64
128/16
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
3
|
32/M
|
Yes
|
No
|
No
|
Yes
|
Headache, myalgia, cough, thrombocytopenia,
GGT ALT
|
0/16
16/16
|
0/0
0/0
|
0/0
16/16
|
0/8
0/8
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
512/128
|
0/0
0/0
|
0/0
512/0
|
0/0
0/0
|
|
Murine typhus
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4
|
28/F
|
|
No
|
No
|
No
|
Chills, headache, vomiting, myalgia,
cough, thrombocytopenia
|
16/128e
16/64e
|
16/64
16/64
|
16/8
0/0
|
16/16
16/64
|
16/16
16/8
|
0/0
0/0
|
0/32
0/8
|
0/0
0/0
|
64/128e
32/32e
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
5
|
35/M
|
Not noticed
|
No
|
No
|
No
|
Chills, headache,
ALT
|
0/64
16/128
|
0/64
16/256
|
0/8
0/8
|
0/64
0/64
|
0/0
0/0
|
0/0
0/0
|
0/32
0/128
|
0/0
0/0
|
16/256
512/256
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
6
|
37/F
|
Not noticed
|
No
|
No
|
No
|
Chills, headache, myalgia, vomiting,
thrombocytopenia,
GGT ALT
|
16/64
128/64
|
32/8
32/0
|
0/0
32/0
|
16/0
128/0
|
16/0
128/8
|
0/0
32/8
|
0/0
32/0
|
0/0
0/0
|
64/8
512/256
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
7
|
20/F
|
Not noticed
|
No
|
No
|
No
|
Headache, back pain
|
0/128
16/64
|
0/64
0/64
|
0/0
0/64
|
0/32
0/64
|
0/0
0/164
|
0/0
0/8
|
0/0
0/0
|
0/0
0/0
|
0/64
128/256
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
SFG rickettsioses
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8
|
70/F
|
|
No
|
No
|
No
|
Chills, headache, vomiting, hepatomegaly,
leukopenia
|
0/32
32/32
|
0/32
32/32
|
0/0
0/0
|
0/8
16/8
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
1024/256d
|
0/0
0/256d
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
9
|
50/M
|
Not noticed
|
Yesc
|
Yes
|
Yes
|
Chills, abdominal pain, confusion,
thrombocytopenia
|
64/8d
64/16
|
128/16d
128/16
|
32/0d
32/0
|
32/0d
64/0
|
32/0d
128/0
|
0/0
0/0
|
16/0d
32/8
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
10
|
45/M
|
|
No
|
No
|
Yes
|
Vomiting, diarrhea, hepato-splenomegaly
|
16/32d
64/32
|
64/32d
64/32
|
16/32d
32/16
|
16/0d
32/16
|
16/16d
16/16
|
0/0
0/0
|
16/8d
32/16
|
0/0
0/0
|
0/16d
16/32
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
11
|
35/M
|
Tick bite
|
No
|
Yes
|
No
|
Chills, headache, vomiting, myalgia,
cough, splenomegaly,
GGT
ALT
|
64/256
16/128
|
0/16
16/32
|
16/8
0/8
|
16/256
16/128
|
0/64
0/64
|
0/32
16/8
|
32/32
0/16
|
0/0
0/0
|
0/256
0/256
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
12
|
37/F
|
A. removed from ear
|
No
|
No
|
No
|
Chills, headache, vomiting, myalgia,
cough, GGT
ALT
|
0/16
128/32
|
0/0
0/0
|
0/0
64/0
|
0/0
32/16
|
0/0
16/32
|
0/8
0/0
|
0/8
32/16
|
0/0
0/0
|
0/32
0/64
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
13
|
20/F
|
Tick bite
|
No
|
Yes
|
No
|
Headache, chills, myalgia
|
32/16d
64/16
|
32/0d
32/0
|
32/0d
64/0
|
64/0d
128/0
|
32/8d
64/8
|
0/0
0/0
|
0/0
0/0
|
32/0d
64/0
|
0/0
|
512/0
512/0
|
0/0
|
0/0
|
0/0
|
|
14
|
55/F
|
|
No
|
No
|
No
|
Chills, headache, myalgia, diarrhea,
thrombocytopenia
|
16/32
128/16
|
16/16
16/16
|
16/16
16/16
|
16/16
16/16
|
16/16
64/0
|
16/16
16/16
|
16/0
64/0
|
32/0
64/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
0/0
0/0
|
|
15
|
29/M
|
|
Yesb
|
No
|
No
|
Chills, headache, myalgia, cough,
thrombocytopenia,
GGT ALT
|
16/16
64/64d
|
16/16
32/32d
|
32/16
32/32d
|
32/16
32/32d
|
16/0
64/64d
|
32/16
32/32d
|
16/0
64/64d
|
16/16
64/64d
|
0/0
0/0
|
256/0
256/0
|
256/0
256/0
|
0/0
0/0
|
0/0
0/0
|
|
| Abbreviations: A., arthropod;
Ig, immunoglobulin; R, rash; E, eschar; N, nodes; Rh, Rickettsia
helvetica; Rc, R. conorii Indian; Rjap, R. japonica;
Rhon, R. honei; Rslo, R. slovaca; AT1, Rickettsia
strain AT1 from Japan; Rheil, “R. heilongjiangii”; Rfel, R.
felis; G, strain Gilliam; Kw, strain Kawazaki; Kp, strain Karp;
Ko, strain Kato. |
| aImmunofluorescence
assay was completed by Western blot and cross-adsorption as described
in the text. For typhus and spotted fever group antigens, the rickettsia
considered potentially responsible for the infection are in bold type. |
| bMaculopapular
over chest and back. |
| cVesiculous on
the legs. |
| dAntigens and
sera used for Western blot assays. |
eAntigens and
sera used for Western blot and cross-adsorption
assays. |
|
