• Tuberculosis and Respiratory Diseases
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• 제63권4호
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• pp.378-381
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• 2007

Tsutsugamushi disease (Scrub typhus) is an acute, febrile illness caused by Orientia tsutsugamushi, which is transmitted to humans through chigger bites. Leptospirosis, a febrile disease caused by various pathogenic Leptospira, and is acquired by exposure to contaminated water and soil. Both diseases have been the most common acute febrile diseases in the autumn in Korea for many years. Concomitant leptospirosis and scrub typhus is quite rare. We report a case of a coinfection with leptospirosis and scrub typhus in a 51-year-old male who presented with fever, abdominal pain and acute dyspnea. The patient was diagnosed with as acalculous cholecystitis, acute respiratory distress syndrome, and septic shock caused by the infection. This is the first case report of a coinfection with leptospirosis and scrub typhus in Korea.

• 대한의생명과학회지
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• 제16권4호
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• pp.311-316
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• 2010

We studied a comparison of the concentration of biochemical markers in sera of patients hospitalized with high fever (n=296) in Jeonbuk province during the last 2 years (2008 to 2009). The patients were divided into three patient groups of viral hemorrhagic fever (VHF) patient group tested positive for Hantavirus (n=53), leptospirosis (LEP) patient group tested positive for Leptospira interrogans (n=137) and scrub typhus (TSU) patient group tested positive for Orientia tsutsugamushi (n=106). We analyzed the concentration of ALP, AST, ALT, blood urea nitrogen, creatinine and glucose and compared the mean levels of them to normal range, the first sample and last sample. The frequencies of abnormal patient elevated above the upper limit of normal for ALP, AST and ALT were 18~43.4%, 78~97% and 62.3~92.7% in patient groups, and 24.5~47.4% (total protein) and 13.2~50.0% (albumin) of patients in patient groups had decreased below the lower limit of normal. The patients showed higher abnormal levels of glucose in patient groups were 58.5% (viral hemorrhagic fever patient group), 66.4% (leptospirosis patient group), 71.7% (scrub typhus patient group) and 66.9% (total patient group). There were significant difference between the first sample and the last sample in the mean levels of AST (decreased 22.2% in viral hemorrhagic fever patient group, 30.2% in leptospirosis patient group, 20.4% in scrub typhus patient group and 24.1% in total patient group), BUN (43.0% in viral hemorrhagic fever patient group, 41.6% in leptospirosis patient group, 47.4% in scrub typhus patient group and 43.0% in total patient group) and glucose (20.2% viral hemorrhagic fever patient group, 17.9% in leptospirosis patient group, 18.6% in scrub typhus patient group and 18.9% in total patient group) in the first sample and the last sample. According to these results, those diseases may cause liver damage and have high concentration of ALP, AST, ALT and glucose in blood even though the patients get out of the hospital.

• Pediatric Infection and Vaccine
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• 제9권2호
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• pp.175-181
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• 2002

목 적:쯔쯔가무시(Tsutusgamushi)병은 리케치아 (Rickettia) 감염증의 하나로 인체병원체인 R. tsutusgamushi에 감염된 좀 진드기 유충(chigger)에 물렸을 때 감염이 된다. 임상적으로 물린 부위에 가피형성, 발열, 발진을 특징으로 하는 급성 발진성 열 성 질환이다. 치료약제로는 Tetracycline, Doxyctcline, Chloramphenicol 등이 사용되고 있으나 소아에서는 약의 부작용으로 인하여 약의 사용에 있어 많은 제한을 받게 되는 경우가 많다. 최근 산모에서 발생한 쯔쯔가무시병을 macrolide 계통의 항생제인 Azithromycin을 치료한 것을 발표한 바가 있다. 이에 저자들은 소아에서 비교적 사용이 용이한 또 다른 macrolide 계열의 항생제인 Clarithromycin을 사용하여 쯔쯔가무시병에 대한 효과를 알아보고자 하였다. 방 법 2001년11월에 마산파티마병원에 급성 열성 질환으로 내원한 환자 중 임상적으로, 혈청학적으로 쯔쯔가무시병으로 진단을 받은 내과 환자 7명과 소아과 환자 3명을 대상으로 Clarithromycin(Ab- bott Laboratories, NorthChicago, IL, USA) 투여하여 쯔쯔가무시병의 치료효과에 대하여 알아보았다. 쯔쯔가무시병의 임상적 진단은 하루 이상의 발열과 최근 수주 이내에 감염 가능성이 있는 지역인들이나 산 등의 지역에 노출된 병력이 있으며 림프절 종대, 반점 구진상의 피부발진과 특징적인 가피 등 의 특징적인 이학적 소견이 동반된 경우 진단을 위한 검사를 실시하였다. 혈청학적인 기준은O. tsutsugamishi 항원 감작 면양 적혈구(sheep red blood cell)를 이용한 수동응집반응검사(passive hamagglutination assay : PHA)인 GENEDIA Tsutsugamushi PHA IIkit(Green Cross, Korea)를 이용하였는데 O. tsutsugamishi 항체가가 1 : 80 이상이면 양성으로 판정하였고 추적검사는 실시하지 않았다. Clarithromycin의 투여량은 성인의 경우 500 mg을 하루에 2회 경구투여 하였으며 소아의 경우 15 mg/kg으로 하루에2회 경구투여 하였다. 결 과 1) 총 대상 환자는 성인 7명, 소아 3명이었으며 성인의 경우 남자는 3명, 여자는 4명이었고 연령은 28세부터 76세까지이었다. 소아의 경우 남자는 1명, 여자는2명이었고4세부터 7세까지의 연령의 분포를 보였다. 임상증상으로는 전 환자에서 발열과 근 육통, 두통 등이 동반되었고 이학적 검사상 발진과 가피를 발견할 수 있었다. 7례에서 PHA 항체 양성 반응 보였고8례에서 간기능의 이상을 보였고6례 에서는 혈소판 감소가 있었다. 간기능의 이상을 보인 환자8례 중 추적관찰이 가능했던 환자6명에서 간기능 정상이 되었고 혈소판 감소증을 보인 환자 중 추적관찰이 가능했던 5명에서 혈소판의 수가 정상적으로 되었다. 2) Clarithromycin 투약 후 열이 떨어지는데 걸리 는 시간은 평균 1.3일(1 ~ 2일)이었으며 투약기간은 6일에서11일까지 평균7.2일을 사용하였다. 전 환자에서 특별한 합병증 없이 회복이 되었다. 결 론 본 연구에서 쯔쯔가무시병의 환자의 치료에 있어 Clarithromycin 투여가 효과적이었으나 증례 수가 많지 않아 향후 더 많은 연구가 이루어져할 것으로 사료된다.

• Parasites, Hosts and Diseases
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• 제57권2호
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• pp.167-173
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• 2019

Rickettsial infections (Rickettsioses) are the causes of acute fever found in Thailand. It is classified as acute febrile illnesses transmitted by bloodsucking arthropod vectors (tick, flea, and chigger). This research investigated pathogens of scrub typhus in vectors from Bangkaew District, Phatthalung Province. A total of 303 pools of vector samples were ticks (Rhipicephalus sanguineus, R. microplus, and Haemaphysalis sp.), fleas (Ctenocephalides felis orientis, C. f. felis, and C. canis), and chiggers (Leptotrombidium deliense, Aschoschoengastia indica, Blankaartia acuscutellaris and Walchia disparunguis pingue) collected from reservoir hosts (dogs and rodents). The 17 and 56 kDa gene of Rickettsia causing scrub typhus were found in 29% of ticks and 98% of flea. DNA sequence analysis reveeled the detected strains were R. asembonensis and Rickettsia sp. cf1 and 5.The chiggers, 1%, were infected with Rickettsia strain TA763, a pathogen of scrub typhus.

• 대한지리학회지
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• 제42권6호
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• pp.863-878
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• 2007

쯔쯔가무시증 환자 발생의 시 공간적 분포를 기후, 서식환경 변화 등 환경생태요인과 관련하여 질병지리적 측면에서 분석하였다. 쯔쯔가무시증은 1951년에 보고된 뒤 1986년에 재발했고, 1998년과 2004년부터 급증하였다. 계절별로는 11월(58%)과 10월(33.2%)에 주로 노인층에서 발병한다. 남부평야지대에 발생하던 쯔쯔가무시증은 점차 동부산지지대를 제외한 전국으로 확산되었으며, 경기도 화성시는 발병자가 급증한 대표지역이다. 발병자가 급증한 것은 기후와 토지이용 변화 등 환경생태요인이 복합적으로 작용한 결과로 본다. 전국적으로는 연평균기온이 상승하고 연평균강수량이 감소하면서 쯔쯔가무시증 환자가 증가하였다. 그러나 사례 조사지역인 화성시, 합천군 등에서는 여름철 기온이 상승하고 강수량 많은 해에 환자가 증가했다. 여름에 기온이 높고 상대적으로 건조하면 식생이 무성해져 털진드기의 생장과 번식이 활발해진다. 이어서 가을이 온화해지면서 털진드기 활동이 활발해지면서 환자가 급증한 것으로 본다. 농촌에서 환자가 많은 것은 1980년대 이후 토지이용 변화에 따라 마을과 경작지 주변에 늘어난 관목숲, 풀숲을 중심으로 쯔쯔가무시증의 매개체인 들쥐류와 털진드기가 번성하면서 질병을 확산시킨 결과로 본다.

• Tuberculosis and Respiratory Diseases
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• 제70권3호
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• pp.247-250
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• 2011

The pandemic (H1N1) 2009 influenza outbreak coincided with the typical Scrub typhus season, which can lead to diagnostic difficulties due to their similar and non-specific symptoms. Here we describe a case of laboratory confirmed co-infection of Pandemic (H1N1) 2009 influenza and Scrub typhus and discuss the difficulties in distinguishing the two illnesses clinically.

• Journal of Microbiology and Biotechnology
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• 제24권12호
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• pp.1728-1735
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• 2014

Scrub typhus, caused by infection with Orientia tsutsugamushi, is a mite-borne zoonotic disease endemic to the Asian-Pacific region. In Korea, the incidence of this disease has increased with climate changes, and over 10,000 cases of infection were reported in 2013. Although this infection is treatable with antibiotics such as doxycycline and azithromycin, an effective prophylactic vaccine against O. tsutsugamushi would be more desirable for preventing scrub typhus in endemic areas. In this study, we investigated the 56-kDa type-specific antigen (TSA56), which is a major outer membrane protein of O. tsutsugamushi, as a vaccine candidate. Intranasal immunization of recombinant TSA56 (rec56) induced a higher level of TSA56-specific IgG than that induced by intramuscular immunization of tsa56-expressing DNA (p56). Both types of immunization induced a cell-mediated immune response to TSA56, as demonstrated by the splenic cell proliferation assay. Mice immunized with p56, followed by rec56 plus heat-labile enterotoxin B subunit from E. coli, had a stronger protection from a homologous challenge with the O. tsutsugamushi Boryong strain than with other combinations. Our preliminary results suggest that an effective human vaccine for scrub typhus can include either recombinant TSA56 protein or tsa56-expressing DNA, and provide the basis for further studies to optimize vaccine performance using additional antigens or different adjuvants.

• Tuberculosis and Respiratory Diseases
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• 제52권3호
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• pp.283-287
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• 2002

Scrub typhus is an acute, febrile disease of humans that is caused by Orientia Tsutsugamushi. It is transmitted through the bite of chiggers. The spectrum of the clinical severity for scrub typhus ranges from mild to severe with fatal complication such as meningoencephalitis, pneumonitis, myocarditis. Severe pulmonary involvement e.g. acute respiratory distress syndrome(ARDS) and meningoencephalitis have rarely been observed since the introduction of specific antibiotic therapy. We experienced a case of scrub typhus manifested with ARDS and meningoencephalitis. The patient was treated with doxycycline, anticonvulsant and mechanical ventilator therapy.

• Parasites, Hosts and Diseases
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• 제50권4호
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• pp.327-331
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• 2012

Monthly surveys were conducted to investigate the occurrence of chigger mites and seroprevalence of scrub typhus among small mammals in Jeollanam-do, the southwestern part of Korea, from November 2006 through October 2007. Fifty-eight small mammals, including 57 Apodemus agrarius (98.3%) and 1 Crocidura lasiura (1.7%), were captured, and a total of 4,675 chigger mites representing 4 genera and 8 species were collected from them. The chigger infestation rate among small mammals was 69.0%. The most predominant species in A. agrarius was Leptotrombidium scutellare (54.0%), followed by Leptotrombidium pallidum (39.4%), Leptotrombidium orientale (4.4%), Leptotrombidium palpale (1.1%), Neotrombicula tamiyai (0.6%), Eushoengastia koreaensis (0.3%), Neotrombicula gardellai (0.3%), and Cheladonta ikaoensis (<0.1%). The chigger index of A. agrarius was the highest in October (740.0), followed by November (242.0), September (134.6), March (98.3), February (38.2), January (35.3), December (34.5), April (30.8), and May (1.7). The average antibody positive rate of scrub typhus in wild rodents was 50.0%. The seropositive rates were high in October (100.0%) and November (83.3%), whereas those in other months were relatively low (28.6-57.1%). The chigger index of L. scutellare rapidly increased in September to form an acuminate peak in October, followed by a gradual decline. These results suggest that the outbreak of scrub typhus in the southwestern part of Korean peninsula is mostly due to L. scutellare.

• Parasites, Hosts and Diseases
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• 제47권4호
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• pp.381-386
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• 2009

A survey to determine the geographical distribution and relative abundance of potential vectors of scrub typhus was conducted from October to November 2006 at 13 localities throughout the Republic of Korea. Apodemus agrarius accounted for 97.6% (80/82) of all rodents, while only 2 Myodes regulus (2/82) were collected. A total of 10,860 chiggers were collected from A. agrarius belonging to 4 genera and 8 species, while only Walehia fragilis (40) was collected from Myodes regulus. Leptotrombidium pallidum (8,137; 74.9%), a vector of scrub typhus, was the predominant species collected from A. agrarius followed by Leptotrombidium scutellare (2,057, 18.9%), Leptotrombidium palpale (279; 2.7%), Leptotrombidium orientale (232; 2.1%), and Leptotrombidium zetum (79; 0.7%), Neotrombicula tamiyai (58; 0.5%), Euschoengastica koreaensis (16; 0.1%), and Cheladonta ikaoensis (2; < 0.1 %). L. pallidum was the predominant chigger collected at collection sites in Gangwon (100%), Gyeonggi (87.2%), Chungnam (100%), Chungbuk (100%), Jeonbuk (73.9%), Jeonnam (77.0%), and Gyeongbuk (66.1%) provinces, whereas L. scutellare was the predominant chigger collected in Gyeongnam province (77.9%) and Jeju Island (62.3%). Data suggest a correlation between chigger population abundance and human cases of scrub typhus in Korea.