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Sample records for scrub typhus immunogens

  1. Scrub typhus

    Directory of Open Access Journals (Sweden)

    Amy G Rapsang

    2013-01-01

    Full Text Available Scrub typhus is an acute febrile illness caused by orientia tsutsugamushi, transmitted to humans by the bite of the larva of trombiculid mites. It causes a disseminated vasculitic and perivascular inflammatory lesions resulting in significant vascular leakage and end-organ injury. It affects people of all ages and even though scrub typhus in pregnancy is uncommon, it is associated with increased foetal loss, preterm delivery, and small for gestational age infants. After an incubation period of 6-21 days, onset is characterized by fever, headache, myalgia, cough, and gastrointestinal symptoms. A primary papular lesion which later crusts to form a flat black eschar, may be present. If untreated, serious complications may occur involving various organs. Laboratory studies usually reveal leukopenia, thrombocytopenia, deranged hepatic and renal function, proteinuria and reticulonodular infiltrate. Owing to the potential for severe complications, diagnosis, and decision to initiate treatment should be based on clinical suspicion and confirmed by serologic tests. A therapeutic trial of tetracycline or chloramphenicol is indicated in patients in whom the diagnosis of scrub typhus is suspected. The recommended treatment regimen for scrub typhus is doxycycline. Alternative regimens include tetracycline, chloramphenicol, azithromycin, ciprofloxacin, rifampicin, and roxithromycin. Treatment of pregnant women with azithromycin was successfully done without relapse and with favorable pregnancy outcomes. Hence, early diagnosis and treatment are essential in order to reduce the mortality and the complications associated with the disease. We searched the English-language literature for reports of scrub typhus in children, pregnant women, and non-pregnant patients with scrub typhus, using the MEDLINE/PubMed database, which includes citations from 1945 to the present time. We used the search terms ′scrub typhus′, ′scrub typhus′ and ′pregnancy′, ′scrub

  2. Gamma-irradiated scrub typhus immunogens: broad-spectrum immunity with combinations of rickettsial strains

    International Nuclear Information System (INIS)

    Eisenberg, G.H. Jr.; Osterman, J.V.

    1979-01-01

    Scrub typhus immunogens were prepared from Rickettsia tsutsugamushi strains Karp, Kato, Gilliam, Kostival, and Buie by exposing frozen infected yolk sac suspensions to 300 krad of gamma radiation. Mouse protection tests showed that each of the irradiated immunogens protected C3H/HeDub mice against high challenge levels of Karp and Gilliam, but that none of these single-strain immunogens were capable of protecting against all five of the challenge strains. Broad-spectrum protection was achieved by using combinations of three strains of irradiated rickettsiae in a vaccination regimen of three injections at 5-day intervals

  3. Opsoclonus in scrub typhus

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    S D'sa

    2012-01-01

    Full Text Available Scrub typhus is a mite borne infectious disease caused by Orientia tsutsugamushi. It is a common cause of undifferentiated febrile illness in the Indian subcontinent. We present a case of scrub typhus with a rare ophthalmic manifestation.Our patient presented with fever and opsoclonus, was diagnosed to have scrub typhus and completely improved upon treatment. Opsoclonus complicates various medical diseases, including viral infections, toxin, encephalitis, brain tumors, and paraneoplastic syndromes. There has been only one previously reported case of opsoclonus in scrub typhus. This phenomenon highlights the increasingly complex presentation of common diseases. It also indicates there is much to be discovered about the immunopathogenesis of this infectious disease.

  4. Diagnosis of Scrub Typhus

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    Koh, Gavin C. K. W.; Maude, Richard J.; Paris, Daniel H.; Newton, Paul N.; Blacksell, Stuart D.

    2010-01-01

    Scrub typhus is transmitted by trombiculid mites and is endemic to East and Southeast Asia and Northern Australia. The clinical syndrome classically consists of a fever, rash, and eschar, but scrub typhus also commonly presents as an undifferentiated fever that requires laboratory confirmation of

  5. Pancreatitis in scrub typhus

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    Alok Bhatt

    2014-01-01

    Full Text Available Scrub typhus is a rickettsial infection prevalent in most parts of India. Acute pancreatitis with pseudocyst formation is a rare complication of this condition. This paper reports acute renal failure, pancreatitis and pseudocyst formation in a 48-year-old female with scrub typhus. Ultrasonography of the abdomen revealed a bulky pancreas with fluid seen along the body of the pancreas in the lesser sac. The infection was successfully treated with doxycycline and supportive treatment. Pancreatitis was managed conservatively. This case report highlights the importance of identifying and managing uncommon complications of a common tropical disease for optimum outcome.

  6. Gamma-irradiated scrub typhus immunogens: analysis for residual replicating rickettsiae

    International Nuclear Information System (INIS)

    Eisenberg, G.H. Jr.; Osterman, J.V.; Stephenson, E.H.

    1980-01-01

    Scrub thyphus immunogens that received inadequate gamma radiation contained residual, viable rickettsiae. The presence of these organisms in the host was masked by the rapid immune response elicited by the large number of inactivated rickettsiae. Transfer of homogenized spleen cells from immunized mice to normal syngeneic recipients provided a sensitive technique for the detection of these viable, replicating organisms

  7. Scrub Typhus, Republic of Palau

    OpenAIRE

    Demma, Linda J.; McQuiston, Jennifer H.; Nicholson, William L.; Murphy, Staci M.; Marumoto, Pearl; Sengebau-Kingzio, J. Maireng; Kuartei, Stevenson; Durand, A. Mark; Swerdlow, David L.

    2006-01-01

    Scrub typhus, caused by Orientia tsutsugamushi, is a severe febrile illness transmitted to humans by trombiculid mites, which normally feed on rodents. The first known outbreak of scrub typhus in Palau occurred in 2001 to 2003 among residents of the remote southwest islands. To determine the extent of scrub typhus distribution in Palau, we tested serum samples from humans and rodents for antibodies to O. tsutsugamushi. Of 212 Palau residents surveyed in 2003, 101 (47.6%) had immunoglobulin G ...

  8. Diagnosis of scrub typhus.

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    Janardhanan, Jeshina; Trowbridge, Paul; Varghese, George M

    2014-12-01

    Scrub typhus is an acute febrile illness that, if untreated, can result in considerable morbidity and mortality. One of the primary reasons for delays in the treatment of this potentially fatal infection is the difficulty in diagnosing the condition. Diagnosis is often complicated because of the combination of non-specific symptoms that overlap with other infections commonly found in endemic areas and the poor available diagnostics. In the majority of the endemic settings, diagnosis still relies on the Weil-Felix test, which is neither sensitive nor specific. Other methods of testing have become available, but at this time, these remain insufficient to provide the rapid point-of-care diagnostics that would be necessary to significantly change the management of this infection by providers in endemic areas. This article reviews the currently available diagnostic tools for scrub typhus and their utility in the clinical setting.

  9. Neuropsychiatric manifestations of scrub typhus

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    Sanjay K Mahajan

    2017-01-01

    Full Text Available Scrub typhus is caused by Orientia tsutsugamushi characterized by focal or disseminated vasculitis and perivasculitis which may involve the lungs, heart, liver, spleen and central nervous system. It was thought to have been eradicated from India. Recently it is being reported from many areas of India. The clinical picture and severity of the symptoms varies widely. The neurological manifestations of scrub typhus are not uncommon but are diverse. Meningoencephalitis is classical manifestation of scrub typhus but cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, neuroleptic malignant syndrome and Guillan-Barré syndrome are other manifestations reported in literature. The availability of literature on the neurological manifestations of scrub typhus is limited to case reports mainly. This article reviews various neurological manifestations of scrub typhus reported in literature.

  10. Status epilepticus in scrub typhus.

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    Kalita, Jayantee; Mani, Vinita E; Bhoi, Sanjeev K; Misra, Usha K

    2016-07-01

    Scrub typhus is an emerging infection, and there is little information about status epilepticus (SE) in scrub typhus. We report the clinical spectrum and outcome of SE in scrub typhus. In a 3-year prospective hospital-based observational study, all scrub typhus patients with SE were included. Scrub typhus was diagnosed by immunochromatography assay. SE was defined if convulsions lasted longer than 5 min. The patients' demographic, clinical, computed tomography (CT), magnetic resonance imaging (MRI), and electroencephalography (EEG) findings were noted. Response to antiepileptic drugs (AEDs) and outcome at 1 month and 1 year were recorded. Between 2012 and 2014, there were 66 patients with scrub typhus admitted with central nervous system (CNS) involvement, 10 (15.2%) of whom had SE (generalized convulsions in 5, secondary generalized in one). The median age of the patients was 34 (range 18-71) years and seven were female. The duration of SE ranged between 10 min and 48 h. SE responded to one AED in five patients, two AEDs in three patients, and more than two AEDs in two patients. Cranial MRI findings were normal. All patients recovered completely with doxycycline by 1 month and AED was withdrawn by 8 months in all. Although 15% patients with scrub typhus may have SE, they have good outcome. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  11. Acute Cholecystitis in Patients with Scrub Typhus

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    Lee, Hyun; Ji, Misuk; Hwang, Jeong-Hwan; Lee, Ja-Yeon; Lee, Ju-Hyung; Chung, Kyung Min; Lee, Chang-Seop

    2015-01-01

    Acute cholecystitis is a rare complication of scrub typhus. Although a few such cases have been reported in patients with scrub typhus, the clinical course is not well described. Of 12 patients, acute cholecystitis developed in 66.7% (8/12) of patients older than 60 yr. The scrub typhus group with acute cholecystitis had marginal significant longer hospital stay and higher cost than the group without cholecystitis according to propensity score matching. Scrub typhus should be kept in mind as ...

  12. HRCT findings of scrub typhus

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    Kim, Kyu Sik; Kang, Sung Soo; Jin, Kong Yong; Lee, Jeong Min; Han, Young Min; Kim, Chong Soo; Chung, Gyung Ho; Lee, Sang Yong; Sohn, Myung Hee; Choi, Ki Chul

    1997-01-01

    To evaluate high-resolution CT (HRCT) findings of scrub typhus. We retrospectively reviewed the HRCT scans of 26 serologically confirmed scrub typhus patients. One underwent follow-up HRCT scanning. Twenty-three(88.5%) of the 26 patients showed abnormal findings. All 23 had lung parenchymal lesions; a small amount of pleural effusion was seen in 11 patients, and lymphadenopathy in six. The predominant parenchymal lesion was thickening of interlobular septae and the axial and intralobular interstitium (n=16). Most lesions were located in both lower lung zones. Other findings were ground-glass attenuation (n=11) and focal parenchymal consolidation (n=8). In one patient, parenchymal lesions were resolved on follow-up HRCT scanning. HRCT findings of interstitial thickening, abnormally increased parenchymal attenuation, pleural effusion and lymphadenopathy with typical clinical symptoms were diagnostic of scrub typhus

  13. HRCT findings of scrub typhus

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    Kim, Kyu Sik; Kang, Sung Soo; Jin, Kong Yong; Lee, Jeong Min; Han, Young Min; Kim, Chong Soo; Chung, Gyung Ho; Lee, Sang Yong; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National Univ. Medical School, Chonju (Korea, Republic of)

    1997-06-01

    To evaluate high-resolution CT (HRCT) findings of scrub typhus. We retrospectively reviewed the HRCT scans of 26 serologically confirmed scrub typhus patients. One underwent follow-up HRCT scanning. Twenty-three(88.5%) of the 26 patients showed abnormal findings. All 23 had lung parenchymal lesions; a small amount of pleural effusion was seen in 11 patients, and lymphadenopathy in six. The predominant parenchymal lesion was thickening of interlobular septae and the axial and intralobular interstitium (n=16). Most lesions were located in both lower lung zones. Other findings were ground-glass attenuation (n=11) and focal parenchymal consolidation (n=8). In one patient, parenchymal lesions were resolved on follow-up HRCT scanning. HRCT findings of interstitial thickening, abnormally increased parenchymal attenuation, pleural effusion and lymphadenopathy with typical clinical symptoms were diagnostic of scrub typhus.

  14. Acute Cholecystitis in Patients with Scrub Typhus.

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    Lee, Hyun; Ji, Misuk; Hwang, Jeong-Hwan; Lee, Ja-Yeon; Lee, Ju-Hyung; Chung, Kyung Min; Lee, Chang-Seop

    2015-11-01

    Acute cholecystitis is a rare complication of scrub typhus. Although a few such cases have been reported in patients with scrub typhus, the clinical course is not well described. Of 12 patients, acute cholecystitis developed in 66.7% (8/12) of patients older than 60 yr. The scrub typhus group with acute cholecystitis had marginal significant longer hospital stay and higher cost than the group without cholecystitis according to propensity score matching. Scrub typhus should be kept in mind as a rare etiology of acute cholecystitis in endemic areas because the typical signs of scrub typhus such as skin rash and eschar can present after the abdominal pain.

  15. Endemic Scrub Typhus-like Illness, Chile

    Science.gov (United States)

    2011-09-01

    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...vectors for murine typhus (R. typhi) and fl ea-borne spotted fever (R. felis), mites as vectors of rickettsialpox (R. akari), and scrub typhus ...rickettsial disease have been reported in this country since 1976 (3). Scrub typhus , caused by O. tsutsugamushi, which is usually transmitted by

  16. Scrub typhus: Clinical spectrum and outcome.

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    Venkategowda, Pradeep M; Rao, S Manimala; Mutkule, Dnyaneshwar P; Rao, Mallela V; Taggu, Alai N

    2015-04-01

    Scrub typhus is one of the differential diagnoses for fever with thrombocytopenia. ARDS associated with Scrub typhus has high morbidity and mortality. To evaluate clinical features, lab values, and outcome in patients with scrub typhus and comparison in patients with or without ARDS. A prospective observational study was conducted on 109 patients with febrile illness and thrombocytopenia during a period of 12 months. All 109 patients were tested with both Immune-chromatography test and Weil felix test. Patients having either Immune-chromatography test/Weil felix test positive have been included and considered as scrub typhus positive whereas negative for both Immune-chromatography and Weil felix test were excluded. Clinical features, lab parameters, and outcome were evaluated in all patients with scrub typhus. Statistical analysis used in this study was T-test. Among 58 patients who were included (After exclusion of 51 patients among total of 109 patients) 34 patients had no ARDS and 24 patients had ARDS. The clinical feature like dyspnoea, cough, low blood pressure (MAPscrub typhus patients group with ARDS. The higher titers of Weil-felix can be correlated with more severe form of disease according to our observation. All 34 Scrub typhus patients without ARDS recovered completely. Among 24 Scrub typhus patients with ARDS, 22 patients recovered, and 2 patients died. Scrub typhus is an important differential diagnosis in a patients having fever with thrombocytopenia. Scrub typhus associated with ARDS has high morbidity and mortality. Early diagnosis and treatment with doxycycline can prevent the occurrence of ARDS.

  17. Peritonitis in Patients with Scrub Typhus

    OpenAIRE

    Lee, Chang-Hun; Lee, Jae-Hoon; Yoon, Ki Jung; Hwang, Jeong-Hwan; Lee, Chang-Seop

    2012-01-01

    Various complications have been reported in scrub typhus cases including acute respiratory distress syndrome, encephalitis, pneumonia, pericarditis, acute renal failure, and acute hepatic failure. Few studies have reported on the gastrointestinal manifestations of scrub typhus. Typical gastrointestinal manifestations in patients with scrub typhus include abdominal pain, nausea, vomiting, hematemesis, melena, and diarrhea. The two cases presented in this study are the first reported cases of p...

  18. Acute pancreatitis associated with scrub typhus.

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    Sv, Padmavathi Devi; M, Aruna; Kumar, Anil Cv; Krishna Reddy, Hari; Bl, Sangeetha; Siva Kumar, V

    2017-01-01

    Scrub typhus, or tsutsugamushi fever, is a zoonosis of rural Asia and the western Pacific islands. The causative organism, Orientia (formerly Rickettsia) tsutsugamushi, is transmitted to humans by the bite of a larval Leptotrombidium mite (chigger). Scrub typhus may have gastrointestinal presentations, such as acute acalculous cholecystitis, duodenal ulcer perforation, peritonitis and gastric ulceration. Acute pancreatitis with scrub typhus has been reported rarely. We report a patient of scrub typhus complicated by acute pancreatitis and acute kidney injury. © The Author(s) 2016.

  19. Clinical manifestations of scrub typhus.

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    Rajapakse, Senaka; Weeratunga, Praveen; Sivayoganathan, Sriharan; Fernando, Sumadhya Deepika

    2017-02-01

    The mite-borne rickettsial zoonosis scrub typhus is widely prevalent in parts of Southeast and Far East Asia, and northern Australia. The disease is an acute febrile illness, associated with rash and often an eschar, which responds dramatically to treatment with antibiotics. In some cases it results in a serious illness leading to multiple organ involvement and death. The disease manifestations are thought to result from a systemic vasculitis, caused by both direct effects of the organisms as well as an exaggerated immune response, although little is understood about its pathogenesis. A wide spectrum of clinical manifestations, affecting nearly every organ system, have been described with scrub typhus. Some of these manifestations are serious and life threatening. In this systematic review, we summarise the typical and atypical manifestations of scrub typhus reported in the literature. Awareness of these unusual manifestations will hopefully guide clinicians towards diagnosing the condition early, and initiating early appropriate antibiotics and other supportive measures. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Scrub Typhus: An Emerging Threat

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    Chakraborty, Sayantani; Sarma, Nilendu

    2017-01-01

    Scrub typhus is caused by Orientia tsutsugamushi (formerly Rickettsia) and is transmitted to humans by an arthropod vector of the Trombiculidae family (Leptotrombidium deliense and L. akamushi). It is the most common re-emerging Rickettsial infection in India and many other South East Asian countries. In fact, scrub typhus is confined geographically to the Asia Pacific region, a billion people are at risk and nearly a million cases are reported every year. Scrub typhus appears particularly to be distributed in the tsutsugamushi triangle which is distributed over a very wide area of 13 million km2 bound by Japan in the east, through China, the Philippines, tropical Australia in the south, and west through India, Pakistan, possibly to Tibet to Afghanistan, and southern parts of the USSR in the north. Eschar is the characteristic lesion that starts as a vesicular lesion at the site of mite feeding. Later, an ulcer forms with black necrotic center and an erythematous border along with regional lymphadenopathy. Other features are fever, maculopapular rash starting from the trunk, and spreading to the limbs. It may affect the central nervous system, cardiovascular system, renal, respiratory, and gastrointestinal systems. Serious complication in the form of myocarditis, pneumonia, meningoencephalitis, acute renal failure, gastrointestinal bleeding, and even acute respiratory distress syndrome may develop. Tetracycline or chloramphenicol remains the main stay of therapy. PMID:28979009

  1. Predictors of Severity in Pediatric Scrub Typhus.

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    Narayanasamy, Dinesh Kumar; Arun Babu, Thirunavukkarasu; Vijayadevagaran, Vijayasankar; Kittu, Devi; Ananthakrishnan, Shanthi

    2018-01-24

    To identify the factors that can predict the severity of scrub typhus in children. This prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children scrub typhus were included in the study. These children were followed during the hospital course and their laboratory results, response to treatment and complications were documented. Cases of 'severe scrub typhus' were identified based on criteria from published adult and pediatric studies. Out of 930 children with fever for more than 7d, IgM ELISA for scrub typhus was positive in 230 children. Ninety one (40.6%) cases fulfilled the criteria of 'severe scrub typhus' in children. Out of 45 factors, 27 potential factors were studied. The multivariate analysis identified 5 factors, breathlessness (OR: 6.85, 95%CI: 2.69 to 9.87), altered sensorium (OR: 11.48, 95% CI 3.43 to 10.19), leucocytosis (OR: 3.38, 95% CI 1.12 to 10.16), hypoalbuminemia (OR: 10.78, 95% CI 2.66 to 48.76), and hyponatremia (OR: 10.08, 95% CI 2.11 to 23.42) to be significantly associated with the 'severe scrub typhus' cases. Breathlessness, altered sensorium, leucocytosis, hypoalbuminemia, and hyponatremia predict severity in childhood scrub typhus. Presence of these factors should alert the treating physician regarding the need for intensive monitoring, treatment or referral.

  2. Extracorporeal Membrane Oxygenation for Complicated Scrub Typhus

    Directory of Open Access Journals (Sweden)

    Eun Sun Kim

    Full Text Available Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi . Although early diagnosis and appropriate antibiotic therapy improve the prognosis for the majority of patients, life-threatening complications are not uncommon. Here, we present a case of successful veno-veno-type extracorporeal membrane oxygenation for scrub typhus-induced complications, including acute respiratory distress syndrome, myocarditis and multi-organ dysfunction. To our knowledge, this is the first case report of successful extracorporeal membrane oxygenation in complicated scrub typhus in Korea.

  3. Scrub typhus: audit of an outbreak.

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    Krishna, Mani Ram; Vasuki, B; Nagaraju, K

    2015-06-01

    To document the epidemiological, clinical and laboratory profile of all children with scrub typhus at a tertiary care centre in Chennai between September 2010 and June 2011. The case records of all children admitted and diagnosed with scrub typhus between September 2010 and June 2011 were analysed to look for salient clinical and laboratory parameters. During the study period, 52 children were admitted with scrub typhus in the authors' hospital. The presenting complaints included fever in all cases. Other symptoms included swelling of legs (50 %) and vomiting (45 %). 13 % presented with CNS symptoms. The commonest physical findings included eschar (67 %), hepatomegaly (94 %), splenomegaly (73 %) and third spacing (67 %). Salient lab parameters included packed cell volume (PCV) scrub typhus in a tertiary care centre is reported. Eschar and hepatosplenomegaly with a high CRP value is helpful in diagnosis. All patients responded well to the treatment.

  4. Epidemiologic characteristics of scrub typhus on Jeju Island

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    Lee, Sung Uk

    2017-01-01

    OBJECTIVES Scrub typhus is the most common febrile disease in Korea during the autumn. Jeju Island is the largest island in South Korea and has a distinctive oceanic climate. This study aimed to identify epidemiologic characteristics of scrub typhus on Jeju Island. METHODS From January 2011 to December 2016, 446 patients were diagnosed with scrub typhus on Jeju Island. The patients’ personal data and the environmental factors that might be related to scrub typhus were investigated and retrosp...

  5. Clinical proteomic analysis of scrub typhus infection.

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    Park, Edmond Changkyun; Lee, Sang-Yeop; Yun, Sung Ho; Choi, Chi-Won; Lee, Hayoung; Song, Hyun Seok; Jun, Sangmi; Kim, Gun-Hwa; Lee, Chang-Seop; Kim, Seung Il

    2018-01-01

    Scrub typhus is an acute and febrile infectious disease caused by the Gram-negative α-proteobacterium Orientia tsutsugamushi from the family Rickettsiaceae that is widely distributed in Northern, Southern and Eastern Asia. In the present study, we analysed the serum proteome of scrub typhus patients to investigate specific clinical protein patterns in an attempt to explain pathophysiology and discover potential biomarkers of infection. Serum samples were collected from three patients (before and after treatment with antibiotics) and three healthy subjects. One-dimensional sodium dodecyl sulphate-polyacrylamide gel electrophoresis followed by liquid chromatography-tandem mass spectrometry was performed to identify differentially abundant proteins using quantitative proteomic approaches. Bioinformatic analysis was then performed using Ingenuity Pathway Analysis. Proteomic analysis identified 236 serum proteins, of which 32 were differentially expressed in normal subjects, naive scrub typhus patients and patients treated with antibiotics. Comparative bioinformatic analysis of the identified proteins revealed up-regulation of proteins involved in immune responses, especially complement system, following infection with O. tsutsugamushi , and normal expression was largely rescued by antibiotic treatment. This is the first proteomic study of clinical serum samples from scrub typhus patients. Proteomic analysis identified changes in protein expression upon infection with O. tsutsugamushi and following antibiotic treatment. Our results provide valuable information for further investigation of scrub typhus therapy and diagnosis.

  6. Scrub Typhus Outbreak in a Remote Primary School, Bhutan, 2014.

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    Tshokey, Tshokey; Graves, Stephen; Tshering, Dorji; Phuntsho, Kelzang; Tshering, Karchung; Stenos, John

    2017-08-01

    Scrub typhus in Bhutan was first reported in 2009. We investigated an outbreak of scrub typhus in a remote primary school during August-October 2014. Delay in recognition and treatment resulted in 2 deaths from meningoencephalitis. Scrub typhus warrants urgent public health interventions in Bhutan.

  7. Scrub Typhus Outbreak in a Remote Primary School, Bhutan, 2014

    OpenAIRE

    Tshokey, Tshokey; Graves, Stephen; Tshering, Dorji; Phuntsho, Kelzang; Tshering, Karchung; Stenos, John

    2017-01-01

    Scrub typhus in Bhutan was first reported in 2009. We investigated an outbreak of scrub typhus in a remote primary school during August?October 2014. Delay in recognition and treatment resulted in 2 deaths from meningoencephalitis. Scrub typhus warrants urgent public health interventions in Bhutan.

  8. Duodenal perforation precipitated by scrub typhus

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    Raghunath Rajat

    2015-01-01

    Full Text Available Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  9. Distribution of Eschar in Pediatric Scrub Typhus.

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    Rose, Winsley; Rajan, Roshni J; Punnen, Anu; Ghosh, Urmi

    2016-10-01

    Identifying an eschar in scrub typhus is useful for initiation of prompt and appropriate antibiotic therapy. The distribution of eschars in all children scrub typhus over a 5 year period is described. Of 431 children admitted with scrub typhus, eschars were present in 176 (40.8%) children with the following distribution: head, face and neck, 33 (19.1%); axillae, 37 (21%); chest and abdomen, 21 (11.9%); genitalia, inguinal region and buttocks, 58 (33%); back, 8 (4.5%); upper extremities, 13 (7.4%); and lower extremities, 5 (2.8%). The commonest sites of eschars were scrotum (27 of 106; 25.5%) and axillae (15 of 106; 14.2%) in males and axillae (22 of 70; 31.4%) and groin (16 of 70; 22.9%) in females. Eschars were seen within skin folds in 100 of 176 (56.8%) children. Children should be carefully examined for the presence of eschar especially in the skin folds of the genitalia, axillae and groin to make an early diagnosis of scrub typhus. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Acute pancreatitis due to scrub typhus

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    Atif Shaikh Iqbal Ahmed

    2014-01-01

    Full Text Available Scrub typhus is endemic in large parts of India and can cause multi-organ failure and death. Acute pancreatitis as a complication is very rare and is potentially fatal. This case series describes seven adult patients who presented with an acute febrile illness and were diagnosed to have scrub typhus with acute pancreatitis. The mean age of the seven patients with acute pancreatitis was 49.4 years, and mean duration of fever prior to presentation was 7.7 days. All seven patients had abdominal pain, and three had a pathognomonic eschar. The mean serum lipase level was 1,509 U/L (normal value: <190 U/L and the mean serum amylase level was 434 U/L (normal value: <200 U/L. Six patients had evidence of multi-organ dysfunction. Hematological and respiratory system dysfunction was seen in five patients, hepatic and renal dysfunction in four, and central nervous system dysfunction in three patients. Three patients who had ≥4 organs involved, died (mortality rate: 42.8%. Our case series shows that pancreatitis in scrub typhus is an extremely rare complication and when present, is associated with increased mortality (42.8%. Physicians may be familiar with the various complications of scrub typhus but less so with acute pancreatitis and hence may be underdiagnosed.

  11. Tsutsugamushi Disease (Scrub Typhus) Meningoencephalitis in ...

    African Journals Online (AJOL)

    Conclusions: Absence of Eschar does not rule out scrub typhus. Clinical features and CSF findings can mimic tuberculous meningitis so misdiagnosis may lead to unwarranted prolonged empirical antituberculous therapy in cases of lymphocytic meningoencephalitis. Delay in treatment can be potentially fatal. WFT still ...

  12. Chest radiographic manifestations of scrub typhus.

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    Abhilash, Kpp; Mannam, P R; Rajendran, K; John, R A; Ramasami, P

    2016-01-01

    Respiratory system involvement in scrub typhus is seen in 20-72% of patients. In endemic areas, good understanding and familiarity with the various radiologic findings of scrub typhus are essential in identifying pulmonary complications. Patients admitted to a tertiary care center with scrub typhus between October 2012 and September 2013 and had a chest X ray done were included in the analysis. Details and radiographic findings were noted and factors associated with abnormal X-rays were analyzed. The study cohort contained 398 patients. Common presenting complaints included fever (100%), generalized myalgia (83%), headache (65%), dyspnea (54%), cough (24.3%), and altered sensorium (14%). Almost half of the patients (49.4%) had normal chest radiographs. Common radiological pulmonary abnormalities included pleural effusion (14.6%), acute respiratory distress syndrome (14%), airspace opacity (10.5%), reticulonodular opacities (10.3%), peribronchial thickening (5.8%), and pulmonary edema (2%). Cardiomegaly was noted in 3.5% of patients. Breathlessness, presence of an eschar, platelet counts of 2 mg/dL had the highest odds of having an abnormal chest radiograph. Patients with an abnormal chest X-ray had a higher requirement of noninvasive ventilation (odds ratio [OR]: 13.98; 95% confidence interval CI: 5.89-33.16), invasive ventilation (OR: 18.07; 95% CI: 6.42-50.88), inotropes (OR: 8.76; 95% CI: 4.35-17.62), higher involvement of other organ systems, longer duration of hospital stay (3.18 ± 3 vs. 7.27 ± 5.58 days; Pscrub typhus have abnormal chest radiographs. Chest radiography should be included as part of basic evaluation at presentation in patients with scrub typhus, especially in those with breathlessness, eschar, jaundice, and severe thrombocytopenia.

  13. Hemorrhagic Transformation of Scrub Typhus Encephalitis: A Rare Entity.

    Science.gov (United States)

    Kim, H-C; Yoon, K-W; Yoo, D-S; Cho, C-S

    2015-12-01

    Central nervous system (CNS) involvement of scrub typhus infection is well known. Most CNS involvement of scrub typhus infection present as meningitis or encephalitis. We report on a patient suffering from hemorrhagic transformation of intracranial lesions caused by Orientia tsutsugamushi. A 53-year-old female farmer who was infected by scrub typhus was treated with doxycycline and recovered from the systemic illness. However, headache persisted. Brain radiologic studies revealed acute intracranial hemorrhage and enhancing lesion, which implied a CNS involvement. Hemorrhagic transformation of encephalitis by scrub typhus is very rare complication and to our best knowledge, this is the first report of hemorrhagic transformation of scrub typhus encephalitis. Clinician should consider the possibility of hemorrhagic transformation of encephalitis in cases of scrub typhus infection.

  14. A case of scrub typhus requiring maintenance hemodialysis

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    Dae-Yeon Kim

    2013-12-01

    Full Text Available Renal failure caused by scrub typhus is known to be reversible. In most cases, renal function is almost fully restored after appropriate antibiotic treatment. A 71-year-old man was diagnosed with scrub typhus complicated by renal failure. A renal biopsy revealed histopathologic findings consistent with acute tubulointerstitial nephritis. Renal function did not improve 18 months after discharge and the patient required continuous hemodialysis. Although severe renal failure requiring dialysis is a rare complication of scrub typhus, we describe a case of scrub typhus requiring maintenance hemodialysis. To the best of our knowledge, this is the first such report.

  15. Epidemiologic characteristics of scrub typhus on Jeju Island.

    Science.gov (United States)

    Lee, Sung Uk

    2017-01-01

    Scrub typhus is the most common febrile disease in Korea during the autumn. Jeju Island is the largest island in South Korea and has a distinctive oceanic climate. This study aimed to identify epidemiologic characteristics of scrub typhus on Jeju Island. From January 2011 to December 2016, 446 patients were diagnosed with scrub typhus on Jeju Island. The patients' personal data and the environmental factors that might be related to scrub typhus were investigated and retrospectively analyzed. The median age of the patients was 58-years-old (range, 8 to 91) and 43% of them worked in the agricultural, forestry or livestock industry. Regardless of their job, 87% of the patients had a history of either working outdoors or of other activities before developing scrub typhus. The south and southeast regions of Jeju Island, especially Namwon-eup, showed the highest incidence of scrub typhus. Workers in mandarin orange orchards seemed to be the highest risk group for scrub typhus infection. Scrub typhus on Jeju Island showed unique characteristics. To efficiently prevent scrub typhus, each year individual regional approaches should be developed based on the epidemiologic characteristics of the disease.

  16. Chest radiographic manifestations of scrub typhus

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    KPP Abhilash

    2016-01-01

    Full Text Available Background and Rationale: Respiratory system involvement in scrub typhus is seen in 20–72% of patients. In endemic areas, good understanding and familiarity with the various radiologic findings of scrub typhus are essential in identifying pulmonary complications. Materials and Methods: Patients admitted to a tertiary care center with scrub typhus between October 2012 and September 2013 and had a chest X ray done were included in the analysis. Details and radiographic findings were noted and factors associated with abnormal X-rays were analyzed. Results: The study cohort contained 398 patients. Common presenting complaints included fever (100%, generalized myalgia (83%, headache (65%, dyspnea (54%, cough (24.3%, and altered sensorium (14%. Almost half of the patients (49.4% had normal chest radiographs. Common radiological pulmonary abnormalities included pleural effusion (14.6%, acute respiratory distress syndrome (14%, airspace opacity (10.5%, reticulonodular opacities (10.3%, peribronchial thickening (5.8%, and pulmonary edema (2%. Cardiomegaly was noted in 3.5% of patients. Breathlessness, presence of an eschar, platelet counts of 2 mg/dL had the highest odds of having an abnormal chest radiograph. Patients with an abnormal chest X-ray had a higher requirement of noninvasive ventilation (odds ratio [OR]: 13.98; 95% confidence interval CI: 5.89–33.16, invasive ventilation (OR: 18.07; 95% CI: 6.42–50.88, inotropes (OR: 8.76; 95% CI: 4.35–17.62, higher involvement of other organ systems, longer duration of hospital stay (3.18 ± 3 vs. 7.27 ± 5.58 days; P< 0.001, and higher mortality (OR: 4.63; 95% CI: 1.54–13.85. Conclusion: Almost half of the patients with scrub typhus have abnormal chest radiographs. Chest radiography should be included as part of basic evaluation at presentation in patients with scrub typhus, especially in those with breathlessness, eschar, jaundice, and severe thrombocytopenia.

  17. Multiple eschars in scrub typhus: a case report.

    Science.gov (United States)

    Koraluru, Munegowda; Nandigam, Manideep; Bairy, Indira; Vidyasagar, Sudha; Varma, Muralidhar

    2017-01-01

    Eschar in scrub typhus aids in early diagnosis and institution of appropriate therapy; however, the eschar positivity rates vary greatly in endemic regions. Multiple eschars in scrub typhus are a rare presentation. Our patient presented with fever and multiple eschars and was empirically started on doxycycline. Nested polymerase chain reaction from all the four eschars and from EDTA blood were positive for 56-kDa type-specific antigen which is specific for Orientia tsutsugamushi The patient recovered completely after 7 days of antibiotic treatment. He was from an area where scrub typhus was not observed previously. An eschar in an acute febrile patient from the "tsutsugamushi triangle" is a valuable sign in scrub typhus diagnosis. A search for multiple eschars in scrub typhus must be made by clinicians. © The Author(s) 2016.

  18. Scrub Typhus Incidence Modeling with Meteorological Factors in South Korea.

    Science.gov (United States)

    Kwak, Jaewon; Kim, Soojun; Kim, Gilho; Singh, Vijay P; Hong, Seungjin; Kim, Hung Soo

    2015-06-29

    Since its recurrence in 1986, scrub typhus has been occurring annually and it is considered as one of the most prevalent diseases in Korea. Scrub typhus is a 3rd grade nationally notifiable disease that has greatly increased in Korea since 2000. The objective of this study is to construct a disease incidence model for prediction and quantification of the incidences of scrub typhus. Using data from 2001 to 2010, the incidence Artificial Neural Network (ANN) model, which considers the time-lag between scrub typhus and minimum temperature, precipitation and average wind speed based on the Granger causality and spectral analysis, is constructed and tested for 2011 to 2012. Results show reliable simulation of scrub typhus incidences with selected predictors, and indicate that the seasonality in meteorological data should be considered.

  19. Scrub Typhus Incidence Modeling with Meteorological Factors in South Korea

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    Jaewon Kwak

    2015-06-01

    Full Text Available Since its recurrence in 1986, scrub typhus has been occurring annually and it is considered as one of the most prevalent diseases in Korea. Scrub typhus is a 3rd grade nationally notifiable disease that has greatly increased in Korea since 2000. The objective of this study is to construct a disease incidence model for prediction and quantification of the incidences of scrub typhus. Using data from 2001 to 2010, the incidence Artificial Neural Network (ANN model, which considers the time-lag between scrub typhus and minimum temperature, precipitation and average wind speed based on the Granger causality and spectral analysis, is constructed and tested for 2011 to 2012. Results show reliable simulation of scrub typhus incidences with selected predictors, and indicate that the seasonality in meteorological data should be considered.

  20. Clinical score to differentiate scrub typhus and dengue: A tool to differentiate scrub typhus and dengue

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    Shubhanker Mitra

    2017-01-01

    Full Text Available Background: Dengue and scrub typhus share similar clinical and epidemiological features, and are difficult to differentiate at initial presentation. Many places are endemic to both these infections where they comprise the majority of acute undifferentiated febrile illnesses. Materials and Methods: We aimed to develop a score that can differentiate scrub typhus from dengue. In this cross-sectional study, 188 cases of scrub typhus and 201 cases of dengue infection who presented to the emergency department or medicine outpatient clinic from September 2012 to April 2013 were included. Univariate followed by multivariate logistic regression analysis was performed to identify clinical features and laboratory results that were significantly different between the two groups. Each variable was assigned scores based on the strength of association and receiver operating characteristics area under the curve (ROC-AUC was generated and compared. Six scoring models were explored to ascertain the model with the best fit. Results: Model 2 was developed using the following six variables: oxygen saturation (>90%, ≤90%, total white blood cell count (7000 cells/cumm, hemoglobin (≤14 and >14 g/dL, total bilirubin (200 and ≥200 IU/dL, and altered sensorium (present or absent. Each variable was assigned scores based on its strength of association. The AUC-ROC curve (95% confidence interval for model 2 was 0.84 (0.79–0.89. At the cut off score of 13, the sensitivity and specificity were 85% and 77% respectively, with a higher score favoring dengue. Conclusion: In areas of high burden of ST and dengue, model 2 (the “clinical score to differentiate scrub typhus and dengue fever” is a simple and rapid clinical scoring system that may be used to differentiate scrub typhus and dengue at initial presentation.

  1. Clinical Score to Differentiate Scrub Typhus and Dengue: A Tool to Differentiate Scrub Typhus and Dengue.

    Science.gov (United States)

    Mitra, Shubhanker; Gautam, Ira; Jambugulam, Mohan; Abhilash, Kundavaram Paul Prabhakar; Jayaseeelan, Vishalakshi

    2017-01-01

    Dengue and scrub typhus share similar clinical and epidemiological features, and are difficult to differentiate at initial presentation. Many places are endemic to both these infections where they comprise the majority of acute undifferentiated febrile illnesses. We aimed to develop a score that can differentiate scrub typhus from dengue. In this cross-sectional study, 188 cases of scrub typhus and 201 cases of dengue infection who presented to the emergency department or medicine outpatient clinic from September 2012 to April 2013 were included. Univariate followed by multivariate logistic regression analysis was performed to identify clinical features and laboratory results that were significantly different between the two groups. Each variable was assigned scores based on the strength of association and receiver operating characteristics area under the curve (ROC-AUC) was generated and compared. Six scoring models were explored to ascertain the model with the best fit. Model 2 was developed using the following six variables: oxygen saturation (>90%, ≤90%), total white blood cell count (7000 cells/cumm), hemoglobin (≤14 and >14 g/dL), total bilirubin (200 and ≥200 IU/dL), and altered sensorium (present or absent). Each variable was assigned scores based on its strength of association. The AUC-ROC curve (95% confidence interval) for model 2 was 0.84 (0.79-0.89). At the cut off score of 13, the sensitivity and specificity were 85% and 77% respectively, with a higher score favoring dengue. In areas of high burden of ST and dengue, model 2 (the "clinical score to differentiate scrub typhus and dengue fever") is a simple and rapid clinical scoring system that may be used to differentiate scrub typhus and dengue at initial presentation.

  2. Activation of the coagulation cascade in patients with scrub typhus.

    Science.gov (United States)

    Lee, Hee-Jeong; Park, Chi-Young; Park, Sang-Gon; Yoon, Na-Ra; Kim, Dong-Min; Chung, Choon-Hae

    2017-09-01

    This retrospective study aimed to evaluate the levels of coagulation factors and presence of disseminated intravascular coagulation (DIC) in patients with scrub typhus. We included patients confirmed to have scrub typhus at the Chosun University Hospital between September 2004 and December 2009. The DIC scores were evaluated in 365 patients and 36 healthy controls. The median concentrations of fibrinogen, d-dimer, and fibrin/fibrinogen degradation products (FDP) were compared between patients and healthy controls (pscrub typhus had longer prothrombin time and lower platelet counts than the controls. Major bleeding was observed in 18/365 patients with scrub typhus. Fifty-one (14.0%) patients presented with severe complications of scrub typhus. Overt DIC and thrombocytopenia (scrub typhus had overt DIC, as defined by the International Society on Thrombosis and Hemostasis DIC score (DIC1) and the DIC-scoring template with a fibrinogen/C-reactive protein-ratio (DIC2), respectively. Three (16.7%) and 10 (55.6%) patients with bleeding had overt DIC, as defined by the DIC1 and DIC2, respectively. Seven (13.7%) and 26 (51%) patients with severe illness had overt DIC, as defined by DIC1 and DIC2, respectively. In conclusion, activation of the coagulation system is an important feature of scrub typhus and is correlated with severe disease, including bleeding. This is the first study to report a relationship between DIC and scrub typhus. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Scrub Typhus among Pediatric Patients in Dambadeniya:A Base Hospital in Sri Lanka

    OpenAIRE

    De Silva, Nalika; Wijesundara, Sarojini; Liyanapathirana, Veranja; Thevanesam, Vasanthi; Stenos, John

    2012-01-01

    Data on pediatric scrub typhus is uncommon in Sri Lanka and other countries. The objective of this study was to identify the clinical features of patients with scrub typhus at a Base Hospital in Sri Lanka. Sixty patients presenting with suspected scrub typhus were included in the study. Their blood samples were tested for the presence of antibodies against rickettsioses using the reference method. Twenty patients had confirmed scrub typhus and 24 had possible scrub typhus. Their clinical feat...

  4. Seroprevalence of Scrub Typhus Infection in Arunachal Pradesh, India.

    Science.gov (United States)

    Jakharia, Aniruddha; Borkakoty, Biswajyoti; Biswas, Dipankar; Yadav, Kaushal; Mahanta, Jagadish

    2016-10-01

    Scrub typhus is a major reason for febrile illness, caused by a bacterium Orientia tsutsugamushi, a rickettsial pathogen. Few outbreaks of scrub typhus have been reported from Arunachal Pradesh in recent past. However, there is lack of seroprevalence data from the region. In this regard, this study was undertaken using archival serum sample available from seven districts of Arunachal Pradesh. This serological study was conducted in Regional Medical Research Center for NE Region, Dibrugarh. Reactivity to IgG class of antibodies against scrub typhus was done using Scrub typhus detect IgG ELISA kit as per manufacturer's protocol. Seroprevalence of scrub typhus in seven districts of Arunachal Pradesh was found to be 40% (120/300). The age-specific scrub typhus seroprevalence rose steadily from 5.6% in children scrub typhus infection should be considered in differential diagnosis of any acute febrile illness in this part of the country. In view of the high prevalence, empirical therapy of doxycycline/azithromycin may be done in cases of undiagnosed fever. Active surveillance has to be done to understand exact magnitude, epidemiological aspects, and distribution of vector and disease of this reemerging neglected tropical disease.

  5. A review of the global epidemiology of scrub typhus.

    Science.gov (United States)

    Xu, Guang; Walker, David H; Jupiter, Daniel; Melby, Peter C; Arcari, Christine M

    2017-11-01

    Scrub typhus is a serious public health problem in the Asia-Pacific area. It threatens one billion people globally, and causes illness in one million people each year. Caused by Orientia tsutsugamushi, scrub typhus can result in severe multiorgan failure with a case fatality rate up to 70% without appropriate treatment. The antigenic heterogeneity of O. tsutsugamushi precludes generic immunity and allows reinfection. As a neglected disease, there is still a large gap in our knowledge of the disease, as evidenced by the sporadic epidemiologic data and other related public health information regarding scrub typhus in its endemic areas. Our objective is to provide a systematic analysis of current epidemiology, prevention and control of scrub typhus in its long-standing endemic areas and recently recognized foci of infection.

  6. Spatial Distribution Analysis of Scrub Typhus in Korea

    OpenAIRE

    Jin, Hong Sung; Chu, Chaeshin; Han, Dong Yeob

    2013-01-01

    Objective: This study analyzes the spatial distribution of scrub typhus in Korea. Methods: A spatial distribution of Orientia tsutsugamushi occurrence using a geographic information system (GIS) is presented, and analyzed by means of spatial clustering and correlations. Results: The provinces of Gangwon-do and Gyeongsangbuk-do show a low incidence throughout the year. Some districts have almost identical environmental conditions of scrub typhus incidence. The land use change of districts does...

  7. Scrub Typhus: An Emerging Neglected Tropical Disease in Nepal.

    Science.gov (United States)

    Upadhyaya, B P; Shakya, G; Adhikari, S; Rijal, N; Acharya, J; Maharjan, L; Marasini, B R

    2016-05-01

    Scrub typhus is a neglected tropical disease and is under reported from Nepal. The objective of this study was to investigate the sero-epidemiology of scrub typhus in patients suffering from acute febrile illness. A total of 434 specimens collected from July to November 2015 at National Public Health Laboratory (NPHL) were investigated for detection of immunoglobulin M (IgM) antibody to Orientiatsutsugamushi.The Scrub Typhus Detect TM kit (InBios, USA) was used to detect the antibodies to O.tsutsugamushi in human serum. Randomly selected 10% positive specimens were used for confirmation by dot- enzyme-linked immunosorbent assay and indirect immunofluorescence assay. Of the total, 175 (40.3%) were positive for IgM antibodies to O. tsutsugamushi. Positive results of scrub typhus were highest among female in 11-20 year followed by males in 41-50 years age group. The IgM antibodies to O. tsutusugamushi were positive in specimens of various geographical regions including 30 districts of Nepal. Positive cases were found in various ecological regions of Nepal. Scrub typhus is one of the neglected tropical diseases in Nepal. Patients with acute febrile illness should be investigated for scrub typhus with high priority. There is an urgent need of reliable and affordable diagnostic tests at all level of health facilities of Nepal. Surveillance and public health awareness about the disease transmission and preventive measures needs to be initiated.

  8. Estimating the burden of scrub typhus: A systematic review.

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    Ana Bonell

    2017-09-01

    Full Text Available Scrub typhus is a vector-borne zoonotic disease that can be life-threatening. There are no licensed vaccines, or vector control efforts in place. Despite increasing awareness in endemic regions, the public health burden and global distribution of scrub typhus remains poorly known.We systematically reviewed all literature from public health records, fever studies and reports available on the Ovid MEDLINE, Embase Classic + Embase and EconLit databases, to estimate the burden of scrub typhus since the year 2000.In prospective fever studies from Asia, scrub typhus is a leading cause of treatable non-malarial febrile illness. Sero-epidemiological data also suggest that Orientia tsutsugamushi infection is common across Asia, with seroprevalence ranging from 9.3%-27.9% (median 22.2% IQR 18.6-25.7. A substantial apparent rise in minimum disease incidence (median 4.6/100,000/10 years, highest in China with 11.2/100,000/10 years was reported through passive national surveillance systems in South Korea, Japan, China, and Thailand. Case fatality risks from areas of reduced drug-susceptibility are reported at 12.2% and 13.6% for South India and northern Thailand, respectively. Mortality reports vary widely around a median mortality of 6.0% for untreated and 1.4% for treated scrub typhus. Limited evidence suggests high mortality in complicated scrub typhus with CNS involvement (13.6% mortality, multi-organ dysfunction (24.1% and high pregnancy miscarriage rates with poor neonatal outcomes.Scrub typhus appears to be a truly neglected tropical disease mainly affecting rural populations, but increasingly also metropolitan areas. Rising minimum incidence rates have been reported over the past 8-10 years from countries with an established surveillance system. A wider distribution of scrub typhus beyond Asia is likely, based on reports from South America and Africa. Unfortunately, the quality and quantity of the available data on scrub typhus epidemiology is

  9. Estimating the burden of scrub typhus: A systematic review.

    Science.gov (United States)

    Bonell, Ana; Lubell, Yoel; Newton, Paul N; Crump, John A; Paris, Daniel H

    2017-09-01

    Scrub typhus is a vector-borne zoonotic disease that can be life-threatening. There are no licensed vaccines, or vector control efforts in place. Despite increasing awareness in endemic regions, the public health burden and global distribution of scrub typhus remains poorly known. We systematically reviewed all literature from public health records, fever studies and reports available on the Ovid MEDLINE, Embase Classic + Embase and EconLit databases, to estimate the burden of scrub typhus since the year 2000. In prospective fever studies from Asia, scrub typhus is a leading cause of treatable non-malarial febrile illness. Sero-epidemiological data also suggest that Orientia tsutsugamushi infection is common across Asia, with seroprevalence ranging from 9.3%-27.9% (median 22.2% IQR 18.6-25.7). A substantial apparent rise in minimum disease incidence (median 4.6/100,000/10 years, highest in China with 11.2/100,000/10 years) was reported through passive national surveillance systems in South Korea, Japan, China, and Thailand. Case fatality risks from areas of reduced drug-susceptibility are reported at 12.2% and 13.6% for South India and northern Thailand, respectively. Mortality reports vary widely around a median mortality of 6.0% for untreated and 1.4% for treated scrub typhus. Limited evidence suggests high mortality in complicated scrub typhus with CNS involvement (13.6% mortality), multi-organ dysfunction (24.1%) and high pregnancy miscarriage rates with poor neonatal outcomes. Scrub typhus appears to be a truly neglected tropical disease mainly affecting rural populations, but increasingly also metropolitan areas. Rising minimum incidence rates have been reported over the past 8-10 years from countries with an established surveillance system. A wider distribution of scrub typhus beyond Asia is likely, based on reports from South America and Africa. Unfortunately, the quality and quantity of the available data on scrub typhus epidemiology is currently too

  10. Scrub typhus: radiological and clinical findings in abdominopelvic involvement.

    Science.gov (United States)

    Kim, Kun Yung; Song, Ji Soo; Park, Eun Hae; Jin, Gong Yong

    2017-03-01

    To describe the clinical and radiological findings of abdominopelvic involvement in scrub typhus. Abdominopelvic computed tomography (CT) of 78 patients with scrub typhus were evaluated by two readers. The presence of gallbladder wall thickening, arterial inhomogeneous enhancement of the liver, periportal edema, splenic infarction, hepatomegaly, splenomegaly, ascites, pleural effusion, and sites of lymphadenopathy were evaluated. Patients were divided into four clinical subgroups according to laboratory findings. Association between imaging findings and subgroups was analyzed by Chi squared test or Fisher's exact test. The most common CT finding was hepatomegaly (74.4%), followed by splenomegaly (66.7%). The majority of patients had at least three areas of abdominopelvic lymphadenopathy (71.8%). Pelvic lymphadenopathy was most commonly seen when eschar was found in the ipsilateral lower extremity (left, n = 5/7; right, n = 8/13). Significant association between hepatic dysfunction and perigastric lymphadenopathy was documented (p = 0.03). Scrub typhus has a spectrum of variable clinical and radiological findings mimicking those of acute hepatitis. Diffuse abdominopelvic lymphadenopathy involving the retroperitoneum and pelvic area may aid in early diagnosis of scrub typhus. Perigastric lymphadenopathy could be a sign of severe scrub typhus combined with hepatic dysfunction.

  11. Severe Fever with Thrombocytopenia Syndrome in Patients Suspected of Having Scrub Typhus.

    Science.gov (United States)

    Wi, Yu Mi; Woo, Hye In; Park, Dahee; Lee, Keun Hwa; Kang, Cheol-In; Chung, Doo Ryeon; Peck, Kyong Ran; Song, Jae-Hoon

    2016-11-01

    To determine prevalence of severe fever with thrombocytopenia syndrome in South Korea, we examined serum samples from patients with fever and insect bite history in scrub typhus-endemic areas. During the 2013 scrub typhus season, prevalence of this syndrome among patients suspected of having scrub typhus was high (23.0%), suggesting possible co-infection.

  12. Diagnostic validation of selected serological tests for detecting scrub typhus.

    Science.gov (United States)

    Koraluru, Munegowda; Bairy, Indira; Varma, Muralidhar; Vidyasagar, Sudha

    2015-07-01

    Clinical diagnosis of scrub typhus is often difficult because the symptoms are very similar to those of other febrile illness such as dengue, leptospirosis, malaria and other viral hemorrhagic fevers. Though better diagnostic tests are available for rickettsial diseases and scrub typhus elsewhere, the Weil-Felix test is still commonly used in India, mainly because microimmunofluorescence assays (M-IFA) were not available in India till recently and relevant staff had insufficient training. The present study was performed to investigate the performance of M-IFA, IgM ELISA, and Weil-Felix test on 546 non-repeated serum samples from subjects suspected of having scrub typhus. One hundred and forty-three of these 546 samples were positive by M-IFA; these cases were also confirmed clinically to have scrub typhus based on their dramatic responses to doxycycline therapy. IgM ELISA was positive in 122 of the 143 M-IFA positive cases and the Weil-Felix test in 96. Though the Weil-Felix test is a heterophile agglutination test, it was found in this study to have good specificity but far too little sensitivity to use as a routine diagnostic test. IgM ELISA can be a good substitute for M-IFA. Incorporation of multiple prototype antigens on M-IFA slides is likely one of the reasons for its superior performance. As newer and better diagnostic assays become available for scrub typhus diagnosis in developed countries, it will be imperative to also use such tests in other endemic countries to prevent over- or under-diagnosis of scrub typhus. © 2015 The Societies and Wiley Publishing Asia Pty Ltd.

  13. Urbanization of scrub typhus disease in South Korea.

    Science.gov (United States)

    Park, Sang-Won; Ha, Na-Young; Ryu, Boyeong; Bang, Ji Hwan; Song, Hoyeon; Kim, Yuri; Kim, Gwanghun; Oh, Myoung-don; Cho, Nam-Hyuk; Lee, Jong-koo

    2015-05-01

    Scrub typhus is an endemic disease in Asia. It has been a rural disease, but indigenous urban cases have been observed in Seoul, South Korea. Urban scrub typhus may have a significant impact because of the large population. Indigenous urban scrub typhus was epidemiologically identified in Seoul, the largest metropolitan city in South Korea, using national notifiable disease data from 2010 to 2013. For detailed analysis of clinical features, patients from one hospital that reported the majority of cases were selected and compared to a historic control group. Chigger mites were prospectively collected in the city using a direct chigger mite-collecting trap, and identified using both phenotypic and 18S rDNA sequencing analyses. Their infection with Orientia tsutsugamushi was confirmed by sequencing the 56-kDa antigen gene. Eighty-eight cases of urban scrub typhus were determined in Seoul. The possible sites of infection were mountainous areas (56.8%), city parks (20.5%), the vicinity of one's own residence (17.0%), and riversides (5.7%). Eighty-seven chigger mites were collected in Gwanak mountain, one of the suspected infection sites in southern Seoul, and seventy-six (87.4%) of them were identified as Helenicula miyagawai and eight (9.2%) as Leptotrombidium scutellare. Pooled DNA extracted from H. miyagawai mites yielded O. tsutsugamushi Boryong strain. Twenty-six patients from one hospital showed low APACHE II score (3.4 ± 2.7), low complication rate (3.8%), and no hypokalemia. We identified the presence of indigenous urban scrub typhus in Seoul, and a subgroup of them had mild clinical features. The chigger mite H. miyagawai infected with O. tsutsugamushi within the city was found. In endemic area, urban scrub typhus needs to be considered as one of the differential febrile diseases and a target for prevention.

  14. The clinical characteristics of pleural effusion in scrub typhus.

    Science.gov (United States)

    Kim, Hyung Ho; Chung, Jong-Hoon; Kim, Dong-Min; Yun, Na Ra; Lee, Jun; Kwon, Yong Eun; Yoon, Sung Ho; Lee, Seung Il; Han, Mi Ah

    2016-06-11

    The aim of this study is to identify the factors associated with the occurrence of pleural effusion and to investigate the characteristics of pleural effusion in scrub typhus. We conducted a retrospective analysis of the medical records of scrub typhus patients between January 2004 and December 2011 at Chosun University Hospital in South Korea. A total of 445 scrub typhus patients were divided into the following two groups: without (n = 352) or with pleural effusion (n = 93). The data of 18 scrub typhus patients who underwent thoracentesis were summarized. Multivariate analysis demonstrated that the following factors were associated with the occurrence of pleural effusion in scrub typhus: older age (odds ratio [OR] = 1.029, P = 0.037, confidence interval [CI] = 1.002-1.056); male gender (OR = 1.924, P = 0.020, CI = 1.109-3.340); presence of heart failure (OR = 2.628, P = 0.039, CI = 1.052-6.565); and lower albumin (OR = 0.107, P ≤ 0.001, CI = 0.058-0.196). Most pleural effusion presentations were bilateral (88 %) and small (91 %). The effusion had transudate characteristics in 7 patients and exudate characteristics in 11 patients based on Light's criteria. This study provided the first data regarding the following four independent risk factors associated with the occurrence of pleural effusion: older age; male gender; the presence of heart failure; and lower albumin. The pleural effusion presentations in scrub typhus patients were bilateral and small in most cases, with transudate and/or exudate characteristics.

  15. Scrub Typhus Leading to Acute Encephalitis Syndrome, Assam, India.

    Science.gov (United States)

    Khan, Siraj A; Bora, Trishna; Laskar, Basanta; Khan, Abdul M; Dutta, Prafulla

    2017-01-01

    To determine the contribution of Orientia tsutsugamushi, the agent of scrub typhus, as a cause of acute encephalitis syndrome (AES) in Assam, India, we conducted a retrospective study of hospital patients with symptoms of AES during 2013-2015. Our findings suggest that O. tsutsugamushi infection leads to AES and the resulting illness and death.

  16. Milder clinical manifestation of scrub typhus in Kinmen, Taiwan

    Directory of Open Access Journals (Sweden)

    Tung-Hung Su

    2013-04-01

    Conclusion: A unique summer-autumn type of scrub typhus with milder disease manifestations is identified in Kinmen. The younger patient population, rapid diagnosis, and prompt treatment may be associated with a shortened disease course and lead to a better outcome.

  17. A study of muscle involvement in scrub typhus.

    Science.gov (United States)

    Kalita, Jayantee; Misra, Usha K; Mani, Vinita E; Mahadevan, Anita; Shankar, Susrala K

    2015-01-15

    Patients with scrub typhus often complain of myalgia, but a comprehensive study on muscle dysfunction is lacking. We therefore report the clinical, electromyographic and muscle biopsy findings in patients with scrub typhus. Consecutive patients with scrub typhus were included, and their clinical and laboratory findings were noted. The patients with myalgia or weakness and elevated serum creatine kinase (CK) were considered to have muscle involvement. Electromyography (EMG) and muscle biopsy were done in some patients. Patients were treated with doxycycline 200mg daily for 7 days, and their clinical and biochemical outcome on discharge and one month were evaluated. 13 out of 33 (39.4%) patients had muscle involvement and their CK levels ranged between 287 and 3166 (859 ± 829) U/L. EMG revealed short duration polyphasic potentials, and muscle histopathology revealed evidence of vasculitis. There were significant correlations between severity of weakness and CK levels (r = -0.6; p scrub typhus. Although muscle histopathology showed evidence of vasculitis, patients responded to doxycycline. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Prevalence and risk factors for scrub typhus in South India.

    Science.gov (United States)

    Trowbridge, Paul; P, Divya; Premkumar, Prasanna S; Varghese, George M

    2017-05-01

    To determine the prevalence and risk factors of scrub typhus in Tamil Nadu, South India. We performed a clustered seroprevalence study of the areas around Vellore. All participants completed a risk factor survey, with seropositive and seronegative participants acting as cases and controls, respectively, in a risk factor analysis. After univariate analysis, variables found to be significant underwent multivariate analysis. Of 721 people participating in this study, 31.8% tested seropositive. By univariate analysis, after accounting for clustering, having a house that was clustered with other houses, having a fewer rooms in a house, having fewer people living in a household, defecating outside, female sex, age >60 years, shorter height, lower weight, smaller body mass index and smaller mid-upper arm circumference were found to be significantly associated with seropositivity. After multivariate regression modelling, living in a house clustered with other houses, female sex and age >60 years were significantly associated with scrub typhus exposure. Overall, scrub typhus is much more common than previously thought. Previously described individual environmental and habitual risk factors seem to have less importance in South India, perhaps because of the overall scrub typhus-conducive nature of the environment in this region. © 2017 John Wiley & Sons Ltd.

  19. Activation of cytotoxic lymphocytes in patients with scrub typhus

    NARCIS (Netherlands)

    de Fost, Maaike; Chierakul, Wirongrong; Pimda, Kriangsak; Dondorp, Arjen M.; White, Nicholas J.; van der Poll, Tom

    2005-01-01

    Thai patients with scrub typhus caused by the intracellular pathogen Orientia tsutsugamushi displayed elevated plasma concentrations of granzymes A and B, interferon-gamma (IFN)-gamma-inducible protein 10, and monokine induced by IFN-gamma. These data suggest that activation of cytotoxic lymphocytes

  20. Molecular detection of Orientia tsutsugamushi from suspected scrub typhus cases

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    Seethalakshmi Srinivasan

    2017-01-01

    Full Text Available Context: Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The disease is under-diagnosed in India, because of low index of suspicion and also due to its nonspecific presentation, and lack of confirmatory diagnostic tests. Aims: This study was undertaken to diagnose scrub typhus in patients with undifferentiated fevers by serology and molecular methods. Materials and Methods: A total of 68 blood samples were collected from patients clinically suspected to have scrub typhus. After transportation to the laboratory, the serum was separated from the blood and subjected to rapid card test. The ethylenediaminetetraacetic acid blood samples were subjected to DNA extraction using QIAamp DNA Mini Kit followed by nested polymerase chain reaction (nPCR. Results: 24/68 (35.29% cases showed the presence of antibody against scrub typhus by serology. 6/68 (8.8% patients showed the presence of outer membrane protein antigen gene 56 kDa by nPCR. 5/24 serology positive cases showed the presence of 56 kDa outer membrane protein antigen gene by nPCR. A large number of cases positive by serology were negative by PCR which may indicate a low sensitivity of this test either due to low copy numbers or due to excess host DNA. Conclusion: Delay in treatment may increase disease severity and leads to higher mortality. Thus, molecular methods of diagnosis may aid in the early diagnosis of infection and enable prompt treatment. This is the first report on the diagnosis of scrub typhus in the suburbs of Chennai using molecular methods and reemphasizes the need for increased awareness of rickettsial infections in rural areas.

  1. Molecular detection of Orientia tsutsugamushi from suspected scrub typhus cases.

    Science.gov (United States)

    Srinivasan, Seethalakshmi; Menon, Thangam

    2017-01-01

    Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The disease is under-diagnosed in India, because of low index of suspicion and also due to its nonspecific presentation, and lack of confirmatory diagnostic tests. This study was undertaken to diagnose scrub typhus in patients with undifferentiated fevers by serology and molecular methods. A total of 68 blood samples were collected from patients clinically suspected to have scrub typhus. After transportation to the laboratory, the serum was separated from the blood and subjected to rapid card test. The ethylenediaminetetraacetic acid blood samples were subjected to DNA extraction using QIAamp DNA Mini Kit followed by nested polymerase chain reaction (nPCR). 24/68 (35.29%) cases showed the presence of antibody against scrub typhus by serology. 6/68 (8.8%) patients showed the presence of outer membrane protein antigen gene 56 kDa by nPCR. 5/24 serology positive cases showed the presence of 56 kDa outer membrane protein antigen gene by nPCR. A large number of cases positive by serology were negative by PCR which may indicate a low sensitivity of this test either due to low copy numbers or due to excess host DNA. Delay in treatment may increase disease severity and leads to higher mortality. Thus, molecular methods of diagnosis may aid in the early diagnosis of infection and enable prompt treatment. This is the first report on the diagnosis of scrub typhus in the suburbs of Chennai using molecular methods and reemphasizes the need for increased awareness of rickettsial infections in rural areas.

  2. Associated factors and clinical implications of serum aminotransferase elevation in scrub typhus.

    Science.gov (United States)

    Su, Tung-Hung; Liu, Chun-Jen; Shu, Pei-Yun; Fu, Yang-Hsien; Chang, Chi-Hsien; Jao, Ping; Kao, Jia-Horng

    2016-12-01

    Timely diagnosis and prompt treatment can reduce the complications of scrub typhus. It is thus important to find easy laboratory tests to help in the diagnosis, especially in patients without eschar at initial presentation. Because serum aminotransferase elevation is common in scrub typhus, its associated factors and clinical implications need further investigations. We conducted a retrospective study in Kinmen, Taiwan, to collect clinically suspected scrub typhus patients notified to Taiwan Centers for Disease Control for confirmation during 2005-2010. Scrub typhus was diagnosed and Orientia tsutsugamushi was genotyped by serological or molecular assays. The laboratory data and clinical information were recorded for analysis. Overall, 344 suspected scrub typhus patients were reported to Taiwan Centers for Disease Control and 288 of them were certified scrub typhus. Scrub typhus patients had significantly more thrombocytopenia, serum aminotransferase elevation (76% vs. 54%, p = 0.001), higher frequency of fever, eschar, and lymphadenopathy, compared with nontyphus patients. Hepatic dysfunction in scrub typhus was associated with older age, longer fever duration, and absence of lymphadenopathy, but seemed to be unrelated to the rickettsial genotypes. Multivariate analysis showed that serum aminotransferase elevation (odds ratio: 3.75; p = 0.003; 95% confidence interval: 1.56-9.01) independently predicted scrub typhus. Furthermore, in suspected scrub typhus patients without eschar, 92% of true typhus patients had serum aminotransferase elevation compared with the nontyphus ones (odds ratio: 6.47; p = 0.028, 95% confidence interval: 1.23-34.11). Hepatic dysfunction in scrub typhus patients is associated with older age, longer fever duration, and absence of lymphadenopathy. Serum aminotransferase elevation can aid in the diagnosis of scrub typhus, especially in suspected patients without eschar. Copyright © 2014. Published by Elsevier B.V.

  3. Rapid Increase in Scrub Typhus Incidence in Mainland China, 2006-2014.

    Science.gov (United States)

    Wu, Yi-Cheng; Qian, Quan; Magalhaes, Ricardo J Soares; Han, Zhi-Hai; Haque, Ubydul; Weppelmann, Thomas A; Hu, Wen-Biao; Liu, Yun-Xi; Sun, Yan-Song; Zhang, Wen-Yi; Li, Shen-Long

    2016-03-01

    Scrub typhus is a vector-borne disease, which has recently reemerged in China. In this study, we describe the distribution and incidence of scrub typhus cases in China from 2006 to 2014 and quantify differences in scrub typhus cases with respect to sex, age, and occupation. The results of our study indicate that the annual incidence of scrub typhus has increased during the study period. The number of cases peaked in 2014, which was 12.8 times greater than the number of cases reported in 2006. Most (77.97%) of the cases were reported in five provinces (Guangdong, Yunnan, Anhui, Fujian, and Shandong). Our study also demonstrates that the incidence rate of scrub typhus was significantly higher in females compared to males (P scrub typhus incidence, but also document an expansion in the geographic distribution throughout the country. © The American Society of Tropical Medicine and Hygiene.

  4. Genotype Diversity and Distribution of Orientia tsutsugamushi Causing Scrub Typhus in Thailand

    Science.gov (United States)

    2011-07-01

    Society for Microbiology. All Rights Reserved. Genotype Diversity and Distribution of Orientia tsutsugamushi Causing Scrub Typhus in Thailand" Toon...2011 Scrub typhus , caused by antigenically disparate isolates of Orientia tsutsugamushi, is a widely distributed mite-borne human disease in the Asia...evaluation of scrub typhus - specific diagnostic assays and vaccines. Using indirect immunoHuorescence assays (IF A) and PCR assays, 0. tsutsugamushi

  5. Scrub typhus meningitis in a renal transplant recipient

    Directory of Open Access Journals (Sweden)

    J Dhanapriya

    2017-01-01

    Full Text Available Scrub typhus is a rickettsial infection commonly seen in Asia. The clinical presentation ranges from nonspecific febrile illness to potentially fatal multiorgan involvement such as liver, kidney, or lung. Central nervous system involvement is uncommon. We report a 45-year-old female renal transplant recipient who presented with fever, headache, meningeal signs, graft dysfunction, and eschar. IgM antibodies against Orientia tsutsugamushi were positive by enzyme-linked immunosorbent assay. Despite oral doxycycline therapy for 5 days, she did not improve but responded well to intravenous azithromycin. To the best of our knowledge, scrub typhus as a cause of meningitis in a renal transplant recipient has not been reported so far.

  6. Immunohistochemical Study of Scrub Typhus: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Bo-Yuan Tseng

    2008-02-01

    Full Text Available Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi, which is transmitted by chiggers. The target cells of this rickettsia are poorly defined in humans. Immunohistochemical staining of tissue sections of patients with scrub typhus is helpful in investigating the target cells of this rickettsia in different organs. We studied two autopsy specimens by immunohistochemical staining using a specific antibody against O. tsutsugamushi. Rickettsiae were located in endothelial cells in all of the organs evaluated, namely heart, lung, brain, kidney, appendix and skin, within cardiac muscle cells and renal tubular epithelial cells, and in macrophages located in the lymph node, liver and spleen. In conclusion, O. tsutsugamushi may disseminate into multiple organs through endothelial cells and macrophages, resulting in the development of fatal complications.

  7. Acute sensorineural hearing loss and severe otalgia due to scrub typhus

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    Kim Dong-Min

    2009-10-01

    Full Text Available Abstract Background Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. Case presentations We encountered a patient with sensorineural hearing loss complicating scrub typhus, and three patients with scrub typhus who complained of otalgia, which was sudden onset, severe, paroxysmal, intermittent yet persistent pain lasting for several seconds, appeared within 1 week after the onset of fever and rash. The acute sensorineural hearing loss and otalgia were resolved after antibiotic administration. Conclusion When patients in endemic areas present with fever and rash and have sensorineural hearing loss or otalgia without otoscopic abnormalities, clinicians should suspect scrub typhus and consider empirical antibiotic therapy.

  8. Successfully Managed Acute Transverse Myelitis Related to Scrub Typhus and Serial Image Findings.

    Science.gov (United States)

    Yun, Jae Sung; Song, Ji Soo; Choi, Eun Jung; Hwang, Jeong-Hwan; Lee, Chang-Seop; Park, Eun Hae

    2017-03-01

    AbstractCentral nervous system involvement manifesting as meningitis or meningoencephalitis is a known complication of scrub typhus, but very few spinal cord lesions such as acute transverse myelitis (ATM) have been reported in association with this disease. Scrub typhus patients with a spinal lesion present with neurologic symptoms including dysuria, motor, and sensory weakness. Herein, we describe a rare case of ATM associated with scrub typhus. Clinical characteristics, cerebrospinal fluid cytology, Orientia tsutsugamushi serum antibody titer, and serial magnetic resonance imaging scans resulted in a diagnosis of ATM associated with scrub typhus.

  9. Severe scrub typhus infection: Clinical features, diagnostic challenges and management

    Science.gov (United States)

    Peter, John Victor; Sudarsan, Thomas I; Prakash, John Anthony J; Varghese, George M

    2015-01-01

    Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay (IFA) for the detection of IgM antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%. PMID:26261776

  10. Epidemiology & risk factors of scrub typhus in south India

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    George M Varghese

    2016-01-01

    Full Text Available Background & objectives: Scrub typhus is a major public health threat in South and Southeastern Asian countries including India. Understanding local patterns of disease and factors that place individuals at risk is pivotal to future preventive measures against scrub typhus. The primary aim of this study was to identify specific epidemiological and geographical factors associated with an increased risk of developing scrub typhus in this region. Methods: We mapped 709 patients from Tamil Nadu, Andhra Pradesh and Telangana who were admitted to the Christian Medical College (CMC Hospital, Vellore, Tamil Nadu, India, for the period 2006-2011, assessed seasonality using monthly counts of scrub typhus cases, and conducted a case-control study among a subset of patients residing in Vellore. Results: The geographic distribution of cases at CMC Hospital clusters around the Tamil Nadu-Andhra Pradesh border. However, distinct hotspots clearly exist distal to this area, near Madurai and the coast in Tamil Nadu, and in the Northeast of Andhra Pradesh. Seasonally, the highest numbers of cases were observed in the cooler months of the year, i.e. September to January. In the case-control analysis, cases were more likely to be agricultural laborers (OR 1.79, 95% CI 1.01 - 3.15, not wear a shirt at home (OR 4.23, 95% CI 1.12 - 16.3, live in houses adjacent to bushes or shrubs (OR 1.95, 95% CI 1.08 - 3.53, and live in a single room home (OR 1.75, 95% CI 1.02 - 3.01. On binary logistic regression, the first three of these variables were statistically significant. Interpretation & conclusions: With the growing number of cases detected in India, scrub typhus is fast emerging as a public health threat and further research to protect the population from this deadly infection is essential. Health education campaigns focusing on the agricultural workers of Southern India, especially during the cooler months of the year, can serve as an important public health measure to

  11. Clinical indicators for severe prognosis of scrub typhus

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    Sriwongpan P

    2013-10-01

    Full Text Available Pamornsri Sriwongpan,1,2 Pornsuda Krittigamas,3 Pacharee Kantipong,4 Naowarat Kunyanone,5 Jayanton Patumanond,1 Sirianong Namwongprom1,61Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Social Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand; 3Department of General Pediatrics, Nakornping Hospital, Chiang Mai, Thailand; 4Department of Internal Medicine, 5Department of Medical Technology, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand; 6Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandBackground: The study explored clinical risk characteristics that may be used to forecast scrub typhus severity under routine clinical practices.Methods: Retrospective data were collected from patients registered at two university-affiliated tertiary care hospitals in the north of Thailand, from 2004 to 2010. Key information was retrieved from in-patient records, out patient cards, laboratory reports and registers. Patients were classified into three severity groups: nonsevere, severe (those with at least one organ involvement, and deceased. Prognostic characteristics for scrub typhus severity were analyzed by a multivariable ordinal continuation ratio regression.Results: A total of 526 patients were classified into nonsevere (n = 357, severe (n = 100, and deceased (n = 69. The significant multivariable prognostic characteristics for scrub typhus severity were increased body temperature (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.45–0.74, P < 0.001, increased pulse rate (OR = 1.03, 95% CI = 1.01–1.05, P < 0.001, presence of crepitation (OR = 3.25, 95% CI = 1.52–6.96, P = 0.001, increased percentage of lymphocytes (OR = 0.97, 95% CI = 0.95–0.98, P = 0.001, increased aspartate aminotransferase (every 10 IU/L (OR = 1.04, 95% CI = 1.02–1.06, P < 0.001, increased serum albumin (OR = 0.47, 95% CI = 0.27–0.80, P = 0

  12. Spatiotemporal Dynamics of Scrub Typhus Transmission in Mainland China, 2006-2014.

    Science.gov (United States)

    Wu, Yi-Cheng; Qian, Quan; Soares Magalhaes, Ricardo J; Han, Zhi-Hai; Hu, Wen-Biao; Haque, Ubydul; Weppelmann, Thomas A; Wang, Yong; Liu, Yun-Xi; Li, Xin-Lou; Sun, Hai-Long; Sun, Yan-Song; Clements, Archie C A; Li, Shen-Long; Zhang, Wen-Yi

    2016-08-01

    Scrub typhus is endemic in the Asia-Pacific region including China, and the number of reported cases has increased dramatically in the past decade. However, the spatial-temporal dynamics and the potential risk factors in transmission of scrub typhus in mainland China have yet to be characterized. This study aims to explore the spatiotemporal dynamics of reported scrub typhus cases in mainland China between January 2006 and December 2014, to detect the location of high risk spatiotemporal clusters of scrub typhus cases, and identify the potential risk factors affecting the re-emergence of the disease. Monthly cases of scrub typhus reported at the county level between 2006 and 2014 were obtained from the Chinese Center for Diseases Control and Prevention. Time-series analyses, spatiotemporal cluster analyses, and spatial scan statistics were used to explore the characteristics of the scrub typhus incidence. To explore the association between scrub typhus incidence and environmental variables panel Poisson regression analysis was conducted. During the time period between 2006 and 2014 a total of 54,558 scrub typhus cases were reported in mainland China, which grew exponentially. The majority of cases were reported each year between July and November, with peak incidence during October every year. The spatiotemporal dynamics of scrub typhus varied over the study period with high-risk clusters identified in southwest, southern, and middle-eastern part of China. Scrub typhus incidence was positively correlated with the percentage of shrub and meteorological variables including temperature and precipitation. The results of this study demonstrate areas in China that could be targeted with public health interventions to mitigate the growing threat of scrub typhus in the country.

  13. Meteorological factors and risk of scrub typhus in Guangzhou, southern China, 2006-2012.

    Science.gov (United States)

    Li, Tiegang; Yang, Zhicong; Dong, Zhiqiang; Wang, Ming

    2014-03-12

    Scrub typhus is becoming the most common vector born disease in Guangzhou, southern China. In this study, we aimed to examine the effect of weather patterns on the incidence of Scrub typhus in the subtropical city of Guangzhou for the period 2006-2012, and assist public health prevention and control measures. Scrub typhus reported cases during the period of 2006-2012 in Guangzhou were obtained from National Notifiable Disease Report System (NNDRS). Simultaneous meteorological data including temperature, relative humidity, atmospheric pressure, sunshine, and rainfall were obtained from the documentation of the Guangzhou Meteorological Bureau. A negative binomial regression was used to identify the relationship between meteorological variables and scrub typhus. Annual incidence rates of scrub typhus from 2006 to 2012 were 3.25, 2.67, 3.81, 4.22, 4.41, 5.12, and 9.75 (per 100 000) respectively. Each 1°C rise in temperature corresponded to an increase of 14.98% (95% CI 13.65% to 16.33%) in the monthly number of scrub typhus cases, while a 1 hPa rise in atmospheric pressure corresponded to a decrease in the number of cases by 8.03% (95% CI -8.75% to -7.31%). Similarly, a 1 hour rise in sunshine corresponded to an increase of 0.17% or 0.54%, and a 1 millimeter rise in rainfall corresponded to an increase of 0.05% or 0.10%, in the monthly number of scrub typhus cases, depending on the variables considered in the model. Our study provided evidence that climatic factors were associated with occurrence of scrub typhus in Guangzhou city, China. Temperature, duration of sunshine, and rainfall were positively associated with scrub typhus incidence, while atmospheric pressure was inversely associated with scrub typhus incidence. These findings should be considered in the prediction of future patterns of scrub typhus transmission.

  14. Clinical and Epidemiological Characteristics of Scrub Typhus and Murine Typhus among Hospitalized Patients with Acute Undifferentiated Fever in Northern Vietnam

    Science.gov (United States)

    Hamaguchi, Sugihiro; Cuong, Ngo Chi; Tra, Doan Thu; Doan, Yen Hai; Shimizu, Kenta; Tuan, Nguyen Quang; Yoshida, Lay-Myint; Mai, Le Quynh; Duc-Anh, Dang; Ando, Shuji; Arikawa, Jiro; Parry, Christopher M.; Ariyoshi, Koya; Thuy, Pham Thanh

    2015-01-01

    A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non–scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting. PMID:25778504

  15. Increased Nucleosomes and Neutrophil Activation Link to Disease Progression in Patients with Scrub Typhus but Not Murine Typhus in Laos.

    Science.gov (United States)

    Paris, Daniel H; Stephan, Femke; Bulder, Ingrid; Wouters, Diana; van der Poll, Tom; Newton, Paul N; Day, Nicholas P J; Zeerleder, Sacha

    2015-01-01

    Cell-mediated immunity is essential in protection against rickettsial illnesses, but the role of neutrophils in these intracellular vasculotropic infections remains unclear. This study analyzed the plasma levels of nucleosomes, FSAP-activation (nucleosome-releasing factor), and neutrophil activation, as evidenced by neutrophil-elastase (ELA) complexes, in sympatric Lao patients with scrub typhus and murine typhus. In acute scrub typhus elevated nucleosome levels correlated with lower GCS scores, raised respiratory rate, jaundice and impaired liver function, whereas neutrophil activation correlated with fibrinolysis and high IL-8 plasma levels, a recently identified predictor of severe disease and mortality. Nucleosome and ELA complex levels were associated with a 4.8-fold and 4-fold increased risk of developing severe scrub typhus, beyond cut off values of 1,040 U/ml for nucleosomes and 275 U/ml for ELA complexes respectively. In murine typhus, nucleosome levels associated with pro-inflammatory cytokines and the duration of illness, while ELA complexes correlated strongly with inflammation markers, jaundice and increased respiratory rates. This study found strong correlations between circulating nucleosomes and neutrophil activation in patients with scrub typhus, but not murine typhus, providing indirect evidence that nucleosomes could originate from neutrophil extracellular trap (NET) degradation. High circulating plasma nucleosomes and ELA complexes represent independent risk factors for developing severe complications in scrub typhus. As nucleosomes and histones exposed on NETs are highly cytotoxic to endothelial cells and are strongly pro-coagulant, neutrophil-derived nucleosomes could contribute to vascular damage, the pro-coagulant state and exacerbation of disease in scrub typhus, thus indicating a detrimental role of neutrophil activation. The data suggest that increased neutrophil activation relates to disease progression and severe complications, and

  16. High seroprevalence of antibodies against spotted fever and scrub typhus bacteria in patients with febrile Illness, Kenya.

    Science.gov (United States)

    Thiga, Jacqueline W; Mutai, Beth K; Eyako, Wurapa K; Ng'ang'a, Zipporah; Jiang, Ju; Richards, Allen L; Waitumbi, John N

    2015-04-01

    Serum samples from patients in Kenya with febrile illnesses were screened for antibodies against bacteria that cause spotted fever, typhus, and scrub typhus. Seroprevalence was 10% for spotted fever group, typhus group, and 5% for scrub typhus group. Results should help clinicians expand their list of differential diagnoses for undifferentiated fevers.

  17. A Spatiotemporal Database to Track Human Scrub Typhus Using the VectorMap Application.

    Directory of Open Access Journals (Sweden)

    Daryl J Kelly

    2015-12-01

    Full Text Available Scrub typhus is a potentially fatal mite-borne febrile illness, primarily of the Asia-Pacific Rim. With an endemic area greater than 13 million km2 and millions of people at risk, scrub typhus remains an underreported, often misdiagnosed febrile illness. A comprehensive, updatable map of the true distribution of cases has been lacking, and therefore the true risk of disease within the very large endemic area remains unknown. The purpose of this study was to establish a database and map to track human scrub typhus. An online search using PubMed and the United States Armed Forces Pest Management Board Literature Retrieval System was performed to identify articles describing human scrub typhus cases both within and outside the traditionally accepted endemic regions. Using World Health Organization guidelines, stringent criteria were used to establish diagnoses for inclusion in the database. The preliminary screening of 181 scrub typhus publications yielded 145 publications that met the case criterion, 267 case records, and 13 serosurvey records that could be georeferenced, describing 13,739 probable or confirmed human cases in 28 countries. A map service has been established within VectorMap (www.vectormap.org to explore the role that relative location of vectors, hosts, and the pathogen play in the transmission of mite-borne scrub typhus. The online display of scrub typhus cases in VectorMap illustrates their presence and provides an up-to-date geographic distribution of proven scrub typhus cases.

  18. Climate variability, animal reservoir and transmission of scrub typhus in Southern China.

    Science.gov (United States)

    Wei, Yuehong; Huang, Yong; Li, Xiaoning; Ma, Yu; Tao, Xia; Wu, Xinwei; Yang, Zhicong

    2017-03-01

    We aimed to evaluate the relationships between climate variability, animal reservoirs and scrub typhus incidence in Southern China. We obtained data on scrub typhus cases in Guangzhou every month from 2006 to 2014 from the Chinese communicable disease network. Time-series Poisson regression models and distributed lag nonlinear models (DLNM) were used to evaluate the relationship between risk factors and scrub typhus. Wavelet analysis found the incidence of scrub typhus cycled with a period of approximately 8-12 months and long-term trends with a period of approximately 24-36 months. The DLNM model shows that relative humidity, rainfall, DTR, MEI and rodent density were associated with the incidence of scrub typhus. Our findings suggest that the incidence scrub typhus has two main temporal cycles. Determining the reason for this trend and how it can be used for disease control and prevention requires additional research. The transmission of scrub typhus is highly dependent on climate factors and rodent density, both of which should be considered in prevention and control strategies for scrub typhus.

  19. Risk factors associated with severe scrub typhus in Shandong, northern China

    Directory of Open Access Journals (Sweden)

    Luyan Zhang

    2014-12-01

    Conclusions: This study indicates that improved diagnosis and timely treatment are important factors for the prevention of severe scrub typhus. When scrub typhus patients present with a rash, lymphadenopathy, or blood platelet count <100 × 109/l, clinicians should be alert to the appearance of severe complications.

  20. A Spatiotemporal Database to Track Human Scrub Typhus Using the VectorMap Application.

    Science.gov (United States)

    Kelly, Daryl J; Foley, Desmond H; Richards, Allen L

    2015-12-01

    Scrub typhus is a potentially fatal mite-borne febrile illness, primarily of the Asia-Pacific Rim. With an endemic area greater than 13 million km2 and millions of people at risk, scrub typhus remains an underreported, often misdiagnosed febrile illness. A comprehensive, updatable map of the true distribution of cases has been lacking, and therefore the true risk of disease within the very large endemic area remains unknown. The purpose of this study was to establish a database and map to track human scrub typhus. An online search using PubMed and the United States Armed Forces Pest Management Board Literature Retrieval System was performed to identify articles describing human scrub typhus cases both within and outside the traditionally accepted endemic regions. Using World Health Organization guidelines, stringent criteria were used to establish diagnoses for inclusion in the database. The preliminary screening of 181 scrub typhus publications yielded 145 publications that met the case criterion, 267 case records, and 13 serosurvey records that could be georeferenced, describing 13,739 probable or confirmed human cases in 28 countries. A map service has been established within VectorMap (www.vectormap.org) to explore the role that relative location of vectors, hosts, and the pathogen play in the transmission of mite-borne scrub typhus. The online display of scrub typhus cases in VectorMap illustrates their presence and provides an up-to-date geographic distribution of proven scrub typhus cases.

  1. Bayesian spatial modelling and the significance of agricultural land use to scrub typhus infection in Taiwan.

    Science.gov (United States)

    Wardrop, Nicola A; Kuo, Chi-Chien; Wang, Hsi-Chieh; Clements, Archie C A; Lee, Pei-Fen; Atkinson, Peter M

    2013-11-01

    Scrub typhus is transmitted by the larval stage of trombiculid mites. Environmental factors, including land cover and land use, are known to influence breeding and survival of trombiculid mites and, thus, also the spatial heterogeneity of scrub typhus risk. Here, a spatially autoregressive modelling framework was applied to scrub typhus incidence data from Taiwan, covering the period 2003 to 2011, to provide increased understanding of the spatial pattern of scrub typhus risk and the environmental and socioeconomic factors contributing to this pattern. A clear spatial pattern in scrub typhus incidence was observed within Taiwan, and incidence was found to be significantly correlated with several land cover classes, temperature, elevation, normalized difference vegetation index, rainfall, population density, average income and the proportion of the population that work in agriculture. The final multivariate regression model included statistically significant correlations between scrub typhus incidence and average income (negatively correlated), the proportion of land that contained mosaics of cropland and vegetation (positively correlated) and elevation (positively correlated). These results highlight the importance of land cover on scrub typhus incidence: mosaics of cropland and vegetation represent a transitional land cover type which can provide favourable habitats for rodents and, therefore, trombiculid mites. In Taiwan, these transitional land cover areas tend to occur in less populated and mountainous areas, following the frontier establishment and subsequent partial abandonment of agricultural cultivation, due to demographic and socioeconomic changes. Future land use policy decision-making should ensure that potential public health outcomes, such as modified risk of scrub typhus, are considered.

  2. Scrub typhus, a disease with increasing threat in Guangdong, China.

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    Wu De

    Full Text Available There has been a rapid increase in the number of scrub typhus cases in Guangdong Province, China. For this reason, an epidemiologic study was conducted to understand the characteristics of scrub typhus epidemics in Guangdong. From 2006 to 2013, the incidence of human cases increased from 0.4321 to 3.5917 per 100,000 with a bimodal peak in human cases typically occurring between May and November. To detect the prevalence of Orientia tsutsugamushi among suspected human cases and rodents, we performed ELISA tests of IgM/IgG and nested PCR tests on 59 whole blood samples from the suspected cases and 112 spleen samples from the rodents. Suspected cases tested positive for anti-O. tsutsugamushi IgM and IgG 66.1% (39/59 and 50.8% (30/59 of the time, respectively. Additionally, 20.3% (12/59 of blood samples and 13.4% (15/112 of spleen samples were positive for PCR. Phylogenetic analysis revealed that there were four definable clusters among the 27 nucleotide sequences of the 56-kDa antigen genes: 44.4% Karp (12/27, 25.9% Kato (7/27, 22.2% Gilliam (6/27 and 7.4% TA763 (2/27. We concluded many suspected cases may result in diagnostic errors; therefore, it is necessary to perform laboratory tests on suspected cases in hospitals. The high infection rate of O. tsutsugamushi among the limited rodents tested suggested that further rodent sampling throughout the province is necessary to further define high-risk areas. Furthermore, the multiple co-circulating genotypes of O. tsutsugamushi play a key role in the pervasiveness of scrub typhus in the Guangdong area.

  3. CLINICAL PROFILE, EPIDEMIOLOGY AND PROGNOSTIC FACTORS IN SCRUB TYPHUS

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    Priyadarshini B

    2017-03-01

    Full Text Available BACKGROUND Scrub typhus is an underdiagnosed disease, but potentially treatable, if diagnosis is made with high index of suspicion. Deaths are attributable to late presentation, delayed diagnosis and drug resistance. MATERIALS AND METHODS The study was an observational study of prospective design conducted in the Department of General Medicine, Government Medical College, Kozhikode, over a period of one year. History, physical examination and relevant lab investigations were done in 70 patients in the study. RESULTS Majority of patients were in working class. Most common physical finding was lymphadenopathy. Eschar was present in 46% of patients. Majority responded to doxycycline. Case fatality was 14.3%. CONCLUSION 1. Most cases occurred during cooler months of the year (Oct-Feb. 2. Fever and headache were the most common symptoms. 3. Lymphadenopathy was the most common sign followed by splenomegaly. 4. Eschar was present in 46% cases. 5. Leucocytosis was associated with poor prognosis and increased complication like meningoencephalitis. 6. Hypoalbuminaemia was associated with increased incidence of complications like myocarditis and encephalitis. 7. More than 2 times, elevation of transaminases was a poor prognostic marker. 8. Most common and important complication was Acute Kidney Injury (AKI. 9. Microangiopathic haemolysis could possibly be a contributory factor for high incidence of AKI associated with scrub typhus. 10. Rampant NSAID use is another contributory factor for high incidence of AKI associated with scrub typhus. 11. Resistance to doxycycline is emerging in our community and we should consider this possibility in cases with strong suspicion with no response to doxycycline.

  4. Acute transverse myelitis following scrub typhus: A case report and review of the literature.

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    Ryu, Hyun-Seung; Moon, Bong Ju; Park, Jae-Young; Kim, Sang-Deok; Seo, Seung-Kwon; Lee, Jung-Kil

    2018-01-19

    Context Scrub typhus is an acute febrile disease caused by Orientia tsutsugamushi. The disease can usually involve the lungs, heart, liver, spleen and brain through hematogenous dissemination. However, very rarely, acute transverse myelitis in the spinal cord develops from scrub typhus. We present a case of acute transverse myelitis following scrub typhus with a review of the literature. Findings A 66-year-old male visited a hospital for general myalgia, mild headache, and fever in October. He was noted to have thick, black papule skin on his abdomen, which was highly suggestive of scrub typhus. To confirm the diagnosis, O. tsutsugamushi antibody titers were examined and detected highly in serum by an indirect fluorescence antibody assay. Doxycycline, the standard treatment for scrub typhus, was administered. However, after seven days of treatment, he rapidly developed weakness in the right leg, paresthesia in both lower limbs, and voiding difficulty. Spinal magnetic resonance imaging (MRI) revealed lesions with high signal intensity involving the spinal cord at the thoracolumbar junction. Paraparesis gradually improved following steroid pulse therapy for five days. At one-year follow-up, he could walk without cane. Conclusions Orientia tsutsugamushi causes scrub typhus, which can affect not only the brain, but also the spinal cord. Although acute transverse myelitis develops rarely from scrub typhus, this should be considered as differential diagnosis in patients of fever with neurological deficit in endemic areas.

  5. Bilateral Symmetrical Brachial Plexopathy in Association with Scrub Typhus: A Rare Presentation

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    Mittal M

    2015-10-01

    Full Text Available Scrub typhus is a commonly encountered rickettsial disease of the Indian subcontinent caused by Orientia tsutsugamushi. It can be associated with various neurological manifestations. We report a case of 50 year old man with bilateral symmetrical brachial plexopathy associated with scrub typhus from the Garhwal region of Uttarakhand state. The initial manifestations were fever, bodyaches and weakness in both upper limbs. Laboratory reports confirmed the diagnosis of scrub typhus. EMG and NCV were strongly suggestive of upper brachial plexopathy. Patient was discharged in satisfactory condition

  6. First case of scrub typhus with meningoencephalitis from Kerala: An emerging infectious threat

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    K Saifudheen

    2012-01-01

    Full Text Available Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi, one of the most common infectious diseases in the Asia-Pacific region. It has been reported from northern, eastern, and southern India, and its presence has been documented in at least 11 Indian states. However, scrub typhus meningoencephalitis has not been well documented in Kerala. We report two cases of scrub typhus meningoencephalitis from northern Kerala. The diagnosis was made based on the clinical pictures, presence of eschar, and a positive Weil-Felix test with a titer of > 1:320. The first patient succumbed to illness due to respiratory failure and the second patient improved well.

  7. Scrub typhus islands in the Taiwan area and the association between scrub typhus disease and forest land use and farmer population density: geographically weighted regression

    Science.gov (United States)

    2013-01-01

    Background The Taiwan area comprises the main island of Taiwan and several small islands located off the coast of the Southern China. The eastern two-thirds of Taiwan are characterized by rugged mountains covered with tropical and subtropical vegetation. The western region of Taiwan is characterized by flat or gently rolling plains. Geographically, the Taiwan area is diverse in ecology and environment, although scrub typhus threatens local human populations. In this study, we investigate the effects of seasonal and meteorological factors on the incidence of scrub typhus infection among 10 local climate regions. The correlation between the spatial distribution of scrub typhus and cultivated forests in Taiwan, as well as the relationship between scrub typhus incidence and the population density of farm workers is examined. Methods We applied Pearson’s product moment correlation to calculate the correlation between the incidence of scrub typhus and meteorological factors among 10 local climate regions. We used the geographically weighted regression (GWR) method, a type of spatial regression that generates parameters disaggregated by the spatial units of analysis, to detail and map each regression point for the response variables of the standardized incidence ratio (SIR)-district scrub typhus. We also applied the GWR to examine the explanatory variables of types of forest-land use and farm worker density in Taiwan in 2005. Results In the Taiwan Area, scrub typhus endemic areas are located in the southeastern regions and mountainous townships of Taiwan, as well as the Pescadore, Kinmen, and Matou Islands. Among these islands and low-incidence areas in the central western and southwestern regions of Taiwan, we observed a significant correlation between scrub typhus incidence and surface temperature. No similar significant correlation was found in the endemic areas (e.g., the southeastern region and the mountainous area of Taiwan). Precipitation correlates positively

  8. [Epidemiology of scrub typhus and influencing factors in Yunnan province, 2006-2013].

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    Sun, Y; Shi, C; Li, X L; Fang, L Q; Cao, W C

    2018-01-10

    Objective: To understand the epidemiological characteristics of scrub typhu s and influencing factors in Yunnan province, and provide further information for the prevention and control of scrub typhus. Methods: Based on the incidence data of scrub typhus reported in Yunnan from 2006 to 2013, the epidemiological characteristics of scrub typhus were analyzed and related environmental factors were identified with panel negative binomial regression model. Results: A total of 8 980 scrub typhus cases were reported during 2006-2013 in Yunnan. The average annual incidence was 2.46/100 000, with an uptrend observed. Natural focus expansion was found, affecting 71.3% of the counties in 2013. The epidemic mainly occurred in summer and autumn with the incidence peak during July-October. The annual incidence was higher in females than in males. More cases occurred in children and farmers, the proportions of cases in farmers and pre-school aged children showed an obvious increase. Panel negative binomial regression model indicated that the transmission risk of scrub typhus was positive associated with monthly temperature and monthly relative humidity. Furthermore, an "U" pattern between the risk and the increased coverage of cropland and grassland as well as an "inverted-U" pattern between the risk and increased coverage of shrub were observed. Conclusion: It is necessary to strengthen the scrub typhus surveillance in warm and moist areas as well as the areas with high coverage of cropland and grassland in Yunnan, and the health education in children and farmers who are at high risk.

  9. The genotypes of Orientia tsutsugamushi, identified in scrub typhus patients in northern Vietnam.

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    Nguyen, Hang L K; Pham, Hang T T; Nguyen, Tinh V; Hoang, Phuong Vm; Le, Mai T Q; Takemura, Taichiro; Hasebe, Futoshi; Hayasaka, Daisuke; Yamada, Akio; Hotta, Kozue

    2017-03-01

    There are an estimated one million patients with scrub typhus in the Asia-Pacific region. There are few reports describing the incidence of scrub typhus in Vietnam. Blood samples collected from 63 patients clinically diagnosed as having scrub typhus from July 2015 to September 2016 were subjected to genotyping of Orientia tsutsugamushi. Of these patients, 42 (67%) tested positive for O. tsutsugamushi, and the most common genotype was identified to be Karp (55%). Other genotypes, TA763, Gilliam type in Japan variant, and Kato were also found in 17%, 17% and 12% of patients, respectively. To better understand the epidemiological landscape of scrub typhus in Vietnam, a countrywide study is needed. LC110330-LC110333, LC110336-LC110351 and LC214804-LC214825. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. A Comparative Study of Hepatitis Caused by Scrub Typhus and Viral Hepatitis A in South Korea

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    Lee, Jun; Kim, Dong-Min; Yun, Na Ra; Byeon, Yu Mi; Kim, Young Dae; Park, Chan Guk; Kim, Man Woo; Han, Mi Ah

    2011-01-01

    We compared clinical features and laboratory findings of 104 patients with hepatitis A and 197 patients with scrub typhus. Nausea, vomiting, abdominal pain, hepatomegaly, and jaundice were common in patient with hepatitis A, and fever and headache were significantly more common in patients with scrub typhus. At presentation, an alanine aminotransferase (ALT) level ≥ 500 U/L was observed in 1% of scrub typhus patients and in 87.5% of hepatitis A patients (P hepatitis A patients. The ALT:lactate dehydrogenase ratio was ≤ 5 in 97.4% of the patients with scrub typhus and > 5 in 95.2% of those with hepatitis A (P 5, and hepatomegaly are indications of viral hepatitis A. PMID:22049041

  11. A comparative study of hepatitis caused by scrub typhus and viral hepatitis A in South Korea.

    Science.gov (United States)

    Lee, Jun; Kim, Dong-Min; Yun, Na Ra; Byeon, Yu Mi; Kim, Young Dae; Park, Chan Guk; Kim, Man Woo; Han, Mi Ah

    2011-11-01

    We compared clinical features and laboratory findings of 104 patients with hepatitis A and 197 patients with scrub typhus. Nausea, vomiting, abdominal pain, hepatomegaly, and jaundice were common in patient with hepatitis A, and fever and headache were significantly more common in patients with scrub typhus. At presentation, an alanine aminotransferase (ALT) level ≥ 500 U/L was observed in 1% of scrub typhus patients and in 87.5% of hepatitis A patients (P hepatitis A patients. The ALT:lactate dehydrogenase ratio was ≤ 5 in 97.4% of the patients with scrub typhus and > 5 in 95.2% of those with hepatitis A (P 5, and hepatomegaly are indications of viral hepatitis A.

  12. Scrub typhus: risks, diagnostic issues, and management challenges

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    Prakash JAJ

    2017-08-01

    Full Text Available John Antony Jude Prakash Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India Abstract: Scrub typhus is an acute febrile illness in the “tsutsugamushi triangle”, transmitted by chiggers that can be treated effectively if detected early. Laboratory testing, including molecular and serological assays, is needed for confirming the diagnosis, especially in the absence of the pathognomonic eschar. In this review, factors that play a role in disease occurrence and clinical clues for diagnosis, in addition to risk factors contributing to disease severity, including mortality, are discussed in detail. Moreover, issues related to diagnostic assays, treatment, and mixed infections are also enumerated and described. Keywords: Orientia tsutsugamushi, disease severity, mortality predictors, diagnosis, coinfections, treatment

  13. Meteorological factors and risk of scrub typhus in Guangzhou, southern China, 2006–2012

    Science.gov (United States)

    2014-01-01

    Background Scrub typhus is becoming the most common vector born disease in Guangzhou, southern China. In this study, we aimed to examine the effect of weather patterns on the incidence of Scrub typhus in the subtropical city of Guangzhou for the period 2006–2012, and assist public health prevention and control measures. Methods Scrub typhus reported cases during the period of 2006–2012 in Guangzhou were obtained from National Notifiable Disease Report System (NNDRS). Simultaneous meteorological data including temperature, relative humidity, atmospheric pressure, sunshine, and rainfall were obtained from the documentation of the Guangzhou Meteorological Bureau. A negative binomial regression was used to identify the relationship between meteorological variables and scrub typhus. Results Annual incidence rates of scrub typhus from 2006 to 2012 were 3.25, 2.67, 3.81, 4.22, 4.41, 5.12, and 9.75 (per 100 000) respectively. Each 1°C rise in temperature corresponded to an increase of 14.98% (95% CI 13.65% to 16.33%) in the monthly number of scrub typhus cases, while a 1 hPa rise in atmospheric pressure corresponded to a decrease in the number of cases by 8.03% (95% CI −8.75% to −7.31%). Similarly, a 1 hour rise in sunshine corresponded to an increase of 0.17% or 0.54%, and a 1 millimeter rise in rainfall corresponded to an increase of 0.05% or 0.10%, in the monthly number of scrub typhus cases, depending on the variables considered in the model. Conclusion Our study provided evidence that climatic factors were associated with occurrence of scrub typhus in Guangzhou city, China. Temperature, duration of sunshine, and rainfall were positively associated with scrub typhus incidence, while atmospheric pressure was inversely associated with scrub typhus incidence. These findings should be considered in the prediction of future patterns of scrub typhus transmission. PMID:24620733

  14. Coagulation and inflammation in scrub typhus and murine typhusu-a prospective comparative study from Laos

    NARCIS (Netherlands)

    Paris, D. H.; Chansamouth, V.; Nawtaisong, P.; Löwenberg, E. C.; Phetsouvanh, R.; Blacksell, S. D.; Lee, S. J.; Dondorp, A. M.; van der Poll, T.; Newton, P. N.; Levi, M. [=Marcel M.; Day, N. P. J.

    2012-01-01

    Scrub typhus (caused by Orientia tsutsugamushi) and murine typhus (caused by Rickettsia typhi) cause up to 28% of febrile episodes in Thailand and Laos. The current understanding of coagulation and inflammation in the pathogenesis of these clinically very similar vasculotropic diseases is limited.

  15. The pathologic splenic rupture of a patient with scrub typhus: a case report

    International Nuclear Information System (INIS)

    Kim, Kum Rae; Park, Won Kyu; Chang, Jay Chun; Cho, Jae Ho; Kim, Jae Woon; Hwang, Mi Soo; Park, Bok Hwan

    2008-01-01

    A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus

  16. The pathologic splenic rupture of a patient with scrub typhus: a case report

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    Kim, Kum Rae; Park, Won Kyu; Chang, Jay Chun; Cho, Jae Ho; Kim, Jae Woon; Hwang, Mi Soo; Park, Bok Hwan [College of Medicine, Yeungnam University, Daegu (Korea, Republic of)

    2008-01-15

    A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus.

  17. Differential diagnosis of scrub typhus meningitis from tuberculous meningitis using clinical and laboratory features.

    Science.gov (United States)

    Valappil, Ashraf V; Thiruvoth, Sohanlal; Peedikayil, Jabir M; Raghunath, Praveenkumar; Thekkedath, Manojan

    2017-12-01

    The involvement of the central nervous system in the form of meningitis or meningoencephalitis is common in scrub typhus and is an important differential diagnosis of other lymphocytic meningitis like tuberculous meningitis (TBM). The aim of this study was to identify the clinical and laboratory parameters that may be helpful in differentiating scrub typhus meningitis from TBM. We compared of the clinical and laboratory features of 57 patients admitted with scrub typhus meningitis or TBM during a 3-year period. Patients who had abnormal cerebrospinal fluid (CSF) and positive scrub typhus enzyme-linked immunosorbent assay serology (n=28) were included in the scrub typhus meningitis group, while the TBM group included those who satisfied the consensus diagnostic criteria of TBM (n=29). Compared with the TBM group, the mean duration of symptoms was less in patients with scrub typhus meningitis, who also had a lower magnitude of neurological deficits, such as altered mental status and cranial nerve and motor deficits. Patients with scrub typhus meningitis had a lower CSF white blood-cell count (WBC) than the TBM group (130.8±213 195±175 cells/mm 3 , P=0.002), lower CSF protein elevation (125±120 vs. 195.2±108.2mg/dl, P=0.002), and higher CSF sugar (70.1±32.4 vs. 48.7±23.4mg/dl, P=0.006). Features predictive of the diagnosis of scrub typhus meningitis included the absence of neurological impairment at presentation, blood serum glutamic-oxaloacetic transaminase>40 international units (IU)/L, serum glutamic-pyruvic transaminase>60 IU/L, total blood leukocyte count>10,000/mm 3 , CSF protein50mg/dl, CSF WBC<100 cells/mm 3 . All patients with scrub typhus meningitis recovered completely following doxycycline therapy CONCLUSIONS: This study suggests that, clinical features, including duration of fever, neurological deficits at presentation and laboratory parameters such as CSF pleocytosis,CSF protein elevation, CSF sugar levels and liver enzyme values are helpful in

  18. Scrub typhus infection presenting as acute heart failure: A case report and systematic review of literature of cardiopulmonary involvement in scrub typhus infection

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    Animesh Ray

    2016-01-01

    Full Text Available We describe a middle aged previoulsy healthy female patient who presented with clinical features suggestive of acute heart failure. Investigations revealed very high NT pro-BNP, right heart enlargement, bilateral pulmonary alveolar edema and bilateral pleural effusion. In view of falling platelet counts and exudative pleural effusion inflammatory/infective causes were considered. Her Weil Felix test was strongly positive and IgM for scrub typhus also returned positive. She was started on doxycycline to which there was dramatic improvement. Thus in this case scrub typhus infection presented as acute right heart failure and the cause seemed elusive at the outset.We also systematically reviewed the existing literature on cardio-pulmonary manifestations of scrub typhus infection.

  19. Meteorological factors affecting scrub typhus occurrence: a retrospective study of Yamagata Prefecture, Japan, 1984-2014.

    Science.gov (United States)

    Seto, J; Suzuki, Y; Nakao, R; Otani, K; Yahagi, K; Mizuta, K

    2017-02-01

    Climate change, by its influence on the ecology of vectors might affect the occurrence of vector-borne diseases. This study examines the effects of meteorological factors in Japan on the occurrence of scrub typhus, a mite-borne zoonosis caused by Orientia tsutsugamushi. Using negative binomial regression, we analysed the relationships between meteorological factors (including temperature, rainfall, snowfall) and spring-early summer cases of scrub typhus in Yamagata Prefecture, Japan, during 1984-2014. The average temperature in July and August of the previous year, cumulative rainfall in September of the previous year, snowfall throughout the winter, and maximum depth of snow cover in January and February were positively correlated with the number of scrub typhus cases. By contrast, cumulative rainfall in July of the previous year showed a negative relationship to the number of cases. These associations can be explained by the life-cycle of Leptotrombidium pallidum, a predominant vector of spring-early summer cases of scrub typhus in northern Japan. Our findings show that several meteorological factors are useful to estimate the number of scrub typhus cases before the endemic period. They are applicable to establish an early warning system for scrub typhus in northern Japan.

  20. Risk factors associated with severe scrub typhus in Shandong, northern China.

    Science.gov (United States)

    Zhang, Luyan; Zhao, Zhongtang; Bi, Zhenwang; Kou, Zengqiang; Zhang, Meng; Yang, Li; Zheng, Li

    2014-12-01

    The aim of this study was to identify risk factors associated with severe scrub typhus, in order to provide a reference for clinical decision-making. A case-control study was conducted of scrub typhus patients who presented at local hospitals between 2010 and 2013. In total, 46 patients with severe scrub typhus complications (cases) and 194 without severe complications (controls) were included. There were significant differences in the duration of illness before effective antibiotic therapy, lymphadenopathy, rash, blood platelet count, white blood cell (WBC) count, percentage neutrophils, and percentage lymphocytes between the case and control groups. Multivariate analysis demonstrated that the following four factors were significantly associated with the severe complications of scrub typhus: (1) duration of illness before effective antibiotic therapy (odds ratio (OR) 2.287, 95% confidence interval (CI) 1.096-4.770); (2) the presence of a rash (OR 3.694, 95% CI 1.300-10.495); (3) lymphadenopathy (OR 2.438, 95% CI 1.090-5.458); (4) blood platelet count scrub typhus. When scrub typhus patients present with a rash, lymphadenopathy, or blood platelet count <100×10(9)/l, clinicians should be alert to the appearance of severe complications. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Hematogenously disseminated Orientia tsutsugamushi-infected murine model of scrub typhus [corrected].

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    Thomas R Shelite

    2014-07-01

    Full Text Available Orientia tsutsugamushi, the etiologic agent of scrub typhus, is a mite-borne rickettsia transmitted by the parasitic larval stage of trombiculid mites. Approximately one-third of the world's population is at risk of infection with Orientia tsutsugamushi, emphasizing its importance in global health. In order to study scrub typhus, Orientia tsutsugamushi Karp strain has been used extensively in mouse studies with various inoculation strategies and little success in inducing disease progression similar to that of human scrub typhus. The objective of this project was to develop a disease model with pathology and target cells similar to those of severe human scrub typhus. This study reports an intravenous infection model of scrub typhus in C57BL/6 mice. This mouse strain was susceptible to intravenous challenge, and lethal infection occurred after intravenous inoculation of 1.25 × 10(6 focus (FFU forming units. Signs of illness in lethally infected mice appeared on day 6 with death occurring ∼ 6 days later. Immunohistochemical staining for Orientia antigens demonstrated extensive endothelial infection, most notably in the lungs and brain. Histopathological analysis revealed cerebral perivascular, lymphohistiocytic infiltrates, focal hemorrhages, meningoencephalitis, and interstitial pneumonia. Disseminated infection of endothelial cells with Orientia in C57BL/6 mice resulted in pathology resembling that of human scrub typhus. The use of this model will allow detailed characterization of the mechanisms of immunity to and pathogenesis of O. tsutsugamushi infection.

  2. Uncommon manifestations of scrub typhus encephalitis in two cases: Clinical and magnetic resonance imaging findings

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    Heo, Young Jin; Jeong, Hae Woong [Dept. of Radiology, Inje University Busan Paik Hospital, Busan (Korea, Republic of)

    2015-11-15

    Scrub typhus is a well-known acute febrile illness caused by Orientia tsutsugamushi. This disease has multiorgan involvement, which includes the lungs, heart, liver, spleen, and the central or peripheral nervous system. Scrub typhus involving the central nervous system (CNS) is not rare. However, meningitis and meningoencephalitis can cause changes in mentation and death and are therefore associated with a poor prognosis. We report two consecutive cases of scrub typhus with CNS involvement. One patient presented with extensive white matter involvement, similar to that observed in acute disseminated encephalomyelitis, whereas the other patient presented with subependymal enhancement along the lateral ventricles. To the best of our knowledge, scrub typhus encephalitis, with extensive white matter involvement and subependymal enhancement, are very rarely described findings in the previous literature. Our patients did not show complete recovery, but the symptoms resolved with treatment. Recognizing these uncommon radiologic findings of scrub typhus may be helpful in the early diagnosis of scrub typhus with CNS involvement, which may alter the prognoses of patients.

  3. Uncommon manifestations of scrub typhus encephalitis in two cases: Clinical and magnetic resonance imaging findings

    International Nuclear Information System (INIS)

    Heo, Young Jin; Jeong, Hae Woong

    2015-01-01

    Scrub typhus is a well-known acute febrile illness caused by Orientia tsutsugamushi. This disease has multiorgan involvement, which includes the lungs, heart, liver, spleen, and the central or peripheral nervous system. Scrub typhus involving the central nervous system (CNS) is not rare. However, meningitis and meningoencephalitis can cause changes in mentation and death and are therefore associated with a poor prognosis. We report two consecutive cases of scrub typhus with CNS involvement. One patient presented with extensive white matter involvement, similar to that observed in acute disseminated encephalomyelitis, whereas the other patient presented with subependymal enhancement along the lateral ventricles. To the best of our knowledge, scrub typhus encephalitis, with extensive white matter involvement and subependymal enhancement, are very rarely described findings in the previous literature. Our patients did not show complete recovery, but the symptoms resolved with treatment. Recognizing these uncommon radiologic findings of scrub typhus may be helpful in the early diagnosis of scrub typhus with CNS involvement, which may alter the prognoses of patients

  4. Epidemiology of scrub typhus and the eschars patterns in South Korea from 2008 to 2012.

    Science.gov (United States)

    Park, Ji-Hyuk; Kim, Sun-Ja; Youn, Seung-Ki; Park, Kisoo; Gwack, Jin

    2014-01-01

    In South Korea, scrub typhus is the most common acute febrile illness in autumn. We analyzed scrub typhus cases reported from 2008 to 2012 to describe the epidemiology of scrub typhus as well as eschar patterns. A total of 30,478 cases were reported from 2008 to 2012; the incidence rates were higher in the southern and western regions of South Korea. The common clinical symptoms of confirmed scrub typhus cases from 2010 to 2012 were fever/chills (95.2%), eschars (78.9%), and myalgia (61.7%). The primary sites of eschars were the lower extremities (19.0%), abdomen/waist (13.4%), and axilla (11.5%) in men and the shoulder/frontal chest (15.1%), lower extremities (14.5%), and abdomen/waist (13.6%) in women. Regardless of gender, eschars tended to be more on the lower extremities among the leisure activities group. Among the occupational farm work group, who usually lived in rural areas, eschars appeared most frequently on the abdomen/waist in men and on the shoulder/frontal chest in women. Eschar patterns were influenced by gender and activities. These results could facilitate the prevention of scrub typhus and clarify the current status of scrub typhus in South Korea.

  5. Tricky typhus ticks two: A report of two sisters from North India presenting with acute respiratory distress syndrome due to scrub typhus

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    R Pai

    2016-01-01

    Full Text Available Scrub typhus is emerging as an important cause of acute febrile illness in Northern India. This is a report of two sisters presenting concurrently with acute respiratory distress syndrome. A diagnosis of scrub typhus was made in both the patients, and they were successfully treated with doxycycline.

  6. A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi.

    Directory of Open Access Journals (Sweden)

    Andrew J Taylor

    Full Text Available Scrub typhus, a bacterial infection caused by Orientia tsutsugamushi, is increasingly recognized as an important cause of fever in Asia, with an estimated one million infections occurring each year. Limited access to health care and the disease's non-specific symptoms mean that many patients are undiagnosed and untreated, but the mortality from untreated scrub typhus is unknown. This review systematically summarizes the literature on the untreated mortality from scrub typhus and disease outcomes.A literature search was performed to identify patient series containing untreated patients. Patients were included if they were symptomatic and had a clinical or laboratory diagnosis of scrub typhus and excluded if they were treated with antibiotics. The primary outcome was mortality from untreated scrub typhus and secondary outcomes were total days of fever, clinical symptoms, and laboratory results. A total of 76 studies containing 89 patient series and 19,644 patients were included in the final analysis. The median mortality of all patient series was 6.0% with a wide range (min-max of 0-70%. Many studies used clinical diagnosis alone and had incomplete data on secondary outcomes. Mortality varied by location and increased with age and in patients with myocarditis, delirium, pneumonitis, or signs of hemorrhage, but not according to sex or the presence of an eschar or meningitis. Duration of fever was shown to be long (median 14.4 days Range (9-19.Results show that the untreated mortality from scrub typhus appears lower than previously reported estimates. More data are required to clarify mortality according to location and host factors, clinical syndromes including myocarditis and central nervous system disease, and in vulnerable mother-child populations. Increased surveillance and improved access to diagnostic tests are required to accurately estimate the untreated mortality of scrub typhus. This information would facilitate reliable quantification of

  7. A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi).

    Science.gov (United States)

    Taylor, Andrew J; Paris, Daniel H; Newton, Paul N

    2015-01-01

    Scrub typhus, a bacterial infection caused by Orientia tsutsugamushi, is increasingly recognized as an important cause of fever in Asia, with an estimated one million infections occurring each year. Limited access to health care and the disease's non-specific symptoms mean that many patients are undiagnosed and untreated, but the mortality from untreated scrub typhus is unknown. This review systematically summarizes the literature on the untreated mortality from scrub typhus and disease outcomes. A literature search was performed to identify patient series containing untreated patients. Patients were included if they were symptomatic and had a clinical or laboratory diagnosis of scrub typhus and excluded if they were treated with antibiotics. The primary outcome was mortality from untreated scrub typhus and secondary outcomes were total days of fever, clinical symptoms, and laboratory results. A total of 76 studies containing 89 patient series and 19,644 patients were included in the final analysis. The median mortality of all patient series was 6.0% with a wide range (min-max) of 0-70%. Many studies used clinical diagnosis alone and had incomplete data on secondary outcomes. Mortality varied by location and increased with age and in patients with myocarditis, delirium, pneumonitis, or signs of hemorrhage, but not according to sex or the presence of an eschar or meningitis. Duration of fever was shown to be long (median 14.4 days Range (9-19)). Results show that the untreated mortality from scrub typhus appears lower than previously reported estimates. More data are required to clarify mortality according to location and host factors, clinical syndromes including myocarditis and central nervous system disease, and in vulnerable mother-child populations. Increased surveillance and improved access to diagnostic tests are required to accurately estimate the untreated mortality of scrub typhus. This information would facilitate reliable quantification of DALYs and

  8. Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea.

    Science.gov (United States)

    Chin, Jung Yeon; Kang, Ki-Woon; Moon, Kyung Min; Kim, Jongwoo; Choi, Yu Jeong

    2018-03-01

    Scrub typhus is known as a self-limited infectious disease. Cardiac complication is uncommon and usually not life-threatening. Until now, few cases of fulminant myocarditis by scrub typhus have been reported. So, we investigated incidence and predictors of acute myocarditis in severe scrub typhus. We retrospectively reviewed 89 patients among 91 scrub typhus confirmed patients who examined an echocardiogram and cardiac biomarkers from 2005 to 2015 in the intensive care unit at our hospital. We excluded two patients who didn't have electrocardiography. Patients were divided into two groups and compared between scrub typhus with (n = 13) and without (n = 76) acute myocarditis. Age, sex, and underlying diseases were similar between the groups. The existence of eschar and duration of general ache and fever were similar between the groups. However, patients with acute myocarditis had more elevated total bilirubin, high incidence of ST elevations and paroxysmal atrial fibrillation (PAF) than those without acute myocarditis. Receiver operating characteristic analysis showed that the PAF was a predictor of myocarditis with a sensitivity of 70% and specificity of 84%. Predictive power of combination of ST-segment elevation and PAF was significantly associated with myocarditis in the multivariate analysis (odds ratio, 1.57; 95% confidence interval [CI], 1.21 to 11.7; p = 0.041) and area under the curve was 0.947 (95% CI, 0.878 to 0.983; p scrub typhus may be more common than previously reported. Patients with high bilirubin and PAF are at increased risk of acute myocarditis with scrub typhus. These patients warrant closer follow-up and echocardiogram would be needed.

  9. Seroprevalence of Scrub Typhus, Typhus, and Spotted Fever Among Rural and Urban Populations of Northern Vietnam.

    Science.gov (United States)

    Trung, Nguyen Vu; Hoi, Le Thi; Thuong, Nguyen Thi Hong; Toan, Tran Khanh; Huong, Tran Thi Kieu; Hoa, Tran Mai; Fox, Annette; Kinh, Nguyen van; van Doorn, H Rogier; Wertheim, Heiman F L; Bryant, Juliet E; Nadjm, Behzad

    2017-05-01

    AbstractRickettsial infections are recognized as important causes of fever throughout southeast Asia. Herein, we determined the seroprevalence to rickettsioses within rural and urban populations of northern Vietnam. Prevalence of individuals with evidence of prior rickettsial infections (IgG positive) was surprisingly low, with 9.14% (83/908) testing positive to the three major rickettsial serogroups thought to circulate in the region. Prevalence of typhus group rickettsiae (TG)-specific antibodies (6.5%, 58/908) was significantly greater than scrub typhus group orientiae (STG)- or spotted fever group rickettsiae (SFG)-specific antibodies ( P < 0.05). The majority of TG seropositives were observed among urban rather than rural residents ( P < 0.05). In contrast, overall antibody prevalence to STG and SFG were both very low (1.1%, 10/908 for STG; 1.7%, 15/908 for SFG), with no significant differences between rural and urban residents. These results provide data on baseline population characteristics that may help inform development of Rickettsia serological testing criteria in future clinical studies.

  10. Scrub typhus re-emergence in India: Contributing factors and way forward.

    Science.gov (United States)

    Ranjan, Jai; Prakash, John Antony Jude

    2018-06-01

    Scrub typhus is a mite borne infectious disease which has re-emerged in India in the 3rd millennium after years of quiescence. In this review, the authors hypothesize the various factors responsible for resurgence of this disease. The main drivers that could have contributed to the upsurge in scrub typhus cases in past two decades are changes in land use land cover (LULC) and urbanisation which are; as a result of the population explosion, causing a strain on sanitation and also increased diversion of forest land for agricultural use. In addition, the availability of better tests, changes in antimicrobial use, climate change also could have impacted the epidemiology, which is showing an upward trend as is evidenced by increasing reports and concomitant publications from India on scrub typhus. Scrub typhus cases are supposed to increase in the coming years as factors like global warming, urbanisation, changes in LULC and rise in AMR (anti-microbial resistance) will be difficult or impossible to control. Therefore, increasing awareness of public and health care professionals regarding scrub typhus coupled with availability of rapid diagnostic assays and implementation of appropriate treatment protocols for control of AFI (acute febrile illness) especially at the community level will help mitigate the scenario in the long run. Copyright © 2018. Published by Elsevier Ltd.

  11. Effects of clarithromycin treatment in scrub typhus in children: comparison with chloramphenicol and azithromycin.

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    Lee, Min; Kim, June; Jo, Dae Sun

    2017-04-01

    Chloramphenicol and tetracycline are not recommended for treating scrub typhus in pediatric patients because of potential side effects, such as aplastic anemia or tooth discoloration. While clarithromycin has recently been used in adults, few reports have been published on its effects in pediatric patients. We report the clinical profiles of pediatric scrub typhus and the effects of clarithromycin on scrub typhus in children. We retrospectively analyzed medical records of 56 children with scrub typhus who were admitted between 2004 and 2013 to Chonbuk National University Hospital, Jeonju, Korea. Cases were divided into 3 groups based on thetreatment drug (chloramphenicol, azithromycin, and clarithromycin). We compared their clinical manifestations and laboratory findings. All patients exhibited fever and rash. Other common clinical manifestations were eschars (66%), lymphadenopathy (48%), upper respiratory symptoms (42%), abdominal pain (32%), and hepatosplenomegaly (14%). Elevated levels of C-reactive protein, erythrocyte sedimentation rates, aspartate transaminase, and alanine transaminase were detected in 95%, 96%, 84%, and 77% of patients, respectively. Additionally, decreased platelet and white blood cell levels were observed in 43% and 36% of patients, respectively. There were no statistical differences between the treatment groups in mean age ( P =0.114) or sex ( P =0.507). However, time to defervescence after the treatments differed significantly, being the shortest in the clarithromycin group ( P =0.019). All patients recovered without complications related to the disease or drugs. Clarithromycin was as effective as chloramphenicol and azithromycin in pediatric scrub typhus patients and may be used as a first-line treatment drug.

  12. Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity.

    Science.gov (United States)

    Chang, Ko; Lee, Nan-Yao; Ko, Wen-Chien; Lin, Wei-Ru; Chen, Yen-Hsu; Tsai, Jih-Jin; Chen, Tun-Chieh; Lin, Chun-Yu; Chang, Ya-Ting; Lu, Po-Liang

    2017-06-22

    The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear. We conducted a retrospective study to identify the characteristics of the elderly aged ≥65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011. Among 441 cases, including 187 cases of scrub typhus, 166 acute Q fever, and 88 murine typhus, 68 (15.4%) cases were elderly patients. The elderly had a higher severe complication rate (10.3% vs. 3.5%, p = 0.022), but did not have a significantly higher mortality rate (1.47% vs. 0.54%, p = 0.396). Compared with those without severe complications, we found the elderly (p = 0.022), dyspnea (p = 0.006), less relative bradycardia (p = 0.004), less febrile illness (p = 0.004), prolonged prothrombin time (PT) (p = 0.002), higher levels of initial C-reactive protein (p = 0.039), blood leukocyte counts (p = 0.01), and lower platelet counts (p = 0.012) are significantly associated with severe complications. Only prolonged prothrombin time was associated with severe complications in multivariate analysis (p = 0.018, CI 95% 0.01-0.66). Among clinical symptoms and laboratory data, multivariate analysis revealed chills was less frequently occurred in the elderly (p = 0.012, 95% confidence interval [CI]: 1.33-9.99). The elderly cases with scrub typhus, murine typhus, or acute Q fever would be more likely to have severe complications, for which prothrombin time prolongation is an important predictor for severe complications. Copyright © 2017. Published by Elsevier B.V.

  13. Q Fever, Scrub Typhus, and Rickettsial Diseases in Children, Kenya, 2011-2012.

    Science.gov (United States)

    Maina, Alice N; Farris, Christina M; Odhiambo, Antony; Jiang, Ju; Laktabai, Jeremiah; Armstrong, Janice; Holland, Thomas; Richards, Allen L; O'Meara, Wendy P

    2016-05-01

    To increase knowledge of undifferentiated fevers in Kenya, we tested paired serum samples from febrile children in western Kenya for antibodies against pathogens increasingly recognized to cause febrile illness in Africa. Of patients assessed, 8.9%, 22.4%, 1.1%, and 3.6% had enhanced seroreactivity to Coxiella burnetii, spotted fever group rickettsiae, typhus group rickettsiae, and scrub typhus group orientiae, respectively.

  14. STATUS OF SCRUB TYPHUS RESEARCH IN INDONESIA (Based on published reports

    Directory of Open Access Journals (Sweden)

    Lim Boo Liat

    2012-09-01

    Full Text Available Scrub typhus merupakan penyakit yang endemis di Indonesia. Akan tetapi laporan mengenai hal tersebut sangat sedikit. Penelusuran hasil penelitian menunjukkan bahwa sebelum tahun 1945 pernah dilaporkan hasil isolasi Rickettsia tsutsugamushi dari penderita demam di beberapa tempat di Indonesia. Setelah tahun 1970 beberapa penelitian seroepidemiologi dilakukan di beberapa daerah di Indonesia terutama daerah transmigrasi dengan hasil prevalensi antibodi terhadap scrub typhus tertinggi di daerah Biak dan Owi, Irian Jaya dan yang terendah di Flores dan Jakarta. Selain itu dilakukan pula penelitian mengenai vektor scrub typhus dan hospesnya dengan hasil di­temukannya 7 species tungau Leptotrombidium termasuk 2 jenis yang merupakan vektor. Saran untuk penelitian di masa yang akan datang diberikan dalam laporan ini.

  15. BIONOMIK TUNGAU VEKTOR SCRUB TYPHUS DAN HOSPESNYA DI DAERAH TRANSMIGRASI KUMPEH, JAMBI

    Directory of Open Access Journals (Sweden)

    Ima Nurisa

    2012-09-01

    Full Text Available A study on bionomics of scrub typhus vector and its host species was conducted in a transmigration scheme of Kumpeh, Jambi, Sumatera. Ten species of trombiculid mites were collected from 6 species of rats and 2 species of squirrels. Leptotrombidium (L. deliense, a known vectorof scrub typhus vector elsewhere, was found mostly on Rattus tiomanicus. This rat species was widely distributed in forest, disturbed land and cultivated land habitations found in the study area. Chigger infestations on R. tioma­nicus trapped in disturbed land were 63.6% — 81.8%. The average number of chigger collected from disturbed land was highest in December, from forest habitation was in October and from the cultivated land habitation was in November. Rattus tiomanicus was found to be a potential rat species for main­taining the natural cycle of scrub typhus in the study area.

  16. Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance.

    Science.gov (United States)

    Kim, Young-Jin; Park, Sungman; Premaratna, Ranjan; Selvaraj, Stephen; Park, Sang-Jin; Kim, Sora; Kim, Donghwan; Kim, Min Soo; Shin, Dong Hoon; Choi, Kyung-Chan; Kwon, Soon-Hwan; Seo, Wonjun; Lee, Nam Taek; Kim, Seung-Han; Kang, Heui Keun; Kim, Yoon-Won

    2016-08-01

    Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus.

  17. Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality.

    Science.gov (United States)

    Bhargava, Anurag; Kaushik, Reshma; Kaushik, Rajeev Mohan; Sharma, Anita; Ahmad, Sohaib; Dhar, Minakshi; Mittal, Garima; Khanduri, Sushant; Pant, Priyannk; Kakkar, Rajesh

    2016-12-01

    Scrub typhus is a re-emerging mite-borne rickettsiosis, which continues to be underdiagnosed, with lethal consequences. The present study was conducted to determine the seasonality, clinical presentation and predictors of mortality in patients with scrub typhus at a tertiary care teaching hospital in northern India. Scrub typhus was suspected in patients attending the hospital as per the standard case definition and serological evidence was obtained by performing an IgM ELISA. A total of 284 patients with scrub typhus from urban and rural areas were seen, predominantly from July to November. The most common clinical presentation was a bilateral community-acquired pneumonia (CAP), which resembled pneumonia due to atypical pathogens and often progressed to acute respiratory distress syndrome (ARDS). An acute undifferentiated febrile illness (AUFI) or a febrile illness associated with altered sensorium, aseptic meningitis, shock, abdominal pain, gastrointestinal bleeding or jaundice was also seen. Eschars were seen in 17 per cent of patients, and thrombocytopenia, transaminitis and azotaemia were frequent. There were 24 deaths (8.5%) caused predominantly by ARDS and multi-organ dysfunction. The mortality in patients with ARDS was high (37%). ARDS [odds ratio (OR)=38.29, 95% confidence interval (CI): 9.93, 147.71] and acute kidney injury (OR=8.30, 95% CI: 2.21, 31.21) were the major predictors of death. The present findings indicate that scrub typhus may be considered a cause of CAP, ARDS, AUFI or a febrile illness with multisystem involvement, in Uttarakhand and Uttar Pradesh, especially from July to November. Empiric therapy of CAP may include doxycycline or azithromycin to ensure coverage of underlying unsuspected scrub typhus.

  18. Clinico - Laboratory Profile of Scrub Typhus - An Emerging Rickettsiosis in India.

    Science.gov (United States)

    Narayanasamy, Dinesh Kumar; Arunagirinathan, Arul Kumaran; Kumar, Revathi Krishna; Raghavendran, V D

    2016-11-01

    To study the clinical and laboratory profile of pediatric scrub typhus in rural south India. This is a descriptive study of the clinical and laboratory features of 117 children with IgM ELISA proven scrub typhus out of 448 children, who were admitted in the Pediatric ward of a tertiary care hospital, during the study period of November 2014 through March 2015. Fever was present in all 117 children, with mean duration of fever at admission as 9 d. Gastrointestinal tract was the most commonly affected system, seen in 51 % of children. Cough (82 %), myalgia (70 %), vomiting (68 %), headache (45 %) and pain abdomen (42 %) were the most common symptoms of scrub typhus. Hepatomegaly (70), splenomegaly (53 %), pallor (50 %) and eschar (41 %) were the common clinical findings in children with scrub typhus. Out of 49 children with eschar, 32 were associated with regional lymphadenopathy, which was commonly seen in axillary, neck and groin regions. Leucocytosis (50 %), anemia (56 %), increased SGOT / SGPT (47 %), thrombocytopenia (41 %), hypoalbuminemia (40 %) and hyponatremia (40 %) were the common lab features. Shock (46 %), myocarditis (24 %) and pneumonia (16 %) were the common complications seen in these children. This study showed that early treatment for scrub typhus results in a good outcome in terms of early recovery and nil mortality. Regional lymphadenopathy is a marker of hidden or developing eschar. Total count and differential count should be interpreted on the background of the duration of fever. Since IgM ELISA, which is diagnostic of scrub typhus may not be widely available, any febrile child coming from rural area with hepatosplenomegaly, pallor, eschar, generalised / regional lymphadenopathy, anemia, leucocytosis, thrombocytopenia and increased Aspartate transaminase (AST) /Alanine aminotransferase (ALT) should be started on empirical Doxycycline or Azithromycin in order to prevent life threatening complications secondary to delay in

  19. Use of Multiplex Real-Time PCR To Diagnose Scrub Typhus.

    Science.gov (United States)

    Tantibhedhyangkul, Wiwit; Wongsawat, Ekkarat; Silpasakorn, Saowaluk; Waywa, Duangdao; Saenyasiri, Nuttawut; Suesuay, Jintapa; Thipmontree, Wilawan; Suputtamongkol, Yupin

    2017-05-01

    Scrub typhus, caused by Orientia tsutsugamushi , is a common cause of acute undifferentiated febrile illness in the Asia-Pacific region. However, its nonspecific clinical manifestation often prevents early diagnosis. We propose the use of PCR and serologic tests as diagnostic tools. Here, we developed a multiplex real-time PCR assay using hydrolysis (TaqMan) probes targeting O. tsutsugamushi 47-kDa, groEL , and human interferon beta (IFN-β gene) genes to improve early diagnosis of scrub typhus. The amplification efficiency was higher than 94%, and the lower detection limit was 10 copies per reaction. We used a human gene as an internal DNA quality and quantity control. To determine the sensitivity of this PCR assay, we selected patients with confirmed scrub typhus who exhibited a clear 4-fold increase in the level of IgG and/or IgM. The PCR assay result was positive in 45 of 52 patients, indicating a sensitivity of 86.5% (95% confidence interval [CI]: 74.2 to 94.4). The PCR assessment was negative for all 136 non-scrub typhus patients, indicating a specificity of 100% (95% CI: 97.3 to 100). In addition, this test helped diagnose patients with inconclusive immunofluorescence assay (IFA) results and using single blood samples. In conclusion, the real-time PCR assay proposed here is sensitive and specific in diagnosing scrub typhus. Combining PCR and serologic tests will improve the diagnosis of scrub typhus among patients presenting with acute febrile illness. Copyright © 2017 American Society for Microbiology.

  20. Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality

    Directory of Open Access Journals (Sweden)

    Anurag Bhargava

    2016-01-01

    Full Text Available Background & objectives: Scrub typhus is a re-emerging mite-borne rickettsiosis, which continues to be underdiagnosed, with lethal consequences. The present study was conducted to determine the seasonality, clinical presentation and predictors of mortality in patients with scrub typhus at a tertiary care teaching hospital in northern India. Methods: Scrub typhus was suspected in patients attending the hospital as per the standard case definition and serological evidence was obtained by performing an IgM ELISA. Results: A total of 284 patients with scrub typhus from urban and rural areas were seen, predominantly from July to November. The most common clinical presentation was a bilateral community-acquired pneumonia (CAP, which resembled pneumonia due to atypical pathogens and often progressed to acute respiratory distress syndrome (ARDS. An acute undifferentiated febrile illness (AUFI or a febrile illness associated with altered sensorium, aseptic meningitis, shock, abdominal pain, gastrointestinal bleeding or jaundice was also seen. Eschars were seen in 17 per cent of patients, and thrombocytopenia, transaminitis and azotaemia were frequent. There were 24 deaths (8.5% caused predominantly by ARDS and multi-organ dysfunction. The mortality in patients with ARDS was high (37%. ARDS [odds ratio (OR=38.29, 95% confidence interval (CI: 9.93, 147.71] and acute kidney injury (OR=8.30, 95% CI: 2.21, 31.21 were the major predictors of death. Interpretation & conclusions: The present findings indicate that scrub typhus may be considered a cause of CAP, ARDS, AUFI or a febrile illness with multisystem involvement, in Uttarakhand and Uttar Pradesh, especially from July to November. Empiric therapy of CAP may include doxycycline or azithromycin to ensure coverage of underlying unsuspected scrub typhus.

  1. Clinical significance of NGAL and KIM-1 for acute kidney injury in patients with scrub typhus.

    Science.gov (United States)

    Sun, In O; Shin, Sung Hye; Cho, A Young; Yoon, Hyun Ju; Chang, Mi Yok; Lee, Kwang Young

    2017-01-01

    The aim of this study is to investigate the clinical significance of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for acute kidney injury (AKI) in patients with scrub typhus. From 2014 to 2015, 145 patients were diagnosed with scrub typhus. Of these, we enrolled 138 patients who were followed up until renal recovery or for at least 3 months. We measured serum and urine NGAL and KIM-1 levels and evaluated prognostic factors affecting scrub typhus-associated AKI. Of the 138 patients, 25 had scrub typhus-associated AKI. The incidence of AKI was 18.1%; of which 11.6%, 4.3%, and 2.2% were classified as risk, injury, and failure, respectively, according to RIFLE criteria. Compared with patients in the non-AKI group, patients in the AKI group were older and showed higher total leukocyte counts and hypoalbuminemia or one or more comorbidities such as hypertension (72% vs 33%, pscrub typhus-associated AKI.

  2. [Spatial analysis of autumn-winter type scrub typhus in Shandong province, 2006-2014].

    Science.gov (United States)

    Yang, H; Bi, Z W; Kou, Z Q; Zheng, L; Zhao, Z T

    2016-05-01

    To discuss the spatial-temporal distribution and epidemic trends of autumn-winter type scrub typhus in Shandong province, and provide scientific evidence for further study for the prevention and control of the disease. The scrub typhus surveillance data during 2006-2014 were collected from Shandong Disease Reporting Information System. The data was analyzed by using software ArcGIS 9.3(ESRI Inc., Redlands, CA, USA), GeoDa 0.9.5-i and SatScan 9.1.1. The Moran' s I, log-likelihood ratio(LLR), relative risk(RR)were calculated and the incidence choropleth maps, local indicators of spatial autocorrelation cluster maps and space scaning cluster maps were drawn. A total of 4 453 scrub typhus cases were reported during 2006-2014, and the annual incidence increased with year. Among the 17 prefectures(municipality)in Shandong, 13 were affected by scrub typhus. The global Moran's I index was 0.501 5(Pscrub typhus in Shandong. Since 2006, the epidemic area of the disease has expanded and the number of high-risk areas has increased. Moreover, the eastward moving and periodically expanding trends of high-risk clusters were detected.

  3. Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India.

    Science.gov (United States)

    Sivarajan, Sunuraj; Shivalli, Siddharudha; Bhuyan, Debomallya; Mawlong, Michael; Barman, Rittwick

    2016-10-05

    India is an integral component of "tsutsugamushi triangle" which depicts a part of the globe endemic to scrub typhus. Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is described as a re-emerging infectious disease in India. The present study aimed to study the clinical and paraclinical profile, complications and predictors of outcome among 90 cases of scrub typhus diagnosed in a hospital of north-eastern India from Sept 2011 to Aug 2012. A longitudinal study was conducted in a hospital of Meghalaya, India between Sept 2011 and Aug 2012. Diagnosis of scrub typhus was arrived by SD BIOLINE tsutsugamushi (solid phase immunochromatographic assay) rapid diagnostic test for antibodies (IgM, IgG or IgA). Descriptive analyses of age, gender, geographic area, symptoms and signs, treatment, laboratory findings, complications, and outcome were conducted. Relative risk (RR) with 95 % confidence interval (CI) was computed for Multiple Organ Dysfunction Syndrome (MODS) and mortality. Binary logistic regression was applied to the significant correlates (P scrub typhus. As many as 662 clinically suspected scrub typhus patients were tested and 90 (13.6 %) were diagnosed to have scrub typhus. Out of 90 patients, 52.2 % (n = 47) were males and their mean (SD) age was 36.29 (13.38) years. Fever of 1.5 mg/dl, and transaminase (AST, ALT or both) >500 U/L were associated with MODS (P 3 mg/dl was also associated with MODS (P 1.5 mg/dl was a predictor of MODS (OR: 76.1, 95 % CI: 4.9-1175.6) and mortality (OR: 18.03, 95 % CI: 1.38-235.1). In this study setting, approximately one-seventh (13.6 %) of the acute undifferentiated febrile illness were due to scrub typhus. Systemic complications were common (33.3 %). Serum creatinine >1.5 mg/dl was a predictor of MODS and mortality.

  4. Scrub typhus causing neonatal hepatitis with acute liver failure-A case series.

    Science.gov (United States)

    Vajpayee, Shailja; Gupta, R K; Gupta, M L

    2017-05-01

    Neonatal hepatitis with acute liver failure due to varied etiology including various infections is reported in the past. Scrub typhus as a cause of neonatal hepatitis has rarely been reported in literature. A high index of clinical suspicion is required for early diagnosis and timely treatment. Severity and prognosis of the disease varies widely because several different strains of Orientia tsutsugamushi exist with different virulence. Delayed diagnosis can result in complication and significant morbidity and mortality. Here, we report three cases of neonatal hepatitis with acute liver failure caused by scrub typhus to increase awareness.

  5. Tsutsugamushi Disease (Scrub Typhus) Meningoencephalitis in North Eastern India: A Prospective Study.

    Science.gov (United States)

    Sharma, S R; Masaraf, H; Lynrah, K G; Lyngdoh, M

    2015-01-01

    Scrub typhus is rampant in northern, eastern, and southern India. Central nervous system involvement in the form of meningitis or meningoencephalitis is common in scrub typhus. As specific laboratory methods remain inadequate or inaccessible in developing countries, prompt diagnosis is often difficult. The aim of this study was to characterize neurological complications in scrub typhus from northeastern region of India. We did a prospective study of scrub meningoencephalitis at North Eastern Indira Gandhi Regional Institute of Medical Sciences among patients admitted to hospital between October 2009 and November 2011. The diagnosis was made based on the clinical pictures, presence of an eschar, and a positive Weil-Felix test (WFT) with a titer of >1:160 and if required a positive scrub IgM enzyme-linked immunosorbent assay. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits, and magnetic resonance imaging (MRI) brain performed if needed. Twenty-three patients of scrub typhus meningitis that were serologically confirmed were included in the study. There were 13 males and 10 females. Fever ≥1 week was the most common manifestation (39.1%). Interestingly, none had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 17 cells/μL, 90%, 86 mg/dL, 0.6605 and 3.6 U/mL, respectively. All patients were treated with doxycycline. There was no mortality in our study. Absence of Eschar does not rule out scrub typhus. Clinical features and CSF findings can mimic tuberculous meningitis so misdiagnosis may lead to unwarranted prolonged empirical antituberculous therapy in cases of lymphocytic meningoencephalitis. Delay in treatment can be potentially fatal. WFT still serves as a useful and affordable diagnostic tool for this disease in resource-poor countries.

  6. Clinical Profile of Scrub Typhus in Pregnancy in Sub-Himalayan Region.

    Science.gov (United States)

    Kumar, Ritesh; Thakur, Surinder; Bhawani, Rajesh; Kanga, Anil; Ranjan, Asha

    2016-10-01

    Scrub typhus is rare in pregnancy, but it has now become an important cause of febrile illness in pregnancy in sub-Himalayan region of India. Only a few case reports have been published so far, and they show adverse maternal and fetal outcomes. No consensus has been reached till now regarding treatment. All the pregnant patients irrespective of period of gestation admitted with febrile illness with positive IgM ELISA for scrub typhus with or without eschar were included. The clinical profile was observed using a detailed history of symptoms, travel, recreation, agricultural activities, treatment record prior to admission, and a detailed examination, and the treatment outcome was noted. Fever workup including cultures, CXR, CSF analysis, serology for scrub was done. IgM scrub typhus was done by kit method manufactured by InBios Intertational, Inc. We observed in total 14 pregnant patients out of which eight were in the the second trimester and six were in the third trimester. The clinical features of the disease observed for pregnant females were the same as for nonpregnant females. There was no difference in the severity of scrub typhus between pregnant and nonpregnant women. No mortality was found in these patients. On follow-up, they had normal peripartum and postpartum periods. All were treated with azithromycin 500 mg once a day for 5 days. Although rare, scrub typhus should be considered in differential diagnosis of fever in pregnant patients especially in scrub season. Azithromycin should be the drug of choice in pregnancy as it has no adverse effect on fetus and pregnancy outcome.

  7. ACUTE CHOLECYSTITIS AS AN UNUSUAL PRESENTATION OF SCRUB TYPHUS: A REPORT OF TWO CASES AND REVIEW OF THE LITERATURE.

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    Charoenphak, Sirima; Rattanawong, Pattara; Sungkanuparph, Somnuek

    2017-01-01

    Scrub typhus rarely presents with acute cholecystitis. We present 2 cases of scrub typhus with cholecystitis. The first patient is a 62 year old female who presented to the hospital with fever and body aches for 1 week and right upper quadrant abdominal pain for 3 days. She gave a history of an insect bite 2 weeks previously. She was diagnosed as having acute cholecystitis and underwent cholecystectomy. She continued with fever post-operatively and physical examination revealed an eschar. She had an immunofluorescence assay (IFA) performed that revealed a high IgM titer for Orientia tsutsugamushi. She was diagnosed as having scrub typhus, treated with doxycycline and she recovered completely. The second patient also presented to the hospital with a 1 week history of fever and upper quadrant abdominal pain. She was diagnosed with having cholecystitis. Her symptoms did not improve with intravenous antibiotics and further investigation revealed elevated titers for O. tsutsugamushi and Leptospira interrogans. She was diagnosed as having a co-infection of scrub typhus and leptospirosis and treated with doxycycline. She recovered completely. Patients from scrub typhus endemic regions who present with acute cholecystitis but do not respond to traditional treatment should be tested for scrub typhus and leptospirosis and should have a careful admission physical examination looking for eschar formation, since scrub typhus may present with acute cholecystitis.

  8. Coincidence between geographical distribution of Leptotrombidium scutellare and scrub typhus incidence in South Korea.

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    Jong Yul Roh

    Full Text Available To clarify the geographical distribution of scrub typhus vectors in Korea, a survey of larval trombiculid mites was conducted from 2005 to 2007 by collecting wild small mammals twice a year (spring and autumn at 24 sites nationwide. A total of 67,325 mites representing 4 genera and 14 species were collected from 783 trapped rodents, corresponding to a chigger index (number of chigger mites per rodent of 86.0. The predominant mite species were Leptotrombidium pallidum (52.6%, Leptotrombiduim scutellare (27.1%, Leptotrombidium palpale (8.2%, Leptotrombidium orientale (5.6%, and Neotrombicula tamiyai (1.7%. However, the proportions of L. scutellare in southern areas, including endemic provinces such as Jeollabuk-Do (34.3%, Jeollanam-Do (49.0%, and Gyeongsangnam-Do (88%, were relatively higher than in central Korean regions where L. pallidum was predominant. In autumn, the ratio of L. scutellare increased to 42% while the ratio of L. pallidum decreased. The geographical distribution map of the L. scutellare chigger index was identical to the incidence pattern of scrub typhus, whereas those of overall mites and L. pallidum showed no relationship with case incidence patterns. Distribution mapping analysis shows an identical geographical distribution of L. scutellare and epidemic incidence of scrub typhus in South Korea. L. pallidum could be another vector at all other parts of the Korean peninsula, including the eastern and northern regions that have a low level of scrub typhus incidence.

  9. Comparison of minocycline and azithromycin for the treatment of mild scrub typhus in northern China.

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    Zhao, Minxing; Wang, Ting; Yuan, Xiaoyu; Du, Weiming; Lin, Miaoxin; Shen, Yanbo

    2016-09-01

    Scrub typhus, caused by Orientia tsutsugamushi, has recently emerged in northern China where the disease had not been known to exist. Although doxycycline and azithromycin are the recommended agents for the treatment of scrub typhus, clinical responses depend both on the susceptibilities of various O. tsutsugamushi strains and the severity of the disease. A retrospective analysis was conducted on patients diagnosed with mild scrub typhus from August 2013 to January 2016 in the Affiliated Hospital of Nantong University, northern China. A total of 40 patients who received minocycline treatment and 34 patients who received azithromycin treatment were included in the analysis. All patients except one defervesced within 120 h after initiating antimicrobial therapy. Kaplan-Meier curves in association with log-rank test showed that the median time to defervescence was significantly shorter for the minocycline-treated group than the azithromycin-treated group (P = 0.003). There were no serious adverse events during treatment. No relapse occurred in either group during the 1-month follow-up period. In conclusion, both minocycline and azithromycin are effective and safe for the treatment of mild scrub typhus, but minocycline is more active than azithromycin against O. tsutsugamushi infection acquired in northern China. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  10. Clinical profile and outcome of children with scrub typhus from Chennai, South India.

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    Ganesh, Ramaswamy; Suresh, Natarajan; Pratyusha, L L; Janakiraman, Lalitha; Manickam, Mani; Andal, A

    2018-06-01

    Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. We prospectively studied the clinico-laboratory profile and outcome of 358 children aged 1 day to 18 years diagnosed with scrub typhus from Chennai, South India. All children (100%) had fever. Eschar was seen in 67%. All children were treated with oral doxycycline and those with complications were treated with intravenous chloramphenicol/azithromycin. Rapid defervescence (within 48 h) after initiation of doxycline was seen in 306 (85%) and 52 (14.5%) developed complications. Multivariate logistic regression analysis revealed that children who had an elevated aspartate amino transferase (> 120 IU/L) and the presence of thrombocytopenia (platelet count less than 1 lac cells/mm 3 ) at admission had high risk of developing complications. The overall mortality rate in this series was 0.8%. Our 4-year study highlights the clinico-laboratory profile of Scrub typhus in children from Chennai, South India. Early recognition and prompt treatment reduces the complication and mortality. What is Known: • Scrub typhus is endemic to tsutsugamushi triangle, a geographical triangle extending from northern Japan in the east to Pakistan and Afghanistan in the west and northern Australia in the south. • There is paucity of data regarding its clinico-laboratory profile in neonates as well as its predictors of outcome. What is New: • Children who had an elevated AST and the presence of thrombocytopenia at admission had high risk of developing complications.

  11. Diagnostic evaluation of rapid tests for scrub typhus in the Indian population is needed.

    Science.gov (United States)

    Shivalli, Siddharudha

    2016-05-12

    Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is being described as a re-emerging infectious disease in India. Differentiating scrub typhus from other endemic diseases like malaria, leptospirosis, dengue fever, typhoid, etc. is difficult due to overlapping clinical features and a lower positivity for eschars in Asian populations. Hence, the diagnosis heavily relies on laboratory tests. Costs and the need of technical expertise limit the wide use of indirect immunoperoxidase or immunofluorescence assays, ELISA and PCR. The Weil-Felix test is the most commonly used and least expensive serological test, but lacks both sensitivity and specificity. Hence, the diagnosis of scrub typhus is often delayed or overlooked. With due consideration of the cost, rapidity, single test result and simplicity of interpretation, rapid diagnostic tests have come into vogue. However, evaluation of rapid diagnostic tests for scrub typhus in the Indian population is needed to justify or discourage their use. Research studies are needed to find the most suitable test in terms of the rapidity of the result, simplicity of the procedure, ease of interpretation and cost to be used in the Indian populace.

  12. Rapid increase of scrub typhus incidence in Guangzhou, southern China, 2006-2014

    NARCIS (Netherlands)

    Y. Sun (Ye); Wei, Y.-H. (Yue-Hong); Yang, Y. (Yang); Ma, Y. (Yu); S.J. de Vlas (Sake); H.-W. Yao (Hong-Wu); Huang, Y. (Yong); Ma, M.-J. (Mai-Juan); K. Liu (Kun); Li, X.-N. (Xiao-Ning); X. Li (Xinlou); Zhang, W.-H. (Wen-Hui); Fang, L.-Q. (Li-Qun); Yang, Z.-C. (Zhi-Cong); Cao, W.-C. (Wu-Chun)

    2017-01-01

    textabstractBackground: In the last decade, scrub typhus (ST) has been emerging or re-emerging in some areas of Asia, including Guangzhou, one of the most affected endemic areas of ST in China. Methods: Based on the data on all cases reported in Guangzhou from 2006 to 2014, we characterized the

  13. Diagnostic performance of serological tests to detect antibodies against acute scrub typhus infection in central India

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    Kiran Pote

    2018-01-01

    Full Text Available Background: Differentiating scrub typhus from other acute febrile illness is difficult due to non specificity of clinical symptoms and relative absence of eschar in Indian population. The diagnosis thus relies mainly on laboratory tests. Antibody based serological tests are mainstay of scrub typhus diagnosis. Here, we evaluated the diagnostic performance of IgM ELISA, IgM IFA and ICT to detect antibodies against O. tsutsugamushi in acute serum of febrile patients. Methodology: The serum samples from 600 randomly selected patients suffering from acute undifferentiated fever were tested by all the three tests mentioned above. We used latent class analysis to generate unbiased results as all the tests for scrub typhus diagnosis are imperfect and none of them can be considered as reference standard. Results: We found that IgM ELISA with cutoff titer 0.5 OD has high diagnostic accuracy (sensitivity 99.9% and specificity 99.15 than IgM IFA (sensitivity 96.8% and specificity 99.7% for scrub typhus diagnosis. ICT used in our study had very high specificity 100% but low sensitivity (38% which would limit its use for acute serum samples. ICT being a screening or point of care test, has to be more sensitive while some compromise with specificity is affordable. Hence, optimal cutoff for ICT should be evaluated under different settings. Conclusion: IgM ELISA being simple and affordable could be an alternative diagnostic test to IgM IFA which is subjective and costly.

  14. Diagnostic performance of serological tests to detect antibodies against acute scrub typhus infection in central India.

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    Pote, Kiran; Narang, Rahul; Deshmukh, Pradeep

    2018-01-01

    Differentiating scrub typhus from other acute febrile illness is difficult due to non specificity of clinical symptoms and relative absence of eschar in Indian population. The diagnosis thus relies mainly on laboratory tests. Antibody based serological tests are mainstay of scrub typhus diagnosis. Here, we evaluated the diagnostic performance of IgM ELISA, IgM IFA and ICT to detect antibodies against O. tsutsugamushi in acute serum of febrile patients. The serum samples from 600 randomly selected patients suffering from acute undifferentiated fever were tested by all the three tests mentioned above. We used latent class analysis to generate unbiased results as all the tests for scrub typhus diagnosis are imperfect and none of them can be considered as reference standard. We found that IgM ELISA with cutoff titer 0.5 OD has high diagnostic accuracy (sensitivity 99.9% and specificity 99.15) than IgM IFA (sensitivity 96.8% and specificity 99.7%) for scrub typhus diagnosis. ICT used in our study had very high specificity 100% but low sensitivity (38%) which would limit its use for acute serum samples. ICT being a screening or point of care test, has to be more sensitive while some compromise with specificity is affordable. Hence, optimal cutoff for ICT should be evaluated under different settings. IgM ELISA being simple and affordable could be an alternative diagnostic test to IgM IFA which is subjective and costly.

  15. Scrub typhus masquerading as HELLP syndrome and puerperal sepsis in an asymptomatic malaria patient.

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    Karim, Habib Md Reazaul; Bhattacharyya, Prithwis; Kakati, Sonai Datta; Borah, Tridip Jyoti; Yunus, Md

    2016-01-01

    Scrub typhus and malaria can involve multiple organ systems and are notoriously known for varied presentations. However, clinical malaria or scrub typhus is unusual without fever. On the other hand, altered sensorium with or without fever, dehydration, hemorrhage and hemolysis may lead to low blood pressure. Presence of toxic granules and elevated band forms in such patients can even mimic sepsis. When such a patient is in the peripartum period, it creates a strong clinical dilemma for the physician especially in unbooked obstetric cases. We present such a case where a 26-year-old unbooked female presented on second postpartum day with severe anemia, altered sensorium, difficulty in breathing along with jaundice and gum bleeding without history of fever. Rapid diagnostic test for malaria was negative and no eschar was seen. These parameters suggested a diagnosis of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet) syndrome with or without puerperal sepsis. Subsequently she was diagnosed as having asymptomatic malaria and scrub typhus and responded to the treatment of it. The biochemical changes suggestive of HELLP syndrome also subsided. We present this case to emphasize the fact that mere absence of fever and eschar does not rule out scrub typhus. It should also be considered as a differential diagnosis in patients with symptoms and signs suggesting HELLP syndrome. Asymptomatic malaria can complicate case scenario towards puerperal sepsis by giving false toxic granules and band form in such situations.

  16. Scrub typhus in rural Rajasthan and a review of other Indian studies.

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    Masand, Rupesh; Yadav, Ritesh; Purohit, Alok; Tomar, Balvir Singh

    2016-05-01

    Scrub typhus is an acute febrile illness which has been reported from various parts of India with Rajasthan recently joining the list of affected states. To report a series of paediatric scrub typhus cases from rural Rajasthan. Retrospective review of children with scrub typhus admitted to the wards and paediatric intensive care unit (PICU) of a tertiary-care hospital. The study was undertaken over an 8-month period from May to December 2013. All patients with a clinical presentation and/or serological confirmation of scrub typhus who tested negative for malaria, enteric fever, dengue, leptospirosis and urinary tract infection (UTI) were included. A range of investigations were undertaken including IgM-ELISA for scrub typhus, followed by appropriate medical management. Thirty patients satisfied the inclusion criteria. The mean (SD, range) age of the patients was 8·56 (3·43, 3-16) years. The most common clinical features were fever (n = 30, 100%), headache (n = 20, 66%), myalgia (n = 15, 50%), hepatosplenomegaly (n = 18, 60%) and pallor (n = 5, 16%). Typical features such as eschar and rash were observed in only one (3·3%) and three (10%) patients, respectively; none had generalised lymphadenopathy or conjunctival congestion. IgM-ELISA for scrub typhus was positive in 28 patients (93·3%) and 27 responded to doxycycline within 24-72 hours. One of the three patients who required PICU support responded to intravenous chloramphenicol and, of the other two (6·6%), one died of acute respiratory distress syndrome and the other owing to acute renal failure. A high index of suspicion is essential for early diagnosis and prevention of complications in scrub typhus together with prompt referral from rural areas to a higher centre. Awareness of the disease manifestations may further help to prevent excessive investigations in patients presenting with non-specific febrile illness and reduce the economic burden to the family and society in resource

  17. Scrub typhus caused by Orientia tsutsugamushi Kawasaki-related genotypes in Shandong Province, northern China.

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    Zhang, Luyan; Bi, Zhenwang; Kou, Zengqiang; Yang, Huili; Zhang, Aihua; Zhang, Shoufeng; Meng, Xiangpeng; Zheng, Li; Zhang, Meng; Yang, Hui; Zhao, Zhongtang

    2015-03-01

    Orientia tsutsugamushi, the causative agent of scrub typhus, is an obligate intracellular bacterium and characterized by dramatic genetic diversity. To elucidate the genotypes of O. tsutsugamushi populating in patients in Shandong Province, a new epidemic zone in China, we sequenced partial of the 56-kDa type-specific antigen gene (TSA) and identified the genotypes of 43 O. tsutsugamushi samples from human patients confirmed with scrub typhus from 2010 to 2013. All of the 43 sequences are in the same clade, 39 of them are in one branch and the other four sequences, nominated as SH1002, SH1306, SH1309, and SH1307 are in four separate branches. To clarify the clinical characterizations caused by Kawasaki-related genotypes, we studied the clinical profiles of these 43 scrub typhus patients. Most patients (88.1%) were farmers lived in rural areas. They presented with fever (100.0%), headache (79.1%), dizziness (32.6%), generalized myalgia (48.8%), fatigue (53.5%), anorexia (53.5%), facial flushing (23.3%), conjunctival congestion (11.6%), skin rashes (58.1%) and lymphadenopathy (23.3%). Eschar (97.7%) was quite common in patients, which provided doctors with a luminous clue for diagnosis of scrub typhus. Thrombocytopenia was seen in 23.1% of patients, and three patients (7.0%) had bronchopneumonia. There was no death report in Shandong Province during the study period. The present study provides beneficial data for clinical, serological, and molecular diagnosis of scrub typhus infections, and also provides foundations for subsequent studies. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Clinical significance of NGAL and KIM-1 for acute kidney injury in patients with scrub typhus.

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    In O Sun

    Full Text Available The aim of this study is to investigate the clinical significance of neutrophil gelatinase-associated lipocalin (NGAL and kidney injury molecule-1 (KIM-1 for acute kidney injury (AKI in patients with scrub typhus.From 2014 to 2015, 145 patients were diagnosed with scrub typhus. Of these, we enrolled 138 patients who were followed up until renal recovery or for at least 3 months. We measured serum and urine NGAL and KIM-1 levels and evaluated prognostic factors affecting scrub typhus-associated AKI.Of the 138 patients, 25 had scrub typhus-associated AKI. The incidence of AKI was 18.1%; of which 11.6%, 4.3%, and 2.2% were classified as risk, injury, and failure, respectively, according to RIFLE criteria. Compared with patients in the non-AKI group, patients in the AKI group were older and showed higher total leukocyte counts and hypoalbuminemia or one or more comorbidities such as hypertension (72% vs 33%, p<0.01, diabetes (40% vs 14%, p<0.01, or chronic kidney disease (32% vs 1%, p<0.01. In addition, serum NGAL values (404± 269 vs 116± 78 ng/mL, P<0.001, KIM-1 values (0.80± 0.52 vs 0.33± 0.68 ng/mL, P<0.001, urine NGAL/creatinine values (371± 672 vs 27± 39 ng/mg, P<0.001 and urine KIM-1/creatinine values (4.04± 2.43 vs 2.38± 1.89 ng/mg, P<0.001 were higher in the AKI group than in the non-AKI group. By multivariate logistic regression, serum NGAL and the presence of chronic kidney disease were significant predictors of AKI.Serum NGAL might be an additive predictor for scrub typhus-associated AKI.

  19. Surveillance of potential hosts and vectors of scrub typhus in Taiwan.

    Science.gov (United States)

    Kuo, Chi-Chien; Lee, Pei-Lung; Chen, Chun-Hsung; Wang, Hsi-Chieh

    2015-12-01

    Scrub typhus is a lethal infectious disease vectored by larval trombiculid mites (i.e. chiggers) infected with Orientia tsutsugamushi (OT) and recent decades have witnessed an emergence of scrub typhus in several countries. Identification of chigger species and their vertebrate hosts is fundamental for the assessment of human risks to scrub typhus under environmental changes, but intensive and extensive survey of chiggers and their hosts is still lacking in Taiwan. Chiggers were collected from shrews and rodents in nine counties of Taiwan and were assayed for OT infections with nested polymerase chain reaction (PCR). PCR products were further sequenced to reveal probable OT strains. Rodents were assessed for OT exposure by immunofluorescent antibody assay. Lastly, incidence rate of scrub typhus in each county was associated with loads and prevalence of chigger infestations, seropositivity rate in rodents, and OT positivity rate in chiggers. Rattus losea was the most abundant (48.7% of 1,285 individuals) and widespread (occurred in nine counties) small mammal species and hosted the majority of chiggers (76.4% of 128,520 chiggers). Leptotrombidium deliense was the most common (64.9% of all identified chiggers) and widespread (occurred in seven counties) chigger species but was replaced by Leptotrombidium pallidum or Leptotrombidium scutellare during the cold seasons in two counties (Matsu and Kinmen) where winter temperatures were lower than other study sites. Seropositivity rate for OT exposure in 876 assayed rodents was 43.0% and OT positivity rate in 347 pools of chiggers was 55.9%, with 15 OT strains identified in the 107 successfully sequenced samples. Incidence rate of scrub typhus was positively correlated with chigger loads, prevalence of chigger infestations, seropositivity rate but not OT positivity rate in chiggers. Our study reveals R. losea as the primary host for chiggers and there exists a geographical and seasonal variation in chigger species in

  20. Increased level and interferon-γ production of circulating natural killer cells in patients with scrub typhus.

    Science.gov (United States)

    Kang, Seung-Ji; Jin, Hye-Mi; Cho, Young-Nan; Kim, Seong Eun; Kim, Uh Jin; Park, Kyung-Hwa; Jang, Hee-Chang; Jung, Sook-In; Kee, Seung-Jung; Park, Yong-Wook

    2017-07-01

    Natural killer (NK) cells are essential immune cells against several pathogens. Not much is known regarding the roll of NK cells in Orientia tsutsugamushi infection. Thus, this study aims to determine the level, function, and clinical relevance of NK cells in patients with scrub typhus. This study enrolled fifty-six scrub typhus patients and 56 health controls (HCs). The patients were divided into subgroups according to their disease severity. A flow cytometry measured NK cell level and function in peripheral blood. Circulating NK cell levels and CD69 expressions were significantly increased in scrub typhus patients. Increased NK cell levels reflected disease severity. In scrub typhus patients, tests showed their NK cells produced higher amounts of interferon (IFN)-γ after stimulation with interleukin (IL)-12 and IL-18 relative to those of HCs. Meanwhile, between scrub typhus patients and HCs, the cytotoxicity and degranulation of NK cells against K562 were comparable. CD69 expressions were recovered to the normal levels in the remission phase. This study shows that circulating NK cells are activated and numerically increased, and they produced more IFN-γ in scrub typhus patients.

  1. Increased level and interferon-γ production of circulating natural killer cells in patients with scrub typhus.

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    Seung-Ji Kang

    2017-07-01

    Full Text Available Natural killer (NK cells are essential immune cells against several pathogens. Not much is known regarding the roll of NK cells in Orientia tsutsugamushi infection. Thus, this study aims to determine the level, function, and clinical relevance of NK cells in patients with scrub typhus.This study enrolled fifty-six scrub typhus patients and 56 health controls (HCs. The patients were divided into subgroups according to their disease severity. A flow cytometry measured NK cell level and function in peripheral blood. Circulating NK cell levels and CD69 expressions were significantly increased in scrub typhus patients. Increased NK cell levels reflected disease severity. In scrub typhus patients, tests showed their NK cells produced higher amounts of interferon (IFN-γ after stimulation with interleukin (IL-12 and IL-18 relative to those of HCs. Meanwhile, between scrub typhus patients and HCs, the cytotoxicity and degranulation of NK cells against K562 were comparable. CD69 expressions were recovered to the normal levels in the remission phase.This study shows that circulating NK cells are activated and numerically increased, and they produced more IFN-γ in scrub typhus patients.

  2. Etiologies of Acute Undifferentiated Fever and Clinical Prediction of Scrub Typhus in a Non-Tropical Endemic Area

    Science.gov (United States)

    Jung, Ho-Chul; Chon, Sung-Bin; Oh, Won Sup; Lee, Dong-Hyun; Lee, Ho-Jin

    2015-01-01

    Scrub typhus usually presents as acute undifferentiated fever. This cross-sectional study included adult patients presenting with acute undifferentiated fever defined as any febrile illness for ≤ 14 days without evidence of localized infection. Scrub typhus cases were defined by an antibody titer of a ≥ fourfold increase in paired sera, a ≥ 1:160 in a single serum using indirect immunofluorescence assay, or a positive result of the immunochromatographic test. Multiple regression analysis identified predictors associated with scrub typhus to develop a prediction rule. Of 250 cases with known etiology of acute undifferentiated fever, influenza (28.0%), hepatitis A (25.2%), and scrub typhus (16.4%) were major causes. A prediction rule for identifying suspected cases of scrub typhus consisted of age ≥ 65 years (two points), recent fieldwork/outdoor activities (one point), onset of illness during an outbreak period (two points), myalgia (one point), and eschar (two points). The c statistic was 0.977 (95% confidence interval = 0.960–0.994). At a cutoff value ≥ 4, the sensitivity and specificity were 92.7% (79.0–98.1%) and 90.9% (86.0–94.3%), respectively. Scrub typhus, the third leading cause of acute undifferentiated fever in our region, can be identified early using the prediction rule. PMID:25448236

  3. Outbreak of scrub typhus in the North East Himalayan region-Sikkim: An emerging threat

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    S Gurung

    2013-01-01

    Full Text Available Scrub typhus is an acute febrile illness that is known to be endemic in the South East Asian countries and the Western Pacific region. We here report an outbreak in the tiny Himalayan state of Sikkim. Patients with pyrexia of unknown origin were evaluated. They were screened by Weil-Felix test and the rapid immunochromatographic method. Samples that were positive by either Weil-Felix agglutination test or by rapid immunochromatography were confirmed by IgM enzyme-linked immunosorbent assay (ELISA. A total 204 samples were screened. Sixty-three patients were confirmed positive among which 42 were male and 21 were female. Effective management and early administration of antibiotics will help prevent the complications and mortality associated with scrub typhus.

  4. Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus.

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    Hur, Jian

    2015-06-01

    When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus probably induced sufficient stress to reactivate the varicella zoster virus. Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction. It is important that a diagnosis of herpes zoster be considered, especially in patients with sudden onset urinary retention.

  5. An Intradermal Inoculation Mouse Model for Immunological Investigations of Acute Scrub Typhus and Persistent Infection.

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    Lynn Soong

    2016-08-01

    Full Text Available Scrub typhus is a neglected tropical disease, caused by Orientia tsutsugamushi, a Gram-negative bacterium that is transmitted to mammalian hosts during feeding by Leptotrombidium mites and replicates predominantly within endothelial cells. Most studies of scrub typhus in animal models have utilized either intraperitoneal or intravenous inoculation; however, there is limited information on infection by the natural route in murine model skin or its related early host responses. Here, we developed an intradermal (i.d. inoculation model of scrub typhus and focused on the kinetics of the host responses in the blood and major infected organs. Following ear inoculation with 6 x 104 O. tsutsugamushi, mice developed fever at 11-12 days post-infection (dpi, followed by marked hypothermia and body weight loss at 14-19 dpi. Bacteria in blood and tissues and histopathological changes were detected around 9 dpi and peaked around 14 dpi. Serum cytokine analyses revealed a mixed Th1/Th2 response, with marked elevations of MCP-1/CCL2, MIP-1α/CCL3 and IL-10 at 9 dpi, followed by increased concentrations of pro-inflammatory markers (IL-6, IL-12, IFN-γ, G-CSF, RANTES/CCL5, KC/CCL11, IL-1α/β, IL-2, TNF-α, GM-CSF, as well as modulatory cytokines (IL-9, IL-13. Cytokine levels in lungs had similar elevation patterns, except for a marked reduction of IL-9. The Orientia 47-kDa gene and infectious bacteria were detected in several organs for up to 84 dpi, indicating persistent infection. This is the first comprehensive report of acute scrub typhus and persistent infection in i.d.-inoculated C57BL/6 mice. This is a significant improvement over current murine models for Orientia infection and will permit detailed studies of host immune responses and infection control interventions.

  6. Determination of cutoff of ELISA and immunofluorescence assay for scrub typhus

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    Nitin Gupta

    2016-01-01

    Full Text Available Background: The most common method employed for diagnosis of scrub typhus is serology. It is widely known that demonstration of ≥4-fold rise in titers of antibody in paired sera is required for diagnosis. However, for guidance of initial treatment, there is a need for rapid diagnosis at the time of admission. Therefore, there is a need for standardized region specific cutoff titers at the time of admission. Materials and Methods: A total of 258 patients of all age groups with clinically suspected scrub typhus over a period of 24 months (October 2013-October 2015 were enrolled. Serum samples of these patients were subjected to immunofluorescent antibody (IFA for immunoglobulin M (IgM (Fuller Labs, USA with dilutions of 1:64, 1:128, 1:256, and 1:512. Serum samples of all 258 patients were subjected to IgM ELISA (Inbios Inc., USA. Any patient with response to antibiotics within 48 h accompanied by either presence of an eschar or positivity by polymerase chain reaction was taken as positive. Receiver operating characteristic (ROC curve was drawn to generate cutoff for these tests. Results: A total of 20 patients were diagnosed as cases of scrub typhus. The ROC curve analysis revealed a cutoff optical density value of 0.87 with sensitivity and specificity of 100% and 94.12%, respectively. ROC curve analysis of IFA revealed sensitivity and specificity of 100% and 93.5%, respectively at 1:64 dilution. Conclusion: Considering cost constraints, centers in and around New Delhi region can use the cutoffs we determined for the diagnosis of scrub typhus.

  7. Clinical profile and improving mortality trend of scrub typhus in South India.

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    Varghese, George M; Trowbridge, Paul; Janardhanan, Jeshina; Thomas, Kurien; Peter, John V; Mathews, Prasad; Abraham, Ooriapadickal C; Kavitha, M L

    2014-06-01

    Scrub typhus, a bacterial zoonosis caused by Orientia tsutsugamushi, may cause multiorgan dysfunction syndrome (MODS) and is associated with significant mortality. This study was undertaken to document the clinical and laboratory manifestations and complications and to study time trends and factors associated with mortality in patients with scrub typhus infection. This retrospective study, done at a university teaching hospital, included 623 patients admitted between 2005 and 2010 with scrub typhus. The diagnosis was established by a positive IgM ELISA and/or pathognomonic eschar with PCR confirmation where feasible. The clinical and laboratory profile, course in hospital, and outcome were documented. Factors associated with mortality were analyzed using multivariate logistic regression analysis. The most common presenting symptoms were fever (100%), nausea/vomiting (54%), shortness of breath (49%), headache (46%), cough (38%), and altered sensorium (26%). An eschar was present in 43.5% of patients. Common laboratory findings included elevated transaminases (87%), thrombocytopenia (79%), and leukocytosis (46%). MODS was seen in 34% of patients. The overall case-fatality rate was 9.0%. Features of acute lung injury were observed in 33.7%, and 29.5% required ventilatory support. On multivariate analysis, shock requiring vasoactive agents (relative risk (RR) 10.5, 95% confidence interval (CI) 4.2-25.7, p<0.001), central nervous system (CNS) dysfunction (RR 5.1, 95% CI 2.4-10.7, p<0.001), and renal failure (RR 3.6, 95% CI 1.7-7.5, p=0.001) were independent predictors of mortality. Over 4 years, a decreasing trend was observed in the mortality rate. Scrub typhus can manifest with potentially life-threatening complications such as lung injury, shock, and meningoencephalitis. MODS occurred in a third of our patients. The overall case-fatality rate was 9%, with shock, renal failure, and CNS associated with a higher mortality. Copyright © 2014 The Authors. Published by

  8. Differences in agricultural activities related to incidence of scrub typhus between Korea and Japan

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    Chang-Jin Ma

    2017-11-01

    Full Text Available OBJECTIVES The purpose of this study was to establish a basis for improving or strengthening the preventive strategy against scrub typhus in Korea by comparing and analyzing the difference of prevention behaviors contributing to the occurrence of scrub typhus in Japan and Korea. METHODS The survey was carried out in Jeollabuk-do, which is a high risk and high incidence area, and Fukuoka Prefecture, which is a high risk and low incidence area. The study included 406 Korean farmers and 216 Japanese farmers. Data were collected through face-to-face surveys by interviewers who had completed standardized education. RESULTS Korean farmers have a higher percentage of agricultural working posture that involved contact with weeds than Japanese farmers (p<0.05. The frequency and proportion of weeding were lower in Korean farmers than in Japanese farmers (p<0.05. The level of knowledge about scrub typhus was significantly higher among Korean farmers than among Japanese farmers (p<0.05. Mostly, the behavior of agriculture work was more appropriate for Japanese farmers than for Korean farmers (p<0.05. The total average level of agricultural work was lower in Korea than in Japan, lower in men than women, and lower in part-time farmers than full-time farmers (p<0.05. CONCLUSIONS This study suggests that it is reasonable to develop and provide a program that can improve the level of preventive behavior taking into consideration the characteristics of the subject in order to reduce the incidence of diseases in high-risk areas for scrub typhus.

  9. Prevalence of scrub typhus in pyrexia of unknown origin and assessment of interleukin-8, tumor necrosis factor-alpha, and interferon-gamma levels in scrub typhus-positive patients.

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    Rizvi, Meher; Sultan, Asfia; Chowdhry, Madhav; Azam, Mohd; Khan, Fatima; Shukla, Indu; Khan, Haris M

    2018-01-01

    Scrub typhus is lesser known cause of fever of unknown origin in India. Even if there have been reports documenting the prevalence of scrub typhus in different parts of India, it is still an unknown entity, and clinicians usually do not consider it as differential diagnosis. The present study was performed to document the prevalence of scrub typhus among febrile patients in western part of Uttar Pradesh and to assess the clinical profile of infected patients on the one hand and knowledge, attitude, and practices among clinicians on the other. A total of 357 adult patients with fever of more than 5-day duration were recruited. All patients underwent complete physical examination, and detailed clinical history was elicited as per predesigned pro forma. After primary screening to rule out malaria, enteric fever, and leptospirosis infection, secondary screening for scrub typhus was done by rapid screen test and IgM ELISA. Scrub typhus infection was positive in 91 (25.5%) cases. The most common symptoms among the patients were fever (100%), pain in abdomen (79.1%), pedal edema 56 (61.5%), rash 44 (48.3%), headache 44 (48.3%), vomiting 42 (46.1%), constipation 33 (36.2%), cough 28 (30.7%), and lymphadenopathy 20 (21.9%). The median values of interleukin-8, interferon-gamma, and tumor necrosis factor-alpha in healthy controls were 15.54 pg/ml, 7.77 pg/ml, and 54.1 pg/ml, respectively, while the median values of these cytokines in scrub typhus-positive patients were 21.04 pg/ml, 8.74 pg/ml, and 73.8 pg/ml, respectively. Our results highlight that scrub typhus infection is an important cause of pyrexia of unknown origin, and active surveillance is necessary to assess the exact magnitude and distribution of the disease.

  10. Clinical Predictors of Multiple Organ Dysfunction Syndromes in Pediatric patients with Scrub Typhus.

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    Zhao, Dongying; Zhang, Yongjun; Yin, Zhaoqing; Zhao, Jing; Yang, Defeng; Zhou, Qun

    2017-06-01

    Scrub typhus can produce multiple organ dysfunction syndrome (MODS). Early recognition of the patients at risk of MODS would be helpful in providing timely management and reducing the mortality. In all, 449 children with scrub typhus were enrolled at three hospitals in Yunnan, China from January 2010 to January 2015. The patients' clinical status of organ system dysfunction was evaluated on the day of discharge from hospital by using standard criteria. The patients were classified into MODS present (64 cases, 14.3%) or MODS absent (385 cases, 85.7%). Multivariate logistic regression analyses revealed that the prognostic factors for MODS included skin rash (odds ratio, OR = 3.3, p = 0.037), time interval form treatment to defervescence (OR = 1.2, p = 0.035), hemoglobin (OR = 0.54, p = 0.041), platelet counts (OR = 0.06, p scrub typhus, our study provides clinicians with important information to improve the clinical monitoring and prognostication of MODS. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Scrub Typhus in Northeastern Thailand: Eschar Distribution, Abnormal Electrocardiographic Findings, and Predictors of Fatal Outcome.

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    Thipmontree, Wilawan; Tantibhedhyangkul, Wiwit; Silpasakorn, Saowaluk; Wongsawat, Ekkarat; Waywa, Duangdao; Suputtamongkol, Yupin

    2016-10-05

    Scrub typhus is endemic in Thailand. Of the 495 patients with acute undifferentiated fever studied in Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, from June 1, 2011, to December 31, 2012, 146 patients (29.5%) had confirmed scrub typhus. The majority of cases were male, farmers, with the mean (±standard deviation) age of 54.1 ± 15.2 years. A total of 59 patients (40.4%) had eschar lesion. The commonest sites for an eschar in male patients were the perineum, inguinal, and buttock area; whereas in females, it was the head and neck area. Abnormal electrocardiogram was found in 39 of 79 patients (49.4%) with sinus tachycardia being the most frequent finding (17, 21.5%). A total of 73 patients (50%) had at least one complication. Myocarditis was the cause of complete heart block in a scrub typhus patient, and he fully recovered after receiving intravenous chloramphenicol treatment. The case fatality rate was 6.2% (nine deaths).The independent predictors for fatal outcome were age over 65 years (odds ratio [OR] = 14.49, 95% confidence interval [CI] = 1.26-166.44, P = 0.03), acute kidney injury (OR = 12.75, 95% CI = 1.77-92.07, P = 0.01), and hyperbilirubinemia (OR = 24.82, 95% CI = 2.12-286.61, P = 0.01). Early diagnosis and prompt appropriate treatment can improve the patient's outcome. © The American Society of Tropical Medicine and Hygiene.

  12. Scrub Typhus: A Clinico-Laboratory Differentiation of Children with and without Meningitis.

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    Bhat, Nowneet Kumar; Pandita, Neerul; Saini, Manju; Dhar, Minakshi; Ahmed, Sohaib; Shirazi, Nadia; Wasim, Sanober; Shirke, Rupali; Chandar, Vipan

    2016-06-01

    Neurological involvement in the form of meningitis or meningoencephalitis, although well documented in scrub typhus, has not been extensively studied in the pediatric population. We report the clinical and laboratory profile of 96 children with scrub typhus and compared those with and without meningitis. Twenty seven (28%) children had clinical and laboratory evidence of meningitis. The most frequent presenting features were fever (100%), meningeal signs (66.6%), nausea and vomiting (56.3%), seizures (55.5%) and altered sensorium (51.8%). The children with meningitis presented early and had significantly lower respiratory and renal impairments when compared with the non-meningitis group. Cerebrospinal fluid (CSF) analysis revealed elevated total leukocyte count (86.73 ± 94.50 cells/mm(3)), mononuclear pleocytosis (lymphocyte percentage of 76.85 ± 15.86), elevated proteins (108.33 ± 52.63 mg%) and normal CSF glucose (64.18 ± 15.92 mg%). We conclude that meningitis is a common and early complication of childhood scrub typhus. The CSF reveals a lymphocytic pleocytosis, raised proteins and a normal glucose level. These children respond promptly to appropriate antibiotics as do children without meningitis. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. A case-control study of risk factors associated with scrub typhus infection in Beijing, China.

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    Yanning Lyu

    Full Text Available To investigate the risk factors of scrub typhus infection in Beijing, China, a case-control study was carried out. Cases (n = 56 were defined as persons who were diagnosed by PCR and serological method within three years. Three neighborhood control subjects were selected by matching for age and occupation. Living at the edge of the village, living in the houses near grassland, vegetable field or ditch, house yard without cement floor, piling weeds in the house or yard, all of these were risk factors for scrub typhus infection. Working in vegetable fields and hilly areas, and harvesting in autumn posed the highest risks, with odds ratios (ORs and 95% confidence intervals (CIs of 3.7 (1.1-11.9, 8.2 (1.4-49.5, and 17.2 (5.1-57.9, respectively. These results would be useful for the establishment of a detail control strategy for scrub typhus infection in Beijing, China.

  14. Clinical significance of hypoalbuminemia in outcome of patients with scrub typhus

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    Kwon Keun-Sang

    2010-07-01

    Full Text Available Abstract Background This study was designed to investigate the clinical significance of hypoalbuminemia as a marker of severity and mortality in patients with Scrub typhus. Methods The patients with scrub typhus were divided into two groups based on the serum albumin levels; Group I (serum albumin Results Of the total 246 patients who underwent the study, 84 patients (34.1% were categorized as Group I and 162 patients were (65.9% as Group II. Group I showed significantly higher incidence of confusion (24.6% vs. 5.3%, p p = 0.002, pleural effusion (22.8% vs. 11.1%, p = 0.03, arrhythmia (12.3% vs. 2.6%, p = 0.008 and non-oliguric acute renal failure (40.4% vs. 11.1%, p p p = 0.012, and higher hospital cost compared to Group II. Conclusions This study showed hypoalbuminemia in scrub typhus was closely related to the frequency of various complication, longer hospital stay, consequently the higher medical cost, necessitating more efficient management of patients, including medical resources.

  15. A Review of Scrub Typhus (Orientia tsutsugamushi and Related Organisms: Then, Now, and Tomorrow

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    Alison Luce-Fedrow

    2018-01-01

    Full Text Available Scrub typhus and the rickettsial diseases represent some of the oldest recognized vector-transmitted diseases, fraught with a rich historical aspect, particularly as applied to military/wartime situations. The vectors of Orientia tsutsugamushi were once thought to be confined to an area designated as the Tsutsugamushi Triangle. However, recent reports of scrub typhus caused by Orientia species other than O. tsutsugamushi well beyond the limits of the Tsutsugamushi Triangle have triggered concerns about the worldwide presence of scrub typhus. It is not known whether the vectors of O. tsutsugamushi will be the same for the new Orientia species, and this should be a consideration during outbreak/surveillance investigations. Additionally, concerns surrounding the antibiotic resistance of O. tsutsugamushi have led to considerations for the amendment of treatment protocols, and the need for enhanced public health awareness in both the civilian and medical professional communities. In this review, we discuss the history, outbreaks, antibiotic resistance, and burgeoning genomic advances associated with one of the world’s oldest recognized vector-borne pathogens, O. tsutsugamushi.

  16. Increased endothelial and macrophage markers are associated with disease severity and mortality in scrub typhus.

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    Otterdal, Kari; Janardhanan, Jeshina; Astrup, Elisabeth; Ueland, Thor; Prakash, John A J; Lekva, Tove; Abraham, O C; Thomas, Kurien; Damås, Jan Kristian; Mathews, Prasad; Mathai, Dilip; Aukrust, Pål; Varghese, George M

    2014-11-01

    Scrub typhus is endemic in the Asia-Pacific region. Mortality is high even with treatment, and further knowledge of the immune response during this infection is needed. This study was aimed at comparing plasma levels of monocyte/macrophage and endothelial related inflammatory markers in patients and controls in South India and to explore a possible correlation to disease severity and clinical outcome. Plasma levels of ALCAM, VCAM-1, sCD163, sCD14, YKL-40 and MIF were measured in scrub typhus patients (n = 129), healthy controls (n = 31) and in infectious disease controls (n = 31), both in the acute phase and after recovery, by enzyme immunoassays. Patients had markedly elevated levels of all mediators in the acute phase, differing from both healthy and infectious disease controls. During follow-up levels of ALCAM, VCAM-1, sCD14 and YKL-40 remained elevated compared to levels in healthy controls. High plasma ALCAM, VCAM-1, sCD163, sCD14, and MIF, and in particular YKL-40 were all associated with disease severity and ALCAM, sCD163, MIF and especially YKL-40, were associated with mortality. Our findings show that scrub typhus is characterized by elevated levels of monocyte/macrophage and endothelial related markers. These inflammatory markers, and in particular YKL-40, may contribute to disease severity and clinical outcome. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  17. Chest radiographic findings of scrub typhus: an analysis of 160 cases occurred in Ulsan area

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    Kim, Ok Hwa; Oh, Dong Heon; Kim, Ki Sung; Woo, Je Ho; Kwon, Jung Hyeok [Dong Kang General Hospital, Ulsan (Korea, Republic of)

    1993-03-15

    Scrub typhus (Tsutsugamushi disease) is an acute febrile systemic illness caused by Rickettsia Tsutsugamushi that is transmitted to humans by the bite of larval-stage trombiculid mites (chiggers). The authors analyzed chest radiographic findings of scrub typhus in 160 patients in Ulsan area. One hundred and eight (67.5%) of 160 patients showed abnormal findings which included lung lesions in 108 patients (67.5%), cardiomegaly in 37 patients (23.1%), lymphadenopathy in 25 patients (15.6%) and pleural effusion in 11 patients (6.9%). Among the lung lesions, interstitial patterns were seen in 107 patients (66.9%), mostly fine or medium reticulonodular, and air-space patterns in 14 patients (8.8%) and combined interstitial and air-space patterns in 13 patients (8.1%). Sixty-four patients (40%) had combined chest radiographic findings. The typical chest radiographic findings of scrub typhus would be helpful in evaluation of the causes of acute febrile illness that occur during late fall in the endemic area.

  18. Chest radiographic findings of scrub typhus: an analysis of 160 cases occurred in Ulsan area

    International Nuclear Information System (INIS)

    Kim, Ok Hwa; Oh, Dong Heon; Kim, Ki Sung; Woo, Je Ho; Kwon, Jung Hyeok

    1993-01-01

    Scrub typhus (Tsutsugamushi disease) is an acute febrile systemic illness caused by Rickettsia Tsutsugamushi that is transmitted to humans by the bite of larval-stage trombiculid mites (chiggers). The authors analyzed chest radiographic findings of scrub typhus in 160 patients in Ulsan area. One hundred and eight (67.5%) of 160 patients showed abnormal findings which included lung lesions in 108 patients (67.5%), cardiomegaly in 37 patients (23.1%), lymphadenopathy in 25 patients (15.6%) and pleural effusion in 11 patients (6.9%). Among the lung lesions, interstitial patterns were seen in 107 patients (66.9%), mostly fine or medium reticulonodular, and air-space patterns in 14 patients (8.8%) and combined interstitial and air-space patterns in 13 patients (8.1%). Sixty-four patients (40%) had combined chest radiographic findings. The typical chest radiographic findings of scrub typhus would be helpful in evaluation of the causes of acute febrile illness that occur during late fall in the endemic area

  19. Differences in agricultural activities related to incidence of scrub typhus between Korea and Japan.

    Science.gov (United States)

    Ma, Chang-Jin; Oh, Gyung-Jae; Kang, Gong-Unn; Lee, Jeong Mi; Lee, Da-Un; Nam, Hae-Sung; Ryu, So Yeon; Lee, Young-Hoon

    2017-01-01

    The purpose of this study was to establish a basis for improving or strengthening the preventive strategy against scrub typhus in Korea by comparing and analyzing the difference of prevention behaviors contributing to the occurrence of scrub typhus in Japan and Korea. The survey was carried out in Jeollabuk-do, which is a high risk and high incidence area, and Fukuoka Prefecture, which is a high risk and low incidence area. The study included 406 Korean farmers and 216 Japanese farmers. Data were collected through face-to-face surveys by interviewers who had completed standardized education. Korean farmers have a higher percentage of agricultural working posture that involved contact with weeds than Japanese farmers (pwork was more appropriate for Japanese farmers than for Korean farmers (pwork was lower in Korea than in Japan, lower in men than women, and lower in part-time farmers than full-time farmers (p<0.05). This study suggests that it is reasonable to develop and provide a program that can improve the level of preventive behavior taking into consideration the characteristics of the subject in order to reduce the incidence of diseases in high-risk areas for scrub typhus.

  20. Cytokine Network in Scrub Typhus: High Levels of Interleukin-8 Are Associated with Disease Severity and Mortality

    Science.gov (United States)

    Astrup, Elisabeth; Janardhanan, Jeshina; Otterdal, Kari; Ueland, Thor; Prakash, John A. J.; Lekva, Tove; Strand, Øystein A.; Abraham, O. C.; Thomas, Kurien; Damås, Jan Kristian; Mathews, Prasad; Mathai, Dilip; Aukrust, Pål; Varghese, George M.

    2014-01-01

    Background Scrub typhus, caused by Orientia tsutsugamushi, is endemic in the Asia-Pacific region. Mortality is high if untreated, and even with treatment as high as 10–20%, further knowledge of the immune response during scrub typhus is needed. The current study was aimed at comparing plasma levels of a variety of inflammatory mediators in scrub typhus patients and controls in South India in order to map the broader cytokine profile and their relation to disease severity and clinical outcome. Methodology/Principal Findings We examined plasma levels of several cytokines in scrub typhus patients (n = 129) compared to healthy controls (n = 31) and infectious disease controls (n = 31), both in the acute phase and after recovery, by multiplex technology and enzyme immunoassays. Scrub typhus patients were characterized by marked changes in the cytokine network during the acute phase, differing not only from healthy controls but also from infectious disease controls. While most of the inflammatory markers were raised in scrub typhus, platelet-derived mediators such as RANTES were markedly decreased, probably reflecting enhanced platelet activation. Some of the inflammatory markers, including various chemokines (e.g., interleukin-8, monocyte chemoattractant peptide-1 and macrophage inflammatory protein-1β) and downstream markers of inflammation (e.g., C-reactive protein and pentraxin-3), were also associated with disease severity and mortality during follow-up, with a particular strong association with interleukin-8. Conclusions/Significance Our findings suggest that scrub typhus is characterized by a certain cytokine profile that includes dysregulated levels of a wide range of mediators, and that this enhanced inflammation could contribute to disease severity and clinical outcome. PMID:24516677

  1. Cytokine network in scrub typhus: high levels of interleukin-8 are associated with disease severity and mortality.

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    Elisabeth Astrup

    2014-02-01

    Full Text Available BACKGROUND: Scrub typhus, caused by Orientia tsutsugamushi, is endemic in the Asia-Pacific region. Mortality is high if untreated, and even with treatment as high as 10-20%, further knowledge of the immune response during scrub typhus is needed. The current study was aimed at comparing plasma levels of a variety of inflammatory mediators in scrub typhus patients and controls in South India in order to map the broader cytokine profile and their relation to disease severity and clinical outcome. METHODOLOGY/PRINCIPAL FINDINGS: We examined plasma levels of several cytokines in scrub typhus patients (n = 129 compared to healthy controls (n = 31 and infectious disease controls (n = 31, both in the acute phase and after recovery, by multiplex technology and enzyme immunoassays. Scrub typhus patients were characterized by marked changes in the cytokine network during the acute phase, differing not only from healthy controls but also from infectious disease controls. While most of the inflammatory markers were raised in scrub typhus, platelet-derived mediators such as RANTES were markedly decreased, probably reflecting enhanced platelet activation. Some of the inflammatory markers, including various chemokines (e.g., interleukin-8, monocyte chemoattractant peptide-1 and macrophage inflammatory protein-1β and downstream markers of inflammation (e.g., C-reactive protein and pentraxin-3, were also associated with disease severity and mortality during follow-up, with a particular strong association with interleukin-8. CONCLUSIONS/SIGNIFICANCE: Our findings suggest that scrub typhus is characterized by a certain cytokine profile that includes dysregulated levels of a wide range of mediators, and that this enhanced inflammation could contribute to disease severity and clinical outcome.

  2. Cytokine network in scrub typhus: high levels of interleukin-8 are associated with disease severity and mortality.

    Science.gov (United States)

    Astrup, Elisabeth; Janardhanan, Jeshina; Otterdal, Kari; Ueland, Thor; Prakash, John A J; Lekva, Tove; Strand, Øystein A; Abraham, O C; Thomas, Kurien; Damås, Jan Kristian; Mathews, Prasad; Mathai, Dilip; Aukrust, Pål; Varghese, George M

    2014-02-01

    Scrub typhus, caused by Orientia tsutsugamushi, is endemic in the Asia-Pacific region. Mortality is high if untreated, and even with treatment as high as 10-20%, further knowledge of the immune response during scrub typhus is needed. The current study was aimed at comparing plasma levels of a variety of inflammatory mediators in scrub typhus patients and controls in South India in order to map the broader cytokine profile and their relation to disease severity and clinical outcome. We examined plasma levels of several cytokines in scrub typhus patients (n = 129) compared to healthy controls (n = 31) and infectious disease controls (n = 31), both in the acute phase and after recovery, by multiplex technology and enzyme immunoassays. Scrub typhus patients were characterized by marked changes in the cytokine network during the acute phase, differing not only from healthy controls but also from infectious disease controls. While most of the inflammatory markers were raised in scrub typhus, platelet-derived mediators such as RANTES were markedly decreased, probably reflecting enhanced platelet activation. Some of the inflammatory markers, including various chemokines (e.g., interleukin-8, monocyte chemoattractant peptide-1 and macrophage inflammatory protein-1β) and downstream markers of inflammation (e.g., C-reactive protein and pentraxin-3), were also associated with disease severity and mortality during follow-up, with a particular strong association with interleukin-8. Our findings suggest that scrub typhus is characterized by a certain cytokine profile that includes dysregulated levels of a wide range of mediators, and that this enhanced inflammation could contribute to disease severity and clinical outcome.

  3. Renal Manifestation in Scrub Typhus during a Major Outbreak in Central Nepal.

    Science.gov (United States)

    Sedhain, A; Bhattarai, G R

    2017-01-01

    Renal involvement and acute kidney injury (AKI) are common clinical manifestations seen in scrub typhus, a vector-borne tropical disease. There are no data on renal manifestation in scrub typhus in Nepal. We conducted a prospective study to analyze the incidence, urinary abnormalities, course, severity, outcome, and the predictors of AKI in patients with scrub typhus during a major outbreak in Central Nepal. Total 1398 patients admitted with acute febrile illness were subjected for Scrub Typhus Detect™ Immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) test, of which 502 (35.90%) patients tested positive and were included in the study. Mean age of the patients was 30.37 ± 18.81 years (range, 1-79 years) with 26.29% in the pediatric age group. Female-to-male ratio was 1.26:1. Mean duration of fever was 6.8 ± 3.1 days. Mean IgM ELISA value for scrub typhus was 2.17 ± 1.70 without difference in AKI and non-AKI groups (2.17 ± 1.76 vs. 2.16 ± 1.62; P = 0.94). Urinary abnormalities were seen in 42.3% of patients. Mean serum creatinine was 1.37 ± 0.69 mg/dl with significant difference in two groups (1.85 ± 0.87 vs. 1.03 ± 0.17; P = 0.003). AKI was seen in 35.8% of patients with majority having Stage 1 AKI (68.3%) followed by Stage 2 (34.1%) and Stage 3 (1.2%). Hemodialysis was required for 3.94% of patients. In 54% of patients, AKI occurred in fifth and sixth day of fever. ICU admission was required for 18.73% of patients and 8.57% required ventilator support. Mortality rate was 1.79%, which was higher among patients with AKI (2.96% vs. 1.0%; P = 0.106). Multivariate analysis revealed that the presence of pneumonia, shock, and acute respiratory distress syndrome predicted the development of AKI.

  4. Renal manifestation in scrub typhus during a major outbreak in central Nepal

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    A Sedhain

    2017-01-01

    Full Text Available Renal involvement and acute kidney injury (AKI are common clinical manifestations seen in scrub typhus, a vector-borne tropical disease. There are no data on renal manifestation in scrub typhus in Nepal. We conducted a prospective study to analyze the incidence, urinary abnormalities, course, severity, outcome, and the predictors of AKI in patients with scrub typhus during a major outbreak in Central Nepal. Total 1398 patients admitted with acute febrile illness were subjected for Scrub Typhus Detect™ Immunoglobulin M (IgM enzyme-linked immunosorbent assay (ELISA test, of which 502 (35.90% patients tested positive and were included in the study. Mean age of the patients was 30.37 ± 18.81 years (range, 1–79 years with 26.29% in the pediatric age group. Female-to-male ratio was 1.26:1. Mean duration of fever was 6.8 ± 3.1 days. Mean IgM ELISA value for scrub typhus was 2.17 ± 1.70 without difference in AKI and non-AKI groups (2.17 ± 1.76 vs. 2.16 ± 1.62; P = 0.94. Urinary abnormalities were seen in 42.3% of patients. Mean serum creatinine was 1.37 ± 0.69 mg/dl with significant difference in two groups (1.85 ± 0.87 vs. 1.03 ± 0.17; P = 0.003. AKI was seen in 35.8% of patients with majority having Stage 1 AKI (68.3% followed by Stage 2 (34.1% and Stage 3 (1.2%. Hemodialysis was required for 3.94% of patients. In 54% of patients, AKI occurred in fifth and sixth day of fever. ICU admission was required for 18.73% of patients and 8.57% required ventilator support. Mortality rate was 1.79%, which was higher among patients with AKI (2.96% vs. 1.0%; P = 0.106. Multivariate analysis revealed that the presence of pneumonia, shock, and acute respiratory distress syndrome predicted the development of AKI.

  5. Scrub typhus point-of-care testing: A systematic review and meta-analysis.

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    Kartika Saraswati

    2018-03-01

    Full Text Available Diagnosing scrub typhus clinically is difficult, hence laboratory tests play a very important role in diagnosis. As performing sophisticated laboratory tests in resource-limited settings is not feasible, accurate point-of-care testing (POCT for scrub typhus diagnosis would be invaluable for patient diagnosis and management. Here we summarise the existing evidence on the accuracy of scrub typhus POCTs to inform clinical practitioners in resource-limited settings of their diagnostic value.Studies on POCTs which can be feasibly deployed in primary health care or outpatient settings were included. Thirty-one studies were identified through PubMed and manual searches of reference lists. The quality of the studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2. About half (n = 14/31 of the included studies were of moderate quality. Meta-analysis showed the pooled sensitivity and specificity of commercially available immunochromatographic tests (ICTs were 66.0% (95% CI 0.37-0.86 and 92.0% (95% CI 0.83-0.97, respectively. There was a significant and high degree of heterogeneity between the studies (I2 value = 97.48%, 95% CI 96.71-98.24 for sensitivity and I2 value = 98.17%, 95% CI 97.67-98.67 for specificity. Significant heterogeneity was observed for total number of samples between studies (p = 0.01, study design (whether using case-control design or not, p = 0.01, blinding during index test interpretation (p = 0.02, and QUADAS-2 score (p = 0.01.There was significant heterogeneity between the scrub typhus POCT diagnostic accuracy studies examined. Overall, the commercially available scrub typhus ICTs demonstrated better performance when 'ruling in' the diagnosis. There is a need for standardised methods and reporting of diagnostic accuracy to decrease between-study heterogeneity and increase comparability among study results, as well as development of an affordable and accurate antigen-based POCT to tackle the

  6. [Spatio-temporal distribution of scrub typhus and related influencing factors in coastal beach area of Yancheng, China].

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    Chen, Y Z; Li, F; Xu, H; Huang, L C; Gu, Z G; Sun, Z Y; Yan, G J; Zhu, Y J; Tang, C

    2016-02-01

    In order to provide better programs on monitoring, early warning and prevention of Scrub Typhus in the coastal beach area, temporal-spatial distribution characteristics of scrub typhus were summarized. Relationships between temporal-spatial clustering of Scrub Typhus, meteorological factors, rodent distribution and the biological characteristics in coastal beach area of Yancheng city, were studied. Reports on network-based Scrub Typhus epidemics and information on population, weather situation through monitoring those stations, from 2005 to 2014 were collected and processed, in the coastal beach area of Yancheng city. Distribution, density of the population concerned and seasonal fluctuation on rodents were monitored in coastal beach area, from April 2011 to December, 2013. METHODS as descriptive statistics, space-time permutation scantistics, autocorrelation and Cross-correlation analysis etc, were used to analyze the temporal-spatial distribution of Scrub Typhus and correlation with rodent distribution, density fluctuation and meteorological indexes. Zero-inflated Pearson (ZIP) regression model was contributed according to the distribution of related data. All methods were calculated under Excel 2003, SPSS 16.0, Mapinfo 11.0, Satscan 9.0 and Stata/SE 10.0 softwares. (1) The incidence of Scrub Typhus was gradually increasing and the highest incidence of the year was seen in 2014, as 5.81/10 million. There was an autumn peak of Scrub typhus, with the highest incidence rate as 12.02/10 million in November. The incidence rate of Scrub typhus appeared high in Binhai, Dafeng and Xiangshui, with the average incidence rates appeared as 3.30/10 million, 3.21/10 million and 2.79/10 million, respectively. There were 12 towns with high incidence rates in the coastal beach area, with incidence rate showed between 4.41/10 and 10.03/10 million. (2) There were three incidence clusters of Scrub typhus seen in 25 towns, between October 2012 and November 2012 in Dongtai, Dafeng

  7. An outbreak investigation of scrub typhus in Western Province, Solomon Islands, 2014

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    Michael Marks

    2016-01-01

    Full Text Available Objective: To identify the etiology and risk factors of undifferentiated fever in a cluster of patients in Western Province, Solomon Islands, May 2014. Methods: An outbreak investigation with a case control study was conducted. A case was defined as an inpatient in one hospital in Western Province, Solomon Islands with high fever (> 38.5 °C and a negative malaria microscopy test admitted between 1 and 31 May 2014. Asymptomatic controls matched with the cases residentially were recruited in a ratio of 1:2. Serum samples from the subjects were tested for rickettsial infections using indirect micro-immunofluorescence assay. Results: Nine cases met the outbreak case definition. All cases were male. An eschar was noted in five cases (55%, and one developed pneumonitis. We did not identify any environmental factors associated with illness. Serum samples of all five follow-up cases (100% had strong-positive IgG responses to scrub typhus. All but one control (10% had a moderate response against scrub typhus. Four controls had low levels of antibodies against spotted fever group rickettsia, and only one had a low-level response to typhus group rickettsia. Discussion: This outbreak represents the first laboratory-confirmed outbreak of scrub typhus in the Western Province of Solomon Islands. The results suggest that rickettsial infections are more common than currently recognized as a cause of an acute febrile illness. A revised clinical case definition for rickettsial infections and treatment guidelines were developed and shared with provincial health staff for better surveillance and response to future outbreaks of a similar kind.

  8. Epidemic characteristics and spatio-temporal patterns of scrub typhus during 2006-2013 in Tai'an, Northern China.

    Science.gov (United States)

    Zheng, L; Yang, H-L; Bi, Z-W; Kou, Z-Q; Zhang, L-Y; Zhang, A-H; Yang, L; Zhao, Z-T

    2015-08-01

    Tai'an, a famous cultural tourist district, is a new endemic foci of scrub typhus in northern China. Frequent reports of travel-acquired cases and absence of effective vaccine indicated a significant health problem of scrub typhus in Tai'an. Thus, descriptive epidemiological methods and spatial-temporal scan statistics were used to describe the epidemic characteristics and detect the significant clusters of the high incidence of scrub typhus at the town level in Tai'an. Results of descriptive epidemiological analysis showed a total of 490 cases were reported in Tai'an with the annual average incidence ranging from 0·48 to 2·27/100 000 during 2006-2013. Females, the elderly and farmers are the high-risk groups. Monthly changes of scrub typhus cases indicated an obvious epidemic period in autumn. Spatial-temporal distribution analysis, showed significant clusters of high incidence mainly located in eastern and northern Tai'an. Our study suggests that more effective, targeted measures for local residents should be implemented in the eastern and northern areas of Tai'an in autumn. Meanwhile, it may prove beneficial for health policy makers to advise travellers to take preventive measures in order to minimize the risk of infection of scrub typhus in Tai'an.

  9. The Correlation of Endoscopic Findings and Clinical Features in Korean Patients with Scrub Typhus: A Cohort Study.

    Science.gov (United States)

    Lee, Jun; Kim, Dong-Min; Yun, Na Ra; Kim, Young Dae; Park, Chan Guk; Kim, Man Woo

    2016-01-01

    Scrub typhus is an infectious disease caused by Orientia tsutsugamushi-induced systemic vasculitis, but the involvement of the gastrointestinal tract and the endoscopic findings associated with scrub typhus are not well understood. We performed a prospective study and recommend performing esophagogastroduodenoscopy (EGD) for all possible scrub typhus patients, regardless of gastrointestinal symptoms. Gastrointestinal symptoms, endoscopic findings and clinical severity based on organ involvement and ICU admission were analyzed. Gastrointestinal symptoms occurred in up to 76.4% of scrub typhus patients. The major endoscopic findings were ulcers (43/127, 33.9%). Interestingly, 7.1% (9/127) of the patients presented with esophageal candidiasis. There was no correlation between the presence or absence of gastrointestinal symptoms and the endoscopic grade (P = 0.995). However, there was a positive correlation between the clinical severity and the endoscopic findings (P = 0.001). Sixty-three percent of the patients presented with erosion or ulcers on prospectively performed endoscopic evaluations, irrespective of gastrointestinal symptoms. Gastrointestinal symptoms did not reflect the need for endoscopy. Scrub typhus patients could have significant endoscopic abnormalities even in the absence of gastrointestinal symptoms.

  10. Molecular characterization of Orientia tsutsugamushi serotypes causing scrub typhus outbreak in southern region of Andhra Pradesh, India.

    Science.gov (United States)

    Usha, K; Kumar, E; Kalawat, Usha; Kumar, B Siddhartha; Chaudhury, A; Gopal, D V R Sai

    2016-10-01

    Scrub typhus is a vector-borne zoonotic infection caused by Orientiatsutsugamushi. Local epidemiology of the circulating serotypes of scrub typhus is not available from most parts of India. We conducted this study for the diagnosis of scrub typhus using IgM ELISA and to detect O. tsutsugamushi serotypes circulating in southern Andhra Pradesh, India. Samples were collected from patients clinically suspected to have scrub typhus and were subjected to IgM ELISA to measure IgM antibodies against O. tsutsugamushi. Nested polymerase chain reaction (PCR) was performed targeting strain-specific regions in ELISA-positive samples. Of a total of 663 samples, 258 (38.91%) were found to be positive by IgM ELISA. Serotypes could be detected in 230 (34.69%) samples only. Only two serotypes, Karp and Kawasaki, were found in the serum samples, with the former being predominant. The dual infection of Karp and Kawasaki serotypes was found in seven patients. Other serotypes such as Gilliam, Kuroki and Kato were not detected in the samples. The nested PCR products proved useful in presumptively identifying the endemic O. tsutsugamushi serotypes. The present study could be significant in understanding scrub typhus epidemiology in this region.

  11. Molecular epidemiology and genetic diversity of Orientia tsutsugamushi from patients with scrub typhus in 3 regions of India.

    Science.gov (United States)

    Varghese, George M; Janardhanan, Jeshina; Mahajan, Sanjay K; Tariang, David; Trowbridge, Paul; Prakash, John A J; David, Thambu; Sathendra, Sowmya; Abraham, O C

    2015-01-01

    Scrub typhus, an acute febrile illness that is widespread in the Asia-Pacific region, is caused by the bacterium Orientia tsutsugamushi, which displays high levels of antigenic variation. We conducted an investigation to identify the circulating genotypes of O. tsutsugamushi in 3 scrub typhus-endemic geographic regions of India: South India, Northern India, and Northeast India. Eschar samples collected during September 2010-August 2012 from patients with scrub typhus were subjected to 56-kDa type-specific PCR and sequencing to identify their genotypes. Kato-like strains predominated (61.5%), especially in the South and Northeast, followed by Karp-like strains (27.7%) and Gilliam and Ikeda strains (2.3% each). Neimeng-65 genotype strains were also observed in the Northeast. Clarifying the genotypic diversity of O. tsutsugamushi in India enhances knowledge of the regional diversity among circulating strains and provides potential resources for future region-specific diagnostic studies and vaccine development.

  12. Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan.

    Science.gov (United States)

    Chang, Ko; Lee, Nan-Yao; Ko, Wen-Chien; Tsai, Jih-Jin; Lin, Wei-Ru; Chen, Tun-Chieh; Lu, Po-Liang; Chen, Yen-Hsu

    2017-02-01

    Dengue fever, rickettsial diseases, and Q fever are acute febrile illnesses with similar manifestations in tropical areas. Early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever may be made by understanding the distinguishing clinical characteristics and the significance of demographic and weather factors. We conducted a retrospective study to identify clinical, demographic, and meteorological characteristics of 454 dengue fever, 178 scrub typhus, 143 Q fever, and 81 murine typhus cases in three Taiwan hospitals. Case numbers of murine typhus and Q fever correlated significantly with temperature and rainfall; the scrub typhus case number was only significantly related with temperature. Neither temperature nor rainfall correlated with the case number of dengue fever. The rarity of dengue fever cases from January to June in Taiwan may be a helpful clue for diagnosis in the area. A male predominance was observed, as the male-to-female rate was 2.1 for murine typhus and 7.4 for Q fever. Multivariate analysis revealed the following six important factors for differentiating the rickettsial diseases and Q fever group from the dengue fever group: fever ≥8 days, alanine aminotransferase > aspartate aminotransferase, platelets >63,000/mL, C-reactive protein >31.9 mg/L, absence of bone pain, and absence of a bleeding syndrome. Understanding the rarity of dengue in the first half of a year in Taiwan and the six differentiating factors may help facilitate the early differential diagnosis of rickettsial diseases and Q fever from dengue fever, permitting early antibiotic treatment. Copyright © 2015. Published by Elsevier B.V.

  13. Dissemination of Orientia tsutsugamushi and inflammatory responses in a murine model of scrub typhus.

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    Christian A Keller

    2014-08-01

    Full Text Available Central aspects in the pathogenesis of scrub typhus, an infection caused by Orientia (O. tsutsugamushi, have remained obscure. Its organ and cellular tropism are poorly understood. The purpose of this study was to analyze the kinetics of bacterial dissemination and associated inflammatory responses in infected tissues in an experimental scrub typhus mouse model, following infection with the human pathogenic strain Karp. We provide a thorough analysis of O. tsutsugamushi infection in inbred Balb/c mice using footpad inoculation, which is close to the natural way of infection. By a novel, highly sensitive qPCR targeting the multi copy traD genes, we quantitatively monitored the spread of O. tsutsugamushi Karp from the skin inoculation site via the regional lymph node to the internal target organs. The highest bacterial loads were measured in the lung. Using confocal imaging, we also detected O. tsutsugamushi at the single cell level in the lung and found a predominant macrophage rather than endothelial localization. Immunohistochemical analysis of infiltrates in lung and brain revealed differently composed lesions with specific localizations: iNOS-expressing macrophages were frequent in infiltrative parenchymal noduli, but uncommon in perivascular lesions within these organs. Quantitative analysis of the macrophage response by immunohistochemistry in liver, heart, lung and brain demonstrated an early onset of macrophage activation in the liver. Serum levels of interferon (IFN-γ were increased during the acute infection, and we showed that IFN-γ contributed to iNOS-dependent bacterial growth control. Our data show that upon inoculation to the skin, O. tsutsugamushi spreads systemically to a large number of organs and gives rise to organ-specific inflammation patterns. The findings suggest an essential role for the lung in the pathogenesis of scrub typhus. The model will allow detailed studies on host-pathogen interaction and provide further

  14. A rapid, sensitive and reliable diagnostic test for scrub typhus in China

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    Zhang Lijuan

    2011-01-01

    Full Text Available Purpose: To evaluate the performances for detection of IgM and IgG antibodies to Orientia. tsutsugamushi (Ot using a gold conjugate-based rapid diagnostic test (RDT. Materials and Methods: The RDT employing mixture recombinant 56-kDa proteins of O. tsutsugamushi and the mIFA assay was performed on 33 patients from Fujian and Yunnan province respectively and 94 positive sera (36 from Hainan province and 58 from Jiangsu province from convalescent stages of the patients with scrub typhus respectively and 82 negative sera from healthy farmers from Anhui province and Beijing City respectively in 2009. A comparison of the RDT and mIFA assay was performed by using the c2 test and the P level of ≤0.05 was considered to be significant. Results: Among these 94 positive sera from convalescent stages of the illness and 82 sera from control farmers, the specificity of RDT was 100% for both IgM and IgG tests. In 33 cases with scrub typhus, 5 cases were positively detected earlier by RDT than by mIFA for the IgM test, and 2 cases were positive for the IgG test. The sensitivities of RDT were 93.9% and 90.9% for IgM and IgG, respectively. Considering IgM and IgG together, the sensitivity was 100%. The geometric mean titre (GMT of IFA and the RDT assay in diluted sera from confirmed cases were 1:37 versus 1:113 respectively (P<0.001 for IgM test and 1:99 versus 1:279 respectively (P<0.016 for IgG. Conclusions: The RDT was more sensitive than the traditional IFA for the early diagnosis of scrub typhus and was particularly suitable for use in rural areas.

  15. Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome.

    Science.gov (United States)

    Varghese, George M; Janardhanan, Jeshina; Trowbridge, Paul; Peter, John V; Prakash, John A J; Sathyendra, Sowmya; Thomas, Kurien; David, Thambu S; Kavitha, M L; Abraham, Ooriapadickal C; Mathai, Dilip

    2013-11-01

    This study sought to document the clinical and laboratory manifestations, genetic variability, and outcomes of scrub typhus, an often severe infection caused by Orientia tsutsugamushi, in South India. Patients admitted to a large teaching hospital with IgM ELISA-confirmed scrub typhus were evaluated. Clinical examination with a thorough search for an eschar, laboratory testing, chest X-ray, and outcome were documented and analyzed. Additionally, a 410-bp region of the 56-kDa type-specific antigen gene of O. tsutsugamushi was sequenced and compared with isolates from other regions of Asia. Most of the 154 patients evaluated presented with fever and non-specific symptoms. An eschar was found in 86 (55%) patients. Mild hepatic involvement was seen in most, with other organ involvement including respiratory, cardiovascular, and renal. Multi-organ dysfunction was noted in 59 (38.3%), and the fatality rate was 7.8%. Hypotension requiring vasoactive agents was found to be an independent predictor of mortality (p<0.001). The phylogeny of 26 samples showed 17 (65%) clustering with the Kato-like group and eight (31%) with the Karp-like group. The presentation of scrub typhus can be variable, often non-specific, but with potentially severe multi-organ dysfunction. Prompt recognition is key to specific treatment and good outcomes. Further study of the circulating strains is essential for the development of a successful vaccine and sensitive point-of-care testing. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  16. Scrub typhus en Scrub itch, in het bijzonder in Nieuw Guinea

    NARCIS (Netherlands)

    Hammen, van der L.

    1956-01-01

    INHOUD Pag. I. Inleiding.................. 1 II. Historisch overzicht............... 3 III. Epidemiologie en oecologie............. 13 IV. Klinische waarnemingen, pathologie, diagnose en behandeling .... 24 V. Aetiologie.................. 27 VI. Scrub itch.................. 28 VII. Preventieve

  17. Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus

    OpenAIRE

    Hur, Jian

    2015-01-01

    When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster...

  18. Burden of Disease Measured by Disability-Adjusted Life Years and a Disease Forecasting Time Series Model of Scrub Typhus in Laiwu, China

    Science.gov (United States)

    Yang, Li-Ping; Liang, Si-Yuan; Wang, Xian-Jun; Li, Xiu-Jun; Wu, Yan-Ling; Ma, Wei

    2015-01-01

    Background Laiwu District is recognized as a hyper-endemic region for scrub typhus in Shandong Province, but the seriousness of this problem has been neglected in public health circles. Methodology/Principal Findings A disability-adjusted life years (DALYs) approach was adopted to measure the burden of scrub typhus in Laiwu, China during the period 2006 to 2012. A multiple seasonal autoregressive integrated moving average model (SARIMA) was used to identify the most suitable forecasting model for scrub typhus in Laiwu. Results showed that the disease burden of scrub typhus is increasing yearly in Laiwu, and which is higher in females than males. For both females and males, DALY rates were highest for the 60–69 age group. Of all the SARIMA models tested, the SARIMA(2,1,0)(0,1,0)12 model was the best fit for scrub typhus cases in Laiwu. Human infections occurred mainly in autumn with peaks in October. Conclusions/Significance Females, especially those of 60 to 69 years of age, were at highest risk of developing scrub typhus in Laiwu, China. The SARIMA (2,1,0)(0,1,0)12 model was the best fit forecasting model for scrub typhus in Laiwu, China. These data are useful for developing public health education and intervention programs to reduce disease. PMID:25569248

  19. Differences in the clinical presentation and the frequency of complications between elderly and non-elderly scrub typhus patients.

    Science.gov (United States)

    Jang, Mi-Ok; Kim, Ji Eun; Kim, Uh Jin; Ahn, Joon Hwan; Kang, Seung-Ji; Jang, Hee-Chang; Jung, Sook-In; Park, Kyung-Hwa

    2014-01-01

    Age can affect the clinical features and severity of infectious disorders, such as scrub typhus. We performed this study to examine differences between elderly and non-elderly scrub typhus patients, and to identify risk factors predictive of disease outcomes. This retrospective study included patients admitted to a tertiary hospital with scrub typhus between 2001 and 2011. A total of 615 patients were enrolled in this study, 328 of which were >65 years of age. Of the elderly patients, 46.0% (151/328) experienced at least one complication compared to only 23.0% (66/287) in younger patients. A linear trend was observed between age and complication rates (p=0.002). The most common complication in elderly patients was acute kidney injury (75, 22.9%). Treatment failure was reported in 10 elderly patients (3.0%) compared to one non-elderly patient (0.3%). Mental confusion and dyspnea of clinical manifestations at admission were common in elderly patients. Frequency of fever, rash, and eschar were similar in both groups. The following four factors were significantly associated with severe scrub typhus in elderly patients: (1) white blood cell (WBC) counts>10,000/mm(3) (OR=2.569, CI=1.298-5.086), (2) MDRD GFR10 points (OR=3.304, CI=1.793-60.87). Complications and mortality were more common in elderly patients, often associated with delays in diagnosis and treatment. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Differential expression of interferon-gamma and interferon-gamma-inducing cytokines in Thai patients with scrub typhus or leptospirosis

    NARCIS (Netherlands)

    Chierakul, Wirongrong; de Fost, Maaike; Suputtamongkol, Yupin; Limpaiboon, Roongreung; Dondorp, Arjen; White, Nicholas J.; van der Poll, Tom

    2004-01-01

    Interferon (IFN)-gamma plays an important role in the induction of a type 1 immune response against intracellular pathogens. We compared the plasma levels of IFN-gamma and IFN-gamma-inducing cytokines in adult Thai patients with scrub typhus, caused by the obligate intracellular bacterium Orientia

  1. Diagnostic accuracy of a loop-mediated isothermal PCR assay for detection of Orientia tsutsugamushi during acute Scrub Typhus infection.

    Science.gov (United States)

    Paris, Daniel H; Blacksell, Stuart D; Nawtaisong, Pruksa; Jenjaroen, Kemajittra; Teeraratkul, Achara; Chierakul, Wirongrong; Wuthiekanun, Vanaporn; Kantipong, Pacharee; Day, Nicholas P J

    2011-09-01

    There is an urgent need to develop rapid and accurate point-of-care (POC) technologies for acute scrub typhus diagnosis in low-resource, primary health care settings to guide clinical therapy. In this study we present the clinical evaluation of loop-mediated isothermal PCR assay (LAMP) in the context of a prospective fever study, including 161 patients from scrub typhus-endemic Chiang Rai, northern Thailand. A robust reference comparator set comprising following 'scrub typhus infection criteria' (STIC) was used: a) positive cell culture isolate and/or b) an admission IgM titer ≥1∶12,800 using the 'gold standard' indirect immunofluorescence assay (IFA) and/or c) a 4-fold rising IFA IgM titer and/or d) a positive result in at least two out of three PCR assays. Compared to the STIC criteria, all PCR assays (including LAMP) demonstrated high specificity ranging from 96-99%, with sensitivities varying from 40% to 56%, similar to the antibody based rapid test, which had a sensitivity of 47% and a specificity of 95%. The diagnostic accuracy of the LAMP assay was similar to realtime and nested conventional PCR assays, but superior to the antibody-based rapid test in the early disease course. The combination of DNA- and antibody-based detection methods increased sensitivity with minimal reduction of specificity, and expanded the timeframe of adequate diagnostic coverage throughout the acute phase of scrub typhus.

  2. Clinical characteristics of the autumn-winter type scrub typhus cases in south of Shandong province, northern China

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    Min Jing-Si

    2009-06-01

    Full Text Available Abstract Background Before 1986, scrub typhus was only found endemic in southern China. Because human infections typically occur in the summer, it is called "summer type". During the autumn-winter period of 1986, a new type of scrub typhus was identified in Shandong and northern Jiangsu province of northern China. This newly recognized scrub typhus was subsequently reported in many areas of northern China and was then called "autumn-winter type". However, clinical characteristics of associated cases have not been reported. Methods From 1995 to 2006, all suspected scrub typhus cases in five township hospitals of Feixian county, Shandong province were enrolled. Indirect immunofluorescent assay (IFA was used as confirmatory serodiagnosis test. Polymerase chain reaction (PCR connected with restriction fragment length polymorphism (RFLP and sequence analyses were used for genotyping of O. tsutsugamushi DNAs. Clinical symptoms and demography of confirmed cases were analyzed. Results A total of 480 scrub typhus cases were confirmed. The cases occurred every year exclusively between September and December with a peak occurrence in October. The case numbers were relatively higher in 1995, 1996, 1997, and 2000 than in other years. 57.9% of cases were in the group aged 21–50. More cases occurred in male (56% than in female (44%. The predominant occupational group of the cases was farmers (85.0%. Farm work was reported the primary exposure to infection in 67.7% of cases. Fever, rash, and eschar were observed in 100.0%, 90.4%, and 88.5% of cases, respectively. Eschars formed frequently on or around umbilicus, abdomen areas, and front and back of waist (34.1% in both genders. Normal results were observed in 88.7% (WBC counts, 84.5% (PLT counts, and 89.7% (RBC counts of cases, respectively. Observations from the five hospitals were compared and no significant differences were found. Conclusion The autumn-winter type scrub typhus in northern China occurred

  3. High-resolution computed tomography findings of swine-origin influenza A (H1N1) virus (S-OIV) infection: comparison with scrub typhus

    International Nuclear Information System (INIS)

    Jo, Bang Sil; Lee, In Jae; Lee, Kwanseop; Im, Hyoung June

    2012-01-01

    Background. Swine-origin influenza A (H1N1) virus (S-OIV) infection and scrub typhus, also known as tsutsugamushi disease can manifest as acute respiratory illnesses, particularly during the late fall or early winter, with similar radiographic findings, such as a predominance of ground-glass opacity (GGO). Purpose. To differentiate S-OIV infection from scrub typhus using high-resolution computed tomography (HRCT). Material and Methods. We retrospectively reviewed the HRCT findings of 14 patients with S-OIV infection and 10 patients with scrub typhus. We assessed the location, cross-sectional distribution, and the presence of a peribronchovascular distribution of GGO and consolidations on HRCT. We also assessed the presence of interlobular septal thickening, bronchial wall thickening, pneumothorax, pneumomediastinum, pleural effusion, and mediastinal or axillary lymph node enlargement. Results. Scrub typhus was more common than S-OIV in elderly patients (P < 0.001). The monthly incidences of S-OIV and scrub typhus infection reached a peak between October and November. About 86% of S-OIV patients and 80% of scrub typhus patients presented with GGO. About 67% of the GGO lesions in S-OIV had a peribronchovascular distribution, but this was absent in scrub typhus (P = 0.005). Consolidation (93% vs. 10%, P < 0.001) and bronchial wall thickening (43% vs. 0%, P = 0.024) were more frequent in S-OIV infection than scrub typhus. Interlobular septal thickening (90% vs. 36%, P = 0.013) and axillary lymphadenopathy (90% vs. 0%, P < 0.001) were more common in scrub typhus than S-OIV infection. Conclusion. There was considerable overlap in HRCT findings between S-OIV infection and scrub typhus. However, S-OIV showed a distinctive peribronchovascular distribution of GGO lesions. Consolidation and bronchial wall thickening were seen more frequently in S-OIV infection, whereas interlobular septal thickening and axillary lymphadenopathy were more common in scrub typhus. Thus, CT could

  4. High-resolution computed tomography findings of swine-origin influenza A (H1N1) virus (S-OIV) infection: comparison with scrub typhus

    Energy Technology Data Exchange (ETDEWEB)

    Jo, Bang Sil; Lee, In Jae; Lee, Kwanseop [Dept. of Radiology, Hallym Univ. College of Medicine, Seoul (Korea, Republic of)], E-mail: ijlee2003@medimail.co.kr; Im, Hyoung June [Dept. of Occupational Medicine, Hallym Univ. College of Medicine, Seoul (Korea, Republic of)

    2012-07-15

    Background. Swine-origin influenza A (H1N1) virus (S-OIV) infection and scrub typhus, also known as tsutsugamushi disease can manifest as acute respiratory illnesses, particularly during the late fall or early winter, with similar radiographic findings, such as a predominance of ground-glass opacity (GGO). Purpose. To differentiate S-OIV infection from scrub typhus using high-resolution computed tomography (HRCT). Material and Methods. We retrospectively reviewed the HRCT findings of 14 patients with S-OIV infection and 10 patients with scrub typhus. We assessed the location, cross-sectional distribution, and the presence of a peribronchovascular distribution of GGO and consolidations on HRCT. We also assessed the presence of interlobular septal thickening, bronchial wall thickening, pneumothorax, pneumomediastinum, pleural effusion, and mediastinal or axillary lymph node enlargement. Results. Scrub typhus was more common than S-OIV in elderly patients (P < 0.001). The monthly incidences of S-OIV and scrub typhus infection reached a peak between October and November. About 86% of S-OIV patients and 80% of scrub typhus patients presented with GGO. About 67% of the GGO lesions in S-OIV had a peribronchovascular distribution, but this was absent in scrub typhus (P = 0.005). Consolidation (93% vs. 10%, P < 0.001) and bronchial wall thickening (43% vs. 0%, P = 0.024) were more frequent in S-OIV infection than scrub typhus. Interlobular septal thickening (90% vs. 36%, P = 0.013) and axillary lymphadenopathy (90% vs. 0%, P < 0.001) were more common in scrub typhus than S-OIV infection. Conclusion. There was considerable overlap in HRCT findings between S-OIV infection and scrub typhus. However, S-OIV showed a distinctive peribronchovascular distribution of GGO lesions. Consolidation and bronchial wall thickening were seen more frequently in S-OIV infection, whereas interlobular septal thickening and axillary lymphadenopathy were more common in scrub typhus. Thus, CT could

  5. Immune thrombocytopenia with multi-organ dysfunction syndrome as a rare presentation of scrub typhus: a case report.

    Science.gov (United States)

    Ittyachen, Abraham M; Abraham, Saramma P; Krishnamoorthy, Smitha; Vijayan, Anuroopa; Kokkat, Jayamohan

    2017-10-06

    Scrub typhus is an acute infectious illness caused by Orientia tsutsugamushi. It is endemic to a part of the world known as the "tsutsugamushi triangle". Humans are accidental hosts in this zoonotic disease. About a third of patients admitted with scrub typhus have evidence of multi-organ dysfunction. Multi-organ dysfunction secondary to scrub typhus carries a high mortality rate. We report a 65-year old lady who was admitted in a Tertiary Care Center in the state of Kerala in India, with 7 day history of fever, myalgia and reduced urine output. Head to foot examination revealed the presence of an eschar on her chest. One week prior to the onset of her illness she had gone trekking through a hilly forest area. She was clinically suspected to have scrub typhus, which was later confirmed with laboratory tests. She developed multi-organ dysfunction syndrome secondary to this illness. Though there was an improvement in the multi-organ dysfunction, thrombocytopenia alone failed to improve. Bone marrow study was done which was suggestive of immune thrombocytopenia. Patient was given a course of steroids with which the thrombocytopenia improved. Failure of platelet count to normalize even after there has been a general improvement of other markers of multi-organ dysfunction in scrub typhus should prompt the clinician to consider other potential causes of thrombocytopenia. An unusual finding as this calls for further research to understand the molecular mechanisms behind such an event. Further, considering the close similarity in clinical presentation of several tropical illnesses, meticulous history taking and a detailed physical examination needs to be emphasized.

  6. Epidemiological, clinical and laboratory profile of scrub typhus cases detected by serology and RT-PCR in Kumaon, Uttarakhand: a hospital-based study.

    Science.gov (United States)

    Rawat, Vinita; Singh, Rajesh Kumar; Kumar, Ashok; Saxena, Sandip R; Varshney, Umesh; Kumar, Mukesh

    2018-04-01

    We analysed the epidemiology, clinical and laboratory data of the 168 scrub typhus cases confirmed by a combination of any one of the following: real time polymerase chain reaction (RT-PCR) and/or immunofluorescence assay (IFA) (IgM and/or IgG). The peak season for scrub typhus was from July to October. By multivariate binary logistic regression analysis, the risk of scrub typhus was about four times in those working in occupation related to forest work. Major clinical manifestations were fever (100%), myalgia (65%), cough (51%) and vomiting (46%); major complications were meningitis/meningoencephatilitis (12.5%) and multi-organ failure (MOF) and pneumonia (5.3% each). Laboratory investigations revealed raised aminotranferase levels and thrombocytopenia in most confirmed cases. We conclude that scrub typhus is an important cause of febrile illness in the Kumaon hills of Uttarakhand where this disease had not previously been considered to exist.

  7. Isolation and Characterization of Orientia tsutsugamushi from Rodents Captured following a Scrub Typhus Outbreak at a Military Training Base, Bothong District, Chonburi Province, Central Thailand

    OpenAIRE

    Rodkvamtook, Wuttikon; Ruang-areerate, Toon; Gaywee, Jariyanart; Richards, Allen L.; Jeamwattanalert, Pimmada; Bodhidatta, Dharadhida; Sangjun, Noppadon; Prasartvit, Anchana; Jatisatienr, Araya; Jatisatienr, Chaiwat

    2011-01-01

    Orientia tsutsugamushi, an obligate intracellular Gram-negative bacterium, is the causative agent of scrub typhus, a vector-borne disease transmitted by infected chiggers (trombiculid mite larvae). In 2002, an outbreak of scrub typhus occurred among Royal Thai Army troops during the annual field training at a military base in Bothong district, Chonburi province, central Thailand. This report describes the outbreak investigation including its transmission cycle. Results showed that 33.9% of 17...

  8. Co-infection of scrub typhus and leptospirosis in patients with pyrexia of unknown origin in Longding district of Arunachal Pradesh in 2013.

    Science.gov (United States)

    Borkakoty, Biswajyoti; Jakharia, Aniruddha; Biswas, Dipankar; Mahanta, Jagadish

    2016-01-01

    Scrub typhus and leptospirosis are bacterial zoonotic disease causing high morbidity and mortality. The seasonal outbreak of pyrexia is common in Arunachal Pradesh (AP); many times the disease remains undiagnosed. An outbreak of pyrexia of unknown origin (PUO) occurred in Longding district of Arunachal Pradesh in 2013, with 108 deaths, which was investigated to elucidate the cause of illness. Blood samples from the affected region with acute pyrexia were collected, and screened for the malaria parasite, scrub typhus IgM and leptospira IgM. Scrub typhus IgM was reactive in 97% (30/31), and 25% (8/31) cases were co-infected with leptospira. Incidentally, scrub typhus reactive (67%) and leptospira co-infection (62.7%) were higher in females. Record of previous 3 years (2011-2013) from Longding, Community Health Centre showed an increase in indoor pyrexia cases by 2-fold or more during October and November. The present study is the first report of co-infection of scrub typhus with leptospirosis from Northeast India. Medical officers in this region should take scrub typhus and leptospirosis in their differential diagnosis of patients with PUO for early diagnosis and effective treatment.

  9. Activation, Impaired Tumor Necrosis Factor-α Production, and Deficiency of Circulating Mucosal-Associated Invariant T Cells in Patients with Scrub Typhus.

    Science.gov (United States)

    Kang, Seung-Ji; Jin, Hye-Mi; Won, Eun Jeong; Cho, Young-Nan; Jung, Hyun-Ju; Kwon, Yong-Soo; Kee, Hae Jin; Ju, Jae Kyun; Kim, Jung-Chul; Kim, Uh Jin; Jang, Hee-Chang; Jung, Sook-In; Kee, Seung-Jung; Park, Yong-Wook

    2016-07-01

    Mucosal-associated invariant T (MAIT) cells contribute to protection against certain microorganism infections. However, little is known about the role of MAIT cells in Orientia tsutsugamushi infection. Hence, the aims of this study were to examine the level and function of MAIT cells in patients with scrub typhus and to evaluate the clinical relevance of MAIT cell levels. Thirty-eight patients with scrub typhus and 53 health control subjects were enrolled in the study. The patients were further divided into subgroups according to disease severity. MAIT cell level and function in the peripheral blood were measured by flow cytometry. Circulating MAIT cell levels were found to be significantly reduced in scrub typhus patients. MAIT cell deficiency reflects a variety of clinical conditions. In particular, MAT cell levels reflect disease severity. MAIT cells in scrub typhus patients displayed impaired tumor necrosis factor (TNF)-α production, which was restored during the remission phase. In addition, the impaired production of TNF-α by MAIT cells was associated with elevated CD69 expression. This study shows that circulating MAIT cells are activated, numerically deficient, and functionally impaired in TNF-α production in patients with scrub typhus. These abnormalities possibly contribute to immune system dysregulation in scrub typhus infection.

  10. Pregnancy outcome in relation to treatment of murine typhus and scrub typhus infection: a fever cohort and a case series analysis.

    Directory of Open Access Journals (Sweden)

    Rose McGready

    2014-11-01

    Full Text Available There is a paucity of published reports on pregnancy outcome following scrub and murine typhus despite these infections being leading causes of undifferentiated fever in Asia. This study aimed to relate pregnancy outcome with treatment of typhus.Data were analyzed from: i pregnant women with a diagnosis of scrub and/or murine typhus from a fever cohort studies; ii case series of published studies in PubMed using the search terms "scrub typhus" (ST, "murine typhus" (MT, "Orientia tsutsugamushi", "Rickettsia tsutsugamushi", "Rickettsia typhi", "rickettsiae", "typhus", or "rickettsiosis"; and "pregnancy", until February 2014 and iii an unpublished case series. Fever clearance time (FCT and pregnancy outcome (miscarriage and delivery were compared to treatment. Poor neonatal outcome was a composite measure for pregnancies sustained to 28 weeks or more of gestation ending in stillbirth, preterm birth, or delivery of a growth restricted or low birth weight newborn.There were 26 women in the fever cohort. MT and ST were clinically indistinguishable apart from two ST patients with eschars. FCTs (median [range] hours were 25 [16-42] for azithromycin (n=5, 34 [20-53] for antimalarials (n=5 and 92 [6-260] for other antibiotics/supportive therapy (n=16. There were 36.4% (8/22 with a poor neonatal outcome. In 18 years, 97 pregnancies were collated, 82 with known outcomes, including two maternal deaths. Proportions of miscarriage 17.3% (14/81 and poor neonatal outcomes 41.8% (28/67 were high, increasing with longer FCTs (p=0.050, linear trend. Use of azithromycin was not significantly associated with improved neonatal outcomes (p=0.610.The published ST and MT world literature amounts to less than 100 pregnancies due to under recognition and under diagnosis. Evidence supporting the most commonly used treatment, azithromycin, is weak. Collaborative, prospective clinical trials in pregnant women are urgently required to reduce the burden of adverse maternal and

  11. Serosurveillance of Scrub Typhus in Small Mammals Collected from Military Training Sites near the DMZ, Northern Gyeonggi-do, Korea, and Analysis of the Relative Abundance of Chiggers from Mammals Examined

    Science.gov (United States)

    2010-09-01

    Korean J Paras/to/. Vol. 48, No. 3: 237-243, September 2010 DOl: JO.J3471kjp.2010.48.J.237 Serosurveillance of Scrub Typhus in Small Mammals...65th Medical BrigadeAJSAMEDDAC-Korea, Unit# 15281, APO AP 96205-5281, USA Abstract: Comprehensive quarterly serosurveillance on scrub typhus in small...rarely observed (prevalence < 1 0%). In contrast to previous surveys, higher chigger indices of the primary scrub typhus vectors, L. pallidum (165.4

  12. Scrub typhus meningoencephalitis, a diagnostic challenge for clinicians: A hospital based study from North-East India

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    M D Jamil

    2015-01-01

    Full Text Available Central nervous system (CNS involvement is a known complication of scrub typhus which range from mild meningitis to frank meninigoencephalitis.Aims and objectives: To study the clinical feature, laboratory parameters and response to treatment of scrub typhus meningitis/meningoencephalitis.Methods and Materials: This is a hospital based prospective observational study from North Eastern India. Diagnosis was based on clinical features and positive serological test (Weil's Felix test and IgM antibody card test.Results: 13 patients of scrub typhus with features of meningitis/meningoencephalitis were included. The mean duration of fever before presentation was 5.61±3.08 days and 4 (30.76 % patients had eschar. Altered sensorium, headache, seizure and meningeal sign were present in 13 (100%, 13 (100%, 6 (46.15% and 10 (76.92% patients respectively. Mean CSF protein, glucose and Adenosine deaminase was 152.16±16.88mg/dl, 55.23±21.7mg/dl, and 16.98±7.37U/L respectively. Mean total count of CSF leukocyte and lymphocyte percentage was 46.07±131 cell/cumm and 98.66±3.09% respectively. Tablet doxycycline with or without injection azithromycin was used and that shows good response 15.38% of patients died and all of them had multi organ dysfunction. Conclusion: Meningoencephalitis is a common manifestation of scrub typhus and diagnosis requires high degree of clinical suspicion which if diagnosed early and specific treatment started, patients usually recover completely with few complications.

  13. The Diversity and Geographical Structure of Orientia tsutsugamushi Strains from Scrub Typhus Patients in Laos.

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    Rattanaphone Phetsouvanh

    Full Text Available Orientia tsutsugamushi is the causative agent of scrub typhus, a disease transmitted by Leptotrombidium mites which is responsible for a severe and under-reported public health burden throughout Southeast Asia. Here we use multilocus sequence typing (MLST to characterize 74 clinical isolates from three geographic locations in the Lao PDR (Laos, and compare them with isolates described from Udon Thani, northeast Thailand. The data confirm high levels of diversity and recombination within the natural O. tsutsugamushi population, and a rate of mixed infection of ~8%. We compared the relationships and geographical structuring of the strains and populations using allele based approaches (eBURST, phylogenetic approaches, and by calculating F-statistics (FST. These analyses all point towards low levels of population differentiation between isolates from Vientiane and Udon Thani, cities which straddle the Mekong River which defines the Lao/Thai border, but with a very distinct population in Salavan, southern Laos. These data highlight how land use, as well as the movement of hosts and vectors, may impact on the epidemiology of zoonotic infections.

  14. Host defenses in experimental scrub typhus: effect of sublethal gamma radiation

    International Nuclear Information System (INIS)

    Kelly, D.J.

    1983-01-01

    The effect of sublethal gamma radiation on inbred mice chronically infected with scrub typhus rickettsiae was examined. Inbred mice which have been inoculated with Gilliam or Karp strain of Rickettsia tsutsugamushi by the subcutaneous route harbored the infection for at least one year. Irradiation of these animals at 12 or 52 weeks post inoculation at normally sublethal levels induced a significantly higher percentage of rickettsemic mice (recrudescence) than in the unirradiated similarly infected control animals. In addition, sublethal irradiation at 12 weeks also induced a quantitative increase in total rickettsiae. Homologous antibody titers to the rickettsiae were examined for five weeks following irradiation to determine the role of the humoral response in radiation induced recrudescence. Modification of recrudescence was investigated using radioprotective drugs. The expected results of this investigation supported the conclusion that the recrudescence of a chronic rickettsial infection in the appropriate host following immunological impairment due to battlefield or clinical exposure to gamma radiation can result in an acute, possibly lethal rickettsemia

  15. Effect of sublethal gamma radiation on host defenses in experimental scrub typhus

    International Nuclear Information System (INIS)

    Kelly, D.J.; Rees, J.C.

    1986-01-01

    The effect of sublethal gamma radiation on inbred mice chronically infected with scrub typhus rickettsiae was examined. Inbred mice which were inoculated with the Gilliam or Karp strain of Rickettsia tsutsugamushi by the subcutaneous route harbored the infection for at least 1 year. Irradiation of these animals at 12 or 52 weeks postinoculation with normally sublethal levels induced a significantly higher percentage of rickettsemic mice (recrudescence) than was seen in the unirradiated, similarly infected control animals. In addition, sublethal irradiation at 12 weeks induced a quantitative increase in total rickettsiae. Homologous antibody titers to the rickettsiae were examined for 5 weeks after irradiation to determine the role of the humoral response in radiation-induced recrudescence. Unirradiated, infected mice showed consistent titers of about 320 throughout the 5-week observation period, and the titer was not affected by exposure of up to 500 rads of gamma radiation. Drug dose-dependent radioprotection and modification of recrudescence was noted in infected, irradiated mice treated with the antiradiation compound S-2-(3-aminopropylamino)ethyl phosphorothioic acid. The results of this investigation supported the conclusion that the recrudescence of a chronic rickettsial infection in the appropriate host after immunological impairment due to gamma radiation can result in an acute, possibly lethal rickettsemia

  16. Scrub Typhus - A Major Cause of Pediatric Intensive Care Admission and Multiple Organ Dysfunction Syndrome: A Single-Center Experience from India.

    Science.gov (United States)

    Giri, Prabahs Prasun; Roy, Joydeb; Saha, Agnisekhar

    2018-02-01

    Scrub typhus has been globally recognized as an emerging infectious disease contributing significantly to pyrexia of unknown origin (PUO) and a potential cause of multiorgan dysfunction syndrome (MODS). We studied the incidence of scrub typhus as a cause of pediatric intensive care unit (PICU) admission and MODS in our hospital and its clinical and laboratory characteristics to measure the incidence of MODS caused by scrub typhus. This study was done in a pediatric teaching hospital in Kolkata, India. Records of patients admitted with PUO from March 2012 to December 2015 were reviewed. Rathi-Goodman-Aghai scoring system was used to identify potential ST patients and confirmed by serological testing. Clinical characteristics, laboratory findings, and treatment response were noted of those needing PICU admissions. Ninety-seven cases of scrub typhus have been identified during that period. PICU admission was needed in 30 of them (31%) which contributed 8.43% of total PICU admissions. Among these 30 patients, 16 (53%) developed MODS which contributed 18.29% of total MODS admitted in PICU. Septic shock was the most common manifestation in as many as 18 (60%) patients followed by encephalopathy in 13 (43%). Patients were treated with either doxycycline alone or in combination with azithromycin. Mean time to complete defervescence was 32 h after first dose of doxycycline. The outcome was excellent without a single mortality. Scrub typhus is an important cause of MODS in this part of the world, especially in fevers associated with features as identified and not responding to conventional antibiotics.

  17. Single-nucleotide polymorphisms in Toll-like receptor (TLR)-2, TLR4 and heat shock protein 70 genes and susceptibility to scrub typhus.

    Science.gov (United States)

    Janardhanan, Jeshina; Joseph Martin, Sherry; Astrup, Elisabeth; Veeramanikandan, R; Aukrust, Pål; Abraham, Ooriapadickal C; Varghese, George M

    2013-11-01

    Scrub typhus is a highly prevalent bacterial infection in India and South Asia that is caused by Orientia tsutsugamushi. The innate immune response to infections is modulated by Toll-like receptors (TLRs) and heat shock proteins (HSPs). This study was done to assess the prevalence and possible association of TLR and HSP polymorphisms in scrub typhus. TLR4 Asp299Gly, TLR4 Thr399Ile, TLR2 Arg753Gln and HSP70-2 A1267G are single-nucleotide polymorphisms (SNPs) that may modulate their activities, and these SNPs were assessed in 137 scrub typhus patients and 134 controls by PCR restriction fragment length polymorphism. We found that the two TLR4 mutations, TLR4 D299G and TLR4T399I, were present in 19.5% and 22% of the study population, respectively, and was in significant linkage disequilibrium with a D' of 0.8. The TLR2 mutation was found to be rare, whereas the HSP A>G mutation was very common (77.5%). Compared with the controls, the prevalence of heterozygous genotype of the TLR4D299G SNP, but not any of the other SNPs, was significantly higher among scrub typhus patients. Further studies using a larger sample size and more candidate genes may better enable in determining the role of these associations in susceptibility and severity of scrub typhus.

  18. Strong interferon-gamma mediated cellular immunity to scrub typhus demonstrated using a novel whole cell antigen ELISpot assay in rhesus macaques and humans.

    Directory of Open Access Journals (Sweden)

    Manutsanun Sumonwiriya

    2017-09-01

    Day 28 (mean 1,416, 95% CI 1,306-1,527 SFC/106 PBMC. No significant change was found in the control group at any time point compared to baseline. Humans from a scrub typhus endemic region of Thailand had mean responses of 189 (95% CI 88-290 SFC/106 PBMC compared to mean responses of 40 (95% CI 9-71 SFC/106 PBMC in people from a non-endemic region and 3 (95% CI 0-7 SFC/106 PBMC in naïve controls. In summary, this highly sensitive assay will enable field immunogenicity studies and further characterization of the host response to O. tsutsugamushi, and provides a link between human and animal models to accelerate vaccine development.

  19. Strong interferon-gamma mediated cellular immunity to scrub typhus demonstrated using a novel whole cell antigen ELISpot assay in rhesus macaques and humans.

    Science.gov (United States)

    Sumonwiriya, Manutsanun; Paris, Daniel H; Sunyakumthorn, Piyanate; Anantatat, Tippawan; Jenjaroen, Kemajittra; Chumseng, Suchintana; Im-Erbsin, Rawiwan; Tanganuchitcharnchai, Ampai; Jintaworn, Suthatip; Blacksell, Stuart D; Chowdhury, Fazle R; Kronsteiner, Barbara; Teparrukkul, Prapit; Burke, Robin L; Lombardini, Eric D; Richards, Allen L; Mason, Carl J; Jones, James W; Day, Nicholas P J; Dunachie, Susanna J

    2017-09-01

    (mean 1,416, 95% CI 1,306-1,527 SFC/106 PBMC). No significant change was found in the control group at any time point compared to baseline. Humans from a scrub typhus endemic region of Thailand had mean responses of 189 (95% CI 88-290) SFC/106 PBMC compared to mean responses of 40 (95% CI 9-71) SFC/106 PBMC in people from a non-endemic region and 3 (95% CI 0-7) SFC/106 PBMC in naïve controls. In summary, this highly sensitive assay will enable field immunogenicity studies and further characterization of the host response to O. tsutsugamushi, and provides a link between human and animal models to accelerate vaccine development.

  20. Typhus

    Science.gov (United States)

    ... Headache Joint and muscle pain Nausea and vomiting Symptoms of epidemic typhus may include: High fever, chills Confusion, decreased alertness, delirium Cough Severe muscle and joint pain Lights that ...

  1. Scrub typhus complicated by acute respiratory distress syndrome and multiorgan failure; an unrecognized alarming entity in central India: A report of two cases

    Directory of Open Access Journals (Sweden)

    Amrish Saxena

    2014-01-01

    Full Text Available Scrub typhus is an acute infectious illness, distributed throughout the Asia Pacific rim. In India, it has been reported from northern, eastern, and southern India. However, cases of scrub typhus have not been well-documented from Vidarbha, an eastern region of Maharashtra state in central India. We report two cases of complicated scrub typhus from Vidarbha region. These cases admitted in unconscious state with 8-10 days history of fever, body ache, cough, and progressive breathlessness. The diagnosis in both cases was based on presence of eschar, a positive Weil-Felix test, and a positive rapid diagnostic test (immunochromatographic assay. Both cases were complicated by acute respiratory distress syndrome (ARDS and multiorgan failure. Both of them presented in their 2 nd week of illness and died during the hospital course in spite of intensive supportive care. The main cause of mortality was delayed referral leading to delay in diagnosis and treatment.

  2. Incidence, risk factors and clinical outcomes of acute kidney injury associated with scrub typhus: a retrospective study of 510 consecutive patients in South Korea (2001-2013).

    Science.gov (United States)

    Hwang, Kyungo; Jang, Ha Nee; Lee, Tae Won; Cho, Hyun Seop; Bae, Eunjin; Chang, Se-Ho; Park, Dong Jun

    2017-03-15

    Renal involvement in scrub typhus ranges from simple urinary abnormalities to acute kidney injury (AKI) leading to death. This study evaluated the incidence, predictors and prognosis of AKI associated with scrub typhus according to the RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria. We retrospectively evaluated the medical records of patients diagnosed with scrub typhus from January 2001 to November 2013 in Gyeongsang National University Hospital. During the study period, 510 patients were diagnosed with scrub typhus and the incidence of AKI was 35.9%. There were 132 (25.9%) patients at risk, 37 (7.3%) with injury and 14 (2.7%) with failure. In comparison with the non-AKI group, the AKI group was older (73.9 vs 63.4 years, pscrub typhus. Our current results suggest that the presence of underlying CKD, older age, lower serum albumin level and time to hospital presentation after symptom onset were important risk factors to determine occurrence of AKI. Whether earlier diagnosis and treatment in patients with the above risk factors reduce the incidence and severity of AKI deserves to be investigated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. Mathematical Modeling for Scrub Typhus and Its Implications for Disease Control.

    Science.gov (United States)

    Min, Kyung Duk; Cho, Sung Il

    2018-03-19

    The incidence rate of scrub typhus has been increasing in the Republic of Korea. Previous studies have suggested that this trend may have resulted from the effects of climate change on the transmission dynamics among vectors and hosts, but a clear explanation of the process is still lacking. In this study, we applied mathematical models to explore the potential factors that influence the epidemiology of tsutsugamushi disease. We developed mathematical models of ordinary differential equations including human, rodent and mite groups. Two models, including simple and complex models, were developed, and all parameters employed in the models were adopted from previous articles that represent epidemiological situations in the Republic of Korea. The simulation results showed that the force of infection at the equilibrium state under the simple model was 0.236 (per 100,000 person-months), and that in the complex model was 26.796 (per 100,000 person-months). Sensitivity analyses indicated that the most influential parameters were rodent and mite populations and contact rate between them for the simple model, and trans-ovarian transmission for the complex model. In both models, contact rate between humans and mites is more influential than morality rate of rodent and mite group. The results indicate that the effect of controlling either rodents or mites could be limited, and reducing the contact rate between humans and mites is more practical and effective strategy. However, the current level of control would be insufficient relative to the growing mite population. © 2018 The Korean Academy of Medical Sciences.

  4. Outcome of Intravenous Azithromycin Therapy in Patients with Complicated Scrub Typhus Compared with That of Doxycycline Therapy Using Propensity-Matched Analysis

    Science.gov (United States)

    Jang, Mi-Ok; Jang, Hee-Chang; Kim, Uh Jin; Ahn, Joon Hwan; Kang, Seung-Ji; Jung, Sook-In; Shin, Hee-Young

    2014-01-01

    There are no well-matched, controlled studies comparing azithromycin with doxycycline for the treatment of complicated scrub typhus. A retrospective propensity score-matched case-control study was performed for patients who presented with complicated scrub typhus and were treated with doxycycline or azithromycin between 2001 and 2011. Data on comorbidities, clinical manifestations, laboratory studies, treatments, and outcomes were extracted for analysis. The clinical characteristics and outcomes of the azithromycin-treated group (n = 73) were compared to those of the doxycycline-treated group (n = 108). Of 181 patients, 73 from each group were matched by propensity scores. There were no significant differences in baseline characteristics between the matched groups. The treatment success and survival rates were not significantly different (89% [65/73 patients] versus 96% [70/73 patients] and 96% [70/73 patients] versus 96% [70/73 patients], respectively [P > 0.05]). No difference was observed in the time to defervescence or length of hospital stay between the two groups (P > 0.05). In complicated scrub typhus patients (n = 181), multivariate analysis showed that only APACHE II score was an independent risk factor for mortality (95% confidence interval, 1.11 to 1.56; P scrub typhus. PMID:24366734

  5. Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure

    Directory of Open Access Journals (Sweden)

    Hu Sung-Yuan

    2011-03-01

    Full Text Available Abstract Background Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed. Case presentations We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days. Conclusion Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.

  6. Development of life stages of Leptotrombidium imphalum and Leptotrombidium chiangraiensis (Acari: Trombiculidae) uninfected and infected with the scrub typhus rickettsia, Orientia tsustugamushi

    Science.gov (United States)

    Leptotrombidium chiangraiensis Tanskul and Linthicum and Leptotrombidium imphalum Vercammen-Grandjean are important vectors of scrub typhus in ricefield habitats in northern Thailand. The developmental biology of all stages of the life cycle of two generations of mites infected with Orientia tsutsug...

  7. A comparative hospital-based observational study of mono- and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever.

    Science.gov (United States)

    Ahmad, S; Dhar, M; Mittal, G; Bhat, N K; Shirazi, N; Kalra, V; Sati, H C; Gupta, V

    2016-04-01

    Positive serology for dengue and/or scrub typhus infection with/without positive malarial smear (designated as mixed or co-infection) is being increasingly observed during epidemics of acute undifferentiated febrile illnesses (AUFIs). We planned to study the clinical and biochemical spectrum of co-infections with Plasmodium sp., dengue virus and scrub typhus and compare these with mono-infection by the same organisms. During the period from December 2012 to December 2013, all cases presenting with AUFIs to a single medical unit of a referral centre in Garhwal region of the north Indian state of Uttarakhand were retrospectively selected and categorised aetiologically as co-infections, malaria, dengue or scrub typhus. The groups thus created were compared in terms of demographic, clinical, biochemical and outcome parameters. The co-infection group (n = 49) was associated with milder clinical manifestations, fewer, milder and non-progressive organ dysfunction, and lesser need for intensive care, mechanical ventilation and dialysis as compared to mono-infections. When co-infections were sub-grouped and compared with the relevant mono-infections, there were differences in certain haematological and biochemical parameters; however, this difference did not translate into differential outcomes. Scrub typhus mono-infection was associated with severe disease in terms of both morbidity and mortality. Malaria, dengue and scrub typhus should be routinely tested in all patients with AUFIs. Co-infections, whether true or due to serological cross-reactivity, appear to be a separate entity so far as presentation and morbidity is concerned. Further insight is needed into the mechanism and identification of the protective infection.

  8. Abundance & distribution of trombiculid mites & Orientia tsutsugamushi, the vectors & pathogen of scrub typhus in rodents & shrews collected from Puducherry & Tamil Nadu, India.

    Science.gov (United States)

    Candasamy, Sadanandane; Ayyanar, Elango; Paily, Kummankottil; Karthikeyan, Patricia Anitha; Sundararajan, Agatheswaran; Purushothaman, Jambulingam

    2016-12-01

    Human cases of scrub typhus are reported every year from Puducherry and adjoining areas in southern India. However, information on the presence of causative agent, Orientia tsutsugamushi, and its vectors is lacking. Hence, the objective of the study was to find out the vector as well as pathogen distribution in rodents and shrews present in the scrub typhus-reported areas in southern India. Trombiculid mites were collected by combing rats and shrews collected using Sherman traps and identified to species level following standard taxonomical keys. The serum samples of the animals were used for Weil-Felix test and the clots containing blood cells were used for DNA extraction and polymerase chain reaction (PCR). A total of 181 animals comprising four rodent species and one shrew species were collected from 12 villages. High proportion of chiggers was collected from the shrew, Suncus murinus (79.1%) and Rattus rattus (47.6%). A total of 10,491 trombiculid mites belonging to nine species were collected. Leptotrombidium deliense, the known vector of scrub typhus pathogen, was the predominant species (71.0%) and the chigger (L. deliense) index was 41.1 per animal. Of the 50 animals screened for the pathogen, 28 showed agglutination against OX-K in Weil-Felix test indicating the presence of antibodies against O. tsutsugamushi, the causative agent of scrub typhus. PCR carried out with the DNA extracted from blood samples of two of the animals were positive for GroEl gene of O. tsutsugamushi. L. deliense index was well above the critical limit of chigger load, indicating that all the villages were receptive for high risk of transmission of scrub typhus to human. Pathogen positivity was higher among animals collected from villages recorded for higher chigger indices due to active transmission between the chigger mites and reservoir host animals. The results are suggestive of routine vector/pathogen surveillance at hot spots to initiate timely preventive measures.

  9. Elevated levels of von Willebrand factor and high mobility group box 1 (HMGB1) are associated with disease severity and clinical outcome of scrub typhus.

    Science.gov (United States)

    Chen, Hongliu; Ning, Zong; Qiu, Ying; Liao, Yuanli; Chang, Haihua; Ai, Yuanyuan; Wei, Yinghua; Deng, Yiming; Shen, Ying

    2017-08-01

    This study aimed to investigate whether von Willebrand factor (vWF) and high mobility group box 1 (HMGB1) are associated with the severity and clinical outcome of scrub typhus and to seek novel biomarkers for surveillance and prediction of the prognosis of this infection. Serum concentrations of vWF and HMGB1 were measured twice by ELISA for scrub typhus patients (n=103), once prior to doxycycline therapy and then on day 7 of doxycycline therapy; concentrations were measured once for healthy controls (n=32). Among the total 103 patients enrolled, 38 had disease complicated by multiple organ dysfunction syndrome (MODS). Serum concentrations of vWF and HMGB1 were significantly higher in all the patients than in the healthy controls, both prior to doxycycline treatment and on day 7 of doxycycline treatment (pscrub typhus (area under the curve (AUC)=0.864, p=0.001, and AUC=0.862, p=0.001, respectively). Elevated levels of vWF and HMGB1 are associated with the severity and clinical outcome of scrub typhus. These represent possible new biomarkers for use in the assessment and prognostic prediction of this infection. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  10. The Epidemiology and Characteristics of Q fever and Co-infections with Scrub Typhus, Murine Typhus or Leptospirosis in Taiwan: A Nationwide Database Study.

    Science.gov (United States)

    Lai, C-H; Sun, W; Lee, C-H; Lin, J-N; Liao, M-H; Liu, S-S; Chang, T-Y; Tsai, K-F; Chang, Y-C; Lin, H-H; Chen, Y-H

    2017-11-01

    Q fever (QF) is a worldwide zoonosis associated with outbreaks. Only a few nationwide studies regarding the surveillance and epidemiology of human QF have been reported. Although QF is endemic in Taiwan, a nationwide database investigation of the epidemiology and characteristics of QF and its associations with scrub typhus (ST), murine typhus (MT) and leptospirosis (LS) has never been reported. We analysed nationwide databases of suspected QF, ST, MT and LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan. A total of 468 (4.2%) QF cases were identified among 11 109 suspected QF cases. QF cases were mainly distributed in the southern and Kaohsiung-Pingtung regions but rarely in the eastern region. Compared to non-QF cases, QF cases had significantly higher percentages of males (88.7 versus 66.2%) and high-risk occupations (farming, animal husbandry or veterinary medicine) (16.2 versus 10.5%). But the percentages of specific animal contact, including cattle (0.6 versus 0.8%) and goats (0.9 versus 1.0%), were low in both. The majority of suspected QF cases (89.4%) were simultaneously suspected with ST, MT or LS, and the combinations of suspected diseases differed between regions. The number of suspected QF cases from the eastern region decreased since 2009, which was not observed in other regions. A total of 1420 (12.8%) cases had confirmed diseases, including QF (453, 4.1%), QF+ST (7, 0.06%), QF+MT (4, 0.04%), QF+LS (4, 0.04%), MT (186, 1.7%), ST (545, 4.9%), ST+LS (11, 0.1%) and LS (210, 1.9%). Compared to cases of unknown disease, QF cases had larger percentages of high-risk occupations (16.2 versus 9.6%) but similar histories of animal contact (29.8 versus 25.1%). QF is an endemic disease in southern Taiwan. It is difficult to differentiate QF from ST, MT or LS only by high-risk occupations and history of animal contact, and co-infection of QF with these diseases should be considered. © 2016 Blackwell Verlag GmbH.

  11. Cascading effect of economic globalization on human risks of scrub typhus and tick-borne rickettsial diseases.

    Science.gov (United States)

    Kuo, Chi-Chien; Huang, Jing-Lun; Shu, Pei-Yun; Lee, Pei-Lung; Kelt, Douglas A; Wang, Hsi-Chieh

    2012-09-01

    The increase in global travel and trade has facilitated the dissemination of disease vectors. Globalization can also indirectly affect vector-borne diseases through the liberalization of cross-border trade, which has far-reaching, worldwide effects on agricultural practices and may in turn influence vectors through the modification of the ecological landscape. While the cascading effect of economic globalization on vector-borne diseases, sometimes acting synergistically with regional agricultural policy, could be substantial and have significant economic, agricultural, and public health implications, research into this remains very limited. We evaluated how abandonment of rice paddies in Taiwan after joining the World Trade Organization, along with periodic plowing, an agricultural policy to reduce farm pests in abandoned fields can unexpectedly influence risks to diseases transmitted by ticks and chiggers (larval trombiculid mites), which we collected from their small-mammal hosts. Sampling was limited to abandoned (fallow) and plowed fields due to the challenge of trapping small mammals in flooded rice paddies. Striped field mice (Apodemus agrarius) are the main hosts for both vectors. They harbored six times more ticks and three times more chiggers in fallow than in plowed plots. The proportion of ticks infected with Rickettsia spp. (etiologic agent of spotted fever) was three times higher in fallow plots, while that of Orientia tsutsugamushi (scrub typhus) in chiggers was similar in both treatments. Fallow plots had more ground cover and higher vegetation than plowed ones. Moreover, ticks and chiggers in both field types were dominated by species known to infest humans. Because ticks and chiggers should exhibit very low survival in flooded rice paddies, we propose that farm abandonment in Taiwan, driven by globalization, may have inadvertently led to increased risks of spotted fever and scrub typhus. However, periodic plowing can unintentionally mitigate vector

  12. Characterization of the rhesus macaque (Macaca mulatta) scrub typhus model: Susceptibility to intradermal challenge with the human pathogen Orientia tsutsugamushi Karp

    Science.gov (United States)

    Sunyakumthorn, Piyanate; Somponpun, Suwit J.; Im-erbsin, Rawiwan; Anantatat, Tippawan; Jenjaroen, Kemajittra; Dunachie, Susanna J.; Lombardini, Eric D.; Burke, Robin L.; Blacksell, Stuart D.; Jones, James W.; Mason, Carl J.; Richards, Allen L.; Day, Nicholas P. J.

    2018-01-01

    Background Scrub typhus is an important endemic disease in tropical Asia caused by Orientia tsutsugamushi for which no effective broadly protective vaccine is available. The successful evaluation of vaccine candidates requires well-characterized animal models and a better understanding of the immune response against O. tsutsugamushi. While many animal species have been used to study host immunity and vaccine responses in scrub typhus, only limited data exists in non-human primate (NHP) models. Methodology/Principle findings In this study we evaluated a NHP scrub typhus disease model based on intradermal inoculation of O. tsutsugamushi Karp strain in rhesus macaques (n = 7). After an intradermal inoculation with 106 murine LD50 of O. tsutsugamushi at the anterior thigh (n = 4) or mock inoculum (n = 3), a series of time course investigations involving hematological, biochemical, molecular and immunological assays were performed, until day 28, when tissues were collected for pathology and immunohistochemistry. In all NHPs with O. tsutsugamushi inoculation, but not with mock inoculation, the development of a classic eschar with central necrosis, regional lymphadenopathy, and elevation of body temperature was observed on days 7–21 post inoculation (pi); bacteremia was detected by qPCR on days 6–18 pi; and alteration of liver enzyme function and increase of white blood cells on day 14 pi. Immune assays demonstrated raised serum levels of soluble cell adhesion molecules, anti-O. tsutsugamushi-specific antibody responses (IgM and IgG) and pathogen-specific cell-mediated immune responses in inoculated macaques. The qPCR assays detected O. tsutsugamushi in eschar, spleen, draining and non-draining lymph nodes, and immuno-double staining demonstrated intracellular O. tsutsugamushi in antigen presenting cells of eschars and lymph nodes. Conclusions/Significance These data show the potential of using rhesus macaques as a scrub typhus model, for evaluation of correlates of

  13. Infection of Rodents by Orientia tsutsugamushi, the Agent of Scrub Typhus in Relation to Land Use in Thailand

    Directory of Open Access Journals (Sweden)

    Kittipong Chaisiri

    2017-10-01

    Full Text Available The relationship between land use structures and occurrence of scrub typhus agent, Orientia tsutsugamushi infection in small wild mammals was conducted in three provinces of Thailand: Buriram, Loei, and Nan. Orientia tsutsugamushi detection was performed using 16S ribosomal DNA (rDNA amplicon sequencing approach using Miseq Illumina platform. In total, 387 animals (rodents and shrews were examined for the bacterium infection. The 16S rDNA sequences of the bacterium were found in nine animals from Bandicota savilei, Berylmys bowersi, Leopoldamys edwardsi, Rattus exulans, R. tanezumi, and Rattus sp. phylogenetic clade 3, yielding 2.3% infection rate, with two new rodent species infected by the bacterium in Thailand: B. bowersi and L. edwardsi. Using a Generalized Linear Mixed Model (GLMM and Random Forest analyses for investigating the association between human-land use and occurrence of the bacterium, forest habitat appeared as a strong explicative variable of rodent infection, meaning that O. tsutsugamushi-infected animals were more likely found in forest-covered habitats. In terms of public health implementation, our results suggest that heterogenous forested areas including forest-converted agricultural land, reforestation areas, or fallow are potential habitats for O. tsutsugamushi transmission. Further understanding of population dynamics of the vectors and their hosts in these habitats could be beneficial for the prevention of this neglected zoonotic disease.

  14. Prospective evaluation of commercial antibody-based rapid tests in combination with a loop-mediated isothermal amplification PCR assay for detection of Orientia tsutsugamushi during the acute phase of scrub typhus infection.

    Science.gov (United States)

    Blacksell, Stuart D; Paris, Daniel H; Chierakul, Wirongrong; Wuthiekanun, Vanaporn; Teeratakul, Achara; Kantipong, Pacharee; Day, Nicholas P J

    2012-03-01

    Samples from 160 prospectively recruited febrile patients with typhus-like illness in an area of Thailand (Chiang Rai, northern Thailand) where scrub typhus is endemic were used to evaluate the diagnostic capabilities of four rapid immunochromatographic tests (ICTs) for the detection of Orientia tsutsugamushi IgM and total antibodies during acute scrub typhus infection. Of the 160 cases, 54 (34%) had been confirmed to have scrub typhus using the reference scrub typhus infection criteria (STIC), i.e., positive cell culture isolation, an admission IgM antibody titer of ≥1:12,800, a 4-fold rising IgM antibody titer, and/or positivity for ≥2 out of 3 PCR gene targets). The ICTs gave the following sensitivities and specificities: the Panbio IgM ICT, 46% (95% confidence interval [CI], 33 to 60) and 95% (95% CI, 89 to 98), respectively; the Standard Diagnostics IgM ICT, 68% (95% CI, 60 to 75) and 73% (95% CI, 68 to 78), respectively; the AccessBio IgM ICT, 56% (95% CI, 48 to 63) and 90% (95% CI, 87 to 94), respectively; and the AccessBio total antibody ABt ICT, 61% (95% CI, 53 to 68) and 68% (95% CI, 63 to 73), respectively. An isothermal loop amplification (LAMP) PCR assay for scrub typhus demonstrated a sensitivity of 52% (95% CI, 38 to 66) and a specificity of 94% (95% CI, 88 to 98). This study has revealed the diagnostic limitations of antibody-based assays in an acute care setting. However, the combination of ICTs with LAMP usually increased sensitivity with a minimal reduction in specificity. The best combination, the Panbio IgM ICT and LAMP, resulted in a sensitivity of 67% (95% CI, 53 to 79) and a specificity of 91% (95% CI, 83 to 95). The combination of antibody-based assays with DNA- or antigen-based tests shows promise for improved diagnostic sensitivity.

  15. Lateral Flow Rapid Test for Accurate and Early Diagnosis of Scrub Typhus: A Febrile Illness of Historically Military Importance in the Pacific Rim.

    Science.gov (United States)

    Chao, Chien-Chung; Zhangm, Zhiwen; Weissenberger, Giulia; Chen, Hua-Wei; Ching, Wei-Mei

    2017-03-01

    Scrub typhus (ST) is an infection caused by Orientia tsutsugamushi. Historically, ST was ranked as the second most important arthropod-borne medical problem only behind malaria during World War II and the Vietnam War. The disease occurs mainly in Southeast Asia and has been shown to emerge and reemerge in new areas, implying the increased risk for U.S. military and civilian personnel deployed to these regions. ST can effectively be treated by doxycycline provided the diagnosis is made early, before the development of severe complications. Scrub Typhus Detect is a lateral flow rapid test based on a mixture of recombinant 56-kDa antigens with broad reactivity. The performance of this prototype product was evaluated against indirect immunofluorescence assay, the serological gold standard. Using 249 prospectively collected samples from Thailand, the sensitivity and specificity for IgM was found to be 100% and 92%, respectively, suggesting a high potential of this product for clinical use. This product will provide a user friendly, rapid, and accurate diagnosis of ST for clinicians to provide timely and accurate treatments of deployed personnel. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  16. Validation of Geno-Sen's scrub typhus real time polymerase chain reaction kit by its comparison with a serological ELISA Test

    Directory of Open Access Journals (Sweden)

    Velmurugan Anitharaj

    2017-01-01

    Full Text Available Background: In the recent past, scrub typhus (ST has been reported from different parts of India, based on Weil-Felix/enzyme-linked immunosorbent assay (ELISA/indirect immunofluorescence assay (IFA. Molecular tests are applied only by a few researchers. Aims: Evaluation of a new commercial real time polymerase chain reaction (PCR kit for molecular diagnosis of ST by comparing it with the commonly used IgM ELISA is our aim. Settings and Design: ST has been reported all over India including Puducherry and surrounding Tamil Nadu and identified as endemic for ST. This study was designed to correlate antibody detection by IgM ELISA and Orientia tsutsugamushi DNA in real time PCR. Materials and Methods: ST IgM ELISA (InBios Inc., USA was carried out for 170 consecutive patients who presented with the symptoms of acute ST during 11 months (November, 2015– September, 2016. All 77 of these patients with IgM ELISA positivity and 49 of 93 IgM ELISA negative patients were subjected to real time PCR (Geno-Sen's ST real time PCR, Himachal Pradesh, India. Statistical Analysis: Statistical analysis for clinical and laboratory results was performed using IBM SPSS Statistics 17 for Windows (SPSS Inc., Chicago, USA. Chi-square test with Yates correction (Fisher's test was employed for a small number of samples. Results and Conclusion: Among 77 suspected cases of acute ST with IgM ELISA positivity and 49 IgM negative patients, 42 and 7 were positive, respectively, for O. tsutsugamushi 56-kDa type-specific gene in real time PCR kit. Until ST IFA, the gold standard diagnostic test, is properly validated in India, diagnosis of acute ST will depend on both ELISA and quantitative PCR.

  17. Complexity of type-specific 56 kDa antigen CD4 T-cell epitopes of Orientia tsutsugamushi strains causing scrub typhus in India.

    Directory of Open Access Journals (Sweden)

    Arunachalam Ramaiah

    Full Text Available Orientia tsutsugamushi (Ots is an obligate, intracellular, mite-transmitted human pathogen which causes scrub typhus. Understanding the diversity of Ots antigens is essential for designing specific diagnostic assays and efficient vaccines. The protective immunodominant type-specific 56 kDa antigen (TSA of Ots varies locally and across its geographic distribution. TSA contains four hypervariable domains. We bioinformatically analyzed 345 partial sequences of TSA available from India, most of which contain only the three variable domains (VDI-III and three spacer conserved domains (SVDI, SVDII/III, SVDIII. The total number (152 of antigenic types (amino acid variants varied from 14-36 in the six domains of TSA that we studied. Notably, 55% (787/1435 of the predicted CD4 T-cell epitopes (TCEs from all the six domains had high binding affinities (HBA to at least one of the prevalent Indian human leukocyte antigen (HLA alleles. A surprisingly high proportion (61% of such TCEs were from spacer domains; indeed 100% of the CD4 TCEs in the SVDI were HBA. TSA sequences from India had more antigenic types (AT than TSA from Korea. Overall, >90% of predicted CD4 TCEs from spacer domains were predicted to have HBA against one or more prevalent HLA types from Indian, Korean, Asia-Pacific region or global population data sets, while only <50% of CD4 TCEs in variable domains exhibited such HBA. The phylogenetically and immunologically important amino acids in the conserved spacer domains were identified. Our results suggest that the conserved spacer domains are predicted to be functionally more important than previously appreciated in immune responses to Ots infections. Changes occurring at the TCE level of TSA may contribute to the wide range of pathogenicity of Ots in humans and mouse models. CD4 T-cell functional experiments are needed to assess the immunological significance of these HBA spacer domains and their role in clearance of Ots from Indian patients.

  18. Autofluorescence microscopy for paired-matched morphological and molecular identification of individual chigger mites (Acari: Trombiculidae, the vectors of scrub typhus.

    Directory of Open Access Journals (Sweden)

    Rawadee Kumlert

    phenotypic-genotypic data is of central importance for future characterization of mites and dissecting the molecular epidemiology of mites transmitting diseases like scrub typhus.

  19. Gamma-irradiated scrub typhus immunogens: development of cell-mediated immunity after vaccination of inbred mice

    International Nuclear Information System (INIS)

    Jerrells, T.R.; Palmer, B.A.; Osterman, J.V.

    1983-01-01

    Mice immunized with three injections of gamma-irradiated Karp strain of Rickettsia tsutsugamushi were evaluated for the presence of cell-mediated immunity by using delayed-type hypersensitivity, antigen-induced lymphocyte proliferation, and antigen-induced lymphokine production. These animals also were evaluated for levels of circulating antibody after immunization as well as for the presence of rickettsemia after intraperitoneal challenge with viable Karp rickettsiae. After immunization with irradiated Karp rickettsiae, a demonstrable cell-mediated immunity was present as evidenced by delayed-type hypersensitivity responsiveness, lymphocyte proliferation, and production of migration inhibition factor and interferon by immune spleen lymphocytes. Also, a reduction in circulating rickettsiae was seen in mice immunized with irradiated rickettsiae after challenge with 1,000 50% mouse lethal doses of viable, homologous rickettsiae. All responses except antibody titer and reduction of rickettsemia were similar to the responses noted in mice immunized with viable organisms. Antibody levels were lower in mice immunized with irradiated rickettsiae than in mice immunized with viable rickettsiae. Furthermore, mice that were immunized with viable rickettsiae demonstrated markedly lower levels of rickettsemia after intraperitoneal challenge compared with either mice immunized with irradiated rickettsiae or nonimmunized mice

  20. Evaluation of a broad-ranging and convenient enzyme-linked immunosorbent assay using the lysate of infected cells with five serotypes of Orientia tsutsugamushi, a causative agent of scrub typhus.

    Science.gov (United States)

    Ogawa, Motohiko; Satoh, Masaaki; Saijo, Masayuki; Ando, Shuji

    2017-01-05

    Scrub typhus is a mite-borne rickettsiosis caused by infection of Orientia tsutsugamushi, which is endemic to several Asia-Pacific Rim countries, including Japan. Although micro-indirect immunofluorescent assay (micro-IFA) is the standard method for the serological diagnosis of scrub typhus, enzyme-linked immunosorbent assay (ELISA) is considered to be more objective, by providing digitized results as opposed to being subject to the judgment of the evaluator as in micro-IFA. Therefore, the aim of this study was to develop a broad-ranging ELISA using the five major prevalent serotypes of O. tsutsugamushi in Japan as the antigens. Furthermore, in contrast to previous studies that used purified microorganisms via ultracentrifugation, we directly used the infected cells, and evaluated the diagnostic accuracy of this simplified method to that of micro-IFA. Evaluation of paired patient sera against the five serotypes showed that the accuracy of ELISA relative to micro-IFA was 87.4 and 79.5% for immunoglobulin (Ig)M and IgG assays, respectively, at the optimized cut-off value. Further evaluation of patient sera against the expected serotype of the infecting strain showed that the accuracy of ELISA compared to micro-IFA increased to 100 and 97.4% in the IgM and IgG assays, respectively. This suggests that use of the five prevalent serotypes contributed to the increase of the accuracy of ELISA. When applying the criteria of serological diagnosis for paired sera samples to ELISA, all 19 patients were diagnosed as positive; a ≥4-fold elevation of the antibody titer was observed in 15 of 19 patients that were positive, and very high antibody titers were observed in both paired sera samples of the remaining four patients. In addition, all samples of healthy subjects and patients with other types of rickettsiosis were diagnosed as negative using these criteria. Our results suggest the excellent performance of the new broad-ranging and convenient ELISA, which appears to be

  1. Epidemic typhus.

    Science.gov (United States)

    Bechah, Yassina; Capo, Christian; Mege, Jean-Louis; Raoult, Didier

    2008-07-01

    Epidemic typhus is transmitted to human beings by the body louse Pediculus humanus corporis. The disease is still considered a major threat by public-health authorities, despite the efficacy of antibiotics, because poor sanitary conditions are conducive to louse proliferation. Until recently, Rickettsia prowazekii, the causal agent, was thought to be confined to human beings and their body lice. Since 1975, R prowazekii infection in human beings has been related to contact with the flying squirrel Glaucomys volans in the USA. Moreover, Brill-Zinsser disease, a relapsed form of epidemic typhus that appears as sporadic cases many years after the initial infection, is unrelated to louse infestation. Stress or a waning immune system are likely to reactivate this earlier persistent infection, which could be the source of new epidemics when conditions facilitate louse infestation. Finally, R prowazekii is a potential category B bioterrorism agent, because it is stable in dried louse faeces and can be transmitted through aerosols. An increased understanding of the pathogenesis of epidemic typhus may be useful for protection against this bacterial threat.

  2. Tsutsugamushi Disease (Scrub Typhus) Meningoencephalitis in ...

    African Journals Online (AJOL)

    cranial nerve deficits, and magnetic resonance imaging (MRI) brain performed if needed. Results: ... There were 13 males and 10 females. Fever ≥1 week ... fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF. ADA were .... With early usage of antibiotics, all features of the disease.

  3. Typhus in Texas

    Centers for Disease Control (CDC) Podcasts

    Dr. Kristy Murray, an associate professor in pediatrics and assistant dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children's Hospital, discusses increased cases of typhus in southern Texas.

  4. Pool scrubbing

    International Nuclear Information System (INIS)

    Lopez-Jimenez, J.; Herranz, J.; Escudero, M.J.; Espigares, M.M.; Peyres, V.; Polo, J.; Kortz, Ch.; Koch, M.K.; Brockmeier, U.; Unger, H.; Dutton, L.M.C.; Smedley, Ch.; Trow, W.; Jones, A.V.; Bonanni, E.; Calvo, M.; Alonso, A.

    1996-12-01

    The Source Term Project in the Third Frame Work Programme of the European Union Was conducted under and important joined effort on pool scrubbing research. CIEMAT was the Task Manager of the project and several other organizations participated in it: JRC-Ispra, NNC Limited, RUB-NES and UPM. The project was divided into several tasks. A peer review of the models in the pool scrubbing codes SPARC90 and BUSCA-AUG92 was made, considering the different aspects in the hydrodynamic phenomenology, particle retention and fission product vapor abortions. Several dominant risk accident sequences were analyzed with MAAP, SPARC90 and BUSCA-AUG92 codes, and the predictions were compared. A churn-turbulent model was developed for the hydrodynamic behaviour of the pool. Finally, an experimental programme in the PECA facility of CIEMAT was conducted in order to study the decontamination factor under jet injection regime, and the experimental observations were compared with the SPARC and BUSCA codes. (Author)

  5. Typhus in Texas

    Centers for Disease Control (CDC) Podcasts

    2017-07-06

    Dr. Kristy Murray, an associate professor in pediatrics and assistant dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital, discusses increased cases of typhus in southern Texas.  Created: 7/6/2017 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 7/6/2017.

  6. Seroprevalence of Scrub Typhus, Typhus, and Spotted Fever Among Rural and Urban Populations of Northern Vietnam

    NARCIS (Netherlands)

    Trung, N.V.; Hoi, L.T.; Thuong, N.T.H.; Toan, T.K.; Huong, T.T.K.; Hoa, T.M.; Fox, A.; Kinh, N.V.; Doorn, H.R. van; Wertheim, H.F.L.; Bryant, J.E.; Nadjm, B.

    2017-01-01

    AbstractRickettsial infections are recognized as important causes of fever throughout southeast Asia. Herein, we determined the seroprevalence to rickettsioses within rural and urban populations of northern Vietnam. Prevalence of individuals with evidence of prior rickettsial infections (IgG

  7. Imported rickettsioses : think of murine typhus

    NARCIS (Netherlands)

    van der Kleij, FGH; Gansevoort, RT; Kreeftenberg, HG

    Murine typhus is a disease still prevalent in many parts of the world. Because the incidence in the US and Europe has declined rapidly, physicians in these continents have become unfamiliar with the clinical picture. Murine typhus is associated with significant morbidity and fatalities do occur,

  8. Self-scrubbing coal

    International Nuclear Information System (INIS)

    Kindig, J.K.

    1992-01-01

    More than 502 million tons - 65 percent of all coal shipped to utilities in 1990 - were above 1.2 pounds of sulfur dioxide per million Btu. Most of the coal, even though cleaned in conventional coal preparation plants, still does not meet the emission limitation the Clean Air Act Amendments mandate for the year 2000. To cope with this fact, most utilities plan to switch to low sulfur (western U.S. or Central Appalachian) coal or install scrubbers. Both solutions have serous drawbacks. Switching puts local miners out of work and weakens the economy in the utility's service territory. Scrubbing requires a major capital expenditure by the utility. Scrubbers also increase the operating complexity and costs of the generating station and produce yet another environmental problem, scrubber sludge. Employing three new cost-effective technologies developed by Customer Coals International (CCl), most non-compliance coals east of the Mississippi River can be brought into year-2000 compliance. The compliance approach employed, depends upon the characteristics of the raw coal. Three types of raw coal are differentiated, based upon the amount of organic sulfur in the coals and the ease (or difficultly) of liberating the pyrite. They are: Low organic sulfur content and pyrite that liberates easily. Moderate organic sulfur content and pyrite that liberates easily. High organic sulfur content or the pyrite liberates with difficulty. In this paper examples of each type of raw coal are presented below, and the compliance approach employed for each is described. The names of the beneficiated coal products produced from each type of raw coal give above are: Carefree Coal, Self-Scrubbing Coal and Dry-Scrubbing Coal

  9. SPS: scrubbing or coating ?

    CERN Document Server

    Jimenez, J M

    2012-01-01

    The operation of the SPS with high intensity bunched beams is limited by the electron cloud building-up in both the arcs and long straight sections. Two consolidation options have been considered: mitigation of the electron cloud using coatings or relying, as before, on the scrubbing runs. A status report on both options will be given with a particular emphasis on measurements plans for 2012 and pending issues. The testing needs, corresponding beam parameters and MD time in 2012 will be addressed. The criteria for the decision making and the corresponding schedule will be discussed.

  10. SPS: scrubbing or coating?

    International Nuclear Information System (INIS)

    Jimenez, J.M.

    2012-01-01

    The operation of the SPS with high intensity bunched beams is limited by the electron cloud building-up in both the arcs and long straight sections. Two consolidation options have been considered: suppression of the electron cloud build-up using coatings or relying, as before, on the scrubbing mitigation. A status report on both options will be given with a particular emphasis on measurements plans for 2012 and pending issues. The testing needs, corresponding beam parameters and MD time in 2012 will be addressed. The criteria for the decision making and the corresponding schedule will be discussed. (author)

  11. Increased Nucleosomes and Neutrophil Activation Link to Disease Progression in Patients with Scrub Typhus but Not Murine Typhus in Laos

    NARCIS (Netherlands)

    Paris, Daniel H.; Stephan, Femke; Bulder, Ingrid; Wouters, Diana; van der Poll, Tom; Newton, Paul N.; Day, Nicholas P. J.; Zeerleder, Sacha

    2015-01-01

    Cell-mediated immunity is essential in protection against rickettsial illnesses, but the role of neutrophils in these intracellular vasculotropic infections remains unclear. This study analyzed the plasma levels of nucleosomes, FSAP-activation (nucleosome-releasing factor), and neutrophil

  12. Dynawave froth scrubbing technology

    International Nuclear Information System (INIS)

    McLean, J.E.

    1989-01-01

    The DynaWave family of scrubbers was developed and patented by DuPont in the 1970's and is used extensively within the company. Because the technology was treated as confidential, information about the scrubbers was not published outside of DuPont. In 1986 Monsanto Enviro-Chem was asked to install a Reverse Jet scrubber at DuPont's Burnside spent acid recovery pant to replace an aging spray humidifying tower. Enviro-Chem was impressed with the technology and entered into a licensing agreement with DuPont in late 1987. This paper addresses the application of DynaWave froth scrubbing technology to metallurgical plant process and effluent gas streams. Froth scrubber design principles an sampling results from pilot plant trails on fluid bed roaster off-gas are presented

  13. [Poland: cholera to typhus, 1831-1950].

    Science.gov (United States)

    Balinska, M A

    1999-12-01

    In this article devoted to Poland's direct and indirect role in the elaboration of contemporary international health structures and to her reputation as an epidemic reservoir of Europe, we consider how Poland came to be perceived as the cordon sanitaire of the West. Traditionally seen as upholding Western values, in the 19th and 20th centuries the country became increasingly associated with "Eastern plagues"-cholera and then typhus-coming from Russia and which could spread to the rest of Europe if Poland did not manage to contain them. When Poland was reconstituted as a nation-state in 1918, the new country won international recognition through her successful attempts to contain a typhus epidemic sweeping westwards from Russia. The Polish government convened the first European, League sponsored, health conference following the First World War. A Polish doctor, L. RAJCHMAN, was chosen to head up the League of Nations Health Organisation (forerunner of the WHO) and later (1946) founded UNICEF. Finally, we examine the key issue of exanthematous typhus in both world wars, exemplifying how a disease can come to be "ideologized", in this case by Nazi Germany. Typhus was the pretext used- in the name of "public health"-for segregating Polish citizens of Jewish origin and even killing them. Paradoxically, typhus was in the process of being eradicated when the war began and German policy of mass resettlements, sequestration, and starvation only spurred the epidemic they supposedly wished to control.

  14. Reemergence of Murine Typhus in the US

    Centers for Disease Control (CDC) Podcasts

    2015-04-21

    Dr. Lucas Blanton discusses the Reemergence of Murine Typhus in Galveston Texas in 2013.  Created: 4/21/2015 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/27/2015.

  15. Improved Purex solvent scrubbing methods

    International Nuclear Information System (INIS)

    Mailen, J.C.; Tallent, O.K.

    1984-01-01

    Studies of hydrazine and hydroxylamine salts as solvent scrubbing agents that can be decomposed into gases are summarized. Results from testing of countercurrent scrubbers and solid sorber columns that produce lesser amounts of permanent salts are reported. The status of studies of the acid-degradation of paraffin diluent and the options for removal of long-chain organic acids is given

  16. Distribution of rats infected with Rickettsia tsutsugamushi (scrub typhus) in an edge habitat.

    Science.gov (United States)

    Muul, I; Chai, K S

    1978-12-01

    No focalization of rats (Rattus tiomanicus and R. argentiventer) infected with Rickettsia tsutsugamushi could be discerned over a 500 m trapping transect at the border between a forest and lalang grass (Imperata cylindrica). R. tiomanicus appeared to occupy 250 m of the transect on the average and had periods during which infections were observed which averaged 97 days. Calulations indicated that more than 50% of individuals become infected over their life-time. The high rate of infection in this and other areas described in earlier publications and the habits of the rats suggest that infected mites are densely and widely dispersed in the areas studied in Malaysia.

  17. Drought and Epidemic Typhus, Central Mexico, 1655–1918

    Science.gov (United States)

    Acuna-Soto, Rudofo; Stahle, David W.

    2014-01-01

    Epidemic typhus is an infectious disease caused by the bacterium Rickettsia prowazekii and transmitted by body lice (Pediculus humanus corporis). This disease occurs where conditions are crowded and unsanitary. This disease accompanied war, famine, and poverty for centuries. Historical and proxy climate data indicate that drought was a major factor in the development of typhus epidemics in Mexico during 1655–1918. Evidence was found for 22 large typhus epidemics in central Mexico, and tree-ring chronologies were used to reconstruct moisture levels over central Mexico for the past 500 years. Below-average tree growth, reconstructed drought, and low crop yields occurred during 19 of these 22 typhus epidemics. Historical documents describe how drought created large numbers of environmental refugees that fled the famine-stricken countryside for food relief in towns. These refugees often ended up in improvised shelters in which crowding encouraged conditions necessary for spread of typhus. PMID:24564928

  18. Murine Typhus: An Important Consideration for the Nonspecific Febrile Illness

    Directory of Open Access Journals (Sweden)

    Gurjot Basra

    2012-01-01

    Full Text Available Murine typhus is a widely distributed flea-borne infection caused by Rickettsia typhi. Symptoms of murine typhus are nonspecific and mimic a variety of other infectious diseases. We herein report a case of murine typhus in an area where the broad use of DDT in the mid-20th century has now made it a rare disease. The patient described presented with headache, fever, and a faint macular rash. Initial laboratory studies revealed a slight transaminase elevation. Further questioning revealed exposure to opossums, prompting the consideration of murine typhus as a diagnosis. Although typhus group antibodies were not present during the patient’s acute illness, empiric therapy with doxycycline was initiated, and the patient defervesced. One month after convalescence, the patient returned to clinic with serum that contained typhus group antibodies with an IgG titer of 1 : 1024. Murine typhus is an important consideration during the workup of a patient with a nonspecific febrile illness. Exposure to reservoir hosts and the flea vector place humans at risk for this disease. Clinician recognition of this entity is required for diagnosis and effective therapy.

  19. NOx retention in scrubbing column

    International Nuclear Information System (INIS)

    Nakazone, A.K.; Costa, R.E.; Lobao, A.S.T.; Matsuda, H.T.; Araujo, B.F.

    1988-07-01

    During the UO 2 dissolution in nitric acid, some different species of NO x are released. The off gas can either be refluxed to the dissolver or be released and retained on special columns. The final composition of the solution is the main parameter to take in account. A process for nitrous gases retention using scubber columns containing H 2 O or diluted HNO 3 is presented. Chemiluminescence measurement was employed to NO x evalution before and after scrubbing. Gas flow, temperature, residence time are the main parameters considered in this paper. For the dissolution of 100g UO 2 in 8M nitric acid, a 6NL/h O 2 flow was the best condition for the NO/NO 2 oxidation with maximum adsorption in the scrubber columns. (author) [pt

  20. Aerosol Scrubbing Performance Test for Self-Priming Scrubbing Nozzle Submerged in Water Pool

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Doo Yong; Jung, Woo Young; Lee, Hyun Chul; Lee, Jong Chan; Kim, Gyu Tae; Song, Yong Jae [FNC Technology Co., Yongin (Korea, Republic of)

    2016-10-15

    A scrubbing nozzle is one of the key components for a wet scrubber process based Containment Filtered Venting System (CFVS). As a part of a development of Korean CFVS, a self-priming scrubbing nozzle shown in Fig. 1 has been developed based on the well-known venturi scrubber concept. The thermal-hydraulic performances such as the pressure drop across the nozzle, water suction behavior and droplet generation inside throat have been tested in the non-submerged condition as well as submerged condition. The self-priming scrubbing nozzle used for the wet scrubber based CFVS has been developed, which is submerged in the water pool. When there is gas flow at the inlet of the nozzle, the pool water is passively sucked from the water suction slit. The fine droplets generated inside the throat capture the aerosol particles and is discharged into the water pool. In the water pool, the pool scrubbing happens. The aerosol scrubbing performance tests for the developed self-priming scrubbing nozzle has been conducted under the operational conditions such as different aerosol sizes, different carrier gas steam fractions, different, different pool water level and nozzle inlet pressure. The major findings are as follows. (1) Aerosol scrubbing efficiency increases with the increase of the aerosol size. (2) Aerosol scrubbing efficiency increases with the increase of the carrier gas steam fraction. (3) Aerosol scrubbing.

  1. Aerosol Scrubbing Performance Test for Self-Priming Scrubbing Nozzle Submerged in Water Pool

    International Nuclear Information System (INIS)

    Lee, Doo Yong; Jung, Woo Young; Lee, Hyun Chul; Lee, Jong Chan; Kim, Gyu Tae; Song, Yong Jae

    2016-01-01

    A scrubbing nozzle is one of the key components for a wet scrubber process based Containment Filtered Venting System (CFVS). As a part of a development of Korean CFVS, a self-priming scrubbing nozzle shown in Fig. 1 has been developed based on the well-known venturi scrubber concept. The thermal-hydraulic performances such as the pressure drop across the nozzle, water suction behavior and droplet generation inside throat have been tested in the non-submerged condition as well as submerged condition. The self-priming scrubbing nozzle used for the wet scrubber based CFVS has been developed, which is submerged in the water pool. When there is gas flow at the inlet of the nozzle, the pool water is passively sucked from the water suction slit. The fine droplets generated inside the throat capture the aerosol particles and is discharged into the water pool. In the water pool, the pool scrubbing happens. The aerosol scrubbing performance tests for the developed self-priming scrubbing nozzle has been conducted under the operational conditions such as different aerosol sizes, different carrier gas steam fractions, different, different pool water level and nozzle inlet pressure. The major findings are as follows. (1) Aerosol scrubbing efficiency increases with the increase of the aerosol size. (2) Aerosol scrubbing efficiency increases with the increase of the carrier gas steam fraction. (3) Aerosol scrubbing

  2. Association of Drought with Typhus Epidemics in Central Mexico

    Science.gov (United States)

    Acuna-Soto, R.; Stahle, D.; Villanueva Diaz, J.; Therrell, M.

    2007-05-01

    Typhus is an acute infectious disease caused by the bacteria Rickettsia prowazekii, which is transmitted among humans by the body lice (Pediculus humanus corporis). The disease is highly contagious and transmission is favored in populations living in crowded conditions. Under these circumstances, typhus transmission is facilitated by factors that favor the colonization and proliferation of body lice such as absence of personal hygiene and wearing the same clothes for long periods of time. Historically, periods of war and famine were associated with devastating epidemics with high mortality rates in many parts of the world. Central Mexico has a long record of typhus epidemics. In this region, at > 2000 meters above sea level, the disease was endemic and occurred with a seasonal pattern in winter, with occasional large epidemics. Recently, we completed a chronology of epidemics in Mexico. A total of 22 well-defined major typhus epidemics were identified between 1650 and 1920. All of them caused periods of increased mortality that lasted 2 - 4 years (more than one standard deviation from the previous ten year period). The record of typhus epidemics was evaluated against the tree-ring record of Cuauhtmoc La Fragua, Puebla. This chronology, based on Douglas fir, has demonstrated to be a faithful record of precipitation in central Mexico. The results indicate that a statistically significant drought (t test, p first year of all 22 large outbreaks of typhus in recent Mexican history. No distinction is made between times of peace and war. This indicates that drought alone was capable of inducing the social conditions for increased transmission of typhus in pre-industrial central Mexico.

  3. Epidemiology of Acute Q Fever, Scrub Typhus, and Murine Typhus, and Identification of Their Clinical Characteristics Compared to Patients with Acute Febrile Illness in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Chung-Hsu Lai

    2009-05-01

    Conclusion: In southern Taiwan, acute Q fever is the most common rickettsiosis. QSM diseases should be suspected in febrile patients who present with relative bradycardia, hepatomegaly, and elevated serum aminotransferases, but without leukocytosis.

  4. Investigation of Sylvatic Typhus at a Wilderness Camp

    Centers for Disease Control (CDC) Podcasts

    In this podcast, Dr. Greg Dasch discusses an outbreak of four cases of sylvatic typhus that occurred at a wilderness camp in Pennsylvania. Sylvatic typhus is very rare in the United States, with only 41 cases since it was discovered in the United States in 1975. Lab work at CDC and the discovery that all four camp counselors who became ill had slept in the same bunk at the camp between 2004 and 2006 ultimately led to confirmation that flying squirrels living in the wall of the cabin were to blame for the illnesses.

  5. FLY ASH RECYCLE IN DRY SCRUBBING

    Science.gov (United States)

    The paper describes the effects of fly ash recycle in dry scrubbing. (Previous workers have shown that the recycle of product solids improves the utilization of slaked lime--Ca(OH)2--for sulfur dioxide (SO2) removal by spray dryers with bag filters.) In laboratory-scale experimen...

  6. Pool scrubbing models for iodine components

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, K [Battelle Ingenieurtechnik GmbH, Eschborn (Germany)

    1996-12-01

    Pool scrubbing is an important mechanism to retain radioactive fission products from being carried into the containment atmosphere or into the secondary piping system. A number of models and computer codes has been developed to predict the retention of aerosols and fission product vapours that are released from the core and injected into water pools of BWR and PWR type reactors during severe accidents. Important codes in this field are BUSCA, SPARC and SUPRA. The present paper summarizes the models for scrubbing of gaseous Iodine components in these codes, discusses the experimental validation, and gives an assessment of the state of knowledge reached and the open questions which persist. The retention of gaseous Iodine components is modelled by the various codes in a very heterogeneous manner. Differences show up in the chemical species considered, the treatment of mass transfer boundary layers on the gaseous and liquid sides, the gas-liquid interface geometry, calculation of equilibrium concentrations and numerical procedures. Especially important is the determination of the pool water pH value. This value is affected by basic aerosols deposited in the water, e.g. Cesium and Rubidium compounds. A consistent model requires a mass balance of these compounds in the pool, thus effectively coupling the pool scrubbing phenomena of aerosols and gaseous Iodine species. Since the water pool conditions are also affected by drainage flow of condensate water from different regions in the containment, and desorption of dissolved gases on the pool surface is determined by the gas concentrations above the pool, some basic limitations of specialized pool scrubbing codes are given. The paper draws conclusions about the necessity of coupling between containment thermal-hydraulics and pool scrubbing models, and proposes ways of further simulation model development in order to improve source term predictions. (author) 2 tabs., refs.

  7. Pool scrubbing models for iodine components

    International Nuclear Information System (INIS)

    Fischer, K.

    1996-01-01

    Pool scrubbing is an important mechanism to retain radioactive fission products from being carried into the containment atmosphere or into the secondary piping system. A number of models and computer codes has been developed to predict the retention of aerosols and fission product vapours that are released from the core and injected into water pools of BWR and PWR type reactors during severe accidents. Important codes in this field are BUSCA, SPARC and SUPRA. The present paper summarizes the models for scrubbing of gaseous Iodine components in these codes, discusses the experimental validation, and gives an assessment of the state of knowledge reached and the open questions which persist. The retention of gaseous Iodine components is modelled by the various codes in a very heterogeneous manner. Differences show up in the chemical species considered, the treatment of mass transfer boundary layers on the gaseous and liquid sides, the gas-liquid interface geometry, calculation of equilibrium concentrations and numerical procedures. Especially important is the determination of the pool water pH value. This value is affected by basic aerosols deposited in the water, e.g. Cesium and Rubidium compounds. A consistent model requires a mass balance of these compounds in the pool, thus effectively coupling the pool scrubbing phenomena of aerosols and gaseous Iodine species. Since the water pool conditions are also affected by drainage flow of condensate water from different regions in the containment, and desorption of dissolved gases on the pool surface is determined by the gas concentrations above the pool, some basic limitations of specialized pool scrubbing codes are given. The paper draws conclusions about the necessity of coupling between containment thermal-hydraulics and pool scrubbing models, and proposes ways of further simulation model development in order to improve source term predictions. (author) 2 tabs., refs

  8. Macrofungi in the lateritic scrub jungles of southwestern India

    Directory of Open Access Journals (Sweden)

    A. A. Greeshma

    2015-09-01

    Full Text Available A pilot study on macrofungi in scrub jungles (with and without fire-impact in lateritic region of southwestern coast of India was carried out.  Out of 11 species in 10 genera recovered, six and five species were confined to scrub jungle and fire-impacted scrub jungle, respectively.  An ectomycorrhizal Amanita sp. was the most frequent in scrub jungle associated with exotic (Acacia auriculiformis and A. mangium and plantation (Anacardium occidentale trees.  Based on traditional knowledge, it is a highly edible and nutritional delicacy in the coastal regions.  Astraeus odoratus was another common ectomycorrhizal fungus in native trees Hopea ponga, which was recovered from the fire-impacted scrub jungle and is possibly edible.  Edible termite mound mushroom Termitomyces striatus was also common in the fire-impacted scrub jungle.  Chlorophyllum molybdites was the most frequent mushroom in the fire-impacted scrub jungle.  

  9. Immunogenicity of autoantigens

    Directory of Open Access Journals (Sweden)

    Keller Andreas

    2011-07-01

    Full Text Available Abstract Background Autoantibodies against self-antigens have been associated not only with autoimmune diseases, but also with cancer and are even found in healthy individuals. The mechanism causing the autoantibody response remains elusive for the majority of the immunogenic antigens. To deepen the understanding of autoantibody responses, we ask whether natural-occurring, autoimmunity-associated and tumor-associated antigens have structural or biological features related to the immune response. To this end, we have carried out the most comprehensive in-silicio study of different groups of autoantigens including large antigen sets identified by our groups combined with publicly available antigen sets. Results We found evidence for an enrichment of genes with a larger exon length increasing the probability of the occurrence of potential immunogenic features such as mutations, SNPs, immunogenic sequence patterns and structural epitopes, or alternative splicing events. While SNPs seem to play a more central role in autoimmunity, somatic mutations seem to be stronger enriched in tumor-associated antigens. In addition, antigens of autoimmune diseases are different from other antigen sets in that they appear preferentially secreted, have frequently an extracellular location, and they are enriched in pathways associated with the immune system. Furthermore, for autoantibodies in general, we found enrichment of sequence-based properties including coiled-coils motifs, ELR motifs, and Zinc finger DNA-binding motifs. Moreover, we found enrichment of proteins binding to proteins or nucleic acids including RNA and enrichment of proteins that are part of ribosome or spliceosome. Both, homologies to proteins of other species and an enrichment of ancient protein domains indicate that immunogenic proteins are evolutionary conserved and that mimicry might play a central role. Conclusions Our results provide evidence that proteins which i are evolutionary conserved

  10. Lymphadenopathy by scrub typhus mimicking metastasis on FDG PET/CT in a patient with a history of breast cancer

    International Nuclear Information System (INIS)

    Lee, Jeong Won; Lee, Sang Mi; Lee, Kyu Taek; Kim, Sung Young; Han, Sun Wook; Kim, Shin Young

    2015-01-01

    We report the case of a 60-year-old woman with left-sided breast cancer who showed lymphadenopathy mimicking metastatic lesions. She underwent surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) after treatment. PET/CT demonstrated multiple lymphadenopathies with increased FDG uptake, most notably in the right axilla. She had an eschar on the right axillary area, and her serologic test was positive for anti-Orientia tsutsugamushi IgM antibody. Ten months after the treatment, follow-up FDG PET/CT and ultrasonography showed improvement in generalized lymphadenopathy

  11. Lymphadenopathy by scrub typhus mimicking metastasis on FDG PET/CT in a patient with a history of breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Won [Dept. of Nuclear Medicine, Catholic Kwandong University International St. Mary' s Hospital, Incheon (Korea, Republic of); Lee, Sang Mi; Lee, Kyu Taek; Kim, Sung Young; Han, Sun Wook; Kim, Shin Young [Sooncheonhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

    2015-06-15

    We report the case of a 60-year-old woman with left-sided breast cancer who showed lymphadenopathy mimicking metastatic lesions. She underwent surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) after treatment. PET/CT demonstrated multiple lymphadenopathies with increased FDG uptake, most notably in the right axilla. She had an eschar on the right axillary area, and her serologic test was positive for anti-Orientia tsutsugamushi IgM antibody. Ten months after the treatment, follow-up FDG PET/CT and ultrasonography showed improvement in generalized lymphadenopathy.

  12. New advances in wet scrubbing improvement efficiencies

    Energy Technology Data Exchange (ETDEWEB)

    Keen, A.R. [Altech Group, Toronto, ON (Canada)

    2000-07-01

    Wet scrubbing systems are the most versatile and cost efficient of all air pollution abatement technologies. This paper presented System REITHER{sup TM} which is a new generation of venturi scrubber. The advantages of this design are that it is simple and compact, has high removal efficiencies for sub-micron dusts or aerosols and it is flexible to handle any mass flow rate. It also provides high and constant reliability, is easy to control and has the potential to absorb gaseous pollutants. Another advantage is that it can handle corrosive streams through corrosion resistant materials. Innovations in wet scrubbing have made it possible to provide reliable and efficient separation of fine particles, corrosive aerosols and gases. New technology provides industrial engineers with a cost effective option when control air emissions is required. 1 fig.

  13. Non-technical skills for scrub practitioners.

    Science.gov (United States)

    McClelland, Guy

    2012-12-01

    The non-technical skills of situational awareness and the formation of effective interpersonal relationships are essential to enhance surgical outcomes. However, most scrub practitioners demonstrate only tacit awareness of these skills and develop such qualities on an informal basis. Application of non-technical skills may be assessed formally, using a structured framework, to transform normative behaviour and to strengthen barriers against the latent threats that may result from fallible humans working in inadequate organisational systems.

  14. Simulation of pool scrubbing experiments using BUSCA

    International Nuclear Information System (INIS)

    Dehbi, A.; Guentay, S.

    1994-01-01

    BUSCA-PSI is a computer code which predicts the aerosol scrubbing taking place when gas bubbles containing fission products rise through stagnant pools of water after a postulated severe accident. A Lagrangian formulation is adopted to follow the path of a bubble as it rises toward the surface of the pool. The BUSCA model includes most aerosol removal mechanisms which are thought to be significant, namely: Jet Impaction at tile orifice, Convection/Diffusiophoresis during steam condensation, Thermophoresis, Sedimentation, Centrifugal Impaction during bubble rise, and Brownian Diffusion. The hydraulic modelling offers a variety of options for the initial globule volume, the stable bubble size, tile bubble rise velocity, and the bubble shape. The heat and mass transfer part of tile model uses correlations found in the relevant literature. BUSCA simulations were performed to determine the decontamination factor (DF) dependence on key aerosol and thermal hydraulic parameters. The decontamination factor increases with height, pool temperature subcooling, and steam content. The decontamination factor exhibits a parabolic dependence on the particle radius. At low particle sizes, the DF is high due to Brownian Diffusion which is the dominant removal mechanism. The DF hits a minimum and then increases with particle size as Centrifugal Impaction and Sedimentation become important. In separate calculations, BUSCA was used to the simulate the aerosol scrubbing experiments performed by EPRI. For cold pool tests, the predicted scrubbing efficiencies were in a good, conservative agreement with the data for both Tin and CsI, and the discrepancies were within the reported measurement errors. For hot pool tests, the code systematically underpredicted the scrubbing DF's; this is potentially due to condensation in the gas space above the pool, a situation not currently modelled by BUSCA. The code was also tested against data produced by the Tepco-Toshiba-Hitachi experiments. The

  15. Clear Liquor Scrubbing with Anhydrite Production

    International Nuclear Information System (INIS)

    Hargrove, O. W.; Carey, T. R.; Lowell, P. S.; Meserole, F. B.; Rhudy, R. G.; Feeley, Thomas J.

    1997-01-01

    The objective of this project to develop an advanced flue gas desulfurization (FGD) process that has decreased capital and operating costs, higher SO 2 removal efficiency, and better by-product solids quality than existing, commercially available technology. A clear liquor process (which uses a scrubbing liquid with no solids) will be used to accomplish this objective rather than a slurry liquor process (which contains solids). This clear liquor scrubbing (CLS) project is focused on three research areas: (1) Development of a clear liquor scrubbing process that uses a clear solution to remove SO 2 from flue gas and can be operated under inhibited-oxidation conditions; (2) Development of an anhydrite process that converts precipitated calcium sulfite to anhydrous calcium sulfate (anhydrite); and (3) Development of an alkali/humidification process to remove HCl from flue gas upstream of the FGD system. The anhydrite process also can be retrofit into existing FGD systems to produce a valuable by-product as an alternative to gypsum. This fits well into another of FETC's PRDA objectives of developing an advanced byproduct recovery subsystem capable of transforming SO 2 into a useable byproduct or high-volume valuable commodities of interest. This paper describes the proposed processes, outlines the test approach, and preliminary Phase I test results

  16. Investigation of Sylvatic Typhus at a Wilderness Camp

    Centers for Disease Control (CDC) Podcasts

    2009-06-30

    In this podcast, Dr. Greg Dasch discusses an outbreak of four cases of sylvatic typhus that occurred at a wilderness camp in Pennsylvania. Sylvatic typhus is very rare in the United States, with only 41 cases since it was discovered in the United States in 1975. Lab work at CDC and the discovery that all four camp counselors who became ill had slept in the same bunk at the camp between 2004 and 2006 ultimately led to confirmation that flying squirrels living in the wall of the cabin were to blame for the illnesses.  Created: 6/30/2009 by Emerging Infectious Diseases.   Date Released: 6/30/2009.

  17. Bartonella quintana and Typhus Group Rickettsiae Exposure among Homeless Persons, Bogotá, Colombia.

    Science.gov (United States)

    Faccini-Martínez, Álvaro A; Márquez, Andrea C; Bravo-Estupiñan, Diana M; Calixto, Omar-Javier; López-Castillo, Christian A; Botero-García, Carlos A; Hidalgo, Marylin; Cuervo, Claudia

    2017-11-01

    In 2015, we investigated Bartonella quintana and typhus group rickettsiae in body lice from homeless persons in Bogotá, Colombia. We found B. quintana-infected body lice and seroprevalence of this microorganism in 19% of homeless persons and typhus group rickettsiae in 56%. Public health professionals should start preemptive measures and active vector control.

  18. Murine typhus in two travelers returning from Bali, Indonesia: an underdiagnosed disease.

    Science.gov (United States)

    Takeshita, Nozomi; Imoto, Kazuya; Ando, Shuji; Yanagisawa, Kunio; Ohji, Goh; Kato, Yasuyuki; Sakata, Akiko; Hosokawa, Naoto; Kishimoto, Toshio

    2010-01-01

    Two Japanese travelers from Bali were diagnosed with murine typhus in Japan during the same period. Although one had only mild illness, the other experienced liver and kidney dysfunction. Murine typhus may be missed not only in endemic areas around the world, but also in travelers, especially those returning from marine resorts in these areas. © 2010 International Society of Travel Medicine.

  19. [Immunogenicity of biosimilars].

    Science.gov (United States)

    van Aerts, L A G J M; Franken, A A M; Leufkens, H G M

    2016-01-01

    Biosimilars of more complex recombinant protein drugs, such as monoclonal antibodies and fusion proteins, are entering the market. The manufacturer should demonstrate that its product does not show any relevant differences in terms of quality characteristics, biological activity, safety and efficacy compared to the reference product, as outlined in EMA guidelines. This should be established with an extensive comparability exercise. One aspect that is subject to particular scrutiny is the immunogenicity of the biosimilar and the reference medicinal product. For three cases, one etanercept and two infliximab biosimilars, we describe how data are assessed and an opinion is reached by authorities. Not in all cases unanimity exists whether all remaining uncertainties on biosimilarity have been resolved satisfactorily before marketing authorisation. The Dutch Medicines Evaluation Board therefore emphasises that even after marketing authorisation, biosimilars and other biologicals should be properly monitored.

  20. Geochemical modeling of magmatic gas scrubbing

    Directory of Open Access Journals (Sweden)

    B. Gambardella

    2005-06-01

    Full Text Available The EQ3/6 software package, version 7.2 was successfully used to model scrubbing of magmatic gas by pure water at 0.1 MPa, in the liquid and liquid-plus-gas regions. Some post-calculations were necessary to account for gas separation effects. In these post-calculations, redox potential was considered to be fixed by precipitation of crystalline a-sulfur, a ubiquitous and precocious process. As geochemical modeling is constrained by conservation of enthalpy upon water-gas mixing, the enthalpies of the gas species of interest were reviewed, adopting as reference state the liquid phase at the triple point. Our results confirm that significant emissions of highly acidic gas species (SO2(g, HCl(g, and HF(g are prevented by scrubbing, until dry conditions are established, at least locally. Nevertheless important outgassing of HCl(g can take place from acid, HCl-rich brines. Moreover, these findings support the rule of thumb which is generally used to distinguish SO2-, HCl-, and HF-bearing magmatic gases from SO2-, HCl-, and HF-free hydrothermal gases.

  1. SCRUB versus trade: Enemies or allies?

    International Nuclear Information System (INIS)

    Platt, J.B.

    1992-01-01

    Under the 1990 Clean Air Act Amendments (CAAA), scrubbing and emission allowance trading will play complementary roles. This paper reviews Phase I announced strategies and presents projections of technology controls, coal switching and industry-wide SO 2 removal costs under different assumptions about trading. The principal uncertainties characterizing today's planning environment are discussed -- ranging from changing expectations for fuel costs to swings in allowance prices and questions about regulation and new operating procedures. Economic forecasting is difficult. A clearer picture of Phase 2 strategies is emerging from EPRI's integrated analysis of fuel, technology and allowance markets -- based on collaboration between A. Van Horn and K. White (management consultants) and T. Hewson (Energy Ventures Analysis). About half the SO 2 reductions required in Phase 2 are likely to come from technology controls and half from coal switching. With trading, the highest cost open-quotes scrubsclose quotes and open-quotes switchesclose quotes can be avoided, more upgrading of low-cost scrubbing is expected, and the role of switching grows to a small extent. Additional benefits from trading, averaging and banking allowances are: better sequencing of technology controls, less stringent specs for equipment, and added flexibility/risk-sharing opportunities in contract arrangements

  2. Review and assessment of pool scrubbing models

    International Nuclear Information System (INIS)

    Herranz, L.E.; Escudero, M.J.; Peyres, V.; Polo, J.; Lopez-Jimenez, J.

    1996-01-01

    Decontamination of fission products bearing bubbles as they through aqueous pools becomes a crucial phenomenon for source term evaluation of hypothetical risk dominant sequences of Light Water Reactors. In the present report a peer review and assessment of models encapsulated in SPARC andBUSCA codes is presented. Several aspects of pool scrubbing have been addressed: particle removal, fission product vapour retention and bubble hydrodynamics. Particular emphasis has been given to the close link between retention and hydrodynamics, from both modelling and experimental point of view. In addition, RHR and SGTR sequences were simulated with SPARC90 and BUSCA-AUG92 codes, and their results were compared with those obtained with MAAP 3.0B.As a result of this work, model capabilities and shortcomings have beenassessed and some areas susceptible of further research have been identified.(Author) 73 refs

  3. Review and assessment of pool scrubbing models

    International Nuclear Information System (INIS)

    Herranz, L.E.; Escudero, M.J.; Peyres, V.; Polo, J.; Lopez, J.

    1996-01-01

    Decontamination of fission products bearing bubbles as they pass through aqueous pools becomes a crucial phenomenon for source term evaluation of hypothetical risk dominant sequences of Light Water Reactors. In the present report a peer review and assessment of models encapsulated in SPARC and BUSCA codes is presented. Several aspects of pool scrubbing have been addressed: particle removal, fission product vapour retention and bubble hydrodynamics. Particular emphasis has been given to the close link between retention and hydrodynamics, from both modelling and experimental point of view. In addition, RHR and SGTR sequences were simulated with SPARC90 and BUSCA-AUG92 codes, and their results were compared with those obtained with MAAP 3.0B. As a result of this work, model capabilities and shortcomings have been assessed and some areas susceptible of further research have been identified. (Author) 73 refs

  4. Review and assessment of pool scrubbing models

    Energy Technology Data Exchange (ETDEWEB)

    Herranz, L.E.; Escudero, M.J.; Peyres, V.; Polo, J.; Lopez, J.

    1996-07-01

    Decontamination of fission products bearing bubbles as they pass through aqueous pools becomes a crucial phenomenon for source term evaluation of hypothetical risk dominant sequences of Light Water Reactors. In the present report a peer review and assessment of models encapsulated in SPARC and BUSCA codes is presented. Several aspects of pool scrubbing have been addressed: particle removal, fission product vapour retention and bubble hydrodynamics. Particular emphasis has been given to the close link between retention and hydrodynamics, from both modelling and experimental point of view. In addition, RHR and SGTR sequences were simulated with SPARC90 and BUSCA-AUG92 codes, and their results were compared with those obtained with MAAP 3.0B. As a result of this work, model capabilities and shortcomings have been assessed and some areas susceptible of further research have been identified. (Author) 73 refs.

  5. Estimated effects of interfacial vaporization on fission product scrubbing

    International Nuclear Information System (INIS)

    Moody, F.J.; Nagy, S.G.

    1983-01-01

    When bubbles containing non-condensible gas rise through a water pool, interfacial evaporation causes a flow of vapor into the bubbles. The inflow reduces the outward particle motion toward the bubble wall, diminishing the effectiveness of fission product particle removal. This analysis provides an estimate of evaporation on pool scrubbing effectiveness. It is shown that hot gas, which boils water at the bubble wall, reduces the effective scrubbing height by less than five centimeters. Although the evaporative humidification in a rising bubble containing non-condensible gas has a diminishing effect on scrubbing mechanisms, substantial decontamination is still expected even for the limiting case of a saturated pool

  6. Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1,2.

    Science.gov (United States)

    Afzal, Zeeshan; Kallumadanda, Sunand; Wang, Feng; Hemmige, Vagish; Musher, Daniel

    2017-08-01

    Murine typhus occurs relatively commonly in southern Texas, as well as in California. We reviewed records of 90 adults and children in whom murine typhus was diagnosed during a 3-year period in 2 hospitals in southern Texas, USA. Most patients lacked notable comorbidities; all were immunocompetent. Initial signs and symptoms included fever (99%), malaise (82%), headache (77%), fatigue (70%), myalgias (68%), and rash (39%). Complications, often severe, in 28% of patients included bronchiolitis, pneumonia, meningitis, septic shock, cholecystitis, pancreatitis, myositis, and rhabdomyolysis; the last 3 are previously unreported in murine typhus. Low serum albumin and elevated procalcitonin, consistent with bacterial sepsis, were observed in >70% of cases. Rash was more common in children; thrombocytopenia, hyponatremia, elevated hepatic transaminases, and complications were more frequent in adults. Murine typhus should be considered as a diagnostic possibility in cases of acute febrile illness in southern and even in more northern US states.

  7. Mosaic HIV envelope immunogenic polypeptides

    Science.gov (United States)

    Korber, Bette T. M.; Gnanakaran, S.; Perkins, Simon; Sodroski, Joseph; Haynes, Barton

    2018-01-02

    Disclosed herein are mosaic HIV envelope (Env) polypeptides that can elicit an immune response to HIV (such as cytotoxic T cell (CTL), helper T cell, and/or humoral responses). Also disclosed are sets of the disclosed mosaic Env polypeptides, which include two or more (for example, three) of the polypeptides. Also disclosed herein are methods for treating or inhibiting HIV in a subject including administering one or more of the disclosed immunogenic polypeptides or compositions to a subject infected with HIV or at risk of HIV infection. In some embodiments, the methods include inducing an immune response to HIV in a subject comprising administering to the subject at least one (such as two, three, or more) of the immunogenic polypeptides or at least one (such as two, three, or more) nucleic acids encoding at least one of the immunogenic polypeptides disclosed herein.

  8. Development of Aerosol Scrubbing Test Loop for Containment Filtered Venting System

    International Nuclear Information System (INIS)

    Lee, Doo Yong; Jung, Woo Young; Lee, Hyun Chul; Lee, Jong Chan; Kim, Gyu Tae

    2016-01-01

    The scrubber tank is filled with scrubbing water with the chemical additives. The droplet separator based on a cyclone is installed above the scrubbing water pool to remove the large droplets that may clog a metal fiber filter installed at the upper section of the scrubber tank. The outlet piping is connected from the scrubber tank to the molecular sieve to chemically remove the gaseous iodine. The aerosol as a particle is physically captured in the scrubbing water pool passing through the scrubbing nozzle as well as the metal fiber filter. The gaseous iodine such as molecular iodine as well as organic iodide is chemically removed in the scrubbing water pool and molecular sieve. The thermal-hydraulic as well as scrubbing performance for the CFVS should be verified with the experiments. The experiment can be divided into the filtration component based experiment and whole system based one. In this paper, the aerosol scrubbing test loop developed to test the thermal-hydraulic and aerosol scrubbing performance of the scrubbing nozzle with the scrubbing water pool is introduced. The aerosol scrubbing test loop has been developed as a part of the Korean CFVS project. In this loop, the filtration components such as the scrubbing nozzle submerged in the scrubbing water pool as well as the cyclone as droplet separator can be tested under the CFVS operating conditions. The aerosol scrubbing performance of the filtration components including pool scrubbing behavior can be tested with the aerosol generation and feeding system and aerosol measurement system.

  9. Development of Aerosol Scrubbing Test Loop for Containment Filtered Venting System

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Doo Yong; Jung, Woo Young; Lee, Hyun Chul; Lee, Jong Chan; Kim, Gyu Tae [FNC Technology, Yongin (Korea, Republic of)

    2016-05-15

    The scrubber tank is filled with scrubbing water with the chemical additives. The droplet separator based on a cyclone is installed above the scrubbing water pool to remove the large droplets that may clog a metal fiber filter installed at the upper section of the scrubber tank. The outlet piping is connected from the scrubber tank to the molecular sieve to chemically remove the gaseous iodine. The aerosol as a particle is physically captured in the scrubbing water pool passing through the scrubbing nozzle as well as the metal fiber filter. The gaseous iodine such as molecular iodine as well as organic iodide is chemically removed in the scrubbing water pool and molecular sieve. The thermal-hydraulic as well as scrubbing performance for the CFVS should be verified with the experiments. The experiment can be divided into the filtration component based experiment and whole system based one. In this paper, the aerosol scrubbing test loop developed to test the thermal-hydraulic and aerosol scrubbing performance of the scrubbing nozzle with the scrubbing water pool is introduced. The aerosol scrubbing test loop has been developed as a part of the Korean CFVS project. In this loop, the filtration components such as the scrubbing nozzle submerged in the scrubbing water pool as well as the cyclone as droplet separator can be tested under the CFVS operating conditions. The aerosol scrubbing performance of the filtration components including pool scrubbing behavior can be tested with the aerosol generation and feeding system and aerosol measurement system.

  10. Separation of iodine from mercury containing scrubbing solutions

    Science.gov (United States)

    Burger, Leland L.; Scheele, Randall D.

    1979-01-01

    Radioactive iodines can be recovered from a nitric acid scrub solution containing mercuric nitrate by passing a current through the scrub solution to react the iodine with the mercuric nitrate to form mercuric iodate which precipitates out. The mercuric iodate can then be reacted to recover the radioiodine for further processing into a form suitable for long-term storage and to recover the mercury for recycling.

  11. Management of Florida Scrub for Threatened and Endangered Species

    Science.gov (United States)

    1998-12-01

    for Florida scrub: 1. The exotic species, cogon grass ( Imperata cylindrica), may become common in degraded scrubs. This is an aggressive, invasive...34Cogongrass, Imperata cylindrica (L.) Beauv.: A good grass gone bad!" Botany Circular No. 28, Florida Dept. Agric. & Consumer Services, Division of Plant...Industry, Gainesville, FL. Colvin, D.L., Gaffney, J., and Shilling, D. G. 1994. "Cogongrass ( Imperata cylindrica (L.) Beauv.) Biology, ecology and

  12. A Markov decision process for managing habitat for Florida scrub-jays

    Science.gov (United States)

    Johnson, Fred A.; Breininger, David R.; Duncan, Brean W.; Nichols, James D.; Runge, Michael C.; Williams, B. Ken

    2011-01-01

    Florida scrub-jays Aphelocoma coerulescens are listed as threatened under the Endangered Species Act due to loss and degradation of scrub habitat. This study concerned the development of an optimal strategy for the restoration and management of scrub habitat at Merritt Island National Wildlife Refuge, which contains one of the few remaining large populations of scrub-jays in Florida. There are documented differences in the reproductive and survival rates of scrubjays among discrete classes of scrub height (Markov models to estimate annual transition probabilities among the four scrub-height classes under three possible management actions: scrub restoration (mechanical cutting followed by burning), a prescribed burn, or no intervention. A strategy prescribing the optimal management action for management units exhibiting different proportions of scrub-height classes was derived using dynamic programming. Scrub restoration was the optimal management action only in units dominated by mixed and tall scrub, and burning tended to be the optimal action for intermediate levels of short scrub. The optimal action was to do nothing when the amount of short scrub was greater than 30%, because short scrub mostly transitions to optimal height scrub (i.e., that state with the highest demographic success of scrub-jays) in the absence of intervention. Monte Carlo simulation of the optimal policy suggested that some form of management would be required every year. We note, however, that estimates of scrub-height transition probabilities were subject to several sources of uncertainty, and so we explored the management implications of alternative sets of transition probabilities. Generally, our analysis demonstrated the difficulty of managing for a species that requires midsuccessional habitat, and suggests that innovative management tools may be needed to help ensure the persistence of scrub-jays at Merritt Island National Wildlife Refuge. The development of a tailored monitoring

  13. Immunogenic and non-immunogenic hyperthyroidism - a comparison

    International Nuclear Information System (INIS)

    Pohl, M.; Emrich, D.

    1993-01-01

    In a retrospective study 161 hyperthyroid patients without treatment were divided into 74 with immunogenic hyperthyroidism (IMH) and 87 with non-immunogenic hypethyroidism (NIMH). The frequency of complaints and the mean hormone concentrations were significantly higher in IMH and the median thyroid volume was significantly smaller. Diffusely reduced sonographic echos were observed in only 50% of patients with IMH compared to 5% of those with NIMH. Homogenous distribution of 99m Tc in the thyroid was observed scintigraphically in 95% of patients with IMH and in only 3% of those with NIMH. Although the median of global thyroid uptake of 99m Tc was significantly higher in IMH there was a broad overlap between the two groups. The mean hormone production is higher in IMH than in NIMH. In order to separate IMH and NIMH, several criteria have to be employed which differ concerning their diagnostic significance. (orig.) [de

  14. Thermal-Hydraulic Performance of Scrubbing Nozzle Used for CFVS

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Chul; Lee, Doo Yong; Jung, Woo Young; Lee, Jong Chan; Kim, Gyu Tae [FNC TECH, Yongin (Korea, Republic of)

    2016-05-15

    A Containment Filtered Venting System (CFVS) is the most interested device to mitigate a threat against containment integrity under the severe accident of nuclear power plant by venting with the filtration of the fission products. FNC technology and partners have been developed the self-priming scrubbing nozzle used for the CFVS which is based on the venturi effect. The thermal-hydraulic performances such as passive scrubbing water suction as well as pressure drop across the nozzle have been tested under various thermal-hydraulic conditions. The two types of test section have been built for testing the thermal-hydraulic performance of the self-priming scrubbing nozzle. Through the visualization loop, the liquid suction performance through the slit, pressure drop across the nozzle are measured. The passive water suction flow through the suction slit at the throat is important parameter to define the scrubbing performance of the self-priming scrubbing nozzle. The water suction flow is increased with the increase of the overhead water level at the same inlet gas flow. It is not so much changed with the change of inlet gas flow at the overhead water level.

  15. Typhus Exanthematicus in Romania During the Second World War (1940-1945) Reflected by Romanian Medical Journals of the Time.

    Science.gov (United States)

    Jeican, Ionuţ Isaia; Botiş, Florin Ovidiu; Gheban, Dan

    2015-01-01

    This article provides a picture of exanthematic Typhus in Romania during the Second World War: epidemiological aspects of this disease in the inner zone and in the zone of military operations, as well as information about the diagnosis, treatment and prophylaxis of the Typhus in our country during this period.

  16. Chest radiographic findings of tsutsugamushi disease and murine typhus in Chunchon

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Heung Chul; Han, Tae Giun; Jang, Won Ho; Hwang, Woo Chul; Park, Man Soo; Lee, Myoung Gu; Kim, Yoon Won [School of Medicine, Hallym University, Chuncheon (Korea, Republic of); Park, Choong Ki [College of Medicine, Hanyang University, Guri (Korea, Republic of)

    1995-06-15

    To evaluate the chest radiographic findings of rickettsial disease including murine typhus and tsutsugamushi disease in Chunchon. Chest radiographic films of 81 cases diagnosed as rickettsial disease(55 cases of tsutsugamushi disease, 26 cases of murine typhus) by immunofluorescence test were retrospectively analyzed. Main serotypes of Rickettsia tsutsugamushi were Gilliam and Karp. Incidence rate of tsutsugamushi disease was 2.1 times greater than that of murine typhus. Chest radiographs were abnormal in 63.6% of tsutsugamushi disease, and in 30.8% of murine typhus. Radiographic findings were Kerly's B line, reticulonodular densities, hilar enlargement, pleural effusion, and splenomegaly in both entities, but pulmonary consolidation was only found in tsutsugamushi disease. The patients with the abnormal radiographic findings were statistically well correlated with cardiomegaly ({rho} < 0.01) and azygos engorgement ({rho} < 0.05), as compared to the patients with normal radiographic findings. Radiographic findings of both murine typhus and tsutsugamushi disease were interstitial pattern. But the chest radiographs in patients with tsutsugamushi disease showed more severe pattern with higher rate of abnormality.

  17. Chest radiographic findings of tsutsugamushi disease and murine typhus in Chunchon

    International Nuclear Information System (INIS)

    Kim, Heung Chul; Han, Tae Giun; Jang, Won Ho; Hwang, Woo Chul; Park, Man Soo; Lee, Myoung Gu; Kim, Yoon Won; Park, Choong Ki

    1995-01-01

    To evaluate the chest radiographic findings of rickettsial disease including murine typhus and tsutsugamushi disease in Chunchon. Chest radiographic films of 81 cases diagnosed as rickettsial disease(55 cases of tsutsugamushi disease, 26 cases of murine typhus) by immunofluorescence test were retrospectively analyzed. Main serotypes of Rickettsia tsutsugamushi were Gilliam and Karp. Incidence rate of tsutsugamushi disease was 2.1 times greater than that of murine typhus. Chest radiographs were abnormal in 63.6% of tsutsugamushi disease, and in 30.8% of murine typhus. Radiographic findings were Kerly's B line, reticulonodular densities, hilar enlargement, pleural effusion, and splenomegaly in both entities, but pulmonary consolidation was only found in tsutsugamushi disease. The patients with the abnormal radiographic findings were statistically well correlated with cardiomegaly (ρ < 0.01) and azygos engorgement (ρ < 0.05), as compared to the patients with normal radiographic findings. Radiographic findings of both murine typhus and tsutsugamushi disease were interstitial pattern. But the chest radiographs in patients with tsutsugamushi disease showed more severe pattern with higher rate of abnormality

  18. Lysis of typhus-group rickettsia-infected targets by lymphokine activated killers

    International Nuclear Information System (INIS)

    Carl, M.; Dasch, G.A.

    1986-01-01

    The authors recently described a subset of OKT8, OKT3-positive lymphocytes from typhus-group rickettsia immune individuals which were capable of lysing autologous PHA-blasts or Epstein-Barr virus transformed B cells (LCL) infected with typhus-group rickettsiae. In order to determine if killing by these effectors was HLA-restricted, they stimulated peripheral blood mononuclear cells (PBMC) from typhus-group rickettsia immune individuals in vitro with typhus-group rickettsia-derived antigen for one week and then measured lysis of autologous LCL or HLA-mismatched LCL in a 4-6 hour Cr 51 -release assay. There was significant lysis of both the autologous and the HLA-mismatched infected targets as compared to the corresponding uninfected targets. Since this suggested that the effectors were lymphokine activated killers (LAK) rather than cytotoxic T lymphocytes, they then tested this hypothesis by stimulating PBMC from both immune and non-immune individuals in vitro for one week with purified interleukin 2 and measuring lysis of infected, autologous LCL. PBMC thus treated, from both immune and non-immune individuals, were capable of significantly lysing autologous, infected LCL as compared to the non-infected control. They therefore conclude that targets infected with typhus-group rickettsiae are susceptible to lysis to LAK

  19. Chest radiographic findings of tsutsugamushi disease and murine typhus in Chunchon

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Heung Chul; Han, Tae Giun; Jang, Won Ho; Hwang, Woo Chul; Park, Man Soo; Lee, Myoung Gu; Kim, Yoon Won [School of Medicine, Hallym University, Chuncheon (Korea, Republic of); Park, Choong Ki [College of Medicine, Hanyang University, Guri (Korea, Republic of)

    1995-06-15

    To evaluate the chest radiographic findings of rickettsial disease including murine typhus and tsutsugamushi disease in Chunchon. Chest radiographic films of 81 cases diagnosed as rickettsial disease(55 cases of tsutsugamushi disease, 26 cases of murine typhus) by immunofluorescence test were retrospectively analyzed. Main serotypes of Rickettsia tsutsugamushi were Gilliam and Karp. Incidence rate of tsutsugamushi disease was 2.1 times greater than that of murine typhus. Chest radiographs were abnormal in 63.6% of tsutsugamushi disease, and in 30.8% of murine typhus. Radiographic findings were Kerly's B line, reticulonodular densities, hilar enlargement, pleural effusion, and splenomegaly in both entities, but pulmonary consolidation was only found in tsutsugamushi disease. The patients with the abnormal radiographic findings were statistically well correlated with cardiomegaly ({rho} < 0.01) and azygos engorgement ({rho} < 0.05), as compared to the patients with normal radiographic findings. Radiographic findings of both murine typhus and tsutsugamushi disease were interstitial pattern. But the chest radiographs in patients with tsutsugamushi disease showed more severe pattern with higher rate of abnormality.

  20. A dermatologist guide to immunogenicity

    Directory of Open Access Journals (Sweden)

    Collin M. Blattner, DO

    2016-09-01

    Full Text Available Dermatologists should be aware that autoantibody formation may occur after the initiation of biologic therapy. This phenomenon has been referred to as immunogenicity and biologic fatigue. Because of this, patients may experience loss of clinical efficacy to a particular drug. To combat this phenomenon, low-dose immunomodulators may be used in hopes of preventing autoantibodies. We review the current literature and provide a basic treatment algorithm for patients with moderate to severe psoriasis.

  1. Immunogenic and non-immunogenic hyperthyroidism - a comparison. Immunogene und nichtimmunogene Hyperthyreose - ein Vergleich

    Energy Technology Data Exchange (ETDEWEB)

    Pohl, M. (Abt. Nuklearmedizin in Zentrum Radiologie, Georg-August-Univ., Goettingen (Germany)); Emrich, D. (Abt. Nuklearmedizin in Zentrum Radiologie, Georg-August-Univ., Goettingen (Germany))

    1993-08-01

    In a retrospective study 161 hyperthyroid patients without treatment were divided into 74 with immunogenic hyperthyroidism (IMH) and 87 with non-immunogenic hypethyroidism (NIMH). The frequency of complaints and the mean hormone concentrations were significantly higher in IMH and the median thyroid volume was significantly smaller. Diffusely reduced sonographic echos were observed in only 50% of patients with IMH compared to 5% of those with NIMH. Homogenous distribution of [sup 99m]Tc in the thyroid was observed scintigraphically in 95% of patients with IMH and in only 3% of those with NIMH. Although the median of global thyroid uptake of [sup 99m]Tc was significantly higher in IMH there was a broad overlap between the two groups. The mean hormone production is higher in IMH than in NIMH. In order to separate IMH and NIMH, several criteria have to be employed which differ concerning their diagnostic significance. (orig.)

  2. Relapse rate following antithyroid drug therapy of immunogenic and non-immunogenic hyperthyroidism

    International Nuclear Information System (INIS)

    Voth, E.; Dickmann, N.; Schicha, H.; Emrich, D.

    1990-01-01

    Data of 196 patients treated for hyperthyroidism exclusively with anthyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogenic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p [de

  3. Quality of surgical scrub in a heart hospital: Do not take it for granted

    Directory of Open Access Journals (Sweden)

    Leila Abdollahi

    2017-09-01

    Full Text Available Introduction: The role of scrub in the prevention of post-surgery infections is well-known. This study aimed to investigate the inputs and process of surgical scrub in operating rooms of the largest heart hospital of northwest Iran. Methods: This study took place with a before-after design as a clinical audit in 2014. A check list developed based on national and international standards of surgical hand scrub was used as the study instrument. Checklists were completed by observation of surgical team scrubbing in real situation. Descriptive statistics and graphs were used to describe the results. Results: A compliance degree with the standards for prerequisites, equipment, general items, process and time of scrub was observed as 58%, 55%, 33%, 68% and 22%, respectively. The compliance degree after the intervention was 72%, 66%, 66%, 85% and 61%, respectively. Improvement was observed in all studied aspects of scrub. The total score of compliance with the standards changed from 47% to 70%. The main issues were incorrect order of scrubbing the areas of the hands, incorrect way of scrubbing the arms, insufficient scrubbing the arms (not above elbow, and lack of awareness about hospital’s policy on scrub time. Conclusion: The results showed defects in the surgical scrub of the studied hospital and that the compliance with the standards can be improved by simple interventions. Periodical audit and observation of the scrub and then feedback is recommended.

  4. Quality of surgical scrub in a heart hospital: Do not take it for granted.

    Science.gov (United States)

    Abdollahi, Leila; Tabrizi, Jafar Sadegh; Jodati, Ahmadreza; Safaie, Naser; Moradi-Joo, Mohammad; Daemi, Amin

    2017-01-01

    Introduction: The role of scrub in the prevention of post-surgery infections is well-known. This study aimed to investigate the inputs and process of surgical scrub in operating rooms of the largest heart hospital of northwest Iran. Methods: This study took place with a before-after design as a clinical audit in 2014. A check list developed based on national and international standards of surgical hand scrub was used as the study instrument. Checklists were completed by observation of surgical team scrubbing in real situation. Descriptive statistics and graphs were used to describe the results. Results: A compliance degree with the standards for prerequisites, equipment, general items, process and time of scrub was observed as 58%, 55%, 33%, 68% and 22%, respectively. The compliance degree after the intervention was 72%, 66%, 66%, 85% and 61%, respectively. Improvement was observed in all studied aspects of scrub. The total score of compliance with the standards changed from 47% to 70%. The main issues were incorrect order of scrubbing the areas of the hands, incorrect way of scrubbing the arms, insufficient scrubbing the arms (not above elbow), and lack of awareness about hospital's policy on scrub time. Conclusion: The results showed defects in the surgical scrub of the studied hospital and that the compliance with the standards can be improved by simple interventions. Periodical audit and observation of the scrub and then feedback is recommended.

  5. Detection of a typhus group Rickettsia in Amblyomma ticks in the state of Nuevo Leon, Mexico.

    Science.gov (United States)

    Medina-Sanchez, Aaron; Bouyer, Donald H; Alcantara-Rodriguez, Virginia; Mafra, Claudio; Zavala-Castro, Jorge; Whitworth, Ted; Popov, Vsevolod L; Fernandez-Salas, Ildefonso; Walker, David H

    2005-12-01

    The state of Nuevo Leon, Mexico has had outbreaks of typhus group rickettsiosis, most recently recognized in 1997. Evaluation of the sera of 345 patients with a dengue-like illness revealed that 25.5% had antibodies reactive with typhus group rickettsiae and 16% had antibodies to Rickettsia parkeri. Rickettsiae were detected by PCR and shell-vial isolations in the field-collected Amblyomma ticks. Molecular characterization by DNA sequence analysis of the gltA, ompB, and 17-kDa gene identified the organisms to be R. prowazekii.

  6. The lived experiences of operating theatre scrub nurses learning technical scrub skills 'I'm doing this right, aren't I? Am I doing this right?'

    Science.gov (United States)

    Radford, Eleanor J; Fotis, Theo

    2018-01-01

    Operating theatre scrub nurses (OTSNs) are not required to have undertaken a secondary or specialist post-registration theatre qualification to work in the operating theatre (OT) setting in the UK. From the systematic review there is only very limited literature or research in how technical scrub skills are acquired. This study explores the lived experiences of OTSNs learning technical scrub skills. The study employed the qualitative methodology of interpretative phenomenological analysis. Data was collected from six participating OTSNs using semi-structured interviews. Four superordinate themes emerged: How technical scrub skills are established, Gatekeepers, How the learner feels whilst learning and, Reflections of the experienced scrub nurse. The study found that the experiences of OTSNs learning technical scrub skills are varied and a variety of teaching and learning methods are utilised. These experiences were influenced by the team, mentor and surgeon within the OT environment. Lived experiences were also influenced by organisational structure and service pressures within the NHS.

  7. Simultaneous stack-gas scrubbing and waste water treatment

    Science.gov (United States)

    Poradek, J. C.; Collins, D. D.

    1980-01-01

    Simultaneous treatment of wastewater and S02-laden stack gas make both treatments more efficient and economical. According to results of preliminary tests, solution generated by stack gas scrubbing cycle reduces bacterial content of wastewater. Both processess benefit by sharing concentrations of iron.

  8. Temperature dependent fission product removal efficiency due to pool scrubbing

    Energy Technology Data Exchange (ETDEWEB)

    Uchida, Shunsuke, E-mail: suchida@iae.or.jp [Institute of Applied Energy, 1-14-2, Nishi-Shimbashi, Minato-ku, Tokyo 105-0003 (Japan); Itoh, Ayumi; Naitoh, Masanori; Okada, Hidetoshi; Suzuki, Hiroyuki [Institute of Applied Energy, 1-14-2, Nishi-Shimbashi, Minato-ku, Tokyo 105-0003 (Japan); Hanamoto, Yukio [KAKEN, Inc., 1044, Hori-machi, Mito 310-0903 (Japan); Osakabe, Masahiro [Tokyo University of Marine Science & Technology, Koutou-ku, Tokyo 135-8533 (Japan); Fujikawa, Masahiro [Japan Broadcasting Corporation, 2-2-1, Jinnan, Shibuya-ku, Tokyo 150-8001 (Japan)

    2016-03-15

    Highlights: • Pool temperature effects on the FP removal were not clearly concluded in the previous publications. • It was confirmed that the removal efficiency decreased with temperature around the boiling point. • A modified empirical formula for FP removal was proposed as a function of sub-cooling temperature. • DF could be predicted with an accuracy within a factor of 2 with the proposed formula. - Abstract: The wet-well of boiling water reactors plays important roles not only to suppress the pressure in the primary containment vessel due to steam scrubbing effects during severe accidents but also to mitigate release of radioactive fission products (FP), aerosols and particulates, into the environment. The effects of steam scrubbing in the wet-well on FP removal have been well studied and reported by changing major parameters determining the removal efficiencies, e.g., aerosol diameters, submergence (depth of scrubbing nozzles) and steam/non-condensable gas volume fraction. Unfortunately, the effects of pool temperature on the FP removal were not clearly concluded in the previous publications, though it would be easily expected that boiling in the pool resulted in reduced aerosol removal efficiency. In order to determine the temperature effects on FP removal efficiency, amounts of cesium in aerosols released from scrubbing pool were measured by changing pool temperature in mini and medium scale scrubbing experiments, and then, it was confirmed that the removal efficiency clearly decreased with temperature around the boiling point. Then, a modified empirical formula to express the FP removal around the boiling point temperature was proposed as a function of sub-cooling temperature by applying the effective steam volume fraction, which was designated as the volume ratio of condensed steam in the pool versus the sum of input steam and non-condensable gas. By comparing the measured removal efficiency with the calculated, it was validated that the

  9. Temperature dependent fission product removal efficiency due to pool scrubbing

    International Nuclear Information System (INIS)

    Uchida, Shunsuke; Itoh, Ayumi; Naitoh, Masanori; Okada, Hidetoshi; Suzuki, Hiroyuki; Hanamoto, Yukio; Osakabe, Masahiro; Fujikawa, Masahiro

    2016-01-01

    Highlights: • Pool temperature effects on the FP removal were not clearly concluded in the previous publications. • It was confirmed that the removal efficiency decreased with temperature around the boiling point. • A modified empirical formula for FP removal was proposed as a function of sub-cooling temperature. • DF could be predicted with an accuracy within a factor of 2 with the proposed formula. - Abstract: The wet-well of boiling water reactors plays important roles not only to suppress the pressure in the primary containment vessel due to steam scrubbing effects during severe accidents but also to mitigate release of radioactive fission products (FP), aerosols and particulates, into the environment. The effects of steam scrubbing in the wet-well on FP removal have been well studied and reported by changing major parameters determining the removal efficiencies, e.g., aerosol diameters, submergence (depth of scrubbing nozzles) and steam/non-condensable gas volume fraction. Unfortunately, the effects of pool temperature on the FP removal were not clearly concluded in the previous publications, though it would be easily expected that boiling in the pool resulted in reduced aerosol removal efficiency. In order to determine the temperature effects on FP removal efficiency, amounts of cesium in aerosols released from scrubbing pool were measured by changing pool temperature in mini and medium scale scrubbing experiments, and then, it was confirmed that the removal efficiency clearly decreased with temperature around the boiling point. Then, a modified empirical formula to express the FP removal around the boiling point temperature was proposed as a function of sub-cooling temperature by applying the effective steam volume fraction, which was designated as the volume ratio of condensed steam in the pool versus the sum of input steam and non-condensable gas. By comparing the measured removal efficiency with the calculated, it was validated that the

  10. Etiology of Acute, Non-Malaria, Febrile Illnesses in Jayapura, Northeastern Papua, Indonesia

    Science.gov (United States)

    2012-01-01

    resistance and unnecessary mor- bidity and mortality. There are limited data on the epidemiology of other febrile illnesses in Papua. Scrub typhus ...World War. 4, 5 In the Dutch colonial era, there were descriptions of several infections, including scrub typhus , leptospirosis, gran- uloma inguinale...paired serologic samples analysis for dengue, Japanese encephalitis, leptospirosis, scrub typhus , murine typhus , and spotted fever group rickettsia

  11. Enhancing poxvirus vectors vaccine immunogenicity.

    Science.gov (United States)

    García-Arriaza, Juan; Esteban, Mariano

    2014-01-01

    Attenuated recombinant poxvirus vectors expressing heterologous antigens from pathogens are currently at various stages in clinical trials with the aim to establish their efficacy. This is because these vectors have shown excellent safety profiles, significant immunogenicity against foreign expressed antigens and are able to induce protective immune responses. In view of the limited efficacy triggered by some poxvirus strains used in clinical trials (i.e, ALVAC in the RV144 phase III clinical trial for HIV), and of the restrictive replication capacity of the highly attenuated vectors like MVA and NYVAC, there is a consensus that further improvements of these vectors should be pursuit. In this review we considered several strategies that are currently being implemented, as well as new approaches, to improve the immunogenicity of the poxvirus vectors. This includes heterologous prime/boost protocols, use of co-stimulatory molecules, deletion of viral immunomodulatory genes still present in the poxvirus genome, enhancing virus promoter strength, enhancing vector replication capacity, optimizing expression of foreign heterologous sequences, and the combined use of adjuvants. An optimized poxvirus vector triggering long-lasting immunity with a high protective efficacy against a selective disease should be sought.

  12. A Markov decision process for managing habitat for Florida scrub-jays

    Science.gov (United States)

    Johnson, Fred A.; Breininger, David R.; Duncan, Brean W.; Nichols, James D.; Runge, Michael C.; Williams, B. Ken

    2011-01-01

    Florida scrub-jays Aphelocoma coerulescens are listed as threatened under the Endangered Species Act due to loss and degradation of scrub habitat. This study concerned the development of an optimal strategy for the restoration and management of scrub habitat at Merritt Island National Wildlife Refuge, which contains one of the few remaining large populations of scrub-jays in Florida. There are documented differences in the reproductive and survival rates of scrubjays among discrete classes of scrub height (strategy that would maximize the long-term growth rate of the resident scrub-jay population. We used aerial imagery with multistate Markov models to estimate annual transition probabilities among the four scrub-height classes under three possible management actions: scrub restoration (mechanical cutting followed by burning), a prescribed burn, or no intervention. A strategy prescribing the optimal management action for management units exhibiting different proportions of scrub-height classes was derived using dynamic programming. Scrub restoration was the optimal management action only in units dominated by mixed and tall scrub, and burning tended to be the optimal action for intermediate levels of short scrub. The optimal action was to do nothing when the amount of short scrub was greater than 30%, because short scrub mostly transitions to optimal height scrub (i.e., that state with the highest demographic success of scrub-jays) in the absence of intervention. Monte Carlo simulation of the optimal policy suggested that some form of management would be required every year. We note, however, that estimates of scrub-height transition probabilities were subject to several sources of uncertainty, and so we explored the management implications of alternative sets of transition probabilities. Generally, our analysis demonstrated the difficulty of managing for a species that requires midsuccessional habitat, and suggests that innovative management tools may be needed to

  13. Nursing typhus victims in the Second World War, 1942-1944: a discussion paper.

    Science.gov (United States)

    Brooks, Jane

    2014-07-01

    This article explores the care British nurses provided to victims of typhus during the Second World War. Typhus is associated with poverty and overcrowding. During wars in the pre-antibiotic era, civilians were particularly susceptible to epidemics, which military governments feared would spread to their troops. This discussion paper draws on archival data from three typhus epidemics in the Second World War to examine the expert work of British nurses in caring for victims during these potential public health disasters. The published sources for the paper include material from nursing and medical journals published between 1940-1947. Archival sources come from the National Archives in Kew, the Wellcome Library and the Army Medical Services Museum, between 1943-1945. Of particular interest is the correspondence with Dame Katharine Jones from nurses on active service overseas. Whilst epidemics of typhus are now rare, nurses in the present day may be required to care for the public in environments of extreme poverty and overcrowding, where life-threatening infectious diseases are prevalent. This article has demonstrated that it is possible for expert and compassionate nursing to alleviate suffering and prevent death, even when medical technologies are unavailable. Expert and compassionate care, adequate nutrition and hydration and attention to hygiene needs are crucial when there are limited pharmacological treatments and medical technologies available to treat infectious diseases. The appreciation of this could have implications for nurses working in current global conflicts. © 2013 John Wiley & Sons Ltd.

  14. Isolation and Characterization of Orientia tsutsugamushi from Rodents Captured following a Scrub Typhus Outbreak at a Military Training Base, Bothong District, Chonburi Province, Central Thailand

    Science.gov (United States)

    2011-01-01

    Faculty o[Sc:ience, Chiang Mai University, Chiang Mai , Thailand; Armed Force)’ Research Institute o[ Medical Science, Royal Thai Army, Bangkok...Science and the Graduate school, Chiang Mai University Thailand, the Armed Forces Research Institute of Medical Science (AFRIMS) Royal Thai Army...mail: A_Pasartvit@yahoo.com. Araya Jatisatienr and Chaiwat Jatisatienr, Department of Biology. Faculty of Science, Chiang Mai University, Muang

  15. Immunogenicity of Anti-TNF-α Biotherapies

    DEFF Research Database (Denmark)

    Bendtzen, Klaus

    2015-01-01

    Immunogenicity of biopharmaceuticals is complex and influenced by both structural and pharmacological factors, and by patient-related conditions such as disease being treated, previous and concomitant therapies, and individual immune responsiveness. Essential for tailored therapeutic strategies b...

  16. Adaptation of a tool to assess non-technical skills of scrub practitioners in Denmark.

    Science.gov (United States)

    Mundt, Anna Sofie; Spanager, Lene; Lyk-Jensen, Helle Teglgaard; Østergaard, Doris

    2017-09-01

    The aim of this study was to adapt the Scottish tool, Scrub Practitioners List of Intraoperative Non-Technical Skills, to Danish organisation and culture. With an explorative and qualitative approach, four group interviews with scrub practitioners, surgeons and anaesthesia staff were conducted. The main differences found were related to communication and teamwork regarding scrub practitioners focus on the team and speaking up. Differences in the non-technical skills described in the behavioural markers are perhaps explained by cultural differences between Scotland and Denmark. A new tool for scrub practitioners in Denmark was adapted. Copyright the Association for Perioperative Practice.

  17. Indian tick typhus presenting with gangrene: a case report from an urban slum of Delhi.

    Science.gov (United States)

    Kumar, Manish; Singh, Raghvendra; Yadav, Mukesh

    2014-01-01

    Indian Tick Typhus has been rarely reported in children from Delhi. A 10-y-old male child from Delhi presented with fever, non specific gastrointestinal symptoms, petechial rash and gangrene of all the toes. Possibility of rickettsial infection was entertained after the child failed to improve with best of the antibiotics. Sample for serology for rickettsial infection was sent and Doxycycline was started empirically. He became afebrile within 72 h of starting Doxycycline. Later, diagnosis of Indian Tick Typhus was confirmed on the basis of IgM positivity against Rickettsia conori. Possibility of rickettsial infection should be entertained in children with history of fever and skin rash, especially if the child fails to improve with a course of antibiotics and common infectious etiologies have been ruled out.

  18. Pool scrubbing and hydrodynamic experiments on jet injection regime

    International Nuclear Information System (INIS)

    Peyres, V.; Espigares, M.M.; Polo, J.; Escudero, M.J.; Herranz, L.E.; Lopez-Jimenez, J.

    1995-01-01

    Plant analyses have shown that pool scrubbing can play an important role in source term during PWR risk dominant sequences. An examination ofboundary conditions governing fission products and aerosols transport through aqueous beds revealed that most of radioactivity is discharged into the pool under jet injection regime. This fact and the lack of experimental data under such conditions pointed the need of setting out an experimental programme which provided reliable experimental data to validate code models. In this report the major results of a pool scrubbing experimental programme carried out in PECA facility are presented. One of the major findings was that a remarkable fraction of particle absorption was not a function of the residence time of bubbles rising through the pool. Such a contribution was assumed to be associated to aerosol removal mechanisms acting at the pool entrance. As a consequence, a hydrodynamic experimental plan was launched to examine the gas behaviour during the initial stages in the pool. Size and shape of gas nuclei the pool were measured and fitted to a long normal distribution. Particularly, size was found to be quite sensitive to inletgas flow and at minor extent to gas composition and pool temperature. SPARC90 and BUSCA-AUG92 were used to simulate the retention tests. Whereas SPARC90 showed a pretty good agreement with experimental data, BUSCA-AUG92 results were far away from measurements in all the cases. SPARC90consistency apparently pointed out the important role of fission products and aerosols retention at the injection zone; nonetheless, a peer examination of pool scrubbing phenomenology at the pool entrance should be carried out to test both hydrodynamic and removal models. Hence, one of the major highlights drawn from this work was the need of further research under representative severe accident conditions (i.e., saturated pools, jet injection regimes, etc.), as well as separate effect tests to validate, improve and

  19. Self-Scrubbing Coal -- an integrated approach to clean air

    Energy Technology Data Exchange (ETDEWEB)

    Harrison, K.E. [Custom Coals Corp., Pittsburgh, PA (United States)

    1997-12-31

    Carefree Coal is coal cleaned in a proprietary dense-media cyclone circuit, using ultrafine magnetite slurries, to remove noncombustible material, including up to 90% of the pyritic sulfur. Deep cleaning alone, however, cannot produce a compliance fuel from coals with high organic sulfur contents. In these cases, Self-Scrubbing Coal will be produced. Self-Scrubbing Coal is produced in the same manner as Carefree Coal except that the finest fraction of product from the cleaning circuit is mixed with limestone-based additives and briquetted. The reduced ash content of the deeply-cleaned coal will permit the addition of relatively large amounts of sorbent without exceeding boiler ash specifications or overloading electrostatic precipitators. This additive reacts with sulfur dioxide (SO{sub 2}) during combustion of the coal to remove most of the remaining sulfur. Overall, sulfur reductions in the range of 80--90% are achieved. After nearly 5 years of research and development of a proprietary coal cleaning technology coupled with pilot-scale validation studies of this technology and pilot-scale combustion testing of Self-Scrubbing Coal, Custom Coals Corporation organized a team of experts to prepare a proposal in response to DOE`s Round IV Program Opportunity Notice for its Clean Coal Technology Program under Public Law 101-121 and Public Law 101-512. The main objective of the demonstration project is the production of a coal fuel that will result in up to 90% reduction in sulfur emissions from coal-fired boilers at a cost competitive advantage over other technologies designed to accomplish the same sulfur emissions and over naturally occurring low sulfur coals.

  20. Lysis of cells infected with typhus group rickettsiae by a human cytotoxic T cell clone

    International Nuclear Information System (INIS)

    Carl, M.; Robbins, F.; Hartzman, R.J.; Dasch, G.A.

    1987-01-01

    Cytolytic human T cells clones generated in response to the intracellular bacterium Rickettsia typhi were characterized. Growing clones were tested for their ability to proliferate specifically in response to antigens derived from typhus group rickettsiae or to lyse targets infected with R. typhi or Rickettsia prowazekii, as measured by 51 Cr-release from target cells. Two clones were able to lyse targets infected with typhus group rickettsiae. One of these clones was more fully characterized because of its rapid growth characteristics. This cytolytic clone was capable of lysing an autologous infected target as well as a target matched for class I and II histocompatibility leukocyte antigens (HLA). It was not capable, however, of lysing either a target mismatched for both class I and II HLA or a target partially matched for class I HLA. In addition, the clone exhibited specificity in that it was able to lyse an autologous target infected with typhus group rickettsiae, but did not lyse an autologous target infected with an antigenically distinct rickettsial species, Rickettsia tsutsugamushi. These results demonstrate, for the first time, that cells infected with intracellular bacteria can be lysed by human cytotoxic T lymphocytes

  1. Determinants of immunogenic response to protein therapeutics.

    Science.gov (United States)

    Singh, Satish K; Cousens, Leslie P; Alvarez, David; Mahajan, Pramod B

    2012-09-01

    Protein therapeutics occupy a very significant position in the biopharmaceutical market. In addition to the preclinical, clinical and post marketing challenges common to other drugs, unwanted immunogenicity is known to affect efficacy and/or safety of most biotherapeutics. A standard set of immunogenicity risk factors are routinely used to inform monitoring strategies in clinical studies. A number of in-silico, in vivo and in vitro approaches have also been employed to predict immunogenicity of biotherapeutics, but with limited success. Emerging data also indicates the role of immune tolerance mechanisms and impact of several product-related factors on modulating host immune responses. Thus, a comprehensive discussion of the impact of innate and adaptive mechanisms and molecules involved in induction of host immune responses on immunogenicity of protein therapeutics is needed. A detailed understanding of these issues is essential in order to fully exploit the therapeutic potential of this class of drugs. This Roundtable Session was designed to provide a common platform for discussing basic immunobiological and pharmacological issues related to the role of biotherapeutic-associated risk factors, as well as host immune system in immunogenicity against protein therapeutics. The session included overview presentations from three speakers, followed by a panel discussion with audience participation. Copyright © 2012. Published by Elsevier Ltd.. All rights reserved.

  2. Gulf-Wide Information System, Environmental Sensitivity Index Scrub-Shrub and Wetlands, Geographic NAD83, LDWF (2001) [esi_scrub-shrub_wetland_LDWF_2001

    Data.gov (United States)

    Louisiana Geographic Information Center — This data set contains Environmental Sensitivity Index (ESI) scrub-shrub and wetlands data of coastal Louisiana. The ESI is a classification and ranking system,...

  3. Factors that influence the non-technical skills performance of scrub nurses: a prospective study.

    Science.gov (United States)

    Kang, Evelyn; Massey, Debbie; Gillespie, Brigid M

    2015-12-01

    To identify and describe the factors that impact on the performance of scrub nurses' non-technical skills performance during the intra-operative phase of surgery. Non-technical skills have been identified as important precursors to errors in the operating room. However, few studies have investigated factors influencing non-technical skills of scrub nurses. Prospective observational study. Structured observations were performed on a sample of 182 surgical procedures across eight specialities by two trained observers from August 2012-April 2013 at two hospital sites. Participants were purposively selected scrub nurses. Bivariate correlations and a multiple linear regression model were used to identify associations among length of surgery, patients' acuity using the American Society of Anesthesiologists classification system, team familiarity, number of occasions scout nurses leave the operating room, change of scout nurse and the outcome, the non-technical skills performance of scrub nurses. Patient acuity and team familiarity were the strongest predictors of scrub nurses' non-technical skills performance at hospital site A. There were no correlations between the predictors and the performance of scrub nurses at hospital site B. A dedicated surgical team and patient acuity potentially influence the performance of scrub nurses' non-technical skills. Familiarity with team members foster advanced planning, thus minimizing distractions and interruptions that impact on scrub nurses' performance. Development of interventions aimed at improving non-technical skills has the potential to make a substantial difference and enhance patient care. © 2015 John Wiley & Sons Ltd.

  4. Brushes and picks used on nails during the surgical scrub to reduce bacteria: a randomised trial.

    Science.gov (United States)

    Tanner, J; Khan, D; Walsh, S; Chernova, J; Lamont, S; Laurent, T

    2009-03-01

    Though brushes are no longer used on the hands and forearms during the surgical scrub, they are still widely used on the nails. The aim of this study was to determine whether nail picks and nail brushes are effective in providing additional decontamination during a surgical hand scrub. A total of 164 operating department staff were randomised to undertake one of the following three surgical hand-scrub protocols: chlorhexidine only; chlorhexidine and a nail pick; or chlorhexidine and a nail brush. Bacterial hand sampling was conducted before and 1h after scrubbing using a modified version of the glove juice method. No statistically significant differences in bacterial numbers were found between any two of the three intervention groups. Nail brushes and nail picks used during surgical hand scrubs do not decrease bacterial numbers and are unnecessary.

  5. Pool scrubbing and hydrodynamic experiment on jet injection regime

    Energy Technology Data Exchange (ETDEWEB)

    Peyres, V.; Espigares, M.M.; Polo, J.; Escudero, M.J.; Herranz, L.E.; Lopez, J.

    1995-07-01

    Plant analyses nave shown that pool scrubbing can play an important role in source term during PWR risk dominant sequences. An examination of boundary conditions governing fission products and aerosols transport through aqueous beds revealed that most of radioactivity is discharged into the pool under jet injection regime. This fact and the lack of experimental data under such conditions pointed the need of setting out an experimental programme which provided reliable experimental data to validate code models. In this report the major results of a pool scrubbing experimental programme carried out in PECA facility are presented. One of the major findings was that a remarkable fraction of particle absorption was not a function of the residence time of bubbles rising through the pool. Such a contribution was assumed to be associated to aerosol removal mechanism acting at the pool entrance. As a consequence. a hydrodynamic experimental plan was launched to examine the gas behaviour during the initial stages in the pool. Size and shape of gas nuclei in the pool were measured and fitted to a lognormal distribution. Particularly, size was found to be quite sensitive to inlet gas flow and at minor extent to gas composition and pool temperature. SPARC90 and BUSCA-AUG92 were used to simulate the retention tests. Whereas SPARC90 showed a pretty good agreement with experimental data, BUSCA-AUG92 results were far away from measurements in all the cases. SPARC90 consistency apparently pointed out the important role of fission products and aerosols retention at the injection zone; nonetheless, a peer examination of pool scrubbing phenomenology at the pool entrance should be carried out to test both hydrodynamic and removal models. Hence, one of the major high lights drawn from this work was the need of further research under representative severe accident conditions (i.e., saturated pools, jet injection regimes, etc.), as well as separate effect tests to validate, improve and

  6. Pool scrubbing and hydrodynamic experiment on jet injection regime

    International Nuclear Information System (INIS)

    Peyres, V.; Espigares, M.M.; Polo, J.; Escudero, M.J.; Herranz, L.E.; Lopez, J.

    1995-01-01

    Plant analyses nave shown that pool scrubbing can play an important role in source term during PWR risk dominant sequences. An examination of boundary conditions governing fission products and aerosols transport through aqueous beds revealed that most of radioactivity is discharged into the pool under jet injection regime. This fact and the lack of experimental data under such conditions pointed the need of setting out an experimental programme which provided reliable experimental data to validate code models. In this report the major results of a pool scrubbing experimental programme carried out in PECA facility are presented. One of the major findings was that a remarkable fraction of particle absorption was not a function of the residence time of bubbles rising through the pool. Such a contribution was assumed to be associated to aerosol removal mechanism acting at the pool entrance. As a consequence. a hydrodynamic experimental plan was launched to examine the gas behaviour during the initial stages in the pool. Size and shape of gas nuclei in the pool were measured and fitted to a lognormal distribution. Particularly, size was found to be quite sensitive to inlet gas flow and at minor extent to gas composition and pool temperature. SPARC90 and BUSCA-AUG92 were used to simulate the retention tests. Whereas SPARC90 showed a pretty good agreement with experimental data, BUSCA-AUG92 results were far away from measurements in all the cases. SPARC90 consistency apparently pointed out the important role of fission products and aerosols retention at the injection zone; nonetheless, a peer examination of pool scrubbing phenomenology at the pool entrance should be carried out to test both hydrodynamic and removal models. Hence, one of the major high lights drawn from this work was the need of further research under representative severe accident conditions (i.e., saturated pools, jet injection regimes, etc.), as well as separate effect tests to validate, improve and

  7. Immunogenicity of novel sulfadimethoxide conjugates | Chen ...

    African Journals Online (AJOL)

    Immunogenicity of novel sulfadimethoxide conjugates. L Chen, J Su, X Zhang, L Li, X He. Abstract. Sulfadimethoxine (SDM) is an antibiotic commonly added to animal feeds. Anti-SDM antibodies are useful for the detection of residual SDM in foods, feeds and biological fluids by ELISA. In this study, we show that SDM is ...

  8. Thinking ahead of the surgeon. An interview study to identify scrub nurses' non-technical skills.

    Science.gov (United States)

    Mitchell, Lucy; Flin, Rhona; Yule, Steven; Mitchell, Janet; Coutts, Kathy; Youngson, George

    2011-07-01

    Efforts to reduce adverse event rates in healthcare have revealed the importance of identifying the essential non-technical (cognitive and social) skills for safe and effective performance. Previous research on non-technical skills for operating theatre staff has concentrated on doctors rather than nursing professionals. The aim of the study was to identify the critical non-technical skills that are essential for safe and effective performance as an operating theatre scrub nurse. Experienced scrub nurses (n = 25) and consultant surgeons (n = 9) from four Scottish hospitals were interviewed using a semi-structured format. The protocols were designed to identify the main social and cognitive skills required by scrub nurses. Interviews were digitally recorded, transcribed verbatim and independently coded to extract behaviours in order to produce a list of the main non-technical skills for safe and effective scrub nurse performance. The non-technical skills of situation awareness, communication, teamwork, task management and coping with stress were identified as key to successful scrub nurse task performance. Component sets of behaviours for each of these categories were also noted. The interviews with subject matter experts from scrub nursing and surgery produced preliminary evidence that situation awareness, communication, teamwork and coping with stress are the principal non-technical skills required for effective performance as a scrub nurse. Copyright © 2010 Elsevier Ltd. All rights reserved.

  9. Code Development of Radioactive Aerosol Scrubbing in Pool-Injection Zone

    Energy Technology Data Exchange (ETDEWEB)

    Jo, Hyun Joung; Ha, Kwang Soon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Jang, Dong Soon [Chungnam National University, Daejeon (Korea, Republic of)

    2015-10-15

    The pool scrubbing models were reviewed and an aerosol scrubbing code has been prepared to calculate decontamination factor through the injection zone. The developed code has been verified using the experimental results and evaluated parametrically on the input variables. In injection zone, the initial steam condensation was most effective mechanism for the aerosol removal, and the steam fraction and pool temperature were highly affected on the decontamination factor by initial steam condensation. The aerosol scrubbing code will be updated to evaluate the decontamination factor at rise zone and finally whole pool scrubber phenomena. If a severe accident occurs in a nuclear power plant (NPP), the aerosol and gaseous fission products might be produced in the reactor vessel, and then released to the environment after the containment failure. FCVS (Filtered Containment Venting System) is one of the severe accident mitigation systems for retaining the containment integrity by discharging the high-temperature and high-pressure fission products to the environment after passing through the filtration system. In general, the FCVS is categorized into two types, wet and dry types. The scrubbing pool could play an important role in the wet type FCVS because a large amount of aerosol is captured in the water pool. The pool scrubbing phenomena have been modelled and embedded in several computer codes, such as SPARC (Suppression Pool Aerosol Removal Code), BUSCA (BUbble Scrubbing Algorithm) and SUPRA (Suppression Pool Retention Analysis). These codes aim at simulating the pool scrubbing process and estimating the decontamination factors (DFs) of the radioactive aerosol and iodine gas in the water pool, which is defined as the ratio of initial mass of the specific radioactive material to final massy after passing through the water pool. The pool scrubbing models were reviewed and an aerosol scrubbing code has been prepared to calculate decontamination factor through the injection

  10. Immunogenicity of therapeutic proteins: the use of animal models.

    Science.gov (United States)

    Brinks, Vera; Jiskoot, Wim; Schellekens, Huub

    2011-10-01

    Immunogenicity of therapeutic proteins lowers patient well-being and drastically increases therapeutic costs. Preventing immunogenicity is an important issue to consider when developing novel therapeutic proteins and applying them in the clinic. Animal models are increasingly used to study immunogenicity of therapeutic proteins. They are employed as predictive tools to assess different aspects of immunogenicity during drug development and have become vital in studying the mechanisms underlying immunogenicity of therapeutic proteins. However, the use of animal models needs critical evaluation. Because of species differences, predictive value of such models is limited, and mechanistic studies can be restricted. This review addresses the suitability of animal models for immunogenicity prediction and summarizes the insights in immunogenicity that they have given so far.

  11. Adaptation of a tool to assess non-technical skills of scrub practitioners in Denmark

    DEFF Research Database (Denmark)

    Mundt, Anna Sofie; Spanager, Lene; Lyk-Jensen, Helle Teglgaard

    2017-01-01

    The aim of this study was to adapt the Scottish tool, Scrub Practitioners List of Intraoperative Non-Technical Skills, to Danish organisation and culture. With an explorative and qualitative approach, four group interviews with scrub practitioners, surgeons and anaesthesia staff were conducted....... The main differences found were related to communication and teamwork regarding scrub practitioners focus on the team and speaking up. Differences in the non-technical skills described in the behavioural markers are perhaps explained by cultural differences between Scotland and Denmark. A new tool...

  12. Estimated effects of interfacial vaporization on fission product scrubbing: Chapter 11

    International Nuclear Information System (INIS)

    Moody, F.J.; Nagy, S.G.

    1983-01-01

    When bubbles containing non-condensible gas rise through a water pool, interfacial evaporation causes a flow of vapor into the bubbles. The inflow reduces the outward particle motion toward the bubble wall, diminishing the effectiveness of fission product particle removal. This analysis provides an estimate of evaporation on pool scrubbing effectiveness. It is shown that hot gas, which boils water at the bubble wall, reduces the effective scrubbing height by less than five centimeters. Although the evaporative humidification in a rising bubble containing non-condensible gas has a diminishing effect on scrubbing mechanisms, substantial decontamination is still expected even for the limiting case of a saturated pool

  13. Typhus, yellow fever and Medicine in Mexico during the French intervention

    Science.gov (United States)

    Gerardo-Ramírez, Monserrat; Zavaleta-Castro, Jesús; Gómez-Quiroz, Luis Enrique

    2018-01-01

    French intervention in Mexico (1861-1867) is particularly full of episodes of patriotic heroism in terms of military, politic and, even, religious affairs, however this history is also rich in episodes related to diseases and the evolution of Mexican scientific medicine practice, epidemics such as typhus (nowadays knows as rickettsiosis), yellow fever, or cholera. Principally, this context outlined the Mexican history and influenced the course of the nation. The epidemics served as fertile land for the development of medicine science leading by prominent physicians, particularly by doctor Miguel Francisco Jiménez. Copyright: © 2018 SecretarÍa de Salud.

  14. Antiseptic Effect of Conventional Povidone-Iodine Scrub, Chlorhexidine Scrub, and Waterless Hand Rub in a Surgical Room: A Randomized Controlled Trial.

    Science.gov (United States)

    Tsai, Jui-Chen; Lin, Yen-Kuang; Huang, Yen-Jung; Loh, El-Wui; Wen, Hsiao-Yun; Wang, Chia-Hui; Tsai, Yin-Tai; Hsieh, Wen-Shyang; Tam, Ka-Wai

    2017-04-01

    OBJECTIVE Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated. DESIGN, SETTING, AND PARTICIPANTS A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University-Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled. INTERVENTION Surgical hand cleansing with conventional 10% povidone-iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol). RESULTS Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, Pantiseptic method (P=.0036), but not other variables, predicted the mean CFU count. CONCLUSIONS Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone-iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable. Infect Control Hosp Epidemiol 2017;38:417-422.

  15. Factors that affect scrub practitioner non-technical skills: A literature review.

    Science.gov (United States)

    McClelland, Guy

    2018-04-01

    Non-technical skills are the cognitive and interpersonal behaviours that compliment clinical competence in surgery. Effective use of non-technical skills is essential for scrub practice, because they facilitate anticipation of the surgeon's requirements and promote appropriate communication behaviours. This literature review analyses the factors that may influence a scrub practitioner's use of non-technical skills during surgery. Recommendations are made that are intended to improve their use by reducing behavioural variations during surgery.

  16. Seawater scrubbing - reduction of SO{sub x} emissions from ship exhausts

    Energy Technology Data Exchange (ETDEWEB)

    Karle, Ida-Maja; Turner, David (Dept. of Chemistry, Goeteborg Univ. (SE))

    2007-07-01

    It is shown that seawater scrubbing is a promising technology for reducing sulphur oxide emissions from ships. The marine chemical aspects of shipboard seawater scrubbing have been modelled and analysed, based on a 12 MW engine burning fuel with a 3% sulphur content. Calculations have been made for different efficiencies of sulphur scrubbing, different water temperatures, and for six different water types (open ocean, Kattegatt, Baltic Proper, Bothnian Sea, Bothnian Bay, and river freshwater). The results of the calculations give the volumes of water required for (i) uptake of SO{sub x} (the scrubbing process), (ii) dilution of the scrubbing water to achieve a pH of 6.5, (iii) further dilution to achieve a pH within 0.2 units of that in the ambient water, and no more that a 1% reduction in dissolved oxygen concentration. The volumes of water required for a given efficiency of the scrubbing process increase with decreasing salinity and with increasing water temperature. The salinity dependence is non-linear, such that operation in the Bothnian Sea, Bothnian Bay and low alkalinity river freshwater would require significantly larger water volumes for scrubbing and dilution that operation in the Baltic Proper, Kattegatt or open ocean. The calculations assume access to large volumes of unaffected, ambient water. This is reasonable for a ship under way in open water, but not in enclosed or semi-enclosed waters, which would therefore require detailed case studies. It may be possible to reduce the volumes of dilution water required by, for example, aeration of the scrubbing water and addition of base to neutralise the acidic sulphur oxides. Further studies would be needed in order to assess these options

  17. Scrub-shrub bird habitat associations at multiple spatial scales in beaver meadows in Massachusetts

    Science.gov (United States)

    Chandler, R.B.; King, D.I.; DeStefano, S.

    2009-01-01

    Most scrub-shrub bird species are declining in the northeastern United States, and these declines are largely attributed to regional declines in habitat availability. American Beaver (Castor canadensis; hereafter “beaver”) populations have been increasing in the Northeast in recent decades, and beavers create scrub-shrub habitat through their dam-building and foraging activities. Few systematic studies have been conducted on the value of beaver-modified habitats for scrub-shrub birds, and these data are important for understanding habitat selection of scrub-shrub birds as well as for assessing regional habitat availability for these species. We conducted surveys in 37 beaver meadows in a 2,800-km2 study area in western Massachusetts during 2005 and 2006 to determine the extent to which these beaver-modified habitats are used by scrub-shrub birds, as well as the characteristics of beaver meadows most closely related to bird use. We modeled bird abundance in relation to microhabitat-, patch-, and landscape-context variables while adjusting for survey-specific covariates affecting detectability using N-mixture models. We found that scrub-shrub birds of regional conservation concern occupied these sites and that birds responded differently to microhabitat, patch, and landscape characteristics of beaver meadows. Generally, scrub-shrub birds increased in abundance along a gradient of increasing vegetation complexity, and three species were positively related to patch size. We conclude that these habitats can potentially play an important role in regional conservation of scrub-shrub birds and recommend that conservation priority be given to larger beaver meadows with diverse vegetation structure and composition.

  18. Jakub Penson and his studies on acute renal failure during typhus epidemics in Warsaw Ghetto.

    Science.gov (United States)

    Rutkowski, Boleslaw

    2004-01-01

    In the Warsaw Ghetto established by the German Nazis as a special district for Polish Jews in 1940 there were two typhus epidemics. Many patients affected by this disease (1500 during the first and 6500 during second epidemic) were treated at The Department of Infectious Disease of Czyste Hospital headed by Dr Jakub Penson--a Polish physician of Jewish origin. A heroic group of 20 physicians not only treated patients in these tragic circumstances, but also performed in defiance of Nazi prohibition, scientific studies on the clinical course of typhus with special attention on hyperazotemia and renal complication. The results of their observations were presented in 1941-42 during clinical meetings in Czyste Hospital and later published by Penson in 1946 in the Polish Physicians Weekly. Among other clinical statements a description of acute renal failure of extrarenal origin, caused by dehydration and toxic influence of primary disease seems the most important one. It has to be taken into account that acute renal failure appearing during Crush Syndrome was described by Bywaters in 1941. Jakub Penson survived the German Nazi occupation and later become a head of the Internal Medicine Department in Gdansk Medical University and one of the precursors of clinical nephrology in Poland.

  19. [Little known activity of the Czestochowa typhus Institute in 1943 and 1944].

    Science.gov (United States)

    Aramowicz, P; Fijałek, J; Lutrzykowski, A

    1996-01-01

    In 1921 Prof. Rudolf Weigl started manufacturing on an industrial scale a typhus vaccine. Until the beginning of World War Two he organised five companies called Weigl Institute. During the Soviet occupation the Lvov plant became the Lvov Sanitary and Bacteriological Institute and after the town was taken over by the German Army on 1st July 1941, Prof. Weigl became a head of research of the Military Typhus Institute. It consisted of four sections for manufacturing the vaccine. All the produce was mainly despatched to the Russian front and only very little reached the civilians. In November and December 1943 the plant was moved to Czestochowa into a main building in Wilsona str. and two four storey others in Jasnogórska str. Its head became a German doctor Mozer (witness test). It is difficult to state numbers the plant employed there being no data left but according to employees still alive there must have been about a hundred lab. staff and two hundred feeders. The plant was divided into "breeding", "preparatory" and "liofilisation" sections. "The breeding" was for feeders and breeding lice. Cages containing about 30,000 lice were fastened to voluntary feeders for each feeding. Next "loaders" covered a so-called key board with 20 insects and infectors introduced and pressurised solution containing live rickets into a louse intestine. After a six or seven day passage, lice ware dried and their intestines prepared to produce liofilizeate all the staff and their families were inoculated. ...

  20. Flotability Improvement of Ilmenite Using Attrition-Scrubbing as a Pretreatment Method

    Directory of Open Access Journals (Sweden)

    Jihua Zhai

    2017-01-01

    Full Text Available Flotation technology of the recovery and utilization of ilmenite from tailings of iron beneficiated in Panzhihua was investigated based on mineralogical study. The results of mineralogical study show that the main occurrence of the valuable mineral are liberated grains of ilmenite. Experimental results of flotation conditions show that attrition-scrubbing raw ores exhibit good flotability with higher recoveries and a slight decrease in grade compared to ores without attrition-scrubbing. Further, open-circuit experiments also prove the superiority of attrition-scrubbing raw ores. The results of closed-circuit experiments show that qualified ilmenite concentrate can be obtained and the yield, grade, and recovery are 22.26%, 47.06%, and 60.73%, respectively. Theoretical study and analysis show that there are two contributions to superior flotability for attrition-scrubbing samples. The first is that the attrition-scrubbing samples can uncover more ferrous ions on the newly-produced fresh ilmenite surface, resulting in the increase in active sites. The other is that in the process of attrition-scrubbing, the transformation of ferrous ions to ferric ions can be promoted.

  1. Novel autoantigens immunogenic in COPD patients

    Directory of Open Access Journals (Sweden)

    Stephan Bernhard

    2009-03-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a respiratory inflammatory condition with autoimmune features including IgG autoantibodies. In this study we analyze the complexity of the autoantibody response and reveal the nature of the antigens that are recognized by autoantibodies in COPD patients. Methods An array of 1827 gridded immunogenic peptide clones was established and screened with 17 sera of COPD patients and 60 healthy controls. Protein arrays were evaluated both by visual inspection and a recently developed computer aided image analysis technique. By this computer aided image analysis technique we computed the intensity values for each peptide clone and each serum and calculated the area under the receiver operator characteristics curve (AUC for each clone and the separation COPD sera versus control sera. Results By visual evaluation we detected 381 peptide clones that reacted with autoantibodies of COPD patients including 17 clones that reacted with more than 60% of the COPD sera and seven clones that reacted with more than 90% of the COPD sera. The comparison of COPD sera and controls by the automated image analysis system identified 212 peptide clones with informative AUC values. By in silico sequence analysis we found an enrichment of sequence motives previously associated with immunogenicity. Conclusion The identification of a rather complex humoral immune response in COPD patients supports the idea of COPD as a disease with strong autoimmune features. The identification of novel immunogenic antigens is a first step towards a better understanding of the autoimmune component of COPD.

  2. Immunogenic hyperthyroidism following radioiodine ablation of focal autonomy

    International Nuclear Information System (INIS)

    Boddenberg, B.; Voth, E.; Schicha, H.

    1993-01-01

    Immunogenic hyperthyroidism rarely develops after radioiodine elimination of focal autonomous thyroid tissue. We observed this phenomenon in 8 patients between 1989 and 1992. The occurrence of immunogenic hyperthyroidism shortly after elimination of autonomous nodules has not been studied nor is it properly understood. Most studies known today describe the development of autonomous nodules in the course of immunogenic hyperthyroidism or ignore the chronologic order of occurrence. The possibility that immunogenic hyperthyroidism may occur after radioiodine therapy of autonomous nodules, makes a consequent follow-up within the first year following radioiodine therapy mandatory. (orig.) [de

  3. Assessing the effectiveness of scrub management at the landscape scale using rapid field assessment and remote sensing.

    Science.gov (United States)

    Redhead, John; Cuevas-Gonzales, Maria; Smith, Geoffrey; Gerard, France; Pywell, Richard

    2012-04-30

    Controlling scrub encroachment is a major challenge for conservation management on chalk grasslands. However, direct comparisons of scrub removal methods have seldom been investigated, particularly at the landscape scale. Effective monitoring of grassland scrub is problematic as it requires simultaneous information on large scale patterns in scrub cover and fine-scale changes in the grassland community. This study addressed this by combining analysis of aerial imagery with rapid field surveys in order to compare the effectiveness of four scrub management strategies on Defence Training Estate Salisbury Plain, UK. Study plots were sited within areas undergoing management and in unmanaged controls. Controls showed dramatic increases in scrub cover, with encroachment of a mean 1096 m(2) per hectare over ten years. Whilst all management strategies were effective in reducing scrub encroachment, they differed in their ability to influence regeneration of scrub and grassland quality. There was a general trend, evident in both the floral community and scrub levels, of increased effectiveness with increasing management intensity. The dual methodology proved highly effective, allowing rapid collection of data over a range of variables and spatial scales unavailable to each method individually. The methodology thus demonstrates potential for a useful monitoring tool. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Mucosal immunogenicity of plant lectins in mice

    Science.gov (United States)

    Lavelle, E C; Grant, G; Pusztai, A; Pfüller, U; O’Hagan, D T

    2000-01-01

    The mucosal immunogenicity of a number of plant lectins with different sugar specificities was investigated in mice. Following intranasal (i.n.) or oral administration, the systemic and mucosal antibody responses elicited were compared with those induced by a potent mucosal immunogen (cholera toxin; CT) and a poorly immunogenic protein (ovalbumin; OVA). After three oral or i.n. doses of CT, high levels of specific serum antibodies were measured and specific IgA was detected in the serum, saliva, vaginal wash, nasal wash and gut wash of mice. Immunization with OVA elicited low titres of serum IgG but specific IgA was not detected in mucosal secretions. Both oral and i.n. delivery of all five plant lectins investigated [Viscum album (mistletoe lectin 1; ML‐1), Lycospersicum esculentum (tomato lectin; LEA), Phaseolus vulgaris (PHA), Triticum vulgaris (wheat germ agglutinin (WGA), Ulex europaeus I (UEA‐1)] stimulated the production of specific serum IgG and IgA antibody after three i.n. or oral doses. Immunization with ML‐1 induced high titres of serum IgG and IgA in addition to specific IgA in mucosal secretions. The response to orally delivered ML‐1 was comparable to that induced by CT, although a 10‐fold higher dose was administered. Immunization with LEA also induced high titres of serum IgG, particularly after i.n. delivery. Low specific IgA titres were also detected to LEA in mucosal secretions. Responses to PHA, WGA and UEA‐1 were measured at a relatively low level in the serum, and little or no specific mucosal IgA was detected. PMID:10651938

  5. Technologies and policies for "hard to scrub" emissions sources

    Science.gov (United States)

    Friedmann, J.

    2016-12-01

    The science of climate change yields harsh math regarding atmospheric accumulations of GHGs. The world is far from target trajectories for 2C or 1.5C, and the global carbon budget is severe. To achieve those targets requires two things. First, we must field technologies that reduce emissions from the "hard to scrub" parts of the US and global economies, such as heavy industry (cement and steel), aviation, ocean shipping, and household cooking and heating. Second, we will likely need negative emissions pathways for those sources that prove extremely difficult to remove or reduce - the climate equivalent of adding revenue to one's budget. Such pathways may well need to convert GHG emissions (especially CO2 and methane) into useful products with minimal infrastructure builds. Dramatic advances in advanced manufacturing, 3D printing, simulation, modeling, and data analytics have made possible solutions which were previously unthinkable or impossible. This include "bespoke reactors", which can simultaneously perform separations and conversions; low-cost modular chemical systems of any scale; biologically inspired or biologically mediated energy services; direct air carbon-capture systems; and electrochemical pathways for emissions reduction and conversion. However, these approaches are unlikely to be fielded without policy actions or reforms that support such systems in competitive global energy markets. Such policy measures do NOT require a carbon price. Rather, they could include individual or combined measures such as emission or performance standards, financial incentives (like tax credits or low-cost access to capital), border adjustable tariffs, creation of CO2 utilities, ands public good surcharges. Innovation in both technical and policy arenas are needed to achieve the goals of the Paris agreement signatories, and these innovations can be simultaneously configured to deliver substantive greenhouse gas mitigation.

  6. Immunogenicity of Anti-TNF-α Biotherapies

    DEFF Research Database (Denmark)

    Bendtzen, Klaus

    2015-01-01

    % of patients do not respond and about 50% of those who do loose response with time. Furthermore, safety may be compromised by immunogenicity with the induction of anti-drug-antibodies (ADA). Assessment of drug pharmacokinetics and ADA is increasingly recognized as a requirement for safe and rational use...... article - and the accompanying article - is to discuss the reasons for recommending assessments of circulating drug and ADA levels in patients treated with anti-TNF biopharmaceuticals and to detail some of the methodological issues that obscure cost-effective and safer therapies....

  7. Typhus in Mexico City during the epoch of the Mexican Revolution, 1913-1916

    Directory of Open Access Journals (Sweden)

    América Molina del Villar

    2015-01-01

    Full Text Available This article studies the impact of the 1915-1916 typhus epidemic in Mexico City, examining its origin and propagation and placing the epidemic in the context of the great social and political vulnerability that originated with the fall of Victoriano Huerta and the capture of the city by a variety of revolutionary forces. The article focuses on the demographic impact of the epidemic, connecting its repercussions with the unhealthy conditions then prevailing in the country's capital, which could largely be attributed to poverty and the interruption of many sanitary measures due to budgetary shortfalls, armed conflict and changes of government. The article draws on sources of information from the historical archives of the Health Secretariat and the Mexico City government, as well as contemporary press reports and the bulletins issued by the Superior Health Council. This article aims to contribute to the historiography of the period from the perspective of social and demographic history.

  8. Comparative scrub solution tests for decontamination of transuranic radionuclides from soils

    International Nuclear Information System (INIS)

    Stevens, J.R.; Kochen, R.L.; Rutherford, D.W.; Riordan, G.A.; Delaney, I.C.

    1982-08-01

    Soil decontamination tests were done using three scrubbing solutions on five different transuranic-contaminated soils from Department of Energy sites. The soils came from Rocky Flats, Colorado; Hanford, Washington; Mound Facility, Ohio; Idaho National Engineering Laboratory, Idaho; and Los Alamos National Laboratory, New Mexico. Decontamination was effected by physical and chemical means. A pH 12.5 scrub effected decontamination by serving as a hydraulic grading and attrition scrub medium; this solution did not solubilize the actinide contamination. A 2% HNO 3 , 0.2% HF, 2% pine oil, and 5% Calgon solution effected decontamination by physical and chemical means; this solution solubilized particulate actinide and actinide dispersed on the surface of soil particles. A 2N HCl scrub was also used to effect decontamination by physical and chemical means; this reagent solubilized soil constituents, removing contamination that had migrated into mineral surfaces. Only Rocky Flats soil was effectively decontaminated by the high pH solution although all soils had an enrichment of the activity in the -150 mesh fraction. Attrition scrubbing with both acid solutions had a better decontamination ability for the +150 mesh fraction for Hanford, INEL, and LANL soils. In addition, the acid solutions solubilized some of the plutonium and had a decontamination effect on the fine fractions

  9. Electro-scrubbing volatile organic carbons in the air stream with a gas diffusion electrode

    Energy Technology Data Exchange (ETDEWEB)

    Yang Ji, E-mail: yangji@ecust.edu.cn [School of Resources and Environmental Engineering, State Environmental Protection Key Laboratory of Environmental Risk Assessment and Control on Chemical Process, East China University of Science and Technology, Shanghai 200237 (China); School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240 (China); Liu Kaichen; Jia Jinping; Cao Limei [School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240 (China)

    2011-04-15

    It is demonstrated that exposing the VOC air streams to the electro-scrubbing reactor with a gas diffusion electrode leads to an efficient removal of organics. The importance order of the influence factors on the electro-scrubbing reactor performance is: conductivity, voltage and air stream flow-rate. The effective conductivity and high voltages generally are beneficial to the removal process and the air flow-rate is not a significant factor compared with the other two, indicating that the reactor might have a consistently satisfying performance within a wide range of gas volumetric load. The mass transfer of both organics and oxygen in the reactor is estimated by mathematical model, and the calculation determines the concentration boundary conditions for the 2-ethoxyethyl acetate removal: if the 2-ethoxyethyl acetate concentration in the inflow air stream holds C{sub G,i} {<=} 0.7198 % , the removal in the electro-scrubbing reactor is electrochemical reaction controlled; if C{sub G,i} > 0.7198 % , the controlling step will be the oxygen mass transfer from the air to the liquid in the electro-scrubbing reactor. The Apparent Current Efficiency of the electro-scrubbing reactor was also determined using COD data, which is significantly higher than some commercial metal oxide electrodes, showing that the reactor is energy efficient and has the promise for the future scale-up.

  10. Preclinical models used for immunogenicity prediction of therapeutic proteins.

    Science.gov (United States)

    Brinks, Vera; Weinbuch, Daniel; Baker, Matthew; Dean, Yann; Stas, Philippe; Kostense, Stefan; Rup, Bonita; Jiskoot, Wim

    2013-07-01

    All therapeutic proteins are potentially immunogenic. Antibodies formed against these drugs can decrease efficacy, leading to drastically increased therapeutic costs and in rare cases to serious and sometimes life threatening side-effects. Many efforts are therefore undertaken to develop therapeutic proteins with minimal immunogenicity. For this, immunogenicity prediction of candidate drugs during early drug development is essential. Several in silico, in vitro and in vivo models are used to predict immunogenicity of drug leads, to modify potentially immunogenic properties and to continue development of drug candidates with expected low immunogenicity. Despite the extensive use of these predictive models, their actual predictive value varies. Important reasons for this uncertainty are the limited/insufficient knowledge on the immune mechanisms underlying immunogenicity of therapeutic proteins, the fact that different predictive models explore different components of the immune system and the lack of an integrated clinical validation. In this review, we discuss the predictive models in use, summarize aspects of immunogenicity that these models predict and explore the merits and the limitations of each of the models.

  11. The Comparative Immunogenicity Of Three Lentogenic Brands Of ...

    African Journals Online (AJOL)

    The comparative immunogenicity of a new lentogenic viscerotropic Newcastle disease vaccine, NDvac-1 (VG/GA strain) and two other existing proprietary pneumotropic lentogenic Newcastle disease vaccines in Nigeria, NDvac-2 (R2B) and NDvac-3 (LaSota) were studied. Immunogenicity was assessed on the basis of ...

  12. Insect Repellents and Associated Personal Protection for a Reduction in Human Disease

    Science.gov (United States)

    2012-01-01

    of topical repellents and scrub typhus was reduced through the use of treated clothing. Successful reduction of leishmaniasis was achieved through the...epidemic typhus , scrub typhus , plague and malaria. The result was the development of many of the modern strategies for vector control that we take for...prevent bites and disease. They gave examples that represented well-documented disease reduction achieved with repellent clothing ( scrub typhus ; McCulloch

  13. Malaria and Other Vector-Borne Infection Surveillance in the U.S. Department of Defense Armed Forces Health Surveillance Center-Global Program: Review of 2009 Accomplishments

    Science.gov (United States)

    2011-03-04

    Vector borne infections (VBIs) such as malaria, dengue fever, yellow fever, scrub typhus , and plague comprise a significant proportion of the global...a VBI: scrub typhus (19), murine typhus (three), Japanese encephalitis (JE) (two), primary dengue infection (12), secondary dengue infection (nine...prioritized by GSRI, half are VBIs (malaria, dengue fever, Rift Valley fever, Chikungunya, CCHF, sandfly fever, O’nyong-nyong, Sindbis virus, scrub typhus

  14. Immunogenicity of therapeutic proteins. Part 2: impact of container closures.

    Science.gov (United States)

    Sharma, Basant

    2007-01-01

    Immunogenicity as a potential consequence of therapeutic protein administration is increasingly being scrutinized in the biopharmaceuticals industry, particularly with the imminent introduction of biosimilar products. Immunogenicity is an important safety aspect requiring rigorous investigation to fully appreciate its impact. Factors involved in product handling, such as storage temperature, light exposure, and shaking, have been implicated in immunogenicity, while container closure systems are no less important. Intended to provide a stable environment for the dosage form, container closures may also interact with a product, affecting performance and potentially enhancing immunogenicity. Glass surfaces, air-liquid interfaces, and lubricants can mediate protein denaturation, while phthalates in plastics and latex rubber are sources of extractables and leachates that may contaminate a product, causing allergic reactions and increasing immunogenicity. The manufacture of therapeutic proteins therefore requires rigorous safety evaluations not just in the context of the product, but also product containment.

  15. Posttranslational Modifications and the Immunogenicity of Biotherapeutics

    Directory of Open Access Journals (Sweden)

    Roy Jefferis

    2016-01-01

    Full Text Available Whilst the amino acid sequence of a protein is determined by its gene sequence, the final structure and function are determined by posttranslational modifications (PTMs, including quality control (QC in the endoplasmic reticulum (ER and during passage through the Golgi apparatus. These processes are species and cell specific and challenge the biopharmaceutical industry when developing a production platform for the generation of recombinant biologic therapeutics. Proteins and glycoproteins are also subject to chemical modifications (CMs both in vivo and in vitro. The individual is naturally tolerant to molecular forms of self-molecules but nonself variants can provoke an immune response with the generation of anti-drug antibodies (ADA; aggregated forms can exhibit enhanced immunogenicity and QC procedures are developed to avoid or remove them. Monoclonal antibody therapeutics (mAbs are a special case because their purpose is to bind the target, with the formation of immune complexes (ICs, a particular form of aggregate. Such ICs may be removed by phagocytic cells that have antigen presenting capacity. These considerations may frustrate the possibility of ameliorating the immunogenicity of mAbs by rigorous exclusion of aggregates from drug product. Alternate strategies for inducing immunosuppression or tolerance are discussed.

  16. A viable on-chip FPGA configuration memory scrubbing approach for CBM-ToF

    Energy Technology Data Exchange (ETDEWEB)

    Oancea, Andrei-Dumitru; Stuellein, Christian; Manz, Sebastian; Gebelein, Jano; Kebschull, Udo [Infrastruktur und Rechnersysteme in der Informationsverarbeitung (IRI), Goethe-Universitaet, Senckenberganlage 31, 60325 Frankfurt am Main (Germany); Collaboration: CBM-Collaboration

    2015-07-01

    The ToF Detector of the CBM Experiment will be equipped with FPGA-based read-out boards (ROBs). These ROBs will be operated in a radiation environment, and therefore need a mitigation mechanism against soft errors in the SRAM-based configuration memories of the FPGAs. The proposed approach combines intrinsic on-chip single upset correction with extrinsic selective frame scrubbing for multiple-bit upsets. The slow control is realized using the GBT-SCA, which is capable of handling interrupts. This enables the new approach of event-driven configuration frame correction. While conventional blind scrubbing leads to a continuous load on the control path, the selective frame scrubbing reduces this load to a minimum. For verification purposes, radiation tests with a proton beam were performed at COSY, Juelich. The occurred soft errors were classified into single and multiple- bit upsets, enabling an estimation of the rate at which extrinsic intervention is necessary.

  17. THE KNOWLEDGE OF HEALTH CARE WORKERS AND DOCTORS REGARDING HAND SCRUB

    Directory of Open Access Journals (Sweden)

    Rahul Sanjeev Chaudhary

    2016-08-01

    Full Text Available BACKGROUND Hand hygiene practices of health care workers has been shown to be an effective measure in preventing hospital acquired infections. This concept has been aptly used to improve understanding, training, monitoring, and reporting hand hygiene among healthcare workers. We conducted this study to assess the knowledge of doctors and health care workers regarding hand scrub. METHODS A study was conducted among doctors and health care workers in a tertiary care hospital. Knowledge was evaluated by using self-structured questionnaire based on the guidelines of hand hygiene prescribed by WHO. RESULTS The awareness and knowledge of preoperative surgical hand scrubbing was moderate in doctors, but unfortunately poor in HCWs. CONCLUSION Our study highlights the need for introducing measures in order to increase the knowledge of preoperative hand scrub in teaching hospital which may translate into good practices.

  18. Extraction, scrub, and strip test results for the solvent transfer to salt waste processing facility

    Energy Technology Data Exchange (ETDEWEB)

    Peters, T. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2017-09-07

    The Savannah River National Laboratory (SRNL) prepared approximately 240 gallons of Caustic-Side Solvent Extraction (CSSX) solvent for use at the Salt Waste Processing Facility (SWPF). An Extraction, Scrub, and Strip (ESS) test was performed on a sample of the prepared solvent using a salt solution prepared by Parsons to determine cesium distribution ratios (D(Cs)), and cesium concentration in the strip effluent (SE) and decontaminated salt solution (DSS) streams. This data will be used by Parsons to help qualify the solvent for use at the SWPF. The ESS test showed acceptable performance of the solvent for extraction, scrub, and strip operations. The extraction D(Cs) measured 15.5, exceeding the required value of 8. This value is consistent with results from previous ESS tests using similar solvent formulations. Similarly, scrub and strip cesium distribution ratios fell within acceptable ranges.

  19. [Immunogenicity of attenuated Salmonella choleraesuis vaccine strain expressing immunogenic genes of Mycoplasma hyopneumoniae in mice].

    Science.gov (United States)

    Ma, Fengying; Zou, Haoyong; He, Qigai

    2011-09-01

    The study was carried out to construct and characterize Salmonella choleraesuis vaccine strain expressing immunogenic genes of Mycoplasma hyopneumoniae and to test its immunogenicity in mice. We made p36, p46, p65 and p97R1-Nrdf, the main immunogenic genes of Mycoplasma hyopneumoniae, to insert into the prokaryotic expression plasmid pYA3493. Then these recombinant plasmids and pYA3493 were electroporated into C500 asd-mutant, resulting in the recombinant Salmonella choleraesuis vaccine strains C36 (pYA-36), C46 (pYA-46), C65 (pYA-65), C97R1-Nrdf(pYA-97R1-Nrdf) and CpYA(pYA3493). We characterized these recombinant Salmonella choleraesuis vaccine strains and tested the immunogenicity in mice by intramuscular injection or orally immunized. The results of the immunogenicity in mice indicated that the group orally immunized with C36, C46, C65, C97R1-Nrdf showed significantly higher Mycoplasma pneumoniae antibody than both the group orally immunized with C36, C46, C65 and the group intramuscular injected with the Mycoplasma hyopneumoniae bacterin (M + PAC) (P Mycoplasma hyopneumoniae bacterin (M + PAC) (P 0.05). The highest level of IL-4 was found in the group orally immunized with C36, C46, C65; higher levels of IL-4 was observed in the group orally immunized with C36, C46, C65, C97R1-Nrdf than the group injected with the Mycoplasma hyopneumoniae bacterin (M + PAC); and the lowest IL-4 level was found in the group injected with C36, C46, C65. There were no significant differences among them (P > 0.05). The Mycoplasma pneumoniae antibody, IFN-gamma or IL-4 production of the each group was obviously higher than the control group (P Mycoplasma hyopneumoniae which has immunogenicity in mice especially by intramuscular injection could probably serve as a vaccine against mycoplasmal pneumonia of swine.

  20. 50 CFR 21.46 - Depredation order for depredating scrub jays and Steller's jays in Washington and Oregon.

    Science.gov (United States)

    2010-10-01

    ..., without a permit, take scrub jays (Aphelocoma coerulescens) and Steller's jays (Cyanocitta stelleri) when... transported or sold or offered for sale except that, such transportation within the area, as may be necessary... the State agricultural department, college, or other public institution may requisition such scrub...

  1. Effects of Width, Edge and Habitat on the Abundance and Nesting Success of Scrub-shrub Birds in Powerline Corridors

    Science.gov (United States)

    David I. King; Richard B. Chandler; Jeffrey M. Collins; Wayne R. Petersen; Thomas E. Lautzenheiser

    2009-01-01

    Concern about declines in scrub–shrub bird populations has resulted in efforts to create and maintain habitat for these species. Vegetation within powerline corridors is managed to prevent contact of vegetation with transmission lines, and comprises approximately 2% of all of habitat for scrub–shrub birds in southern New England. Although previous studies have...

  2. Recombinant Brucella abortus gene expressing immunogenic protein

    Energy Technology Data Exchange (ETDEWEB)

    Mayfield, J.E.; Tabatabai, L.B.

    1991-06-11

    This patent describes a synthetic recombinant DNA molecule containing a DNA sequence. It comprises a gene of Brucella abortus encoding an immunogenic protein having a molecular weight of approximately 31,000 daltons as determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis under denaturing conditions, the protein having an isoelectric point around 4.9, and containing a twenty-five amino acid sequence from its amino terminal end consisting of Gln-Ala-Pro-Thr-Phe-Phe-Arg-Ile-Gly-Thr-Gly-Gly-Thr-Ala-Gly-Thr-Tyr-Tyr-Pro-Ile-Gly-Gly-Leu-Ile-Ala, wherein Gln, Ala, Pro, Thr, Phe, Arg, Ile, Gly, Tyr, and Leu, respectively, represent glutamine, alanine, proline, threonine, phenylalanine, arginine, isolecuine, glycine, tyrosine, and leucine.

  3. Immunogenicity of UV-inactivated measles virus

    International Nuclear Information System (INIS)

    Zahorska, R.; Mazur, N.; Korbecki, M.

    1978-01-01

    By means of the antigen extinction limit test it was shown that a triple dose vaccination of guinea pigs with UV-inactivated measles virus gave better results, than a single dose vaccination which was proved by the very low immunogenicity index. For both vaccination schemes (single and triple) the immune response was only sligthly influenced by a change of dose from 10 5 to 10 6 HadU 50 /ml or by the addition of aluminum adjuvant. In the antigen extinction limit test the antibody levels were determined by two methods (HIT and NT) the results of which were statistically equivalent. The UV-inactivated measles virus was also found to induce hemolysis-inhibiting antibodies. (orig.) [de

  4. Real-Life Efficacy, Immunogenicity and Safety of Biosimilar Infliximab.

    Science.gov (United States)

    Vegh, Zsuzsanna; Kurti, Zsuzsanna; Lakatos, Peter L

    2017-01-01

    Recently, the use of biosimilar infliximab (IFX) in the treatment of inflammatory bowel diseases has become widespread in some European and non-European countries. Data on the efficacy, safety and immunogenicity from real-life cohorts are accumulating. The first reports showed similar outcomes in the induction and maintenance of remission, mucosal healing, safety and immunogenicity profile to the originator IFX. In the present review, we aimed to summarize the existing knowledge on the efficacy, safety and immunogenicity profile of biosimilar IFX reported from real-life cohorts. © 2017 S. Karger AG, Basel.

  5. Influence of solvent radiolysis on extraction, scrubbing and stripping of uranium and some fission products

    International Nuclear Information System (INIS)

    Gawlowska, W.; Nowak, M.

    1978-01-01

    Radiolytically degraded TBP-n-paraffins solvent was used in the laboratory flow-sheet to study the influence of radiation exposure on decontamination of uranium. The influence of accumulated doses on extraction, scrubbing and stripping of uranium and some fission products has been discussed. (author)

  6. Frequent contamination of nursing scrubs is associated with specific care activities.

    Science.gov (United States)

    Thom, Kerri A; Escobar, Daniel; Boutin, Mallory A; Zhan, Min; Harris, Anthony D; Johnson, J Kristie

    2018-05-01

    The objective of this article is to assess health care worker (HCW) and patient care factors associated with bacterial contamination of scrubs. We performed a cohort study of critical care HCWs. Participants were given 4 sets of new scrubs; each set was sampled 8 times during the 8-month study period on random days in the last 4 hours of the shift. Total colony counts and presence of prespecified pathogenic bacteria were assessed. Generalized estimating equation was used to identify factors associated with contamination. There were 720 samples obtained from 90 HCWs; 30% of samples were contaminated with pathogenic bacteria. Multivariate analysis showed that providing care for patients with wounds (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.17-2.62; P contamination. A second model showed the average log colony count of bacterial contamination of scrubs was higher when a bath was given (log colony count difference, 0.21; P = .05) but lower among HCWs assigned to care for at least 1 patient on contact precautions (log colony count difference, 0.28; P contaminated with bacteria. Providing care for patients with wounds or giving a bath were associated with scrub contamination by pathogenic bacteria. However, the amount of contamination was lower among HCWs who were assigned to care for patients on contact precautions. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  7. Re-caching by Western scrub-jays (Aphelocoma californica cannot be attributed to stress.

    Directory of Open Access Journals (Sweden)

    James M Thom

    Full Text Available Western scrub-jays (Aphelocoma californica live double lives, storing food for the future while raiding the stores of other birds. One tactic scrub-jays employ to protect stores is "re-caching"-relocating caches out of sight of would-be thieves. Recent computational modelling work suggests that re-caching might be mediated not by complex cognition, but by a combination of memory failure and stress. The "Stress Model" asserts that re-caching is a manifestation of a general drive to cache, rather than a desire to protect existing stores. Here, we present evidence strongly contradicting the central assumption of these models: that stress drives caching, irrespective of social context. In Experiment (i, we replicate the finding that scrub-jays preferentially relocate food they were watched hiding. In Experiment (ii we find no evidence that stress increases caching. In light of our results, we argue that the Stress Model cannot account for scrub-jay re-caching.

  8. Characteristics of coastal sage scrub in relation to fire history and use by California gnatcatchers

    Science.gov (United States)

    Jan L. Beyers; Ginger C. Pena

    1995-01-01

    Abstract: Plant cover and vegetation structure were examined at two inland coastal sage scrub sites differing in fire history and use by California gnatcatchers. Salvia mellifera and Eriogonum fasciculatum dominated one site; shrub cover on gnatcatcher occupied plots averaged 50 percent greater than on unoccupied plots. At the other site, gnatcatcher-occupied plots had...

  9. 75 FR 17396 - Notice of Availability of Government-Owned Inventions; Available for Licensing

    Science.gov (United States)

    2010-04-06

    ... diagnostics and therapeutics for scrub typhus and HIV infections'', Inventors: Wei Mei Ching, Chien Chung Chao... orientia tsutsugamushi to be used as a vaccine component against scrub typhus'', Inventors: Wei Mei Ching..., ``Recombinant antigens for diagnosis and prevention of murine typhus'', Inventor: Wei Mei Ching, issued June 9...

  10. Glycan bioengineering in immunogen design for tumor T antigen immunotargeting

    DEFF Research Database (Denmark)

    Sendra, Victor G; Zlocowski, Natacha; Ditamo, Yanina

    2009-01-01

    MM2 energy function showed that pentalysine (Lys5) linker and benzyl (Bzl) residue enhance TFD rigidity of the glycosidic bond. Antibodies raised against BzlalphaTFD-Lys5 immunogen recognize tumor T antigen. Competitive assays confirm that TFD-related structures are the main glycan epitope...... to the bioengineered glycoconjugate inhibited CT26 tumor cell proliferation and reduced tumor growth in an in vivo mouse model. These results show that TFD bioengineering is a useful immunogenic strategy with potential application in cancer therapy. The same approach can be extended to other glycan immunogens......Bioengineering of Galbeta3GalNAcalpha, known as Thomsen-Friedenreich disaccharide (TFD), is studied to promote glycan immunogenicity and immunotargeting to tumor T antigen (Galbeta3GalNAcalpha-O-Ser/Thr). Theoretical studies on disaccharide conformations by energy minimization of structures using...

  11. Development of a behavioural marker system for scrub practitioners' non-technical skills (SPLINTS system).

    Science.gov (United States)

    Mitchell, Lucy; Flin, Rhona; Yule, Steven; Mitchell, Janet; Coutts, Kathy; Youngson, George

    2013-04-01

    Adverse events still occur despite ongoing efforts to reduce harm to patients. Contributory factors to adverse events are often due to limitations in clinicians' non-technical skills (e.g. communication, situation awareness), rather than deficiencies in technical competence. We developed a behavioural rating system to provide a structured means for teaching and assessing scrub practitioners' (i.e. nurse, technician, operating department practitioner) non-technical skills. Psychologists facilitated focus groups (n = 4) with experienced scrub practitioners (n = 16; 4 in each group) to develop a preliminary taxonomy. Focus groups reviewed lists of non-technical-skill-related behaviours that were extracted from an interview study. The focus groups labelled skill categories and elements and also provided examples of good and poor behaviours for those skills. An expert panel (n = 2 psychologists; n = 1 expert nurse) then used an iterative process to individually and collaboratively review and refine those data to produce a prototype skills taxonomy. A preliminary taxonomy containing eight non-technical skill categories with 28 underlying elements was produced. The expert panel reduced this to three categories (situation awareness, communication and teamwork, task management), each with three underlying elements. The system was called the Scrub Practitioners' List of Intraoperative Non-Technical Skills system. A scoring system and a user handbook were also developed. A prototype behavioural rating system for scrub practitioners' non-technical skills was developed, to aid in teaching and providing formative assessment. This important aspect of performance is not currently explicitly addressed in any educational route to qualify as a scrub practitioner. © 2012 Blackwell Publishing Ltd.

  12. Non-technical skills of the operating theatre scrub nurse: literature review.

    Science.gov (United States)

    Mitchell, Lucy; Flin, Rhona

    2008-07-01

    This paper is a report of a review to identify the non-technical (cognitive and social) skills used by scrub nurses. Recognition that failures in non-technical skills contributed to accidents in high-risk industries led to the development of research programmes to study the role of cognition and social interactions in operational safety. Recently, psychological research in operating theatres has revealed the importance of non-technical skills in safe and efficient performance. Most of the studies to date have focused on anaesthetists and surgeons. On-line sources and university library catalogues, publications of the Association for Perioperative Practice, National Association of Theatre Nurses and Association of Peri-Operative Registered Nurses were searched in 2007. Studies were included in the review if they presented data from scrub nurses on one or more of their non-technical skills. These findings were examined in relation to an existing medical non-technical skills framework with categories of communication, teamwork, leadership, situation awareness and decision-making. Of 424 publications retrieved, 13 were reviewed in detail. Ten concerned communication and eight of those also had data on teamwork. In 11 papers teamwork was examined, and one focused on nurses' situation awareness, teamwork and communication. None of the papers we reviewed examined leadership or decision-making by scrub nurses. Further work is needed to identify formally the non-technical skills which are important to the role of scrub nurse and then to design training in the identified non-technical skills during the education and development of scrub nurses.

  13. Bacterial Agents Andantibiogram of Most Common Isolated Organisms from Hands of Surgical Team Members after Scrubbing

    Directory of Open Access Journals (Sweden)

    PS Mohseni- Meybodi

    2008-04-01

    Full Text Available Introduction: Many post-surgical wound infections in hospitals cause morbidity and morality of patients and these are usually transmitted via hands of surgical personnel. The aim of the present study was to detect and antibiogram the bacterial agents following scrubbing of hands of surgical personnel before operation. Methods: Hands of 134 personnels of operation room were swabbed following scrubbing with antiseptic Betadine solution. Swab samples were inoculated on selective and differential media such as blood ager, McConky and manitol salt agar(MSA. Following incubation of media at 37c° for 24hr, bacterial species were identified using differential related tests. The isolated species were than antibiogramed and the results together with other data was analysed by SPSS software program. Results: Of the total of 134 cases, 81(60.4% were male and 53(39.6% female. The mean scrub time for each person was (206.1+/-103.2 seconds; 6 to 60 seconds base change. Increasing time of scrub was significantly correlated with decreasing rate of bacteria (P=0.003, (R=-0.254. Contamination was present in 129(96.3% cases following scrubbing. Maximum contamination was observed in nails (92.5%. Average number of bacteria for each individual was between 0 and 159. 62.6% of isolated bacteria were non- staphylococci and 7.7% were S. aureus. Vancomycin and ceftizoxim were the most sensitive, while penicillin was the least sensitive antibiotic. Conclusion: Results revealed that hand contamination was more than the expected standard level. Therefore, regarding the critical task of surgical personnel, training of all operation room staff is highly recommended to minimize the rate of contamination.

  14. Battlefield-Acquired Immunogenicity to Metals Affects Orthopaedic Implant Outcome

    Science.gov (United States)

    2015-10-01

    Award Number: W81XWH-10-2-0138 TITLE: Battlefield-Acquired Immunogenicity to Metals Affects Orthopaedic Implant Outcome PRINCIPAL INVESTIGATOR...Immunogenicity to Metals Affects Orthopaedic pla t Outcome 5b. GRANT NUMBER W91ZSQ0135N646 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Nadim James...DISTRIBUTION / AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEM ENTARY NOTES 14. ABSTRACT The effects of battlefield

  15. Changes in the decontamination factor of cesium iodide on evaporation of a scrubbing solution in the Filtered Containment Venting System

    Energy Technology Data Exchange (ETDEWEB)

    Na, Young Su; Ha, Kwang Soon; Kim, Sungil; Cho, Song-Won [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2015-10-15

    When the pressure in the containment building approaches a setting value, the FCVS(Filtered Containment Venting System) operates. The amount of steam and gas mixtures generated during a severe accident can be released into the FCVS. Non-condensable gases and fine aerosols can pass a scrubbing solution and the filters in the FCVS vessel. The decontaminated gases are finally discharged from the FCVS to the outside environment. Previous study observed that a scrubbing solution in the FCVS vessel was constantly evaporating owing to high-temperature steam released continuously from the containment building. A scrubbing solution in the FCVS vessel was completely evaporated at about 31 hours after the FCVS operation. Pool evaporation in the FCVS vessel can negatively affect the decontamination feature of the FCVS because it reduces the scrubbing depth for fission products in an aerosol form. This study carefully evaluated the decontamination factor of metal iodide aerosols especially cesium iodide (CsI), on a scrubbing solution in the FCVS. This paper summarizes the calculated results on the decontamination factor of CsI in the FCVS vessel, which was presented at the international OECD-NEA/NUGENIA-SARNET workshop. This study estimated the decontamination factor of CsI on a scrubbing solution in the FCVS. The MELCOR computer code simulated that an SBO occurred in the OPR 1000. The FCVS consists of a cylindrical vessel with a 3 m diameter and 6.5 m height, and it includes a scrubbing solution of 21 tons. Accumulated mass of CsI aerosol was calculated in a scrubbing solution and the atmosphere in the FCVS vessel and the outside environment. In the early FCVS operation, the decontamination factor of CsI aerosol rapidly increased owing to steam condensation in a scrubbing solution. When the temperature of a pool approached its saturation temperature, the decontamination factor of CsI aerosol started to decrease.

  16. Impact of product-related factors on immunogenicity of biotherapeutics.

    Science.gov (United States)

    Singh, Satish Kumar

    2011-02-01

    All protein therapeutics have the potential to be immunogenic. Several factors, including patient characteristics, disease state, and the therapy itself, influence the generation of an immune response. Product-related factors such as the molecule design, the expression system, post-translational modifications, impurities, contaminants, formulation and excipients, container, closure, as well as degradation products are all implicated. However, a critical examination of the available data shows that clear unequivocal evidence for the impact of these latter factors on clinical immunogenicity is lacking. No report could be found that clearly deconvolutes the clinical impact of the product attributes on patient susceptibility. Aggregation carries the greatest concern as a risk factor for immunogenicity, but the impact of aggregates is likely to depend on their structure as well as on the functionality (e.g., immunostimulatory or immunomodulatory) of the therapeutic. Preclinical studies are not yet capable of assessing the clinically relevant immunogenicity potential of these product-related factors. Simply addressing these risk factors as part of product development will not eliminate immunogenicity. Minimization of immunogenicity has to begin at the molecule design stage by reducing or eliminating antigenic epitopes and building in favorable physical and chemical properties. Copyright © 2010 Wiley-Liss, Inc.

  17. Integrating Science & Management: Florida Scrub-Jay Conservation along the Central Florida's Atlantic Coast

    Science.gov (United States)

    Breininger, David R.

    2018-01-01

    Florida scrub-jays are a species listed under the Endangered Species Act. The NASA Ecology program has been a partner for conservation, recovery, and translocation across the species range. The objectives of this talk are to update members of the Archie Carr Working Group recovery, conservation, and translocation activities and describe how the Archie Carr National Wildlife Refuge and nearby conservation lands relate to species recovery actions.

  18. Use of face masks by non-scrubbed operating room staff: a randomized controlled trial.

    Science.gov (United States)

    Webster, Joan; Croger, Sarah; Lister, Carolyn; Doidge, Michelle; Terry, Michael J; Jones, Ian

    2010-03-01

    Ambiguity remains about the effectiveness of wearing surgical face masks. The purpose of this study was to assess the impact on surgical site infections (SSIs) when non-scrubbed operating room staff did not wear surgical face masks. Eight hundred twenty-seven participants undergoing elective or emergency obstetric, gynecological, general, orthopaedic, breast or urological surgery in an Australian tertiary hospital were enrolled. Complete follow-up data were available for 811 patients (98.1%). Operating room lists were randomly allocated to a 'Mask group' (all non-scrubbed staff wore a mask) or 'No Mask group' (none of the non-scrubbed staff wore masks). The primary end point, SSI was identified using in-patient surveillance; post discharge follow-up and chart reviews. The patient was followed for up to six weeks. Overall, 83 (10.2%) surgical site infections were recorded; 46/401 (11.5%) in the Masked group and 37/410 (9.0%) in the No Mask group; odds ratio (OR) 0.77 (95% confidence interval (CI) 0.49 to 1.21), p = 0.151. Independent risk factors for surgical site infection included: any pre-operative stay (adjusted odds ratio [aOR], 0.43 (95% CI, 0.20; 0.95), high BMI aOR, 0.38 (95% CI, 0.17; 0.87), and any previous surgical site infection aOR, 0.40 (95% CI, 0.17; 0.89). Surgical site infection rates did not increase when non-scrubbed operating room personnel did not wear a face mask.

  19. Nuclear ventilation installations. Method of control of the scrubbing coefficient of iodine trap

    International Nuclear Information System (INIS)

    1982-12-01

    The present standard aims at defining a method to control the scrubbing coefficient of radioactive iodine trapping systems, used in nuclear ventilation installations. It applies to the installations where the trapping, efficiency of radioactive iodine has to be known, tested and compared to a reference value generally included in the safety reports. It applies to the installations where the absolute pressure of the air in the ventilation systems is above 1,4. 10 5 Pa (1,4 Bar) [fr

  20. Characterisation of plastic microbeads in facial scrubs and their estimated emissions in Mainland China.

    Science.gov (United States)

    Cheung, Pui Kwan; Fok, Lincoln

    2017-10-01

    Plastic microbeads are often added to personal care and cosmetic products (PCCPs) as an abrasive agent in exfoliants. These beads have been reported to contaminate the aquatic environment and are sufficiently small to be readily ingested by aquatic organisms. Plastic microbeads can be directly released into the aquatic environment with domestic sewage if no sewage treatment is provided, and they can also escape from wastewater treatment plants (WWTPs) because of incomplete removal. However, the emissions of microbeads from these two sources have never been estimated for China, and no regulation has been imposed on the use of plastic microbeads in PCCPs. Therefore, in this study, we aimed to estimate the annual microbead emissions in Mainland China from both direct emissions and WWTP emissions. Nine facial scrubs were purchased, and the microbeads in the scrubs were extracted and enumerated. The microbead density in those products ranged from 5219 to 50,391 particles/g, with an average of 20,860 particles/g. Direct emissions arising from the use of facial scrubs were estimated using this average density number, population data, facial scrub usage rate, sewage treatment rate, and a few conservative assumptions. WWTP emissions were calculated by multiplying the annual treated sewage volume and estimated microbead density in treated sewage. We estimated that, on average, 209.7 trillion microbeads (306.9 tonnes) are emitted into the aquatic environment in Mainland China every year. More than 80% of the emissions originate from incomplete removal in WWTPs, and the remaining 20% are derived from direct emissions. Although the weight of the emitted microbeads only accounts for approximately 0.03% of the plastic waste input into the ocean from China, the number of microbeads emitted far exceeds the previous estimate of plastic debris (>330 μm) on the world's sea surface. Immediate actions are required to prevent plastic microbeads from entering the aquatic environment

  1. Physico-Chemical Properties of Personal Care Products Containing Guava Scrub Granules as Exfoliating Agent

    International Nuclear Information System (INIS)

    Zahariah Ismail; Mohd Fadlly Jumadi; Nurdiyana Mohamed Johari

    2015-01-01

    Treated guava scrub granules (GSG) as an exfoliating agent were obtained from the decanter waste at Sime Darby Food and Beverages, Sungai Wangi, Perak (SDFB). The treated GSG and tocotrienol were the main active ingredients incorporated in a basic formulation containing 87 % palm-based derivatives. Guava body scrub (GBS) and guava facial scrub (GFS) lotions were developed at skin pH 5.5 and pH 5.6 respectively. Both products were found to be stable for three years due to the liquid crystalline structure in the emulsion system , having small particle size (490 nm and 880 nm) and high zeta potential values (-54 mv and -39 mv). The rheological properties showed that the GBS lotion had a viscosity at 900 Pas and a yield value at 98 Pa, whereas the GFS lotion 60 Pas and 6 Pa viscosity and yield values respectively. The formulations were designed to be soft and flowable, with the firmness force indicated at 111 g and 66 g for GBS lotion and GFS lotion respectively. Efficacy testing on 20 healthy subjects showed a significant decrease of 21 % and 22 % in skin sebum removal for GBS lotion and GFS lotion respectively. (author)

  2. Influence of attrition scrubbing, ultrasonic treatment, and oxidant additions on uranium removal from contaminated soils

    International Nuclear Information System (INIS)

    Timpson, M.E.; Elless, M.P.; Francis, C.W.

    1994-01-01

    As part of the Uranium in Soils Integrated Demonstration Project being conducted by the US Department of Energy, bench-scale investigations of selective leaching of uranium from soils at the Fernald Environmental Management Project site in Ohio were conducted at Oak Ridge National Laboratory. Two soils (storage pad soil and incinerator soil), representing the major contaminant sources at the site, were extracted using carbonate- and citric acid-based lixiviants. Physical and chemical processes were used in combination with the two extractants to increase the rate of uranium release from these soils. Attrition scrubbing and ultrasonic dispersion were the two physical processes utilized. Potassium permanganate was used as an oxidizing agent to transform tetravalent uranium to the hexavalent state. Hexavalent uranium is easily complexed in solution by the carbonate radical. Attrition scrubbing increased the rate of uranium release from both soils when compared with rotary shaking. At equivalent extraction times and solids loadings, however, attrition scrubbing proved effective only on the incinerator soil. Ultrasonic treatments on the incinerator soil removed 71% of the uranium contamination in a single extraction. Multiple extractions of the same sample removed up to 90% of the uranium. Additions of potassium permanganate to the carbonate extractant resulted in significant changes in the extractability of uranium from the incinerator soil but had no effect on the storage pad soil

  3. Temperature impact on SO2 removal efficiency by ammonia gas scrubbing

    International Nuclear Information System (INIS)

    He Boshu; Zheng Xianyu; Wen Yan; Tong Huiling; Chen Meiqian; Chen Changhe

    2003-01-01

    Emissions reduction in industrial processes, i.e. clean production, is an essential requirement for sustainable development. Fossil fuel combustion is the main emission source for gas pollutants, such as NO X , SO 2 and CO 2 , and coal is now a primary energy source used worldwide with coal combustion being the greatest atmospheric pollution source in China. This paper analyzes flue gas cleaning by ammonia scrubbing (FGCAS) for power plants to remove gaseous pollutants, such as NO X , SO 2 and CO 2 , and presents the conceptual zero emission design for power plants. The byproducts from the FGCAS process can be used in agriculture or for gas recovery. Experimental results presented for SO 2 removal from the simulated flue gas in a continuous flow experiment, which was similar to an actual flue gas system, showed that the effectiveness of the ammonia injection or scrubbing depends on the temperature. The FGCAS process can effectively remove SO 2 , but the process temperature should be below 60 deg. C or above 80 deg. C for SO 2 reduction by NH 3 scrubbing

  4. Effective immunotherapy of weakly immunogenic solid tumours using a combined immunogene therapy and regulatory T-cell inactivation.

    LENUS (Irish Health Repository)

    Whelan, M C

    2012-01-31

    Obstacles to effective immunotherapeutic anti-cancer approaches include poor immunogenicity of the tumour cells and the presence of tolerogenic mechanisms in the tumour microenvironment. We report an effective immune-based treatment of weakly immunogenic, growing solid tumours using a locally delivered immunogene therapy to promote development of immune effector responses in the tumour microenvironment and a systemic based T regulatory cell (Treg) inactivation strategy to potentiate these responses by elimination of tolerogenic or immune suppressor influences. As the JBS fibrosarcoma is weakly immunogenic and accumulates Treg in its microenvironment with progressive growth, we used this tumour model to test our combined immunotherapies. Plasmids encoding GM-CSF and B7-1 were electrically delivered into 100 mm(3) tumours; Treg inactivation was accomplished by systemic administration of anti-CD25 antibody (Ab). Using this approach, we found that complete elimination of tumours was achieved at a level of 60% by immunogene therapy, 25% for Treg inactivation and 90% for combined therapies. Moreover, we found that these responses were immune transferable, systemic, tumour specific and durable. Combined gene-based immune effector therapy and Treg inactivation represents an effective treatment for weakly antigenic solid growing tumours and that could be considered for clinical development.

  5. Factors contributing to the immunogenicity of meningococcal conjugate vaccines

    Science.gov (United States)

    Bröker, Michael; Berti, Francesco; Costantino, Paolo

    2016-01-01

    ABSTRACT Various glycoprotein conjugate vaccines have been developed for the prevention of invasive meningococcal disease, having significant advantages over pure polysaccharide vaccines. One of the most important features of the conjugate vaccines is the induction of a T-cell dependent immune response, which enables both the induction of immune memory and a booster response after repeated immunization. The nature of the carrier protein to which the polysaccharides are chemically linked, is often regarded as the main component of the vaccine in determining its immunogenicity. However, other factors can have a significant impact on the vaccine's profile. In this review, we explore the physico-chemical properties of meningococcal conjugate vaccines, which can significantly contribute to the vaccine's immunogenicity. We demonstrate that the carrier is not the sole determining factor of the vaccine's profile, but, moreover, that the conjugate vaccine's immunogenicity is the result of multiple physico-chemical structures and characteristics. PMID:26934310

  6. Immunogenicity and Clinical Efficacy of Influenza Vaccination In Pregnancy

    Directory of Open Access Journals (Sweden)

    Alexander W Kay

    2015-06-01

    Full Text Available Pregnant women are at high risk from influenza due to disproportionate morbidity, mortality, and adverse pregnancy outcomes following infection. As such, they are classified as a high priority group for vaccination. However, changes in the maternal immune system required to accommodate the allogeneic fetus may alter the immunogenicity of influenza vaccines. A large number of studies have evaluated the safety of the influenza vaccine. Here, we will review available studies on the immunogenicity and efficacy of the influenza vaccine during pregnancy, focusing on both humoral and cellular immunity.

  7. Field Evaluation of Immunogenicity of Five Commercial Vaccines ...

    African Journals Online (AJOL)

    Field Evaluation of Immunogenicity of Five Commercial Vaccines Against Newcastle Disease in Poultry Farms in Ibadan, Nigeria. ... The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). If you would like more information ...

  8. Immunogenicity moderation effect of interleukin-24 on myelogenous leukemia cells.

    Science.gov (United States)

    Yu, Xin; Miao, Jingcheng; Xia, Wei; Gu, Zong-Jiang

    2018-04-01

    Previous studies have shown that interleukin-24 (IL-24) has tumor-suppressing activity by multiple pathways. However, the immunogenicity moderation effect of IL-24 on malignant cells has not been explored extensively. In this study, we investigated the role of IL-24 in immunogenicity modulation of the myelogenous leukemia cells. Data show that myelogenous leukemia cells express low levels of immunogenicity molecules. Treatment with IL-24 could enhance leukemia cell immunogenicity, predominantly regulate leukemia cells to produce immune-associated cytokines, and improve the cytotoxic sensitivity of these cells to immune effector cells. IL-24 expression could retard transplanted leukemia cell tumor growth in vivo in athymic nude mice. Moreover, IL-24 had marked effects on downregulating the expression of angiogenesis-related proteins vascular endothelial growth factor, cluster of differentiation (CD) 31, CD34, collagen IV and metastasis-related factors CD147, membrane type-1 matrix metalloproteinase (MMP), and MMP-2 and MMP-9 in transplanted tumors. These findings indicated novel functions of this antitumor gene and characterized IL-24 as a promising agent for further clinical trial for hematologic malignancy immunotherapy.

  9. Immunogenicity and safety of an acellular pertussis, diphtheria ...

    African Journals Online (AJOL)

    Objective. To assess the immunogenicity and safety data for a pentavalent combination vaccine containing acellular pertussis, inactivated poliovirus, and Haemophilus influenzae (Hib) polysaccharide-conjugate antigens. Methods. A DTaP-IPV//PRP~T vaccine (Pentaxim™) was given at 6, 10 and 14 weeks of age to 212 ...

  10. Dealing with immunogenicity of biologicals: assessment and clinical relevance

    NARCIS (Netherlands)

    Wolbink, Gerrit J.; Aarden, Lucien A.; Dijkmans, B. A. C.

    2009-01-01

    PURPOSE OF REVIEW: In the last decade, biologicals revolutionized rheumatology. An increasing number of patients benefit from biotherapeuticals. However, some patients do not respond to treatment and others lose their response after a certain time. Immunogenicity is one of the factors linked to

  11. Safety and immunogenicity of two Haemophilus influenzae type b ...

    African Journals Online (AJOL)

    Objectives. Haemophilus influenzae type b (Hib) infection remains a major public health problem inthe developing world. We evaluated the safety and immunogenicity of a new PRP-CRM197 conjugate Hib vaccine (Vaxem Hib, Chiron Vacdnes), compared with theHibTITER vaccine (WyethLederle Vaccines), following the ...

  12. Comparative immunogenicity of local and imported infectious bursal ...

    African Journals Online (AJOL)

    A comparative immunogenicity and efficacy study of local and imported infectious bursal disease (IBD) vaccines administered to chicks (cockerels) at varying regimes (10 and 18, 10 and 28, 14 and 35 days of age) was carried out. The test birds were challenged seven days after the booster dose of the IBD vaccine by ...

  13. Human factors related to time-dependent infection control measures: "Scrub the hub" for venous catheters and feeding tubes.

    Science.gov (United States)

    Caspari, Lindsay; Epstein, Elizabeth; Blackman, Amy; Jin, Li; Kaufman, David A

    2017-06-01

    The use of catheter hub decontamination protocols is a common practice to reduce central line-associated bloodstream infections. However, few data exist on the most effective disinfection procedure prior to hub access accounting for human factors and time-dependent practices in real time in the clinical setting. An observational design with a multimodal intervention was used in this study in a neonatal intensive care unit. Direct observations on nurse compliance of scrub times with decontamination when accessing of venous catheter and feeding tube hubs were conducted during 3 phases: (1) baseline period prior to any interventions; (2) during an educational intervention phase; and (3) during a timer intervention period when using a timing device, either an actual timer or music button. Overall, both education and the timing device interventions increased the mean scrub time ± SD of venous catheter hubs. Mean baseline scrub times of 10 ± 5 seconds were lower compared with 23 ± 12 seconds after educational intervention (P music button use (P observed with scrub times of feeding tubes. Time-based infection control measures, such as scrubbing the hub, must be implemented with aids that qualify specific times to account for human factors, to ensure adherence to time-dependent measures aimed at decreasing nosocomial infections. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  14. An Assessment of Fission Product Scrubbing in Sodium Pools Following a Core Damage Event in a Sodium Cooled Fast Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Bucknor, M.; Farmer, M.; Grabaskas, D.

    2017-06-26

    The U.S. Nuclear Regulatory Commission has stated that mechanistic source term (MST) calculations are expected to be required as part of the advanced reactor licensing process. A recent study by Argonne National Laboratory has concluded that fission product scrubbing in sodium pools is an important aspect of an MST calculation for a sodium-cooled fast reactor (SFR). To model the phenomena associated with sodium pool scrubbing, a computational tool, developed as part of the Integral Fast Reactor (IFR) program, was utilized in an MST trial calculation. This tool was developed by applying classical theories of aerosol scrubbing to the decontamination of gases produced as a result of postulated fuel pin failures during an SFR accident scenario. The model currently considers aerosol capture by Brownian diffusion, inertial deposition, and gravitational sedimentation. The effects of sodium vapour condensation on aerosol scrubbing are also treated. This paper provides details of the individual scrubbing mechanisms utilized in the IFR code as well as results from a trial mechanistic source term assessment led by Argonne National Laboratory in 2016.

  15. Sample Results From The Extraction, Scrub, And Strip Test For The Blended NGS Solvent

    Energy Technology Data Exchange (ETDEWEB)

    Washington, A. L. II [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Peters, T. B. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2014-03-03

    This report summarizes the results of the extraction, scrub, and strip testing for the September 2013 sampling of the Next Generation Solvent (NGS) Blended solvent from the Modular Caustic Side-Solvent Extraction Unit (MCU) Solvent Hold Tank. MCU is in the process of transitioning from the BOBCalixC6 solvent to the NGS Blend solvent. As part of that transition, MCU has intentionally created a blended solvent to be processed using the Salt Batch program. This sample represents the first sample received from that blended solvent. There were two ESS tests performed where NGS blended solvent performance was assessed using either the Tank 21 material utilized in the Salt Batch 7 analyses or a simulant waste material used in the V-5/V-10 contactor testing. This report tabulates the temperature corrected cesium distribution, or DCs values, step recovery percentage, and actual temperatures recorded during the experiment. This report also identifies the sample receipt date, preparation method, and analysis performed in the accumulation of the listed values. The calculated extraction DCs values using the Tank 21H material and simulant are 59.4 and 53.8, respectively. The DCs values for two scrub and three strip processes for the Tank 21 material are 4.58, 2.91, 0.00184, 0.0252, and 0.00575, respectively. The D-values for two scrub and three strip processes for the simulant are 3.47, 2.18, 0.00468, 0.00057, and 0.00572, respectively. These values are similar to previous measurements of Salt Batch 7 feed with lab-prepared blended solvent. These numbers are considered compatible to allow simulant testing to be completed in place of actual waste due to the limited availability of feed material.

  16. Sample Results From The Extraction, Scrub, And Strip Test For The Blended NGS Solvent

    International Nuclear Information System (INIS)

    Washington, A. L. II; Peters, T. B.

    2014-01-01

    This report summarizes the results of the extraction, scrub, and strip testing for the September 2013 sampling of the Next Generation Solvent (NGS) Blended solvent from the Modular Caustic Side-Solvent Extraction Unit (MCU) Solvent Hold Tank. MCU is in the process of transitioning from the BOBCalixC6 solvent to the NGS Blend solvent. As part of that transition, MCU has intentionally created a blended solvent to be processed using the Salt Batch program. This sample represents the first sample received from that blended solvent. There were two ESS tests performed where NGS blended solvent performance was assessed using either the Tank 21 material utilized in the Salt Batch 7 analyses or a simulant waste material used in the V-5/V-10 contactor testing. This report tabulates the temperature corrected cesium distribution, or DCs values, step recovery percentage, and actual temperatures recorded during the experiment. This report also identifies the sample receipt date, preparation method, and analysis performed in the accumulation of the listed values. The calculated extraction DCs values using the Tank 21H material and simulant are 59.4 and 53.8, respectively. The DCs values for two scrub and three strip processes for the Tank 21 material are 4.58, 2.91, 0.00184, 0.0252, and 0.00575, respectively. The D-values for two scrub and three strip processes for the simulant are 3.47, 2.18, 0.00468, 0.00057, and 0.00572, respectively. These values are similar to previous measurements of Salt Batch 7 feed with lab-prepared blended solvent. These numbers are considered compatible to allow simulant testing to be completed in place of actual waste due to the limited availability of feed material

  17. Enhancement of the SPARC90 code to pool scrubbing events under jet injection regime

    Energy Technology Data Exchange (ETDEWEB)

    Berna, C., E-mail: ceberes@iie.upv.es [Instituto de Ingeniería Energética, Universitat Politècnica de València (UPV), Camino de Vera 14, 46022 Valencia (Spain); Escrivá, A.; Muñoz-Cobo, J.L. [Instituto de Ingeniería Energética, Universitat Politècnica de València (UPV), Camino de Vera 14, 46022 Valencia (Spain); Herranz, L.E., E-mail: luisen.herranz@ciemat.es [Unit of Nuclear Safety Research Division of Nuclear Fission, CIEMAT, Avda. Complutense 22, 28040 Madrid (Spain)

    2016-04-15

    Highlights: • Review of the most recent literature concerning submerged jets. • Emphasize all variables and processes occurring along the jet region. • Highlight the gaps of knowledge still existing related to submerged jets. • Enhancement of SPARC90-Jet to estimate aerosol removal under jet injection regime. • Validation of the SPARC90-Jet results against pool scrubbing experimental data. - Abstract: Submerged gaseous jets may have an outstanding relevance in many industrial processes and may be of particular significance in severe nuclear accident scenarios, like in the Fukushima accident. Even though pool scrubbing has been traditionally associated with low injection velocities, there are a number of potential scenarios in which fission product trapping in aqueous ponds might also occur under jet injection regime (like SGTR meltdown sequences in PWRs and SBO ones in BWRs). The SPARC90 code was developed to determine the fission product trapping in pools during severe accidents. The code assumes that carrier gas arrives at the water ponds at low or moderate velocities and it forms a big bubble that eventually detaches from the injection pipe. However, particle laden gases may enter the water at very high velocities resulting in a submerged gas jet instead. This work presents the fundamentals, major hypotheses and changes introduced into the code in order to estimate particle removal during gas injection in pools under the jet regime (SPARC90-Jet). A simplified and reliable approach to submerged jet hydrodynamics has been implemented on the basis of updated equations for jet hydrodynamics and aerosol removal, so that gas–liquid and droplet-particles interactions are described. The code modifications have been validated as far as possible. However, no suitable hydrodynamic tests have been found in the literature, so that an indirect validation has been conducted through comparisons against data from pool scrubbing experiments. Besides, this validation

  18. Enhancement of the SPARC90 code to pool scrubbing events under jet injection regime

    International Nuclear Information System (INIS)

    Berna, C.; Escrivá, A.; Muñoz-Cobo, J.L.; Herranz, L.E.

    2016-01-01

    Highlights: • Review of the most recent literature concerning submerged jets. • Emphasize all variables and processes occurring along the jet region. • Highlight the gaps of knowledge still existing related to submerged jets. • Enhancement of SPARC90-Jet to estimate aerosol removal under jet injection regime. • Validation of the SPARC90-Jet results against pool scrubbing experimental data. - Abstract: Submerged gaseous jets may have an outstanding relevance in many industrial processes and may be of particular significance in severe nuclear accident scenarios, like in the Fukushima accident. Even though pool scrubbing has been traditionally associated with low injection velocities, there are a number of potential scenarios in which fission product trapping in aqueous ponds might also occur under jet injection regime (like SGTR meltdown sequences in PWRs and SBO ones in BWRs). The SPARC90 code was developed to determine the fission product trapping in pools during severe accidents. The code assumes that carrier gas arrives at the water ponds at low or moderate velocities and it forms a big bubble that eventually detaches from the injection pipe. However, particle laden gases may enter the water at very high velocities resulting in a submerged gas jet instead. This work presents the fundamentals, major hypotheses and changes introduced into the code in order to estimate particle removal during gas injection in pools under the jet regime (SPARC90-Jet). A simplified and reliable approach to submerged jet hydrodynamics has been implemented on the basis of updated equations for jet hydrodynamics and aerosol removal, so that gas–liquid and droplet-particles interactions are described. The code modifications have been validated as far as possible. However, no suitable hydrodynamic tests have been found in the literature, so that an indirect validation has been conducted through comparisons against data from pool scrubbing experiments. Besides, this validation

  19. Extraction, Scrub, and Strip Test Results for the Salt Waste Processing Facility Caustic Side Solvent Extraction Solvent Sample

    Energy Technology Data Exchange (ETDEWEB)

    Peters, T. B. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2017-10-06

    An Extraction, Scrub, and Strip (ESS) test was performed on a sample of Salt Waste Processing Facility (SWPF) Caustic-Side Solvent Extraction (CSSX) solvent and salt simulant to determine cesium distribution ratios (D(Cs)), and cesium concentration in the strip effluent (SE) and decontaminated salt solution (DSS) streams; this data will be used by Parsons to help determine if the solvent is qualified for use at the SWPF. The ESS test showed acceptable performance of the solvent for extraction, scrub, and strip operations. The extraction D(Cs) measured 12.5, exceeding the required value of 8. This value is consistent with results from previous ESS tests using similar solvent formulations. Similarly, scrub and strip cesium distribution ratios fell within acceptable ranges. This revision was created to correct an error. The previous revision used an incorrect set of temperature correction coefficients which resulted in slight deviations from the correct D(Cs) results.

  20. Extraction, scrub, and strip test results for the salt waste processing facility caustic side solvent extraction solvent example

    Energy Technology Data Exchange (ETDEWEB)

    Peters, T. B. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2017-08-01

    An Extraction, Scrub, and Strip (ESS) test was performed on a sample of Salt Waste Processing Facility (SWPF) Caustic-Side Solvent Extraction (CSSX) solvent and salt simulant to determine cesium distribution ratios (D(Cs)), and cesium concentration in the strip effluent (SE) and decontaminated salt solution (DSS) streams; this data will be used by Parsons to help determine if the solvent is qualified for use at the SWPF. The ESS test showed acceptable performance of the solvent for extraction, scrub, and strip operations. The extraction D(Cs) measured 12.9, exceeding the required value of 8. This value is consistent with results from previous ESS tests using similar solvent formulations. Similarly, scrub and strip cesium distribution ratios fell within acceptable ranges.

  1. Parasites of domestic and wild animals in South Africa. XXXII. Ixodid ticks on scrub hares in the Transvaal.

    Science.gov (United States)

    Horak, I G; Spickett, A M; Braack, L E; Penzhorn, B L

    1993-09-01

    A total of 264 scrub hares (Lepus saxatilis) were examined for ixodid ticks at various localities in the Kruger National Park, eastern Transvaal Lowveld. Thirteen tick species were recovered from these hares. The seasonal abundances of the immature stages of Amblyomma hebraeum, Amblyomma marmoreum, Hyalomma truncatum, Rhipicephalus appendiculatus, Rhipicephalus evertsi evertsi, Rhipicephalus simus and Rhipicephalus zambeziensis and all stages of a Rhipicephalus sp. (near R. pravus) were determined. Three scrub hares, examined in the north-western Transvaal Bushveld, were infested with five ixodid tick species. Ten hares examined in the eastern Transvaal Highveld harboured three species. A total of 15 ixodid tick species were recovered from the scrub hares examined in the three regions of the Transvaal. No haematozoa were found in blood smears made from the hares examined in the southern region of the Kruger National Park.

  2. Dose-response model of murine typhus (Rickettsia typhi: time post inoculation and host age dependency analysis

    Directory of Open Access Journals (Sweden)

    Tamrakar Sushil B

    2012-03-01

    Full Text Available Abstract Background Rickettsia typhi (R. mooseri is the causative agent of murine typhus. It is one of the most widely distributed flea-borne diseases with a relatively mild febrile initial illness with six to 14 days of incubation period. The bacterium is gram negative and an obligate intracellular pathogen. The disease is transmitted to humans and vertebrate host through fleabites or via contact with infected feces. This paper develops dose-response models of different routes of exposure for typhus in rodents. Methods Data from published articles were analyzed using parametric dose-response relationship models. Dose-response relationships were fit to data using the method of maximum likelihood estimation (MLE. Results Dose-response models quantifying the effects of different ages of rats and time post inoculation in BALB/c mice were analyzed in the study. Both the adult rats (inoculated intradermally and newborn rats (inoculated subcutaneously were best fit by exponential models and both distributions could be described by a single dose-response relationship. The BALB/C mice inoculated subcutaneously were best fit by Beta-Poisson models. The time post inoculation analysis showed that there was a definite time and response relationship existed in this case. Conclusions Intradermally or subcutaneously inoculated rats (adult and newborn models suggest that less than 1 plaque-forming unit (PFU (1.33 to 0.38 in 95% confidence limits of the pathogen is enough to seroconvert 50% of the exposed population on average. For the BALB/c mouse time post inoculation model, an average dose of 0.28 plaque-forming units (PFU (0.75 to 0.11 in 95% confidence limits will seroconvert 50% of the exposed mice.

  3. Murine (endemic typhus in Brazil: case report and review Tifo murino (endêmico no Brasil: relato de caso e revisão

    Directory of Open Access Journals (Sweden)

    Luiz J. Silva

    2004-10-01

    Full Text Available Murine typhus has been increasingly recognized worldwide and is becoming a relevant differential diagnosis in febrile conditions. In Brazil, murine typhus has never received much attention. We present a recently diagnosed case and a literature review that suggests that the disease could be more prevalent in Southeastern Brazil than acknowledged until now.O tifo murino tem sido reconhecido com freqüência crescente em todo o mundo e vem se tornando um relevante diagnóstico diferencial de quadros febris. No Brasill, o tifo murino nunca mereceu grande atenção. Descrevemos um caso clínico e fazemos revisão da literatura que sugere que a doença poderia ser mais prevalente no sudeste brasileiro do que reconhecido até então.

  4. Production of adsorbent from palm shell for radioactive iodine scrubbing process

    International Nuclear Information System (INIS)

    Mohamad Azman Che Mat Isa; Ku Halim Ku Hamid; Muhd Noor Muhd Yunus; Mohamad Puad Abu; Abdul Halim Badaruddin; Mohammad Nizammudin Abd Aziz; Muhd Ridwan Abdul Rahim

    2010-01-01

    The biggest biomass source in Malaysia comes from oil palm industry. According to the statistic of year 2004, Malaysia produced 40 million tones per year of biomass which 30 million tones of biomass originated from the oil palm industries. Therefore, the biomass waste such as palm kernel shell can be used to produce granular adsorbent for radioactive materials. For that reason, a newly system, called Rocking Kiln - Fluidized Bed (RK - FB) was developed to utilize large amount of the biomass to produce high value added product. Charcoal or chemically produced activated carbon could be produced by using the kiln. Washing process was introduced to remove particles, minerals and volatile matters from charcoal produced and then would create more surface area in the adsorbent by creating more active sites. In this research, the adsorbent produced was used to scrub iodine 131. In nuclear power reactor, iodine isotope 131 is produced during nuclear fission, and this elementary radioactive iodine may pollute exhaust air streams that could cause thyroid cancer. For removal of radioactive iodine, normally a potassium iodide - impregnated activated carbon (KI - AC) is used. Thus, a process will be developed to produce KI - AC and this product will be used to calculate the efficiency to remove the radioactive iodine 131.The results obtain show that adsorbent produced has a high potential to be used in radioactive adsorbing and likely more economics. This paper will elaborate further the experimental set-up of in Kiln - Fluidized Bed (RK - FB), adsorbent quality and radioactive scrubbing process. (author)

  5. POSSIBILITY OF BENEFICIATION OF SILICA SAND FROM THE CROATIAN DEPOSITS USING ATTRITION SCRUBBING

    Directory of Open Access Journals (Sweden)

    Ivan Sobota

    2011-12-01

    Full Text Available To meet high quality requirements defined for specific industrial applications, the raw sand often has to be subjected to extensive physical and chemical processing. The possibility of achieving silica sand concentrate of required quality depends mostly on raw sand properties, primarily mineral impurity types and contents, and features of applied beneficiation methods. When the impurities occur in the form of oxide coatings on the surfaces of the single sand grains, attriton scrubbing is applied. By reducing the proportion of oxide coatings on the grains, the quality of sand can be improved. With the aim to determine the possibilities of the beneficiation of silica sand from significant Croatian deposits (“Vrtlinska”, “Štefanac” and “Španovica” and achieve concentrate grade complying with the requirements of domestic industry, laboratory tests were conducted on three raw sand samples with different SiO2 and impurity contents. Grain size distribution, chemical and mineral composition of raw sand samples, and the possibility of their quality improvement by applying the washing, classification and attrition scrubbing were defined by analysis of test results (the paper is published in Croatian.

  6. Effects of high fire frequency in creosote bush scrub vegetation of the Mojave Desert

    Science.gov (United States)

    Brooks, M.L.

    2012-01-01

    Plant invasions can increase fire frequency in desert ecosystems where fires were historically infrequent. Although there are many resource management concerns associated with high frequency fire in deserts, fundamental effects on plant community characteristics remain largely unstudied. Here I describe the effects of fire frequency on creosote bush scrub vegetation in the Mojave Desert, USA. Biomass of the invasive annual grass Bromus rubens L. increased following fire, but did not increase further with additional fires. In contrast, density, cover and species richness of native perennial plants each decreased following fire and continued to decrease with subsequent fires, although not as dramatically as after the initial fire. Responses were similar 5 and 14 years post-fire, except that cover of Hymenoclea salsola Torr. & A. Gray and Achnatherum speciosa Trin. & Rupr. both increased in areas burnt once. These results suggest that control of B. rubens may be equally warranted after one, two or three fires, but revegetation of native perennial plants is most warranted following multiple fires. These results are valid within the scope of this study, which is defined as relatively short term vegetation responses (???14 years) to short fire return intervals (6.3 and 7.3 years for the two and three fire frequency levels) within creosote bush scrub of the Mojave Desert. ?? 2012 IAWF.

  7. Trial Watch: Immunogenic cell death inducers for anticancer chemotherapy.

    Science.gov (United States)

    Pol, Jonathan; Vacchelli, Erika; Aranda, Fernando; Castoldi, Francesca; Eggermont, Alexander; Cremer, Isabelle; Sautès-Fridman, Catherine; Fucikova, Jitka; Galon, Jérôme; Spisek, Radek; Tartour, Eric; Zitvogel, Laurence; Kroemer, Guido; Galluzzi, Lorenzo

    2015-04-01

    The term "immunogenic cell death" (ICD) is now employed to indicate a functionally peculiar form of apoptosis that is sufficient for immunocompetent hosts to mount an adaptive immune response against dead cell-associated antigens. Several drugs have been ascribed with the ability to provoke ICD when employed as standalone therapeutic interventions. These include various chemotherapeutics routinely employed in the clinic (e.g., doxorubicin, epirubicin, idarubicin, mitoxantrone, bleomycin, bortezomib, cyclophosphamide and oxaliplatin) as well as some anticancer agents that are still under preclinical or clinical development (e.g., some microtubular inhibitors of the epothilone family). In addition, a few drugs are able to convert otherwise non-immunogenic instances of cell death into bona fide ICD, and may therefore be employed as chemotherapeutic adjuvants within combinatorial regimens. This is the case of cardiac glycosides, like digoxin and digitoxin, and zoledronic acid. Here, we discuss recent developments on anticancer chemotherapy based on ICD inducers.

  8. Human monoclonal antibodies: the residual challenge of antibody immunogenicity.

    Science.gov (United States)

    Waldmann, Herman

    2014-01-01

    One of the major reasons for seeking human monoclonal antibodies has been to eliminate immunogenicity seen with rodent antibodies. Thus far, there has yet been no approach which absolutely abolishes that risk for cell-binding antibodies. In this short article, I draw attention to classical work which shows that monomeric immunoglobulins are intrinsically tolerogenic if they can be prevented from creating aggregates or immune complexes. Based on these classical studies two approaches for active tolerization to therapeutic antibodies are described.

  9. Immunogenicity of ascites tumor cells following in vitro hyperthermia

    International Nuclear Information System (INIS)

    Dickson, J.A.; Jasiewicz, M.L.; Simpson, A.C.

    1982-01-01

    The concept that host immunization may be achieved by heat-induced antigenic modifications of cancer cells and/or the release of immunogenic products by dead or dying tumor cells following in vitro heating was examined. Ehrlich ascites cells were used, inasmuch as it was claimed that in vitro hyperthermia increased the immunogenicity of these cells. Tumor cell populations of different viability were obtained by heating Ehrlich cells at 42.5 degrees, 45 degrees, or 60 degrees C. Viable and nonviable cells were separated by Ficoll-Hypaque density centrifugation; viable nonreplicating cells were obtained by treatment with mitomycin C. Cell populations of different viability after heating were left to die slowly over 3 days at 37 degrees C. Swiss TO mice were then given injections of the treated cells and/or medium. No survival benefit occurred in mice inoculated with any of these different components and then challenged with viable tumor cells. Injection of irradiated cells, however, did produce host immunity. Similarly, D23 rat hepatoma ascites cells produced host immunity after 15,000 rad but not after heating. The claim that in vitro hyperthermia increases the immunogenicity of tumor cells was not confirmed

  10. Immunogenic Apoptosis as a Novel Tool for Anticancer Vaccine Development

    Directory of Open Access Journals (Sweden)

    Barbara Montico

    2018-02-01

    Full Text Available Immunogenic apoptosis, or more appropriately called immunogenic cell death (ICD, is a recently described form of apoptosis induced by a specific set of chemotherapeutic drugs or by physical therapeutic modalities, such as ionizing irradiation and photodynamic therapy. The peculiar characteristic of ICD is the ability to favor recognition and elimination of dying tumor cells by phagocytes in association with the release of pro-inflammatory molecules (such as cytokines and high-mobility group box-1. While in vitro and animal models pointed to ICD as one of the molecular mechanisms mediating the clinical efficacy of some anticancer agents, it is hard to clearly demonstrate its contribution in cancer patients. Clinical evidence suggests that the induction of ICD alone is possibly not sufficient to fully subvert the immunosuppressive tumor microenvironment. However, interesting results from recent studies contemplate the exploitation of ICD for improving the immunogenicity of cancer cells to use them as an antigen cargo in the development of dendritic cell (DC vaccines. Herein, we discuss the effects of danger signals expressed or released by cancer cells undergoing ICD on the maturation and activation of immature and mature DC, highlighting the potential added value of ICD in adoptive immunotherapy protocols.

  11. Meningococcal B vaccine. An immunogenic vaccine possibly useful during outbreaks.

    Science.gov (United States)

    2014-09-01

    Invasive meningococcal infections can be life-threatening and cause severe sequelae. Antibiotic therapy is only partially effective. Bexsero is the first meningococcal B vaccine to be approved in the European Union. It contains four capsular antigens from various strains of group B meningococci. Clinical trials of this meningococcal B vaccine did not assess clinical protection. Two immunogenicity studies in adults, one in adolescents and six in infants, are available. They established the immunogenicity of the meningococcal B vaccine, determined age-appropriate vaccination schedules, and verified that concomitant administration of other vaccines did not undermine its immunogenicity. In the absence of relevant clinical trials, an in vitro study showed that sera from vaccinated individuals were likely to have bactericidal activity against 85% of 200 invasive meningococcal B strains isolated in France in 2007-2008. The meningococcal B vaccine provoked local adverse effects in most vaccinees, including local erythema, induration and pain. Fever occurred in about half of vaccinated children. Six cases of Kawasaki syndrome have been reported in children who received the vaccine, compared to only one case in control groups. In practice, the harm-benefit balance of this meningococcal B vaccine justify using it during outbreaks, provided the outbreak strain is covered by the vaccine antigens. Vaccinees should be enrolled in studies designed to evaluate clinical efficacy and to better determine the risk of Kawasaki syndrome.

  12. Results of radioiodine therapy using different radiation doses in patients suffering from immunogenic and non-immunogenic hyperthyroidism

    International Nuclear Information System (INIS)

    Moser, E.

    1992-01-01

    During the past few years high rates of recidivation have increasingly been reported following drug treatment for hyperthyroidism. In view of these unsatisfactory results it is only natural that the use of surgery and ratioiodine treatment is now more often considered in order to achieve complete elimination of the metabolic disorders caused by hyperactivity of the thyroid gland. The aim of this study was to investigate into the effectiveness of radioiodine therapy in a large cohort of patients (n = 925). Particular attention was given to the influence of the dose applied to the thyroid tissue on the rates of success achieved in immunogenic hyperthyroidism (IH) and autonomous disorders (non-immunogenic hyperthyroidism = NIH). (orig./GDG) [de

  13. Identification of Novel Immunogenic Proteins of Neisseria gonorrhoeae by Phage Display.

    Directory of Open Access Journals (Sweden)

    Daniel O Connor

    Full Text Available Neisseria gonorrhoeae is one of the most prevalent sexually transmitted diseases worldwide with more than 100 million new infections per year. A lack of intense research over the last decades and increasing resistances to the recommended antibiotics call for a better understanding of gonococcal infection, fast diagnostics and therapeutic measures against N. gonorrhoeae. Therefore, the aim of this work was to identify novel immunogenic proteins as a first step to advance those unresolved problems. For the identification of immunogenic proteins, pHORF oligopeptide phage display libraries of the entire N. gonorrhoeae genome were constructed. Several immunogenic oligopeptides were identified using polyclonal rabbit antibodies against N. gonorrhoeae. Corresponding full-length proteins of the identified oligopeptides were expressed and their immunogenic character was verified by ELISA. The immunogenic character of six proteins was identified for the first time. Additional 13 proteins were verified as immunogenic proteins in N. gonorrhoeae.

  14. Identification of immunogenic hot spots within plum pox potyvirus capsid protein for efficient antigen presentation.

    Science.gov (United States)

    Fernández-Fernández, M Rosario; Martínez-Torrecuadrada, Jorge L; Roncal, Fernando; Domínguez, Elvira; García, Juan Antonio

    2002-12-01

    PEPSCAN analysis has been used to characterize the immunogenic regions of the capsid protein (CP) in virions of plum pox potyvirus (PPV). In addition to the well-known highly immunogenic N- and C-terminal domains of CP, regions within the core domain of the protein have also shown high immunogenicity. Moreover, the N terminus of CP is not homogeneously immunogenic, alternatively showing regions frequently recognized by antibodies and others that are not recognized at all. These results have helped us to design efficient antigen presentation vectors based on PPV. As predicted by PEPSCAN analysis, a small displacement of the insertion site in a previously constructed vector, PPV-gamma, turned the derived chimeras into efficient immunogens. Vectors expressing foreign peptides at different positions within a highly immunogenic region (amino acids 43 to 52) in the N-terminal domain of CP were the most effective at inducing specific antibody responses against the foreign sequence.

  15. Effect of High-Intensity Wildfire and Silvicultural Treatments on Reptile Communities in Sand-Pine Scrub

    Science.gov (United States)

    Cathryn H. Greenberg; Daniel G. Neary; Larry D. Harris

    1994-01-01

    We tested whether the herpetofuunal response to clearcutting followed by site preparation was similar to high-intensity wildfire foIlowed by salvage logging in sand- pine scrub. Herpetofaunal communities were compared in three replicated 5- to 7-yearpost-disturbance treatments and mature sand-pine forest. The three disturbance treatments were (1) high-intensity...

  16. Recovery of perchloroethylene scrubbing medium generated in the refabrication of high-temperature gas-cooled reactor fuel

    Energy Technology Data Exchange (ETDEWEB)

    Judd, M.S.; Van Cleve, J.E. Jr.; Rainey, W.T. Jr.

    1976-11-01

    During the refabrication of high-temperature gas-cooled reactor (HTGR) fuel, perchloroethylene (C/sub 2/Cl/sub 4/) is used as the nonmoderating scrubbing medium to remove condensable hydrocarbons, carbon soot, and uranium-bearing particulates from the off-gas streams. The process by which the contaminated perchloroethylene is recycled is discussed.

  17. Recovery of perchloroethylene scrubbing medium generated in the refabrication of high-temperature gas-cooled reactor fuel

    International Nuclear Information System (INIS)

    Judd, M.S.; Van Cleve, J.E. Jr.; Rainey, W.T. Jr.

    1976-11-01

    During the refabrication of high-temperature gas-cooled reactor (HTGR) fuel, perchloroethylene (C 2 Cl 4 ) is used as the nonmoderating scrubbing medium to remove condensable hydrocarbons, carbon soot, and uranium-bearing particulates from the off-gas streams. The process by which the contaminated perchloroethylene is recycled is discussed

  18. Simultaneous removal of nitrogen oxide/nitrogen dioxide/sulfur dioxide from gas streams by combined plasma scrubbing technology.

    Science.gov (United States)

    Chang, Moo Been; Lee, How Ming; Wu, Feeling; Lai, Chi Ren

    2004-08-01

    Oxides of nitrogen (NOx) [nitrogen oxide (NO) + nitrogen dioxide (NO2)] and sulfur dioxide (SO2) are removed individually in traditional air pollution control technologies. This study proposes a combined plasma scrubbing (CPS) system for simultaneous removal of SO2 and NOx. CPS consists of a dielectric barrier discharge (DBD) and wet scrubbing in series. DBD is used to generate nonthermal plasmas for converting NO to NO2. The water-soluble NO2 then can be removed by wet scrubbing accompanied with SO2 removal. In this work, CPS was tested with simulated exhausts in the laboratory and with diesel-generator exhausts in the field. Experimental results indicate that DBD is very efficient in converting NO to NO2. More than 90% removal of NO, NOx, and SO2 can be simultaneously achieved with CPS. Both sodium sulfide (Na2S) and sodium sulfite (Na2SO3) scrubbing solutions are good for NO2 and SO2 absorption. Energy efficiencies for NOx and SO2 removal are 17 and 18 g/kWh, respectively. The technical feasibility of CPS for simultaneous removal of NO, NO2, and SO2 from gas streams is successfully demonstrated in this study. However, production of carbon monoxide as a side-product (approximately 100 ppm) is found and should be considered.

  19. Diverse manifestations of tumorigenicity and immunogenicity displayed by the poorly immunogenic B16-BL6 melanoma transduced with cytokine genes.

    Science.gov (United States)

    Arca, M J; Krauss, J C; Strome, S E; Cameron, M J; Chang, A E

    1996-05-01

    We evaluated the in vivo response to the poorly immunogenic B16-BL6 (BL6) murine melanoma genetically altered to secrete interleukin-2 (IL-2), IL-4, interferon gamma (IFN gamma) and granulocyte/macrophage-colony-stimulating factor (GM-CSF). Three parameters were evaluated: (1) tumorigenicity, (2) vaccination of naive animals, and (3) assessment of antitumor reactivity of T cells derived from tumor-draining lymph nodes (TDLN). Secretion of IL-2 abrogated the tumorigenicity of BL6, while IFN gamma and IL-4 partially reduced tumorigenicity, and GM-CSF had no effect. Protective immunity to wild-type tumor challenge could not be achieved by vaccination with irradiated cytokine-secreting tumors, although IL-2 and IL-4 secretion appeared to retard the growth of the challenge inoculum significantly. An alternative method to evaluate the immunogenicity of the cytokine-secreting tumors was to measure the ability of T cells obtained from TDLN to mediate regression of wild-type tumor in adoptive immunotherapy. Neither IL-2 nor IFN gamma secretion resulted in the induction of immune T cells. By contrast, GM-CSF and IL-4 secretion were found to induce immune T cells in the TDLN with GM-CSF being superior to IL-4. The combined secretion of GM-CSF and IL-4 did not lead to enhanced induction of immune T cells. GM-CSF secretion was found to upregulate B7-1 expression in TDLN, consistent with an increase in the population of antigen-presenting cells. These studies demonstrated that reduced tumorigenicity by cytokine secretion did not correlate with increased immunogenicity. With the cytokines examined, there was limited capability of developing protective immunity against the BL6 tumor. Nevertheless, GM-CSF and IL-4 secretion significantly enhanced T cell immune reactivity to the poorly immunogenic BL6 tumor.

  20. Intrinsic immunogenicity of rapidly-degradable polymers evolves during degradation.

    Science.gov (United States)

    Andorko, James I; Hess, Krystina L; Pineault, Kevin G; Jewell, Christopher M

    2016-03-01

    Recent studies reveal many biomaterial vaccine carriers are able to activate immunostimulatory pathways, even in the absence of other immune signals. How the changing properties of polymers during biodegradation impact this intrinsic immunogenicity is not well studied, yet this information could contribute to rational design of degradable vaccine carriers that help direct immune response. We use degradable poly(beta-amino esters) (PBAEs) to explore intrinsic immunogenicity as a function of the degree of polymer degradation and polymer form (e.g., soluble, particles). PBAE particles condensed by electrostatic interaction to mimic a common vaccine approach strongly activate dendritic cells, drive antigen presentation, and enhance T cell proliferation in the presence of antigen. Polymer molecular weight strongly influences these effects, with maximum stimulation at short degradation times--corresponding to high molecular weight--and waning levels as degradation continues. In contrast, free polymer is immunologically inert. In mice, PBAE particles increase the numbers and activation state of cells in lymph nodes. Mechanistic studies reveal that this evolving immunogenicity occurs as the physicochemical properties and concentration of particles change during polymer degradation. This work confirms the immunological profile of degradable, synthetic polymers can evolve over time and creates an opportunity to leverage this feature in new vaccines. Degradable polymers are increasingly important in vaccination, but how the inherent immunogenicity of polymers changes during degradation is poorly understood. Using common rapidly-degradable vaccine carriers, we show that the activation of immune cells--even in the absence of other adjuvants--depends on polymer form (e.g., free, particulate) and the extent of degradation. These changing characteristics alter the physicochemical properties (e.g., charge, size, molecular weight) of polymer particles, driving changes in

  1. Impact of elevated CO2 on a Florida Scrub-oak Ecosystems

    Energy Technology Data Exchange (ETDEWEB)

    Drake, Bert G

    2013-01-01

    Since May of 1996, we have conducted an experiment in Florida Scrub Oak to determine the impact of elevated atmospheric CO2 and climate change on carbon, water, and nutrient cycling in this important terrestrial ecosystem. Florida scrub oak is the name for a collective of species occupying much of the Florida peninsula. The dominant tree species are oaks and the dwarf structure of this community makes it an excellent system in which to test hypotheses regarding the potential capacity of woody ecosystems to assimilate and sequester anthropogenic carbon. Scrub oak is fire dependent with a return cycle of 10-15 years, a time which would permit an experiment to follow the entire cycle. Our site is located on Cape Canaveral at the Kennedy Space Center, Florida. After burning in 1995, we built 16 open top chambers, half of which have been fumigated with pure CO2 sufficient to raise the concentration around the plants to 350 ppm above ambient. In the intervening 10 years we have non destructively measured biomass of shoots and roots, ecosystem gas exchange using chambers and eddy flux, leaf photosynthesis and respiration, soil respiration, and relevant environmental factors such as soil water availability, temperature, light, etc. The overwhelming result from analysis of our extensive data base is that elevated CO2 has had a profound impact on this ecosystem that, overall, has resulted in increased carbon accumulation in plant shoots, roots and litter. Our measurements of net ecosystem gas exchange also indicate that the ecosystem has accumulated carbon much in excess of the increased biomass or soil carbon suggesting a substantial export of carbon through the porous, sandy soil into the water table several meters below the surface. A major discovery is the powerful interaction between the stimulation of growth, photosynthesis, and respiration by elevated CO2 and other environmental factors particularly precipitation and nitrogen. Our measurements focused attention on

  2. Standardizing terms, definitions and concepts for describing and interpreting unwanted immunogenicity of biopharmaceuticals

    DEFF Research Database (Denmark)

    Rup, B; Pallardy, M; Sikkema, D

    2015-01-01

    scientists are involved in: interpretation and management of clinical and biological outcomes of BP immunogenicity, improvement of methods for describing, predicting and mitigating immunogenicity risk and elucidation of underlying causes. Collaboration and alignment of efforts across these communities...... the Risk; www.abirisk.eu] was formed by leading clinicians, academic scientists and EFPIA (European Federation of Pharmaceutical Industries and Associations) members to elucidate underlying causes, improve methods for immunogenicity prediction and mitigation and establish common definitions around terms...

  3. Numerical Model of SO2 Scrubbing with Seawater Applied to Marine Engines

    Directory of Open Access Journals (Sweden)

    Lamas M. I.

    2016-04-01

    Full Text Available The present paper proposes a CFD model to study sulphur dioxide (SO2 absorption in seawater. The focus is on the treatment of marine diesel engine exhaust gas. Both seawater and distilled water were compared to analyze the effect of seawater alkalinity. The results indicate that seawater is more appropriate than distilled water due to its alkalinity, obtaining almost 100% cleaning efficiency for the conditions analyzed. This SO2 reduction meets the limits of SOx emission control areas (SECA when operating on heavy fuel oil. These numerical simulations were satisfactory validated with experimental tests. Such data are essential in designing seawater scrubbers and judging the operating cost of seawater scrubbing compared to alternative fuels.

  4. Genetic Variation in Past and Current Landscapes: Conservation Implications Based on Six Endemic Florida Scrub Plants

    International Nuclear Information System (INIS)

    Menges, E.S.; Pickert, R.; Dolan, R.W.; Yahr, R.; Gordon, D.R.

    2010-01-01

    If genetic variation is often positively correlated with population sizes and the presence of nearby populations and suitable habitats, landscape proxies could inform conservation decisions without genetic analyses. For six Florida scrub endemic plants (Dicerandra frutescens, Eryngium cuneifolium, Hypericum cumulicola, Liatris ohlingerae, Nolina brittoniana, and Warea carteri), we relate two measures of genetic variation, expected heterozygosity and alleles per polymorphic locus (APL), to population size and landscape variables. Presettlement areas were estimated based on soil preferences and GIS soils maps. Four species showed no genetic patterns related to population or landscape factors. The other two species showed significant but inconsistent patterns. For Liatris ohlingerae, APL was negatively related to population density and weakly, positively related to remaining presettlement habitat within 32 km. For Nolina brittoniana, APL increased with population size. The rather weak effects of population area/size and both past and current landscape structures suggest that genetic variation needs to be directly measured and not inferred for conservation planning.

  5. Noncondensable hydrogen sulfide incineration with brine scrubbing air emissions control system

    International Nuclear Information System (INIS)

    Goddard, W.B.; Goddard, C.B.; McClain, D.W.

    1990-01-01

    This paper reports on the technical and institutional feasibility of incinerating hydrogen sulfide (H2S) contained in geothermal noncondensable gases, and the use of geothermal brine for sulfur dioxide scrubbing and absorption as an Air Emissions Control System (AECS), for geothermal power plant, that have been documented through engineering analysis in the Phase I grant study funded through the California Department of Health Services (DOHS), Hazardous Materials Reduction Grant Program and hosted by California Energy Company (CECI). Grant funding for Phase II now has been approved to proceed with the project through the pilot plant design phase. This innovative AECS does not necessitate the use of hazardous materials or produce hazardous wastes. Cost savings were documented compared to injection pump operation or conventional AECS without the use of hazardous materials. The phase II project is to design, improve, research and develop a source reduction demonstration pilot plant geothermal noncondensable H2S incineration AECS

  6. Seasonality of the activity pattern of Callithrix penicillata (Primates, Callitrichidae in the cerrado (scrub savanna vegetation

    Directory of Open Access Journals (Sweden)

    S. L. Vilela

    Full Text Available Two wild groups of Callithrix penicillata, the Black Pincelled Marmoset, were observed from January to September 1998, in two areas, one an area of dense scrub savanna vegetation (cerrado and the other, a semidecidual woodland (cerradão, both within the boundaries of the Ecological Reserve of IBGE (Brazilian Institute of Geography and Statistics, in an environmentally protected area, the APA (Portuguese abbreviation for "environmental protected area" Gama/Cabeça-de-Veado, Brasília, DF. The behavioral data collected during the rainy (January 15 to April 15 and dry season (June 1 to September 15 were compared. Because of the proximity to the Reserve facilities, the group from the dense scrub savanna vegetation (CD was submitted to antropic impacts different from the group in the semidecidual woodland (CE, which was using as territory an area that had been suffering from man-made fires every two years as part of a long-term experimental project on fire impacts. The behavioral data was quantified by instantaneous cross-section ("scan sampling" every ten minutes with records of locomotion, rest, foraging for insects, use of exudate, and feeding. During the whole year, the greatest percentage of time spent by CE and CD was in foraging for insects, with 44% and 39%, respectively. It was evident when comparing the data for the two seasons that, for both groups, foraging for insects was more intense during the dry season, possibly to complement the shortage of food, and locomotion increased during the rainy season. The greater the availability and distribution of fruit in the areas, the greater the locomotion of the groups to obtain these resources. None of the other behavioral patterns, including the use of exudates, presented significant differences between the two seasons. Both groups foraged more frequently during the dry season and locomoted more during the rainy one.

  7. Safety and immunogenicity of a live attenuated mumps vaccine

    Science.gov (United States)

    Liang, Yan; Ma, Jingchen; Li, Changgui; Chen, Yuguo; Liu, Longding; Liao, Yun; Zhang, Ying; Jiang, Li; Wang, Xuan-Yi; Che, Yanchun; Deng, Wei; Li, Hong; Cui, Xiaoyu; Ma, Na; Ding, Dong; Xie, Zhongping; Cui, Pingfang; Ji, Qiuyan; Wang, Jingjing; Zhao, Yuliang; Wang, Junzhi; Li, Qihan

    2014-01-01

    Background: Mumps, a communicable, acute and previously well-controlled disease, has had recent and occasional resurgences in some areas. Methods: A randomized, double-blind, controlled and multistep phase I study of an F-genotype attenuated mumps vaccine produced in human diploid cells was conducted. A total of 300 subjects were enrolled and divided into 4 age groups: 16–60 years, 5–16 years, 2–5 years and 8–24 months. The groups were immunized with one injection per subject. Three different doses of the F-genotype attenuated mumps vaccine, A (3.5 ± 0.25 logCCID50), B (4.25 ± 0.25 logCCID50) and C (5.0 ± 0.25 logCCID50), as well as a placebo control and a positive control of a licensed A-genotype vaccine (S79 strain) were used. The safety and immunogenicity of this vaccine were compared with those of the controls. Results: The safety evaluation suggested that mild adverse reactions were observed in all groups. No serious adverse event (SAE) was reported throughout the trial. The immunogenicity test showed a similar seroconversion rate of the neutralizing and ELISA antibody in the 2- to 5-year-old and 8- to 24-month-old groups compared with the seroconversion rate in the positive control. The GMT of the neutralizing anti-F-genotype virus antibodies in the vaccine groups was slightly higher than that in the positive control group. Conclusions: The F-genotype attenuated mumps vaccine evaluated in this clinical trial was demonstrated to be safe and have effective immunogenicity vs. control. PMID:24614759

  8. Listeriolysin o is strongly immunogenic independently of its cytotoxic activity.

    Directory of Open Access Journals (Sweden)

    Javier A Carrero

    Full Text Available The presentation of microbial protein antigens by Major Histocompatibility Complex (MHC molecules is essential for the development of acquired immunity to infections. However, most biochemical studies of antigen processing and presentation deal with a few relatively inert non-microbial model antigens. The bacterial pore-forming toxin listeriolysin O (LLO is paradoxical in that it is cytotoxic at nanomolar concentrations as well as being the source of dominant CD4 and CD8 T cell epitopes following infection with Listeria monocytogenes. Here, we examined the relationship of LLO toxicity to its antigenicity and immunogenicity. LLO offered to antigen presenting cells (APC as a soluble protein, was presented to CD4 T cells at picomolar to femtomolar concentrations- doses 3000-7000-fold lower than free peptide. This presentation required a dose of LLO below the cytotoxic level. Mutations of two key tryptophan residues reduced LLO toxicity by 10-100-fold but had no effect on its presentation to CD4 T cells. Thus there was a clear dissociation between the cytotoxic properties of LLO and its very high antigenicity. Presentation of LLO to CD8 T cells was not as robust as that seen in CD4 T cells, but still occurred in the nanomolar range. APC rapidly bound and internalized LLO, then disrupted endosomal compartments within 4 hours of treatment, allowing endosomal contents to access the cytosol. LLO was also immunogenic after in vivo administration into mice. Our results demonstrate the strength of LLO as an immunogen to both CD4 and CD8 T cells.

  9. Virulence, immunogenicity and vaccine properties of a novel chimeric pestivirus

    DEFF Research Database (Denmark)

    Rasmussen, Thomas Bruun; Uttenthal, Åse; Reimann, Ilona

    2007-01-01

    A chimeric pestivirus of border disease virus Gifhorn and bovine viral diarrhea virus CP7 (Meyers et al., 1996) was constructed. Virulence, immunogenicity and vaccine properties of the chimeric virus were studied in a vaccination–challenge experiment in pigs. The chimeric virus proved...... to be avirulent and neither chimeric virus nor viral RNA was detected in serum after vaccination. The safety of the vaccine was tested by horizontal transmission to sentinel pigs, which remained uninfected. The vaccine efficacy was examined by challenge infection with classical swine fever virus (CSFV) Eystrup...

  10. Immunogenic Targets for Specific Immunotherapy in Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Lu Zhang

    2012-01-01

    Full Text Available Multiple myeloma remains an incurable disease although the prognosis has been improved by novel therapeutics and agents recently. Relapse occurs in the majority of patients and becomes fatal finally. Immunotherapy might be a powerful intervention to maintain a long-lasting control of minimal residual disease or to even eradicate disseminated tumor cells. Several tumor-associated antigens have been identified in patients with multiple myeloma. These antigens are expressed in a tumor-specific or tumor-restricted pattern, are able to elicit immune response, and thus could serve as targets for immunotherapy. This review discusses immunogenic antigens with therapeutic potential for multiple myeloma.

  11. Safety and Immunogenicity of a Candidate Parvovirus B19 Vaccine

    OpenAIRE

    Bernstein, David I; El Sahly, Hana M; Keitel, Wendy A; Wolff, Mark; Simone, Gina; Segawa, Claire; Wong, Susan; Shelly, Daniel; Young, Neal S; Dempsey, Walla

    2011-01-01

    Parvovirus B19 is an important human pathogen causing erythema infectiosum, transient aplastic crisis in individuals with underlying hemolytic disorders and hydrops fetalis. We therefore evaluated a parvovirus B19 virus like particle (VLP) vaccine. The safety and immunogenicity of a 25 μg dose of parvovirus B19 recombinant capsid; 2.5 and 25 μg doses of the recombinant capsid given with MF59; and saline placebo were assessed in healthy adults. Because of 3 unexplained cutaneous events the stu...

  12. Identification and characterization of immunogenic proteins of Mycoplasma genitalium

    DEFF Research Database (Denmark)

    Svenstrup, Helle Friis; Jensen, J.S.; Gevaert, K.

    2006-01-01

    serum against M. genitalium G37, determine their identity by mass spectrometry, and develop an M. genitalium-specific enzyme-linked immunosorbent assay (ELISA) free from cross-reactivity with M. pneumoniae antibodies. Using recombinant fragments of the C-terminal part of MgPa (rMgPa), we developed....... genitalium strains were isolated (J. S. Jensen, H. T. Hansen, and K. Lind, J. Clin. Microbiol. 34:286-291, 1996). The objective of this study was to characterize immunogenic proteins of M. genitalium by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting by using a hyperimmune rabbit...

  13. Immunogenicity of an HPV-16 L2 DNA vaccine

    Science.gov (United States)

    Hitzeroth, Inga I.; Passmore, Jo-Ann S.; Shephard, Enid; Stewart, Debbie; Müller, Martin; Williamson, Anna-Lise; Rybicki, Edward P.; Kast, W. Martin

    2009-01-01

    The ability to elicit cross-neutralizing antibodies makes human papillomavirus (HPV) L2 capsid protein a possible HPV vaccine. We examined and compared the humoral response of mice immunised with a HPV-16 L2 DNA vaccine or with HPV-16 L2 protein. The L2 DNA vaccine elicited a non-neutralising antibody response unlike the L2 protein. L2 DNA vaccination suppressed the growth of L2-expressing C3 tumor cells, which is a T cell mediated effect, demonstrating that the lack of non-neutralizing antibody induction by L2 DNA was not caused by lack of T cell immunogenicity of the construct. PMID:19559114

  14. Power requirements of biogas upgrading by water scrubbing and biomethane compression: Comparative analysis of various plant configurations

    International Nuclear Information System (INIS)

    Budzianowski, Wojciech M.; Wylock, Christophe E.; Marciniak, Przemysław A.

    2017-01-01

    Highlights: • Insights into power requirements of biomethane production from biogas are provided. • Process model is constructed, validated and simulated. • High-pressure and low-pressure plant operation in different configurations is compared. - Abstract: Biogas upgrading by water scrubbing followed by biomethane compression is an environmentally benign process. It may be achieved using various plant configurations characterised by various power requirements with associated effects on biomethane sustainability. Therefore, the current study has been undertaken to systematically investigate the power requirements of a range of water scrubbing options. Two groups of water scrubbing are analysed: (1) high pressure water scrubbing (HPWS) and (2) near-atmospheric pressure water scrubbing (NAPWS). A water scrubbing plant model is constructed, experimentally validated and simulated for seven upgrading plant configurations. Simulation results show that the power requirement of biogas upgrading in HPWS plants is mainly associated with biogas compression. In contrast, in NAPWS plants the main power is required for water pumping. In both plants the compression of the biomethane from atmosphereic pressure to 20 MPa also contributes remarkably. It is observed that the lowest specific power requirement can be obtained for a NAPWS plant without water regeneration (0.24 kW h/Nm"3 raw biogas) but this plant requires cheap water supply, e.g. outlet water from a sewage treatment plant or river. The second is HPWS without flash (0.29 kW h/Nm"3 raw biogas). All other HPWS with flash and NAPWS with water regeneration plants have specific power requirements between 0.30 and 0.33 kW h/Nm"3 raw biogas. Biogas compression without upgrading requires about 0.29 kW h/Nm"3 raw biogas. The thermodynamic efficiency of biogas upgrading is between 2.2% and 9.8% depending on the plant configuration while biomethane compression efficiency is higher, about 55%. This result implies that the

  15. Structure of fumarate hydratase from Rickettsia prowazekii, the agent of typhus and suspected relative of the mitochondria

    International Nuclear Information System (INIS)

    Phan, Isabelle; Subramanian, Sandhya; Olsen, Christian; Edwards, Thomas E.; Guo, Wenjin; Zhang, Yang; Van Voorhis, Wesley C.; Stewart, Lance J.; Myler, Peter J.

    2011-01-01

    Fumarate hydratase is an enzyme of the tricarboxylic acid cycle, one of the metabolic pathways characteristic of the mitochondria. The structure of R. prowazekii class II fumarate hydratase is reported at 2.4 Å resolution and is compared with the available structure of the human homolog. Rickettsiae are obligate intracellular parasites of eukaryotic cells that are the causative agents responsible for spotted fever and typhus. Their small genome (about 800 protein-coding genes) is highly conserved across species and has been postulated as the ancestor of the mitochondria. No genes that are required for glycolysis are found in the Rickettsia prowazekii or mitochondrial genomes, but a complete set of genes encoding components of the tricarboxylic acid cycle and the respiratory-chain complex is found in both. A 2.4 Å resolution crystal structure of R. prowazekii fumarate hydratase, an enzyme catalyzing the third step of the tricarboxylic acid cycle pathway that ultimately converts phosphoenolpyruvate into succinyl-CoA, has been solved. A structure alignment with human mitochondrial fumarate hydratase highlights the close similarity between R. prowazekii and mitochondrial enzymes

  16. Development of a transgenic mouse model to study the immunogenicity of recombinant human insulin

    NARCIS (Netherlands)

    Torosantucci, Riccardo; Brinks, Vera; Kijanka, Grzegorz; Halim, Liem Andhyk; Sauerborn, Melody; Schellekens, Huub; Jiskoot, Wim

    2014-01-01

    Mouse models are commonly used to assess the immunogenicity of therapeutic proteins and to investigate the immunological processes leading to antidrug antibodies. The aim of this work was to develop a transgenic (TG) Balb/c mouse model for evaluating the immunogenicity of recombinant human insulin

  17. Results of radioiodine therapy of patients with immunogenic and non-immunogenic hyperthyroidism using different radiation doses

    International Nuclear Information System (INIS)

    Moser, E.; Pickardt, C.R.; Mann, K.; Engelhardt, D.; Kirsch, C.M.; Knesewitsch, P.; Tatsch, K.; Kreisig, T.; Kurz, C.; Saller, B.; Klinikum Grosshadern, Muenchen; Muenchen Univ.

    1988-01-01

    The aim of this study was to check the efficacy of radioiodine ( 131 I) therapy (RIT) in a large number of patients (n = 506) suffering from immunogenic or non-immunogenic hyperthyroidism (Graves' disease, Plummer's disease). Since there is no causal cure for immunogenic hyperthyroidism RIT provides, like all other modalities, only a moderate rate of success which is clearly dose-related. Applying 60 Gy, normal thyroid function can be achieved is only 54% of the cases. A dose of 150 Gy succeeds in 86% of the cases. The solitary decompensated autonomous adenoma (DAA) can be eliminated surgically as well as by RIT with a high degree of success (95%). Contrary to surgery, RIT does not have any noticeable early or late morbidity. The high rate of success of RIT in patients with DAA could be confirmed in two groups with different follow-up periods (16 and 65 months). As expected, the rate of hypothyroidism increased from 11% in the early group to 23% in the late group. Multinodular autonomous adenomas can be eliminated successfully using RIT as well. The concept to apply a dose of 400 Gy to the total functional autonomous tissue as determined by ultrasound yields better results (95%) than 150 Gy to the whole thyroid gland as measured by ultrasound (88%). The rate of hypothyroidism as shown by these results (up to a maximum of 62% after RIT of Graves' disease using 150 Gy) is the lesser evil compared to remaining or recurrent hyperthyroidism since these patients can be treated with thyroid hormones without problems. (orig.) [de

  18. Salk's HIV immunogen: an immune-based therapy in human trials since 1988.

    Science.gov (United States)

    Jonas Salk, the developer of the first polio vaccine, has created a therapeutic vaccine for HIV which helps the immune system fight disease progression. Salk uses inactivated HIV-1 virus combined with Incomplete Freund's Adjuvant (IFA) in the vaccine preparation. The resulting HIV-1 immunogen was first studied in 1987, and since then, 235 seropositive individuals have received inoculations without serious adverse effects. Data from the first 25 subjects indicate that immunization with the HIV-1 immunogen results in improvement of cell-mediated response against the virus, a slower increase in the amount of virus present, and a reduced rate of clinical progression. Subsequent studies also show that higher doses of immunogen may produce stronger cell-mediated responses and high HIV-DTH (delayed-type hypersensitivity responsiveness immunogen) is associated with better outcome. Additional trials of HIV-1 immunogen are awaiting Food and Drug Administration approval.

  19. The Effect of Irradiation on the Immunogenity of Brucella Abortus

    International Nuclear Information System (INIS)

    Arifin, M.; Tuasikal, Boky J.; Endhang Pudjiastuti; Ernawati Yulia

    2004-01-01

    An experiment was carried out to study the effect of irradiation on the immunogenity of B. abortus. The B. abortus were irradiated by Gamma Cells ( 60 Co). An experiment were divided into four groups. The first group (V1) was inoculated by irradiated B. abortus with the dose of 0.25 kGy. The second group (V2) was inoculated by irradiated B. abortus with the dose of 0.50 kGy. The third group (V3) was inoculated by irradiated B. abortus with the dose of 0.75 kGy. The fourth group (V4) was inoculated by Brucella vaccine 8.19. The observation respectively were included purely test, safety test, RBT serological test, diffusion test, development the colony of B. abortus in lien, and pathology anatomic inspection. The results obtained showed that 0.25 kGy was the expectantly dose of irradiation which could not only decreasing the infectivity of B. abortus but also has the ability to become a good immunogen for stimulating the immune response in the experiment animals. (author)

  20. Cytokines in immunogenic cell death: Applications for cancer immunotherapy.

    Science.gov (United States)

    Showalter, Anne; Limaye, Arati; Oyer, Jeremiah L; Igarashi, Robert; Kittipatarin, Christina; Copik, Alicja J; Khaled, Annette R

    2017-09-01

    Despite advances in treatments like chemotherapy and radiotherapy, metastatic cancer remains a leading cause of death for cancer patients. While many chemotherapeutic agents can efficiently eliminate cancer cells, long-term protection against cancer is not achieved and many patients experience cancer recurrence. Mobilizing and stimulating the immune system against tumor cells is one of the most effective ways to protect against cancers that recur and/or metastasize. Activated tumor specific cytotoxic T lymphocytes (CTLs) can seek out and destroy metastatic tumor cells and reduce tumor lesions. Natural Killer (NK) cells are a front-line defense against drug-resistant tumors and can provide tumoricidal activity to enhance tumor immune surveillance. Cytokines like IFN-γ or TNF play a crucial role in creating an immunogenic microenvironment and therefore are key players in the fight against metastatic cancer. To this end, a group of anthracyclines or treatments like photodynamic therapy (PDT) exert their effects on cancer cells in a manner that activates the immune system. This process, known as immunogenic cell death (ICD), is characterized by the release of membrane-bound and soluble factors that boost the function of immune cells. This review will explore different types of ICD inducers, some in clinical trials, to demonstrate that optimizing the cytokine response brought about by treatments with ICD-inducing agents is central to promoting anti-cancer immunity that provides long-lasting protection against disease recurrence and metastasis. Copyright © 2017. Published by Elsevier Ltd.

  1. The convergence of radiation and immunogenic cell death signaling pathways

    International Nuclear Information System (INIS)

    Golden, Encouse B.; Pellicciotta, Ilenia; Demaria, Sandra; Barcellos-Hoff, Mary H.; Formenti, Silvia C.

    2012-01-01

    Ionizing radiation (IR) triggers programmed cell death in tumor cells through a variety of highly regulated processes. Radiation-induced tumor cell death has been studied extensively in vitro and is widely attributed to multiple distinct mechanisms, including apoptosis, necrosis, mitotic catastrophe (MC), autophagy, and senescence, which may occur concurrently. When considering tumor cell death in the context of an organism, an emerging body of evidence suggests there is a reciprocal relationship in which radiation stimulates the immune system, which in turn contributes to tumor cell kill. As a result, traditional measurements of radiation-induced tumor cell death, in vitro, fail to represent the extent of clinically observed responses, including reductions in loco-regional failure rates and improvements in metastases free and overall survival. Hence, understanding the immunological responses to the type of radiation-induced cell death is critical. In this review, the mechanisms of radiation-induced tumor cell death are described, with particular focus on immunogenic cell death (ICD). Strategies combining radiotherapy with specific chemotherapies or immunotherapies capable of inducing a repertoire of cancer specific immunogens might potentiate tumor control not only by enhancing cell kill but also through the induction of a successful anti-tumor vaccination that improves patient survival.

  2. Influences of obesity on the immunogenicity of Hepatitis B vaccine.

    Science.gov (United States)

    Liu, Fang; Guo, Zhirong; Dong, Chen

    2017-05-04

    Hepatitis B vaccine is regarded as the most effective method for the prevention of hepatitis B virus (HBV) infection. However, several factors such as age, body mass index and immunocompetent state have been reported to be associated with reduced immunization responses. The present commentary was aimed to discuss the influences of obesity on the immunogenicity of hepatitis B vaccines. Available peer-reviewed literatures, practice guidelines, and statistics published on hepatitis B vaccine in obesity between 1973 and 2015. Obesity was significantly associated with non-response to hepatitis B vaccine immunization. The risk of nonresponsiveness of hepatitis B vaccine among obese people increased with BMI. Moreover, the obesity might lead to an increased risk of HBV vaccine-escape mutations. The mechanism responsible for decreased immunization responses in obesity included leptin-induced systemic and B cell intrinsic inflammation, impaired T cell responses and lymphocyte division and proliferation. Therefore, more studies should be performed to analyze the influences of obesity on the immunogenicity of hepatitis B vaccines to improve the immunoprotecive effect of hepatitis B vaccines in future.

  3. Size, Shape, and Sequence-Dependent Immunogenicity of RNA Nanoparticles.

    Science.gov (United States)

    Guo, Sijin; Li, Hui; Ma, Mengshi; Fu, Jian; Dong, Yizhou; Guo, Peixuan

    2017-12-15

    RNA molecules have emerged as promising therapeutics. Like all other drugs, the safety profile and immune response are important criteria for drug evaluation. However, the literature on RNA immunogenicity has been controversial. Here, we used the approach of RNA nanotechnology to demonstrate that the immune response of RNA nanoparticles is size, shape, and sequence dependent. RNA triangle, square, pentagon, and tetrahedron with same shape but different sizes, or same size but different shapes were used as models to investigate the immune response. The levels of pro-inflammatory cytokines induced by these RNA nanoarchitectures were assessed in macrophage-like cells and animals. It was found that RNA polygons without extension at the vertexes were immune inert. However, when single-stranded RNA with a specific sequence was extended from the vertexes of RNA polygons, strong immune responses were detected. These immunostimulations are sequence specific, because some other extended sequences induced little or no immune response. Additionally, larger-size RNA square induced stronger cytokine secretion. 3D RNA tetrahedron showed stronger immunostimulation than planar RNA triangle. These results suggest that the immunogenicity of RNA nanoparticles is tunable to produce either a minimal immune response that can serve as safe therapeutic vectors, or a strong immune response for cancer immunotherapy or vaccine adjuvants. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Size, Shape, and Sequence-Dependent Immunogenicity of RNA Nanoparticles

    Directory of Open Access Journals (Sweden)

    Sijin Guo

    2017-12-01

    Full Text Available RNA molecules have emerged as promising therapeutics. Like all other drugs, the safety profile and immune response are important criteria for drug evaluation. However, the literature on RNA immunogenicity has been controversial. Here, we used the approach of RNA nanotechnology to demonstrate that the immune response of RNA nanoparticles is size, shape, and sequence dependent. RNA triangle, square, pentagon, and tetrahedron with same shape but different sizes, or same size but different shapes were used as models to investigate the immune response. The levels of pro-inflammatory cytokines induced by these RNA nanoarchitectures were assessed in macrophage-like cells and animals. It was found that RNA polygons without extension at the vertexes were immune inert. However, when single-stranded RNA with a specific sequence was extended from the vertexes of RNA polygons, strong immune responses were detected. These immunostimulations are sequence specific, because some other extended sequences induced little or no immune response. Additionally, larger-size RNA square induced stronger cytokine secretion. 3D RNA tetrahedron showed stronger immunostimulation than planar RNA triangle. These results suggest that the immunogenicity of RNA nanoparticles is tunable to produce either a minimal immune response that can serve as safe therapeutic vectors, or a strong immune response for cancer immunotherapy or vaccine adjuvants.

  5. Exposure and risk factors to coxiella burnetii, spotted fever group and typhus group Rickettsiae, and Bartonella henselae among volunteer blood donors in Namibia.

    Directory of Open Access Journals (Sweden)

    Bruce H Noden

    Full Text Available The role of pathogen-mediated febrile illness in sub-Saharan Africa is receiving more attention, especially in Southern Africa where four countries (including Namibia are actively working to eliminate malaria. With a high concentration of livestock and high rates of companion animal ownership, the influence of zoonotic bacterial diseases as causes of febrile illness in Namibia remains unknown.The aim of the study was to evaluate exposure to Coxiella burnetii, spotted fever and typhus group rickettsiae, and Bartonella henselae using IFA and ELISA (IgG in serum collected from 319 volunteer blood donors identified by the Blood Transfusion Service of Namibia (NAMBTS. Serum samples were linked to a basic questionnaire to identify possible risk factors. The majority of the participants (64.8% had extensive exposure to rural areas or farms. Results indicated a C. burnetii prevalence of 26.1% (screening titre 1∶16, and prevalence rates of 11.9% and 14.9% (screening titre 1∶100 for spotted fever group and typhus group rickettsiae, respectively. There was a significant spatial association between C. burnetii exposure and place of residence in southern Namibia (P0.012, especially cattle (P>0.006, were also significantly associated with C. burnetii exposure. Males were significantly more likely than females to have been exposed to spotted fever (P<0.013 and typhus (P<0.011 group rickettsiae. Three (2.9% samples were positive for B. henselae possibly indicating low levels of exposure to a pathogen never reported in Namibia.These results indicate that Namibians are exposed to pathogenic fever-causing bacteria, most of which have flea or tick vectors/reservoirs. The epidemiology of febrile illnesses in Namibia needs further evaluation in order to develop comprehensive local diagnostic and treatment algorithms.

  6. Impurity of Sulfur Layers and Magmatic Gas Scrubbing: Implications for Gas Monitoring

    Science.gov (United States)

    Scolamacchia, T.

    2017-12-01

    The evidence of bodies of elemental sulfur (Se) beneath acid crater lakes at the summit of composite active volcanoes has been recognized several decades ago (Oppenheimer and Stevenson, 1989; Christenson and Woods, 1993). But Se accumulation was already hypothesized a century ago at Kusatzu Shirane (Japan) based on the observation of sulfur spherules floating on its crater-lake (Ohashi, 1919). Since these pioneering works, other studies have focused on understanding key aspects of molten sulfur bodies, considered a feature unique of volcanic lakes. Instead, it is reasonable to assume that Se bodies occur in several volcanic settings because a) several reactions may lead to Se deposition from S-bearing gases, and b) crater-lakes, surface expressions of hydrothermal systems, are transient features. The scrubbing of several magmatic gases, some of which critical for volcano monitoring, has been attributed to ground/surface waters (Symonds et al. 2001). Nevertheless, gas scrubbing could reflect viscosity variations of impure Se within hydrothermal systems. Industrial experiments indicated that impurities (organics, H2S, ammonia, HCl, HF, HBr, HI) hinder Se polymerization at T ≥ 160ºC, allowing viscosity to remain low for long time depending on the maximum T achieved and heating rates (Bacon and Fanelli, 1943). However, a prolonged heating destroys the viscosity-modifying substances (e.g. H2Sx formed by reactions with organics, H2S, or ammonia) and dramatic Se viscosity increases occur after a certain number of heating and cooling cycles. A prolonged boiling of Se with organics was observed to release H2S, following H2Sx disruption. Some gases (e.g. SO2) do not affect Se viscosity. In volcanic environments gases such as SO2, CO2 could escape under Selow viscosity regimes. Also, halogens absence in gas emissions could be caused by their participation in reactions within S-layers causing its viscosity to remain low. More data are needed to validate the hypothesis

  7. Ecological Restoration of Coastal Sage Scrub and Its Potential Role in Habitat Conservation Plans.

    Science.gov (United States)

    BOWLER

    2000-07-01

    Extensive acreage loss of coastal sage scrub (CSS), isolation of surviving stands, and the federal listing of several animal species with obligate relationships to this plant community, particularly the threatened California gnatcatcher (Polioptila californica), have led to attempts to create CSS to mitigate habitat lost to urban development and other causes. Many of these creations lie within habitat conservation plan (HCP) sites, and they could play a more prominent role by being repositories for plants taken from a single site having site-specific genetics. Among others, one technique that increases initial resemblance to natural stands uses digitized, to-scale photography, which has been ground-truthed to verify vascular plant associations, which appear as mosaics on a landscape. A combination of placing patches of salvaged, mature canopy plants within larger matrices of imprinted or container plant plots appears to significantly enhance immediate use by CSS obligate bird species, accelerate "spread" or expansion of CSS, and can also introduce many epiphytic taxa that otherwise would be slow or unable to occupy developing CSS creations. Reptile, amphibian, butterfly, and rodent diversity in a salvaged canopy restoration case study at the University of California, Irvine, showed CSS species foraging and inhabiting transplanted canopy patches. Using restoration techniques to expand existing CSS stands has more promise than creating isolated patches, and the creation of canopies resembling CSS mid-fire cycle stands is now common. Gnatcatchers and other birds use restorations for foraging and occasional nesting, and in some cases created stands along "biological corridors" appear to be useful to bird movement. Patches of transplanted sage scrub shrubs along habitat edges appear to break up linear edge effects. There are no data on which long-term survival, succession, or postfire behavior can be predicted for CSS restoration sites, and postfire community changes

  8. Assessment of ASTEC-CPA pool scrubbing models against POSEIDON-II and SGTR-ARTIST data

    International Nuclear Information System (INIS)

    Herranz, Luis E.; Fontanet, Joan

    2009-01-01

    Aerosol scrubbing in pools mitigates the potential source term in key severe accident scenarios in PWRs and BWRs. Even though models were extensively validated in the past, a thorough and systematic validation under key challenging conditions is missing. Some of those conditions are high injection velocity, high pool temperature and/or presence of submerged structures. In particular, in-code models have been neither updated nor validated based on the most recent experimental data. The POSEIDON-II and the SGTR-ARTIST projects produced sets of data under conditions of utmost interest for pool scrubbing validation: high temperature and submerged structures. This paper investigates the response of models encapsulated in the CPA module of the ASTEC code in the simulation of those experimental set-ups. The influence of key pool scrubbing variables like steam fraction, water depth, gas flow-rate and particle size has been analyzed. Additionally, comparisons to stand-alone code (i.e., SPARC90) responses have also been obtained, so that prediction-to-data deviations can be discussed and attributed to either model grounds and/or model implementation in integral accident codes. This work has demonstrated that ASTEC-CPA limitations to capture fundamental trends of aerosol pool scrubbing are substantial (although the SGTR scenarios should not be properly considered within the CPA scope) and they stem from both original models (i.e., SPARC90) and model implementation. This work has been carried out within the European SARNET project of the VI Framework Program of EURATOM. (author)

  9. Effect of 4% chlorhexidine gluconate predisinfection skin scrub prior to hepatectomy: a double-blinded, randomized control study.

    Science.gov (United States)

    Hsieh, Ching-Shui; Cheng, Hsiu-Chi; Lin, Jen-Shiou; Kuo, Shou-Jen; Chen, Yao-Li

    2014-01-01

    This trial was designed to compare the efficacy of 4% chlorhexidine gluconate (CHG) with normal saline (NS) as a predisinfection skin-scrub solution prior to standard presurgical skin preparation. Data was collected at a single transplantation center where patients electing resection of hepatic tumors were recruited between October 2011 and September 2012. In total, 100 patients were consecutively enrolled for random assignment to either 4% CHG or NS as a predisinfection skin-scrub solution prior to surgery. Our aim was to assess the comparative antiseptic efficacy of CHG in this setting, focusing on cutaneous microbial colonization (at baseline, preoperatively, and postoperatively) and postsurgical site infections as primary outcome measures. Positivity rates of baseline, preoperative, and postoperative cultures were similar for both groups, showing significant declines (relative to baseline) after skin preparation and no significant postsurgical rebound. Rates of surgical site infection were also similar in both groups (CHG, 6.0%; NS, 4.1%; P = 1.0). For patients with hepatic tumors undergoing hepatectomy, the effect of 4% CHG as a predisinfection scrub solution was similar to that of NS in terms of skin decontamination and surgical site infections.

  10. Genetic Variation in Past and Current Landscapes: Conservation Implications Based on Six Endemic Florida Scrub Plants

    Directory of Open Access Journals (Sweden)

    Eric S. Menges

    2010-01-01

    Full Text Available If genetic variation is often positively correlated with population sizes and the presence of nearby populations and suitable habitats, landscape proxies could inform conservation decisions without genetic analyses. For six Florida scrub endemic plants (Dicerandra frutescens, Eryngium cuneifolium, Hypericum cumulicola, Liatris ohlingerae, Nolina brittoniana, and Warea carteri, we relate two measures of genetic variation, expected heterozygosity and alleles per polymorphic locus (APL, to population size and landscape variables. Presettlement areas were estimated based on soil preferences and GIS soils maps. Four species showed no genetic patterns related to population or landscape factors. The other two species showed significant but inconsistent patterns. For Liatris ohlingerae, APL was negatively related to population density and weakly, positively related to remaining presettlement habitat within 32 km. For Nolina brittoniana, APL increased with population size. The rather weak effects of population area/size and both past and current landscape structures suggest that genetic variation needs to be directly measured and not inferred for conservation planning.

  11. Gopher Tortoise (Gopherus polyphemus) Densities in Coastal Scrub and Slash Pine Flatwoods in Florida

    Science.gov (United States)

    Breininger, David R.; Schmalzer, Paul A.; Hinkle, C. Ross

    1994-01-01

    Densities of gopher tortoises were compared with habitat characteristics in scrub and in flatwood habitats on the Kennedy Space Center, Florida. Tortoises were distributed widely among habitat types and did not have higher densities in well-drained (oak-palmetto) than in poorly-drained (saw palmetto) habitats. Fall densities of tortoises ranged from a mean of 2.7 individuals/ha in disturbed habitat to 0.0 individuals/ha in saw palmetto habitat. Spring densities of tortoises ranged from a mean of 2.5 individuals/ha in saw palmetto habitat to 0.7 individuals/ha in oak-palmetto habitat. Densities of tortoises were correlated positively with the percent herbaceous cover, an indicator of food resources. Plots were divided into three burn classes; these were areas burned within three years, burned four to seven years, and unburned for more than seven years prior to the study. Relationships between densities of tortoises and time-since-fire classes were inconsistent.

  12. BUSCA-JUN91. Reference manual for the calculation of radionuclide scrubbing in water pools

    International Nuclear Information System (INIS)

    Ramsdale, S.A.; Friederichs, H.G.

    1995-06-01

    BUSCA models the decontamination of a bubble as it rises through a water pool. The bubble may contain a mixture of non-condensable gases, steam, iodine vapor and aerosol particles. The bubble thermal-hydraulics are modelled as well as the removal of soluble vapour and aerosol contaminants. The code was originally developed at SRD (part of the UK Atomic Energy Authority) during the mid 1980's. A description of an early version of the code was presented in Reference. Since then, the code has been further enhanced by collaboration within the European Pool Scrubbing Group and additional mechanisms included in its calculations. In particular, PSI (Paul Scherrer Institute, Wuerenlingen) has converted the original FACSIMILE code into FORTRAN and added different bubble initial volume, geometry and bubble rise speed options, UPM (Universidad Politecnica de Madrid) has added the bubble breakup modelling and SRD has added the cluster and plume features. This report describes the BUSCA code version JUN91 which treats the bubble hydrodynamics and removal of aerosol particles and soluble gas in an attempt to calculate the decontamination factor (mass in/mass out), including its input and output requirements. It must be stressed that the development of BUSCA is an on-going project. Currently SRD and PSI have added additional models in their own versions. (orig.)

  13. Local climatic conditions constrain soil yeast diversity patterns in Mediterranean forests, woodlands and scrub biome.

    Science.gov (United States)

    Yurkov, Andrey M; Röhl, Oliver; Pontes, Ana; Carvalho, Cláudia; Maldonado, Cristina; Sampaio, José Paulo

    2016-02-01

    Soil yeasts represent a poorly known fraction of the soil microbiome due to limited ecological surveys. Here, we provide the first comprehensive inventory of cultivable soil yeasts in a Mediterranean ecosystem, which is the leading biodiversity hotspot for vascular plants and vertebrates in Europe. We isolated and identified soil yeasts from forested sites of Serra da Arrábida Natural Park (Portugal), representing the Mediterranean forests, woodlands and scrub biome. Both cultivation experiments and the subsequent species richness estimations suggest the highest species richness values reported to date, resulting in a total of 57 and 80 yeast taxa, respectively. These values far exceed those reported for other forest soils in Europe. Furthermore, we assessed the response of yeast diversity to microclimatic environmental factors in biotopes composed of the same plant species but showing a gradual change from humid broadleaf forests to dry maquis. We observed that forest properties constrained by precipitation level had strong impact on yeast diversity and on community structure and lower precipitation resulted in an increased number of rare species and decreased evenness values. In conclusion, the structure of soil yeast communities mirrors the environmental factors that affect aboveground phytocenoses, aboveground biomass and plant projective cover. © FEMS 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. A simplified model of aerosol scrubbing by a water pool overlying core debris interacting with concrete

    International Nuclear Information System (INIS)

    Powers, D.A.; Sprung, J.L.

    1993-11-01

    A classic model of aerosol scrubbing from bubbles rising through water is applied to the decontamination of gases produced during core debris interactions with concrete. The model, originally developed by Fuchs, describes aerosol capture by diffusion, sedimentation, and inertial impaction. This original model for spherical bubbles is modified to account for ellipsoidal distortion of the bubbles. Eighteen uncertain variables are identified in the application of the model to the decontamination of aerosols produced during core debris interactions with concrete by a water pool of specified depth and subcooling. These uncertain variables include properties of the aerosols, the bubbles, the water and the ambient pressure. Results are analyzed using a nonparametric, order statistical analysis that allows quantitative differentiation of stochastic and phenomenological uncertainty. The sampled values of the decontamination factors are used to construct estimated probability density functions for the decontamination factor at confidence levels of 50%, 90% and 95%. The decontamination factors for pools 30, 50, 100, 200, 300, and 500 cm deep and subcooling levels of 0, 2, 5, 10, 20, 30, 50, and 70 degrees C are correlated by simple polynomial regression. These polynomial equations can be used to estimate decontamination factors at prescribed confidence levels

  15. Impact of fire on the macrofungal diversity in scrub jungles of south-west India

    Directory of Open Access Journals (Sweden)

    Ammatanda A. Greeshma

    2016-01-01

    Full Text Available Fortnightly survey in control and fire-impacted regions of scrub jungle of south-west coast of India during south-west monsoon (50 m2 quadrats up to 10 weeks yielded 34 and 25 species of macrofungi, respectively. The species as well as sporocarp richness were the highest during the fourth week, while the diversity attained the highest during the second week in control region. In fire-impacted region, the species and sporocarp richness and diversity peaked at sixth week. Seven species common to both regions were Chlorophyllum molybdites, Lepiota sp., Leucocoprinus birnbaumii, Marasmius sp. 3, Polyporus sp., Schizophyllum commune and Tetrapyrgos nigripes. The overall sporocarp richness was higher in fire-impacted than in control region. The Jaccard’s similarity between regions was 13.5%, while fortnights of regions ranged from 0% (10th week to 11.7% (eighth week. Control region showed single-species dominance by Xylaria hypoxylon, while multispecies dominance by Cyathus striatus and Lentinus squarrosulus in fire-impacted region. Except for air temperature, nine abiotic factors significantly differed between control and fire-impacted regions. The Pearson correlation was positive between species richness and phosphorus content in fire-impacted region (r = 0.696, while sporocarp richness was negatively correlated with pH in control region (r = −0.640. Economically viable species were 12 and 10 without overlap in control and fire-impacted regions, respectively.

  16. Age, sex and social influences on adult survival in the cooperatively breeding Karoo Scrub-robin

    Science.gov (United States)

    Lloyd, Penn; Martin, Thomas E.; Taylor, Andrew; Braae, Anne; Altwegg, Res

    2016-01-01

    Among cooperatively breeding species, helpers are hypothesised to increase the survival of breeders by reducing breeder workload in offspring care and increased group vigilance against predators. Furthermore, parental nepotism or other benefits of group living may provide a survival benefit to young that delay dispersal to help. We tested these hypotheses in the Karoo Scrub-robin (Cercotrichas coryphaeus), a long-lived, and facultative cooperatively breeding species in which male helpers make substantial contributions to the care of young. We found that annual breeder survival in the presence of helpers did not differ detectably from breeders without helpers or breeders that lost helpers. Furthermore, helpers did not gain a survival benefit from deferred breeding; apparent survival did not differ detectably between male helpers and male breeders followed from one year old. These results are consistent with other studies suggesting a lack of adult survival benefits among species where breeders do not substantially reduce workloads when helpers are present. They are also consistent with the hypothesis that males that delay dispersal make the ‘best of a bad job’ by helping on their natal territory to gain indirect fitness benefits when they are unable to obtain a territory vacancy nearby.

  17. Nucleation and capture of condensible airborne contaminants in an aqueous scrubbing system

    International Nuclear Information System (INIS)

    Postma, A.K.; Hilliard, R.K.

    1978-09-01

    The fate of condensible contaminants in an aqueous scrubbing system was evaluated. Knowledge of the behavior of volatile fission product compounds is important in evaluating the effectiveness of emergency air cleaning systems proposed for use in containment systems of breeder reactor plants. When a high temperature air stream passes through a spray quench chamber, very large cooling rates occur in the drop boundary layers. These large cooling rates cause large supersaturations in airborne concentrations of condensible contaminants, and one predicts that most condensation would take place through homogeneous nucleation. The very small particles formed would agglomerate, and attach to sodium aerosol particles which would be present. In the study the overall removal efficiency of volatile fission product species (typified by NaI, SeO 2 , and Sb 2 O 3 ) in an air cleaning train (quench chamber, venturi scrubber, and fibrous bed) was theoretically evaluated. The overall removal efficiency of condensible materials was found to be lower than that for sodium compound aerosols because the freshly condensed particles would be smaller in size. For a base case, a removal efficiency of 99.97 percent was predicted for condensible materials. The fibrous bed scrubber exhibited superior particle removal characteristics for small particles compared to the quench chamber and venturi scrubber. Its removal efficiency exceeded 97 percent for even the most penetrating particle size (about 0.4 micron aerodynamic diameter). Therefore, all condensible fission products would be removed with efficiencies exceeding 97 percent

  18. Post-Fire Recovery in Coastal Sage Scrub: Seed Rain and Community Trajectory.

    Directory of Open Access Journals (Sweden)

    Erin Conlisk

    Full Text Available Disturbance is a primary mechanism structuring ecological communities. However, human activity has the potential to alter the frequency and intensity of natural disturbance regimes, with subsequent effects on ecosystem processes. In Southern California, human development has led to increased fire frequency close to urban areas that can form a positive feedback with invasive plant spread. Understanding how abiotic and biotic factors structure post-fire plant communities is a critical component of post-fire management and restoration. In this study we considered a variety of mechanisms affecting post-fire vegetation recovery in Riversidean sage scrub. Comparing recently burned plots to unburned plots, we found that burning significantly reduced species richness and percent cover of exotic vegetation the first two years following a 100-hectare wildfire. Seed rain was higher in burned plots, with more native forb seeds, while unburned plots had more exotic grass seeds. Moreover, there were significant correlations between seed rain composition and plant cover composition the year prior and the year after. Collectively, this case study suggests that fire can alter community composition, but there was not compelling evidence of a vegetation-type conversion. Instead, the changes in the community composition were temporary and convergence in community composition was apparent within two years post-fire.

  19. Post-Fire Recovery in Coastal Sage Scrub: Seed Rain and Community Trajectory.

    Science.gov (United States)

    Conlisk, Erin; Swab, Rebecca; Martínez-Berdeja, Alejandra; Daugherty, Matthew P

    2016-01-01

    Disturbance is a primary mechanism structuring ecological communities. However, human activity has the potential to alter the frequency and intensity of natural disturbance regimes, with subsequent effects on ecosystem processes. In Southern California, human development has led to increased fire frequency close to urban areas that can form a positive feedback with invasive plant spread. Understanding how abiotic and biotic factors structure post-fire plant communities is a critical component of post-fire management and restoration. In this study we considered a variety of mechanisms affecting post-fire vegetation recovery in Riversidean sage scrub. Comparing recently burned plots to unburned plots, we found that burning significantly reduced species richness and percent cover of exotic vegetation the first two years following a 100-hectare wildfire. Seed rain was higher in burned plots, with more native forb seeds, while unburned plots had more exotic grass seeds. Moreover, there were significant correlations between seed rain composition and plant cover composition the year prior and the year after. Collectively, this case study suggests that fire can alter community composition, but there was not compelling evidence of a vegetation-type conversion. Instead, the changes in the community composition were temporary and convergence in community composition was apparent within two years post-fire.

  20. Determination of low chloride values in Rocky Flats scrub alloy solutions and other complex matrices

    International Nuclear Information System (INIS)

    Holcomb, H.P.

    1985-01-01

    A turbidimetric method, using silver chloride, has been developed to determine low ppM quantities of chloride in Rocky Flats scrub alloy (RFSA) dissolver solutions. This analytical technique has also been applied to other complex matrices such as process 50% caustic and neutralized Purex low heat liquid waste concentrate. A controlled-pH precipitation with NaOH, during which chloride remains in solution, is used to pretreat samples to minimize salt effects from acids, bases, and/or hydrolyzable ions. Control of pH with bromocresol purple indicator also provides a more consistent pH for silver chloride formation, aiding in turbidity reproducibility. Disodium ethylenediaminetetraacetic acid is employed to negate covalent bonding by Hg(II) with chloride. The average standard deviation was +-17% for turbidity reproducibility in simulated sample aliquots containing a total of 10 to 100 μg chloride. For actual RFSA samples, the relative standard deviation ranged from +-14% to +-26%, depending on initial chloride values. 8 refs., 1 fig

  1. Western scrub-jays allocate longer observation time to more valuable information.

    Science.gov (United States)

    Watanabe, Arii; Grodzinski, Uri; Clayton, Nicola S

    2014-07-01

    When humans mentally reconstruct past events and imagine future scenarios, their subjective experience of mentally time travelling is accompanied by the awareness of doing so. Despite recent popularity of studying episodic memory in animals, such phenomenological consciousness has been extremely difficult to demonstrate without agreed behavioural markers of consciousness in non-linguistic subjects. We presented western scrub-jays (Aphelocoma californica) with a task requiring them to allocate observing time between two peepholes to see food being hidden in either of two compartments, one where observing the hiding location was necessary to later relocate the food, and another where food could easily be found without watching. Jays first separately experienced these consequences of possessing information in each compartment and subsequently, once given a choice, made more looks and spent more time looking into the compartment where information was necessary than into the compartment where it was unnecessary. Thus, the jays can collect information to solve a future problem. Moreover, they can differentiate sources of information according to their potential value and modify behaviour to efficiently collect important, usable information. This is the first evidence of metacognition in a species that passes the behavioural criteria for both retrospective and prospective mental time travel.

  2. Optimization of sodium bicarbonate injection for acid scrubbing in hospital waste incineration plant

    International Nuclear Information System (INIS)

    Rozainee, M.; Salleh, M.; Mutahharah, M.M.; Anwar Johari

    2010-01-01

    Optimization of sodium bicarbonate (NaHCO 3 ) injection for acid hydrochloric (HCl) scrubbing was conducted on a hospital waste incineration plant. The plant employs a rotary kiln system having burning capacity of 350 kg/h hospital waste (average calorific value of 17.4 MJ/kg) and is operated on a 24 hr/ day basis. Currently, NaHCO 3 injection rate is 25 kg/h as recommended by manufacturer to meet the Department of Environment (DOE) standard emission limit of 200 mg/Nm 3 HCl. Testing of HCl emission at various injection rates of 25, 20, 15 and 10 kg/ h results in HCl final concentration in the range of 0.58-7.13, 5.63-7.74, 0.07-2.99 and 3-28 mg/Nm 3 respectively. The results showed that NaHCO 3 injection rate as low as 10 kg/ h could still meet the HCl stipulated emission limit. Economic comparison between 25 and 10 kg/ h injection rates showed that total saving on NaHCO 3 and disposal of fly ash was RM 22,000 per month (equivalent to saving RM 260,000 per year) when using 10 kg/ h injection rate. It was concluded from the study that optimum injection rate would not only save cost and reduce wastage but also reduce bag house loading rate and prolong the life span of filter bags. (author)

  3. Waterless Hand Rub Versus Traditional Hand Scrub Methods for Preventing the Surgical Site Infection in Orthopedic Surgery.

    Science.gov (United States)

    Iwakiri, Kentaro; Kobayashi, Akio; Seki, Masahiko; Ando, Yoshiyuki; Tsujio, Tadao; Hoshino, Masatoshi; Nakamura, Hiroaki

    2017-11-15

    MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. A retrospective cohort study with prospectively collected data. The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264

  4. Ultraviolet irradiation in transplantation biology. Manipulation of immunity and immunogenicity

    International Nuclear Information System (INIS)

    Deeg, H.J.

    1988-01-01

    Ultraviolet irradiation, particularly in the UVB range, has profound effects on immunological mechanisms. Optimum and tolerable doses of exposure vary from species to species, and from organ to organ. As a result of limited depth penetration and possibly significant energy absorption in nontargeted cells, every model requires diligent determination of an effective nontoxic approach. Nevertheless, it is clear that UVB and UVC irradiation can abolish proliferative and stimulatory ability as well as accessory/antigen-presenting ability of leukocytes in vitro. UV treatment alters cell-surface properties, calcium mobilization, cytokine production and release, and other subcellular processes. Preliminary data suggest that these manipulations also suppress immunity and reduce immunogenicity in vivo. Exposure of solid organs and of large volumes of blood is difficult due to technical problems--in particular poor depth penetration and absorption of UV energy in generally available transfusion bags. 111 references

  5. Trial watch: Immunogenic cell death induction by anticancer chemotherapeutics.

    Science.gov (United States)

    Garg, Abhishek D; More, Sanket; Rufo, Nicole; Mece, Odeta; Sassano, Maria Livia; Agostinis, Patrizia; Zitvogel, Laurence; Kroemer, Guido; Galluzzi, Lorenzo

    2017-01-01

    The expression "immunogenic cell death" (ICD) refers to a functionally unique form of cell death that facilitates (instead of suppressing) a T cell-dependent immune response specific for dead cell-derived antigens. ICD critically relies on the activation of adaptive responses in dying cells, culminating with the exposure or secretion of immunostimulatory molecules commonly referred to as "damage-associated molecular patterns". Only a few agents can elicit bona fide ICD, including some clinically established chemotherapeutics such as doxorubicin, epirubicin, idarubicin, mitoxantrone, bleomycin, bortezomib, cyclophosphamide and oxaliplatin. In this Trial Watch, we discuss recent progress on the development of ICD-inducing chemotherapeutic regimens, focusing on studies that evaluate clinical efficacy in conjunction with immunological biomarkers.

  6. Alpha particles induce expression of immunogenic markers on tumour cells

    International Nuclear Information System (INIS)

    Gorin, J.B.; Gouard, S.; Cherel, M.; Davodeau, F.; Gaschet, J.; Morgenstern, A.; Bruchertseifer, F.

    2013-01-01

    The full text of the publication follows. Radioimmunotherapy (RIT) is an approach aiming at targeting the radioelements to tumours, usually through the use of antibodies specific for tumour antigens. The radiations emitted by the radioelements then induce direct killing of the targeted cells as well as indirect killing through bystander effect. Interestingly, it has been shown that ionizing radiations, in some settings of external radiotherapy, can foster an immune response directed against tumour cells. Our research team is dedicated to the development of alpha RIT, i.e RIT using alpha particle emitters, we therefore decided to study the effects of such particles on tumour cells in regards to their immunogenicity. First, we studied the effects of bismuth 213, an alpha emitter, on cellular death and autophagy in six different tumour cell lines. Then, we measured the expression of 'danger' signals and MHC molecules at the cell surface to determine whether irradiation with 213 Bi could cause the tumour cells to be recognized by the immune system. Finally a co-culture of dendritic cells with irradiated tumour cells was performed to test whether it would induce dendritic cells to mature. No apoptosis was detected within 48 hours after irradiation in any cell line, however half of them exhibited signs of autophagy. No increase in membrane expression of 'danger' signals was observed after treatment with 213 Bi, but we showed an increase in expression of MHC class I and II for some cell lines. Moreover, the co-culture experiment indicated that the immunogenicity of a human adenocarcinoma cell line (LS 174T) was enhanced in vitro after irradiation with alpha rays. These preliminary data suggest that alpha particles could be of interest in raising an immune response associated to RIT. (authors)

  7. Identification of an Immunogenic Subset of Metastatic Uveal Melanoma.

    Science.gov (United States)

    Rothermel, Luke D; Sabesan, Arvind C; Stephens, Daniel J; Chandran, Smita S; Paria, Biman C; Srivastava, Abhishek K; Somerville, Robert; Wunderlich, John R; Lee, Chyi-Chia R; Xi, Liqiang; Pham, Trinh H; Raffeld, Mark; Jailwala, Parthav; Kasoji, Manjula; Kammula, Udai S

    2016-05-01

    Uveal melanoma is a rare melanoma variant with no effective therapies once metastases develop. Although durable cancer regression can be achieved in metastatic cutaneous melanoma with immunotherapies that augment naturally existing antitumor T-cell responses, the role of these treatments for metastatic uveal melanoma remains unclear. We sought to define the relative immunogenicity of these two melanoma variants and determine whether endogenous antitumor immune responses exist against uveal melanoma. We surgically procured liver metastases from uveal melanoma (n = 16) and cutaneous melanoma (n = 35) patients and compared the attributes of their respective tumor cell populations and their infiltrating T cells (TIL) using clinical radiology, histopathology, immune assays, and whole-exomic sequencing. Despite having common melanocytic lineage, uveal melanoma and cutaneous melanoma metastases differed in their melanin content, tumor differentiation antigen expression, and somatic mutational profile. Immunologic analysis of TIL cultures expanded from these divergent forms of melanoma revealed cutaneous melanoma TIL were predominantly composed of CD8(+) T cells, whereas uveal melanoma TIL were CD4(+) dominant. Reactivity against autologous tumor was significantly greater in cutaneous melanoma TIL compared with uveal melanoma TIL. However, we identified TIL from a subset of uveal melanoma patients which had robust antitumor reactivity comparable in magnitude with cutaneous melanoma TIL. Interestingly, the absence of melanin pigmentation in the parental tumor strongly correlated with the generation of highly reactive uveal melanoma TIL. The discovery of this immunogenic group of uveal melanoma metastases should prompt clinical efforts to determine whether patients who harbor these unique tumors can benefit from immunotherapies that exploit endogenous antitumor T-cell populations. Clin Cancer Res; 22(9); 2237-49. ©2015 AACR. ©2015 American Association for Cancer Research.

  8. Evidence of Two Lyssavirus Phylogroups with Distinct Pathogenicity and Immunogenicity

    Science.gov (United States)

    Badrane, Hassan; Bahloul, Chokri; Perrin, Pierre; Tordo, Noël

    2001-01-01

    The genetic diversity of representative members of the Lyssavirus genus (rabies and rabies-related viruses) was evaluated using the gene encoding the transmembrane glycoprotein involved in the virus-host interaction, immunogenicity, and pathogenicity. Phylogenetic analysis distinguished seven genotypes, which could be divided into two major phylogroups having the highest bootstrap values. Phylogroup I comprises the worldwide genotype 1 (classic Rabies virus), the European bat lyssavirus (EBL) genotypes 5 (EBL1) and 6 (EBL2), the African genotype 4 (Duvenhage virus), and the Australian bat lyssavirus genotype 7. Phylogroup II comprises the divergent African genotypes 2 (Lagos bat virus) and 3 (Mokola virus). We studied immunogenic and pathogenic properties to investigate the biological significance of this phylogenetic grouping. Viruses from phylogroup I (Rabies virus and EBL1) were found to be pathogenic for mice when injected by the intracerebral or the intramuscular route, whereas viruses from phylogroup II (Mokola and Lagos bat viruses) were only pathogenic by the intracerebral route. We showed that the glycoprotein R333 residue essential for virulence was naturally replaced by a D333 in the phylogroup II viruses, likely resulting in their attenuated pathogenicity. Moreover, cross-neutralization distinguished the same phylogroups. Within each phylogroup, the amino acid sequence of the glycoprotein ectodomain was at least 74% identical, and antiglycoprotein virus-neutralizing antibodies displayed cross-neutralization. Between phylogroups, the identity was less than 64.5% and the cross-neutralization was absent, explaining why the classical rabies vaccines (phylogroup I) cannot protect against lyssaviruses from phylogroup II. Our tree-axial analysis divided lyssaviruses into two phylogroups that more closely reflect their biological characteristics than previous serotypes and genotypes. PMID:11238853

  9. Synthetic peptide vaccines: palmitoylation of peptide antigens by a thioester bond increases immunogenicity

    DEFF Research Database (Denmark)

    Beekman, N.J.C.M.; Schaaper, W.M.M.; Tesser, G.I.

    1997-01-01

    Synthetic peptides have frequently been used to immunize animals. However, peptides less than about 20 to 30 amino acids long are poor immunogens. In general, to increase its immunogenicity, the presentation of the peptide should be improved, and molecular weight needs to be increased. Many...... or an amide bond. It was found that these S-palmitoylated peptides were much more immunogenic than N-palmitoylated peptides and at least similar to KLH-conjugated peptides with respect to appearance and magnitude of induced antibodies (canine parvovirus) or immunocastration effect (gonadotropin...

  10. Immunogenicity of biotherapy used in psoriasis: the science behind the scenes.

    Science.gov (United States)

    Jullien, Denis; Prinz, Jörg C; Nestle, Frank O

    2015-01-01

    A potential limitation in the use of biologic drugs used to treat psoriasis is the development of anti-drug antibodies (ADAs). Many factors contribute to this unwanted immune response, from the product itself, to its mode of administration, the underlying disease, and patient characteristics. ADAs may decrease the efficacy of biologic drugs by neutralizing them or modifying their clearance and may account for hypersensitivity reactions. This article reviews the scientific basis of immunogenicity and the mechanisms by which it affects clinical outcomes. It also considers testing for immunogenicity and how biologic therapy of psoriasis may be tailored on the basis of immunogenicity.

  11. Two Pathogens and One Disease: Detection and Identification of Flea-Borne Rickettsiae in Areas Endemic for Murine Typhus in California

    Science.gov (United States)

    EREMEEVA, MARINA E.; KARPATHY, SANDOR E.; KRUEGER, LAURA; HAYES, ERICA K.; WILLIAMS, ASHLEY M.; ZALDIVAR, YAMITZEL; BENNETT, STEPHEN; CUMMINGS, ROBERT; TILZER, ART; VELTEN, ROBERT K.; KERR, NELSON; DASCH, GREGORY A.; HU, RENJIE

    2018-01-01

    Results of an environmental assessment conducted in a newly emergent focus of murine typhus in southern California are described. Opossums, Didelphis virginiana Kerr, infested with cat fleas, Ctenocephalides felis Buché, in the suburban area were abundant. Animal and flea specimens were tested for the DNA of two flea-borne rickettsiae, Rickettsia typhi and Rickettsia felis. R. felis was commonly detected in fleas collected throughout this area while R. typhi was found at a much lower prevalence in the vicinity of just 7 of 14 case-patient homes identified. DNA of R. felis, but not R. typhi, was detected in renal, hepatic, and pulmonary tissues of opossums. In contrast, there were no hematologic polymerase chain reaction findings of R. felis or R. typhi in opossums, rats, and cats within the endemic area studied. Our data suggest a significant probability of human exposure to R. felis in the area studied; however, disease caused by this agent is not recognized by the medical community and may be misdiagnosed as murine typhus using nondiscriminatory serologic methods. PMID:23270180

  12. Influence of corticosterone treatment on nestling begging in Florida scrub-jays (Aphelocoma coerulescens).

    Science.gov (United States)

    Elderbrock, Emily K; Small, Thomas W; Schoech, Stephan J

    2018-04-01

    Altricial young are dependent on adults for protection and food, and they display nutritional need by begging to elicit feeding from parents. Begging at high levels can be energetically expensive and attract predators; thus, an individual must balance its nutritional needs with these potential costs. Further, because a parent is limited in the amount of food it can provide, begging can contribute to both parent-offspring conflict and sibling-sibling competition. Many extrinsic and intrinsic factors may contribute to begging behavior. One intrinsic factor of interest is corticosterone (CORT), a metabolic hormone hypothesized to play a role in regulating a nestling's begging behavior. We investigated the hypothesis that increased exposure to CORT influences nestling begging behavior in an altricial species, the Florida scrub-jay (Aphelocoma coerulescens). We treated one nestling per treatment nest with a twice-daily dose of exogenous hormone via a CORT-injected waxworm, whereas a second individual received a vehicle-injected waxworm. We monitored individual nestling and adult behavior at all nests with the use of high-definition video cameras on several days during treatment. We found no difference in begging rate between CORT fed and vehicle fed nestlings within a treatment nest. Further, to determine whether CORT treatment had indirect effects on the entire brood, we monitored additional nests, in which nestlings were not manipulated. When treatment and controls were compared, overall begging rates of nestlings in treatment nests were greater than those in control nests. This result suggests that CORT treatment of an individual altered its behavior, as well as that of its siblings. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Summary of INCO corrosion tests in power plant flue gas scrubbing processes

    International Nuclear Information System (INIS)

    Hoxie, E.C.; Tuffnell, G.W.

    1976-01-01

    Corrosion tests in a number of flue-gas desulfurization units have shown that carbon steel, low alloy steels, and Type 304L stainless steel are inadequate in the wet portions of the scrubbers. Type 316L stainless steel is sometimes subject to localized corrosive attack in scrubber environments with certain combinations of pH and chloride content. A corollary is that corrosion of Type 316L stainless steel might be controlled by control of scrubbing media pH and chloride content. Although an attempt was made to correlate the pitting and crevice corrosion obtained on the Type 316 stainless steel test samples with chloride and pH measurements, relatively wide scatter in the data indicated only a modest correlation. This is attributed to variations in local conditions, especially beneath deposits, that differ from the liquor samples obtained for analysis, to processing upsets, to temperature differences, and to some extent to inaccuracies in measurement of pH and chloride levels. The data do show, however, that molybdenum as an alloying element in stainless steels and high nickel alloys was very beneficial in conferring resistance to localized attack in scrubber environments. High nickel alloys containing appreciable amounts of molybdenum such as Hastelloy alloy C-276 and Inconel alloy 625 can be used for critical components. Chloride stress corrosion cracking (SCC) of austenitic stainless steels has generally not been a problem in FGD scrubbers, apparently because operating temperatures are comparatively low. An exception is reheater tubing where some failures have occurred because of elevated temperatures in conjunction with condensate that forms during shut-down periods or carryover of chloride laden mist from the scrubber. This problem can be overcome by proper alloy selection or maintaining dry conditions

  14. Beam scrubbing of beam pipes during the first commissioning of SuperKEKB

    Science.gov (United States)

    Suetsugu, Y.; Shibata, K.; Ishibashi, T.; Kanazawa, K.; Shirai, M.; Terui, S.; Hisamatsu, H.

    2018-02-01

    The first (Phase-1) commissioning of SuperKEKB-an electron-positron collider with asymmetric energies located at KEK, in Tsukuba, Japan-started in February 2016, after more than five years of upgrading work on KEKB, and successfully ended in June of the same year. This paper describes one major task of Phase-1 commissioning: beam scrubbing the surface of the beam pipes, to prepare them for a sufficiently long beam lifetime and low background noise in the next commissioning, when a new particle detector will be installed. The pressure rises per unit beam current (dP/dI [Pa A-1]) were continuously monitored, and the coefficient of photon-stimulated desorption (PSD), η [molecules photon-1], was evaluated in the arc sections. The value of η decreased steadily with the beam dose, as expected. For arc sections in the positron ring, where most of the beam pipes were newly fabricated, the decrease in η against the photon dose (D) was similar to that previously reported; that is: η ∝ D-0.5 ∼ 0.8. At high storage beam currents, the evolution of η was affected by gas desorption resulting from the multipacting of electrons-that is, the electron cloud effect (ECE), which is a phenomenon particular to high-intensity positron rings. For the arc sections in the electron ring, η also decreased smoothly with the photon dose D, approximately as ∝ D-0.8. Given that most of these beam pipes were reused from KEKB, the value of η was much lower than that of the positron ring, and also lower than that of the electron ring of KEKB from the early stages of D. This implies that the surface of the reused beam pipes remembered the conditions in the KEKB, which is a known memory effect. The results obtained for η are compared with those obtained in various other accelerators.

  15. Product related factors influencing the immunogenicity of interferon beta-1b

    NARCIS (Netherlands)

    Haji Abdolvahab, M.

    2016-01-01

    Therapeutic interferon beta is the first line treatment of relapsing remitting Multiple Sclerosis. However, despite their success in improving patient wellbeing, all IFNβ products encounter a significant problem: immunogenicity. In some patients, IFNβ products induce the formation of antidrug

  16. The effect of immunomodulators on the immunogenicity of TNF-blocking therapeutic monoclonal antibodies: a review

    NARCIS (Netherlands)

    Krieckaert, C.L.; Bartelds, G.M.; Lems, W.F.; Wolbink, G.J.

    2010-01-01

    Therapeutic monoclonal antibodies have revolutionized the treatment of various inflammatory diseases. Immunogenicity against these antibodies has been shown to be clinically important: it is associated with shorter response duration because of diminishing concentrations in the blood and with

  17. Approaches to vaccines against Orientia tsutsugamushi

    Directory of Open Access Journals (Sweden)

    Gustavo eValbuena

    2013-01-01

    Full Text Available Scrub typhus is a severe mite-borne infection caused by Orientia tsutsugamushi, an obligately intracellular bacterium closely related to Rickettsia. The disease explains a substantial proportion of acute undifferentiated febrile cases that require hospitalization in rural areas of Asia, the North of Australia, and many islands of the Pacific ocean. Delayed antibiotic treatment is common due to the lack of effective commercially available diagnostic tests and the lack of specificity of the early clinical presentation. The systemic infection of endothelial cells that line the vasculature with Orientia can lead to many complications and fatalities. In survivors, immunity does not last long, and is poorly cross-reactive among numerous strains. In addition, chronic infections are established in an unknown number of patients. All those characteristics justify the pursuit of a prophylactic vaccine against O. tsutsugamushi; however, despite continuous efforts to develop such a vaccine since World War II, the objective has not been attained. In this review, we discuss the history of vaccine development against Orientia to provide a clear picture of the challenges that we continue to face from the perspective of animal models and the immunological challenges posed by an intracellular bacterium that normally triggers a short-lived immune response. We finish with a proposal for development of an effective and safe vaccine for scrub typhus through a new approach with a strong focus on T cell-mediated immunity, empirical testing of the immunogenicity of proteins encoded by conserved genes, and assessment of protection in relevant animal models that truly mimic human scrub typhus.

  18. Approaches to vaccines against Orientia tsutsugamushi.

    Science.gov (United States)

    Valbuena, Gustavo; Walker, David H

    2012-01-01

    Scrub typhus is a severe mite-borne infection caused by Orientia tsutsugamushi, an obligately intracellular bacterium closely related to Rickettsia. The disease explains a substantial proportion of acute undifferentiated febrile cases that require hospitalization in rural areas of Asia, the North of Australia, and many islands of the Pacific Ocean. Delayed antibiotic treatment is common due to the lack of effective commercially available diagnostic tests and the lack of specificity of the early clinical presentation. The systemic infection of endothelial cells that line the vasculature with Orientia can lead to many complications and fatalities. In survivors, immunity does not last long, and is poorly cross-reactive among numerous strains. In addition, chronic infections are established in an unknown number of patients. All those characteristics justify the pursuit of a prophylactic vaccine against O. tsutsugamushi; however, despite continuous efforts to develop such a vaccine since World War II, the objective has not been attained. In this review, we discuss the history of vaccine development against Orientia to provide a clear picture of the challenges that we continue to face from the perspective of animal models and the immunological challenges posed by an intracellular bacterium that normally triggers a short-lived immune response. We finish with a proposal for development of an effective and safe vaccine for scrub typhus through a new approach with a strong focus on T cell-mediated immunity, empirical testing of the immunogenicity of proteins encoded by conserved genes, and assessment of protection in relevant animal models that truly mimic human scrub typhus.

  19. Immunogenicity of HPV prophylactic vaccines: Serology assays and their use in HPV vaccine evaluation and development.

    Science.gov (United States)

    Pinto, Ligia A; Dillner, Joakim; Beddows, Simon; Unger, Elizabeth R

    2018-01-17

    When administered as standard three-dose schedules, the licensed HPV prophylactic vaccines have demonstrated extraordinary immunogenicity and efficacy. We summarize the immunogenicity of these licensed vaccines and the most commonly used serology assays, with a focus on key considerations for one-dose vaccine schedules. Although immune correlates of protection against infection are not entirely clear, both preclinical and clinical evidence point to neutralizing antibodies as the principal mechanism of protection. Thus, immunogenicity assessments in vaccine trials have focused on measurements of antibody responses to the vaccine. Non-inferiority of antibody responses after two doses of HPV vaccines separated by 6 months has been demonstrated and this evidence supported the recent WHO recommendations for two-dose vaccination schedules in both boys and girls 9-14 years of age. There is also some evidence suggesting that one dose of HPV vaccines may provide protection similar to the currently recommended two-dose regimens but robust data on efficacy and immunogenicity of one-dose vaccine schedules are lacking. In addition, immunogenicity has been assessed and reported using different methods, precluding direct comparison of results between different studies and vaccines. New head-to-head vaccine trials evaluating one-dose immunogenicity and efficacy have been initiated and an increase in the number of trials relying on immunobridging is anticipated. Therefore, standardized measurement and reporting of immunogenicity for the up to nine HPV types targeted by the current vaccines is now critical. Building on previous HPV serology assay standardization and harmonization efforts initiated by the WHO HPV LabNet in 2006, new secondary standards, critical reference reagents and testing guidelines will be generated as part of a new partnership to facilitate harmonization of the immunogenicity testing in new HPV vaccine trials. Copyright © 2018 Elsevier Ltd. All rights

  20. Toxicity attenuation optimization of crotalic venom by gamma radiation and studies of its immunogenic properties

    International Nuclear Information System (INIS)

    Clissa, Patricia Bianca

    1997-01-01

    Literature data show that 2.0 kGy dose of gamma radiation, generated by 60 source, reduces the toxic activity of Crotalus durissus terrificus venom, without altering its immunogenic capacity. When crotoxin, main toxin from crotalic venom, was irradiated with the same dose, toxicity was also reduced and the immunogenicity was maintained. This fact was attributed to aggregates (compounds with high molecular weight generated during irradiation), that showed no toxicity but were able to induce the antibodies formation against native venom. Crotalus durissus terrificus venom was irradiated with 2.0, 3.0, 5.0 and 10.0 kGy doses and submitted to molecular exclusion chromatography, in order to find an efficient dose that produces large amounts of non toxic but still immunogenic aggregates. After being isolated, the products of irradiation were evaluated for the amount produced, molecular alteration, and toxic and immunogenic activities. These parameters were also analyzed for the whole venom irradiated. The results from different doses irradiated venom were compared with native one, and 2.0 kGy dose was confirmed to be the most efficient in the association of toxicity attenuation with maintenance of immunogenicity of the crotalic venom, while other doses, in spite of being efficient in the toxicity attenuation, they were not able to keep the immunogenicity property. So, the dose of 2.0 kGy could be used to immunize animals in order to improve anticrotalic sera production. (author)

  1. Dynamics of vegetation and soils of oak/saw palmetto scrub after fire: Observations from permanent transects

    Science.gov (United States)

    Schmalzer, Paul A.; Hinkle, G. Ross

    1991-01-01

    Ten permanent 15 m transects previously established in two oak/saw palmetto scrub stands burned in December 1986, while two transects remained unburned. Vegetation in the greater than 0.5 m and the less than 0.5 m layers on these transects was sampled at 6, 12, 18, 24, and 36 months postburn and determined structural features of the vegetation (height, percent bare ground, total cover). The vegetation data were analyzed from each sampling by height layer using detrended correspondence analysis ordination. Vegetation data for the greater than 0.5 m layer for the entire time sequence were combined and analyzed using detrended correspondence analysis ordination. Soils were sampled at 6, 12, 18, and 24 months postburn and analyzed for pH, conductivity, organic matter, exchangeable cations (Ca, Mg, K, Na), NO3-N, NH4-N, Al, available metals (Cu, Fe, Mn, Zn), and PO4-P. Shrub species recovered at different rates postfire with saw palmetto reestablishing cover greater than 0.5 m within one year, but the scrub oaks had not returned to preburn cover greater than 0.5 m in 3 years after the fire. These differences in growth rates resulted in dominance shifts after the fire with saw palmetto increasing relative to the scrub oaks. Overall changes in species richness were minor, although changes occurred in species richness by height layers due to different growth rates. Soils of well drained and poorly drained sites differed markedly. Soil responses to the fire appeared minor. Soil pH increased at 6 and 12 months postfire; calcium increased at 6 months postburn. Nitrate-nitrogen increased at 12 months postburn. Low values of conductivity, PO4-P, Mg, K, Na, and Fe at 12 months postburn may be related to heavy rainfall the preceding month. Seasonal variability in some soil parameters appeared to occur.

  2. Design and scale-up of an oxidative scrubbing process for the selective removal of hydrogen sulfide from biogas

    International Nuclear Information System (INIS)

    Krischan, J.; Makaruk, A.; Harasek, M.

    2012-01-01

    Highlights: ► Alkaline oxidative scrubbing proved for biogas desulfurization ► Effect of operating conditions on hydrogen sulfide removal efficiency. ► Minimization of caustic and oxidant consumption. ► Process control via pH, redox potential and conductivity measurement. ► Investigation of long-term behavior of pilot plant operation. - Abstract: Reliable and selective removal of hydrogen sulfide (H 2 S) is an essential part of the biogas upgrading procedure in order to obtain a marketable and competitive natural gas substitute for flexible utilization. A promising biogas desulfurization technology has to ensure high separation efficiency regardless of process conditions or H 2 S load without the use or production of toxic or ecologically harmful substances. Alkaline oxidative scrubbing is an interesting alternative to existing desulfurization technologies and is investigated in this work. In experiments on a stirred tank reactor and a continuous scrubbing column in laboratory-scale, H 2 S was absorbed from a gas stream containing large amounts of carbon dioxide (CO 2 ) into an aqueous solution prepared from sodium hydroxide (NaOH), sodium bicarbonate (NaHCO 3 ) and hydrogen peroxide (H 2 O 2 ). The influence of pH, redox potential and solution aging on the absorption efficiency and the consumption of chemicals was investigated. Because of the irreversible oxidation reactions of dissolved H 2 S with H 2 O 2 , high H 2 S removal efficiencies were achieved while the CO 2 absorption was kept low. At an existing biogas upgrading plant an industrial-scale pilot scrubber was constructed, which efficiently desulfurizes 180 m 3 /h of raw biogas with an average removal efficiency of 97%, even at relatively high and strongly fluctuating H 2 S contents in the crude gas.

  3. Comparison of post-fire seedling establishment between scrub communities in mediterranean and non-mediterranean climate ecosystems

    Science.gov (United States)

    Carrington, M.E.; Keeley, J.E.

    1999-01-01

    I Both fire regimes and the conditions under which fires occur vary widely. Abiotic conditions (such as climate) in combination with fire season, frequency and intensity could influence vegetation responses to fire. A variety of adaptations facilitate post-fire recruitment in mediterranean climate ecosystems, but responses of other communities are less well known. We evaluated the importance of climate by comparing sites with mediterranean and subtropical climates. 2 We used paired burned and mature sites in chamise chaparral, mixed chaparral and coastal sage scrub (California), and rosemary scrub, sand pine scrub and sand-hill (Florida), to test whether (i) patterns of pre-fire and post-fire seedling recruitment are more similar between communities within a region than between regions, and (ii) post-fire stimulation of seedling establishment is greater in regions with marked fire-induced contrasts in abiotic site characteristics. 3 Post-fire seedling densities were more similar among sites within climatic regions than between regions. Both seedling densities and proportions of species represented by seedlings after fires were generally higher in California. 4 The only site characteristic showing a pre-fire-post-fire contrast was percentage open canopy, and the effect was greater in California than in Florida. Soil properties were unaffected by fire. 5 Mediterranean climate ecosystems in other regions have nutrient-poor soils similar to our subtropical Florida sites, but show post-fire seedling recruitment patterns more similar to the nutrient-rich sites in California. Climate therefore appears to play a more major role than soil characteristics.

  4. Structure-Based Design of Head-Only Fusion Glycoprotein Immunogens for Respiratory Syncytial Virus.

    Directory of Open Access Journals (Sweden)

    Jeffrey C Boyington

    Full Text Available Respiratory syncytial virus (RSV is a significant cause of severe respiratory illness worldwide, particularly in infants, young children, and the elderly. Although no licensed vaccine is currently available, an engineered version of the metastable RSV fusion (F surface glycoprotein-stabilized in the pre-fusion (pre-F conformation by "DS-Cav1" mutations-elicits high titer RSV-neutralizing responses. Moreover, pre-F-specific antibodies, often against the neutralization-sensitive antigenic site Ø in the membrane-distal head region of trimeric F glycoprotein, comprise a substantial portion of the human response to natural RSV infection. To focus the vaccine-elicited response to antigenic site Ø, we designed a series of RSV F immunogens that comprised the membrane-distal head of the F glycoprotein in its pre-F conformation. These "head-only" immunogens formed monomers, dimers, and trimers. Antigenic analysis revealed that a majority of the 70 engineered head-only immunogens displayed reactivity to site Ø-targeting antibodies, which was similar to that of the parent RSV F DS-Cav1 trimers, often with increased thermostability. We evaluated four of these head-only immunogens in detail, probing their recognition by antibodies, their physical stability, structure, and immunogenicity. When tested in naïve mice, a head-only trimer, half the size of the parent RSV F trimer, induced RSV titers, which were statistically comparable to those induced by DS-Cav1. When used to boost DS-Cav1-primed mice, two head-only RSV F immunogens, a dimer and a trimer, boosted RSV-neutralizing titers to levels that were comparable to those boosted by DS-Cav1, although with higher site Ø-directed responses. Our results provide proof-of-concept for the ability of the smaller head-only RSV F immunogens to focus the vaccine-elicited response to antigenic site Ø. Decent primary immunogenicity, enhanced physical stability, potential ease of manufacture, and potent

  5. FAUNA BINATANG MENGERAT DAN PARASITNYA DI BEBERAPA DAERAH TRANSMIGRASI DI INDONESIA, SERTA HUBUNGANNYA DENGAN PENYAKIT RICKETTSIOSIS YANG DITULARKAN OLEH VEKTOR

    Directory of Open Access Journals (Sweden)

    Tuti R. Hadi

    2012-09-01

    Full Text Available Surveys on small mammal parasites conducted in several transmigration schemes in South Sulawesi, Central Sulawesi and East Kalimantan, Indonesia revealed 10 species of murid rodents. Rattus exulans and some forest rats were predominant in newly opened schemes, whereas Rattus rattus was predomi­nant in older schemes. Six species of rats collected in all areas surveyed were found infested with a chigger species Lepto trombodium (L. deliensis, a known vector of scrub typhus. Xenopsylla cheopis, a flea vector of murine typhus, was not found during the survey. Serological studies revealed that 22.7% of the rats collected in an area planned for a transmigration scheme in Central Sulawesi, have antibodies against scrub typhus and 12,5% against murine typhus. The risk of transmission of scrub typhus and murine typhus to human is discussed.

  6. Toward precision manufacturing of immunogene T-cell therapies.

    Science.gov (United States)

    Xu, Jun; Melenhorst, J Joseph; Fraietta, Joseph A

    2018-05-01

    Cancer can be effectively targeted using a patient's own T cells equipped with synthetic receptors, including chimeric antigen receptors (CARs) that redirect and reprogram these lymphocytes to mediate tumor rejection. Over the past two decades, several strategies to manufacture genetically engineered T cells have been proposed, with the goal of generating optimally functional cellular products for adoptive transfer. Based on this work, protocols for manufacturing clinical-grade CAR T cells have been established, but these complex methods have been used to treat only a few hundred individuals. As CAR T-cell therapy progresses into later-phase clinical trials and becomes an option for more patients, a major consideration for academic institutions and industry is developing robust manufacturing processes that will permit scaling-out production of immunogene T-cell therapies in a reproducible and efficient manner. In this review, we will discuss the steps involved in cell processing, the major obstacles surrounding T-cell manufacturing platforms and the approaches for improving cellular product potency. Finally, we will address the challenges of expanding CAR T-cell therapy to a global patient population. Copyright © 2018 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  7. Cancer-testis antigen expression and immunogenicity in AL amyloidosis

    International Nuclear Information System (INIS)

    Rosenzweig, M A; Landau, H; Seldin, D; O'Hara, C; Girnius, S; Hanson, N; Frosina, D; Sedrak, C; Arcila, M; Comenzo, R L; Giralt, S; Gnjatic, S; Jungbluth, A A; Koehne, G

    2012-01-01

    Light-chain amyloidosis (AL) is a plasma cell dyscrasia closely related to multiple myeloma. In multiple myeloma, the cancer-testis antigens (CTAs) CT7 (MAGE-C1), CT10 (MAGE-C2) and MAGE-A CTAs are expressed in up to 80% of cases. In this study, we investigated the expression and immunogenicity of several CTAs in patients with AL amyloidosis in a total of 38 bone marrow specimens by employing standard immunohistochemistry techniques on paraffin-embedded archival tissues. Plasma samples from 35 patients (27 with matched bone marrow samples) were also analyzed by ELISA for sero reactivity to a group of full-length CTA proteins. CT7 was present in 25/38 (66%) while CT10 was demonstrated in 3/38 and GAGE in 1/38 AL amyloid cases. The expression pattern was mostly focal. There were no significant differences with regard to organ involvement, response to treatment, or prognosis in CTA positive compared to negative cases. None of the specimens showed spontaneous humoral immunity to CT7, but sero reactivity was observed in individual patients to other CTAs. This study identifies CT7 as the prevalent CTA in plasma cells of patients with AL amyloidosis. Further analyses determining the biology of CTAs in AL amyloidosis and their value as potential targets for immunotherapy are warranted

  8. Safety and immunogenicity of a candidate parvovirus B19 vaccine.

    Science.gov (United States)

    Bernstein, David I; El Sahly, Hana M; Keitel, Wendy A; Wolff, Mark; Simone, Gina; Segawa, Claire; Wong, Susan; Shelly, Daniel; Young, Neal S; Dempsey, Walla

    2011-10-06

    Parvovirus B19 is an important human pathogen causing erythema infectiosum, transient aplastic crisis in individuals with underlying hemolytic disorders and hydropsfetalis. We therefore evaluated a parvovirus B19 virus like particle (VLP) vaccine. The safety and immunogenicity of a 25 μg dose of parvovirus B19 recombinant capsid; 2.5 and 25 μg doses of the recombinant capsid given with MF59; and saline placebo were assessed in healthy adults. Because of 3 unexplained cutaneous events the study was halted after enrollment of 43 subjects and before any subject received their third scheduled dose. The rashes developed 5-9 days after the first or second injection and were seen in one placebo recipient (without an injection site lesion) and two vaccine recipients (with injection site reactions). No clear cause was established. Other safety evaluations revealed mostly injection site reactions that were mild to moderate with an increase in pain in subjects receiving vaccine and MF59. After dose 2 the majority of vaccine recipients developed ELISA and neutralizing antibody to parvovirus B19. Given the possible severe consequences of parvovirus B19 infection, further development of a safe and effective vaccine continues to be important. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Predictive markers of safety and immunogenicity of adjuvanted vaccines.

    Science.gov (United States)

    Mastelic, Beatris; Garçon, Nathalie; Del Giudice, Giuseppe; Golding, Hana; Gruber, Marion; Neels, Pieter; Fritzell, Bernard

    2013-11-01

    Vaccination represents one of the greatest public health triumphs; in part due to the effect of adjuvants that have been included in vaccine preparations to boost the immune responses through different mechanisms. Although a variety of novel adjuvants have been under development, only a limited number have been approved by regulatory authorities for human vaccines. This report reflects the conclusions of a group of scientists from academia, regulatory agencies and industry who attended a conference on the current state of the art in the adjuvant field. Held at the U.S. Pharmacopeial Convention (USP) in Rockville, Maryland, USA, from 18 to 19 April 2013 and organized by the International Association for Biologicals (IABS), the conference focused particularly on the future development of effective adjuvants and adjuvanted vaccines and on overcoming major hurdles, such as safety and immunogenicity assessment, as well as regulatory scrutiny. More information on the conference output can be found on the IABS website, http://www.iabs.org/. Copyright © 2013. Published by Elsevier Ltd.. All rights reserved.

  10. Cancer vaccine development: Designing tumor cells for greater immunogenicity

    Science.gov (United States)

    Bozeman, Erica N.; Shashidharamurthy, Rangaiah; Paulos, Simon A.; Palaniappan, Ravi; D’Souza, Martin; Selvaraj, Periasamy

    2014-01-01

    Cancer vaccine development is one of the most hopeful and exhilarating areas in cancer research. For this reason, there has been a growing interest in the development and application of novel immunotherapies for the treatment of cancer with the focus being on stimulating the immune system to target tumor cells specifically while leaving normal cells unharmed. From such research has emerged a host of promising immunotherapies such as dendritic cell-based vaccines, cytokine therapies and gene transfer technology. These therapies seek to counteract the poor immunogenicity of tumors by augmenting the host’s immune system with a variety of immunostimulatory proteins such as cytokines and costimulatory molecules. While such therapies have proven effective in the induction of anti-tumor immunity in animal models, they are less than optimal and pose a high risk of clinical infeasibility. Herein, we further discuss these immunotherapies as well as a feasible and efficient alternative that, in pre-clinical animal models, allows for the expression of specific immunostimulatory molecules on the surface of tumor cells by a novel protein transfer technology. PMID:20036822

  11. Comparison of the immunogenic effect of rabies vaccines

    Energy Technology Data Exchange (ETDEWEB)

    Kiss, Zs [Allatgyogyaszati Oltoanyagellenoerzoe Intezet, Budapest (Hungary)

    1981-10-01

    Immunogenic effect of the Lyssa and Lyssavac rabies vaccines were compared in sheep. Blood samples were collected 8 times from the experimental groups of 5 animals each during a 6-month period after vaccination. The dynamics of virus neutralizing antibodies was followed and the in vitro reactions of peripheral lymphocytes were studied. In the 3rd week after vaccination the titre of virus neutralizing antibodies was higher (1:128.4) in the experimental group immunized with the Lyssavac than in that immunized with the Lyssa vaccine (1:118) and it remained also at a higher level in the 6th month after vaccination (1:50) than that of the group immunized with the latter vaccine (1:20.4). As regards the in vitro reactions of lymphocytes, no essential differences were found either in the rates of immune rosette formation or in the degree of blastogenesis measured by the incorporation of /sup 3/HTdR. The mean values of IgG and IgM positive cells were also similar in both experimental groups as it was determined by immunofluorescence.

  12. Drug Target Interference in Immunogenicity Assays: Recommendations and Mitigation Strategies.

    Science.gov (United States)

    Zhong, Zhandong Don; Clements-Egan, Adrienne; Gorovits, Boris; Maia, Mauricio; Sumner, Giane; Theobald, Valerie; Wu, Yuling; Rajadhyaksha, Manoj

    2017-11-01

    Sensitive and specific methodology is required for the detection and characterization of anti-drug antibodies (ADAs). High-quality ADA data enables the evaluation of potential impact of ADAs on the drug pharmacokinetic profile, patient safety, and efficacious response to the drug. Immunogenicity assessments are typically initiated at early stages in preclinical studies and continue throughout the drug development program. One of the potential bioanalytical challenges encountered with ADA testing is the need to identify and mitigate the interference mediated by the presence of soluble drug target. A drug target, when present at sufficiently high circulating concentrations, can potentially interfere with the performance of ADA and neutralizing antibody (NAb) assays, leading to either false-positive or, in some cases, false-negative ADA and NAb assay results. This publication describes various mechanisms of assay interference by soluble drug target, as well as strategies to recognize and mitigate such target interference. Pertinent examples are presented to illustrate the impact of target interference on ADA and NAb assays as well as several mitigation strategies, including the use of anti-target antibodies, soluble versions of the receptors, target-binding proteins, lectins, and solid-phase removal of targets. Furthermore, recommendations for detection and mitigation of such interference in different formats of ADA and NAb assays are provided.

  13. Can music serve as a "cultural immunogen"? An explorative study.

    Science.gov (United States)

    Ruud, Even

    2013-08-07

    The aim of this study is to explore how people in contemporary society may apply music in their everyday life to improve their health and well-being. Through a series of qualitative interviews, informants gave their narratives about how music had become a part of their health practice. Six narratives concerning this type of everyday musical self-care are presented, and the following questions are sought to be answered: What kinds of musical practices do people apply in order to regulate their health and promote their sense of well-being? What kind of generative health mechanism can we observe or theorize when people use music to enhance their well-being? What kinds of rituals, contextual circumstances and personal health beliefs are operating in these situations? The findings suggests that some people may sing, participate in a choir, dance to music, compose songs, play precomposed music, or play in a band as part of a reflexive strategy to improve their health and well-being. Further analysis also identified six generative factors that may contribute to the immunogen functions of music: A pragmatic concept of music, music as a social and emotional resource, music as a supportive self object, musical competency, rituals, and locus of control. These findings may have implication for the field of music therapy as it will fill the gap between the clinical use of music done by professional music therapists and the everyday "musicking" performed by people outside the institutional practice.

  14. Faunal responses to fire in chaparral and sage scrub in California, USA

    Science.gov (United States)

    van Mantgem, Elizabeth; Keeley, Jon E.; Witter, Marti

    2015-01-01

    Impact of fire on California shrublands has been well studied but nearly all of this work has focused on plant communities. Impact on and recovery of the chaparral fauna has received only scattered attention; this paper synthesizes what is known in this regard for the diversity of animal taxa associated with California shrublands and outlines the primary differences between plant and animal responses to fire. We evaluated the primary faunal modes of resisting fire effects in three categories: 1) endogenous survival in a diapause or diapause-like stage, 2) sheltering in place within unburned refugia, or 3) fleeing and recolonizing. Utilizing these patterns in chaparral and sagescrub, as well as some studies on animals in other mediterranean-climate ecosystems, we derived generalizations about how plants and animals differ in their responses to fire impacts and their post fire recovery. One consequence of these differences is that variation in fire behavior has a much greater potential to affect animals than plants. For example, plants recover from fire endogenously from soil-stored seeds and resprouts, so fire size plays a limited role in determining recovery patterns. However, animals that depend on recolonization of burned sites from metapopulations may be greatly affected by fire size. Animal recolonization may also be greatly affected by regional land use patterns that affect colonization corridors, whereas such regional factors play a minimal role in plant community recovery. Fire characteristics such as rate of spread and fire intensity do not appear to play an important role in determining patterns of chaparral and sage scrub plant recovery after fire. However, these fire behavior characteristics may have a profound role in determining survivorship of some animal populations as slow-moving, smoldering combustion may limit survivorship of animals in burrows, whereas fast-moving, high intensity fires may affect survivorship of animals in above ground refugia or

  15. The effect of severe drought on the abundance of ticks on vegetation and on scrub hares in the Kruger National Park

    Directory of Open Access Journals (Sweden)

    A.M. Spickett

    1995-08-01

    Full Text Available Free-living ixodid ticks were collected monthly from August 1988 to July 1993 from the vegetation of landscape zones 17 (Sclerocarya caffra/Acacia nigrescens Savanna and 4 (Thickets of the Sabie and Crocodile Rivers in the south-east and south-west of the Kruger National Park respectively, and parasitic ticks from scrub hares in the latter landscape zone. Total tick collections from the vegetation of both landscape zones were lowest in the year following the drought year of August 1991 to July 1992, while the tick burdens of the scrub hares were lowest during the drought year itself.

  16. Design and scale-up of an oxidative scrubbing process for the selective removal of hydrogen sulfide from biogas.

    Science.gov (United States)

    Krischan, J; Makaruk, A; Harasek, M

    2012-05-15

    Reliable and selective removal of hydrogen sulfide (H(2)S) is an essential part of the biogas upgrading procedure in order to obtain a marketable and competitive natural gas substitute for flexible utilization. A promising biogas desulfurization technology has to ensure high separation efficiency regardless of process conditions or H(2)S load without the use or production of toxic or ecologically harmful substances. Alkaline oxidative scrubbing is an interesting alternative to existing desulfurization technologies and is investigated in this work. In experiments on a stirred tank reactor and a continuous scrubbing column in laboratory-scale, H(2)S was absorbed from a gas stream containing large amounts of carbon dioxide (CO(2)) into an aqueous solution prepared from sodium hydroxide (NaOH), sodium bicarbonate (NaHCO(3)) and hydrogen peroxide (H(2)O(2)). The influence of pH, redox potential and solution aging on the absorption efficiency and the consumption of chemicals was investigated. Because of the irreversible oxidation reactions of dissolved H(2)S with H(2)O(2), high H(2)S removal efficiencies were achieved while the CO(2) absorption was kept low. At an existing biogas upgrading plant an industrial-scale pilot scrubber was constructed, which efficiently desulfurizes 180m(3)/h of raw biogas with an average removal efficiency of 97%, even at relatively high and strongly fluctuating H(2)S contents in the crude gas. Copyright © 2012 Elsevier B.V. All rights reserved.

  17. Recovery of actinides from TBP-Na2Co3 scrub-waste solutions: the ARALEX process

    International Nuclear Information System (INIS)

    Horwitz, E.P.; Bloomquist, C.A.A.; Mason, G.W.; Leonard, R.A.; Ziegler, A.A.

    1979-08-01

    A flowsheet for the recovery of actinides from TBP-Na 2 CO 3 scrub-waste solutions has been developed, based on batch extraction data, and tested, using laboratory-scale countercurrent extraction techniques. The process, called the ARALEX process, uses 2-ethyl-1-hexanol (2-EHOH) to extract the TBP degradation products (HDBP and H 2 MBP) from acidified Na 2 CO 3 scrub waste leaving the actinides in the aqueous phase. Dibutyl and monobutyl phosphoric acids are attached to the 2-EHOH molecules through hydrogen bonds, which also diminish the ability of the HDBP and H 2 MBP to complex actinides. Thus all actinides remain in the aqueous raffinate. Dilute sodium hydroxide solutions can be used to back-extract the dibutyl and monobutyl phosphoric acid esters as their sodium salts. The 2-EHOH can then be recycled. After extraction of the acidified carbonate waste with 2-EHOH, the actinides may be readily extracted from the raffinate with DHDECMP or, in the case of tetra- and hexavalent actinides, with TBP. The ARALEX process can also be applied to other actinide waste streams which contain appreciable concentrations of polar organic compounds (e.g., detergents) that interfere with conventional actinide ion exchange and liquid-liquid extraction procedures. 20 figures, 6 tables

  18. Immunogenicity induced by biologicals in the treatment of psoriasis and psoriatic arthritis: View of the problem

    Directory of Open Access Journals (Sweden)

    T. V. Korotaeva

    2015-01-01

    Full Text Available The present-day views of the immunogenicity of biological agents (BAs used to in the treatment of psoriasis and psoriatic arthritis are analyzed. The immunogenicity of these medicaments is noted to depend on their molecular structure, individual patient characteristics, and used treatment regimens. As this takes place, the primary structure of the drug and its posttranslation modifications during manufacture are key factors. It is pointed out that a number of antigenic structures may give rise to the body's BA antibodies – murine epitopes, idiotopes, and allotropes, neoantigens forming in the coupling area of hybrid proteins, nonlinear epitopes present in the aggregated preparations. BAs that tend to form large immune complexes with these antibodies are most immunogenic. The antibodies to most BAs, except drugs based on soluble tumor necrosis factor-α receptors (etanercept, are neutralizing, i.e. they affect the efficiency of therapy, particularly when used over a long period of time.The results of trials evaluating the impact of antibodies to BAs on their clinical value are considered. It is believed that immunogenicity is itself of great importance in respect to the occurrence of the escape phenomenon of a response to BA therapy and to its safety. Attention is drawn to immunogenicity diagnostic problems; at the same it is noted that none of the used laboratory diagnostic techniques can reveal individual BA antibody forms and isotypes. It is concluded that there is a need for further investigations to standardize optimal methods for diagnosing neutralizing antibodies, to elaborate criteria for predicting a response to therapy in terms of an immunogenicity factor, and to reveal pathogenetic mechanisms responsible for the production of antibodies to BAs. The design of novel medicaments with minimal immunogenicity will depend on whether these mechanisms are common to all drugs or specific.

  19. Applying biotin-streptavidin binding for iscom (immunostimulating complex) association of recombinant immunogens.

    Science.gov (United States)

    Wikman, Maria; Friedman, Mikaela; Pinitkiatisakul, Sunan; Hemphill, Andrew; Lövgren-Bengtsson, Karin; Lundén, Anna; Ståhl, Stefan

    2005-04-01

    We have previously reported strategies for Escherichia coli production of recombinant immunogens fused to hydrophobic peptide or lipid tags to improve their capacity to be incorporated into an adjuvant formulation. In the present study, we have explored the strong interaction between biotin and SA (streptavidin) (K(D) approximately 10(-15) M) to couple recombinant immunogens to iscoms (immunostimulating complexes). Two different concepts were evaluated. In the first concept, a His(6)-tagged SA fusion protein (His(6)-SA) was bound to Ni(2+)-loaded iscom matrix (iscom without associated protein), and biotinylated immunogens were thereafter associated with the SA-coated iscoms. The immunogens were either biotinylated in vivo on E. coli expression or double biotinylated in vivo and in vitro. In the second concept, the recombinant immunogens were expressed as SA fusion proteins, which were directly bound to a biotinylated iscom matrix. A 53-amino-acid malaria peptide (M5), derived from the central repeat region of the Plasmodium falciparum blood-stage antigen Pf155/RESA, and a 232-amino-acid segment (SRS2') from the central region (from Pro-97 to Lys-328) of the major surface antigen NcSRS2 of the protozoan parasite Neospora caninum, served as model immunogens in the present study. All fusion proteins generated were found to be efficiently expressed and could be recovered to high purity using affinity chromatography. The association between the different immunogen-containing fusion proteins and the corresponding iscom matrix was demonstrated by analytical ultracentrifugation in a sucrose density gradient. However, some fusion proteins were, to a certain extent, also found to associate unspecifically with a regular iscom matrix. Furthermore, selected iscom fractions were demonstrated to induce high-titre antigen-specific antibody responses on immunization of mice. For the particular target immunogen SRS2', the induced antibodies demonstrated reactivity to the native

  20. Immunogenicity of novel mumps vaccine candidates generated by genetic modification.

    Science.gov (United States)

    Xu, Pei; Chen, Zhenhai; Phan, Shannon; Pickar, Adrian; He, Biao

    2014-03-01

    Mumps is a highly contagious human disease, characterized by lateral or bilateral nonsuppurative swelling of the parotid glands and neurological complications that can result in aseptic meningitis or encephalitis. A mumps vaccination program implemented since the 1960s reduced mumps incidence by more than 99% and kept the mumps case numbers as low as hundreds of cases per year in the United States before 2006. However, a large mumps outbreak occurred in vaccinated populations in 2006 and again in 2009 in the United States, raising concerns about the efficacy of the vaccination program. Previously, we have shown that clinical isolate-based recombinant mumps viruses lacking expression of either the V protein (rMuVΔV) or the SH protein (rMuVΔSH) are attenuated in a neurovirulence test using newborn rat brains (P. Xu et al., Virology 417:126-136, 2011, http://dx.doi.org/10.1016/j.virol.2011.05.003; P. Xu et al., J. Virol. 86:1768-1776, 2012, http://dx.doi.org/10.1128/JVI.06019-11) and may be good candidates for vaccine development. In this study, we examined immunity induced by rMuVΔSH and rMuVΔV in mice. Furthermore, we generated recombinant mumps viruses lacking expression of both the V protein and the SH protein (rMuVΔSHΔV). Analysis of rMuVΔSHΔV indicated that it was stable in tissue culture cell lines. Importantly, rMuVΔSHΔV was immunogenic in mice, indicating that it is a promising candidate for mumps vaccine development.

  1. Understanding the immunogenicity and antigenicity of nanomaterials: Past, present and future

    International Nuclear Information System (INIS)

    Ilinskaya, Anna N.; Dobrovolskaia, Marina A.

    2016-01-01

    Nanoparticle immunogenicity and antigenicity have been under investigation for many years. During the past decade, significant progress has been made in understanding what makes a nanoparticle immunogenic, how immune cells respond to nanoparticles, what consequences of nanoparticle-specific antibody formation exist and how they challenge the application of nanoparticles for drug delivery. Moreover, it has been recognized that accidental contamination of therapeutic protein formulations with nanosized particulate materials may contribute to the immunogenicity of this type of biotechnology products. While the immunological properties of engineered nanomaterials and their application as vaccine carriers and adjuvants have been given substantial consideration in the current literature, little attention has been paid to nanoparticle immuno- and antigenicity. To fill in this gap, we herein provide an overview of this subject to highlight the current state of the field, review past and present research, and discuss future research directions. - Highlights: • Most engineered nanomaterials are not immunogenic per se. • Generation of nanoparticle-specific antibody can be T-cell dependent or independent. • Antibodies can be generated to particle core, terminal groups or surface coatings. • Engineered and accidental nanomaterials have distinct contribution to immunogenicity. • Tunable physicochemical properties make each nanoparticle unique.

  2. Can dendritic cells improve whole cancer cell vaccines based on immunogenically killed cancer cells?

    Science.gov (United States)

    Cicchelero, Laetitia; Denies, Sofie; Devriendt, Bert; de Rooster, Hilde; Sanders, Niek N

    2015-01-01

    Immunogenic cell death (ICD) offers interesting opportunities in cancer cell (CC) vaccine manufacture, as it increases the immunogenicity of the dead CC. Furthermore, fusion of CCs with dendritic cells (DCs) is considered a superior method for generating whole CC vaccines. Therefore, in this work, we determined in naive mice whether immunogenically killed CCs per se (CC vaccine) elicit an antitumoral immune response different from the response observed when immunogenically killed CCs are associated with DCs through fusion (fusion vaccine) or through co-incubation (co-incubation vaccine). After tumor inoculation, the type of immune response in the prophylactically vaccinated mice differed between the groups. In more detail, fusion vaccines elicited a humoral anticancer response, whereas the co-incubation and CC vaccine mainly induced a cellular response. Despite these differences, all three approaches offered a prophylactic protection against tumor development in the murine mammary carcinoma model. In summary, it can be concluded that whole CC vaccines based on immunogenically killed CCs may not necessarily require association with DCs to elicit a protective anticancer immune response. If this finding can be endorsed in other cancer models, the manufacture of CC vaccines would greatly benefit from this new insight, as production of DC-based vaccines is laborious, time-consuming and expensive. PMID:26587315

  3. Sequence variability is correlated with weak immunogenicity in Streptococcus pyogenes M protein.

    Science.gov (United States)

    Lannergård, Jonas; Kristensen, Bodil M; Gustafsson, Mattias C U; Persson, Jenny J; Norrby-Teglund, Anna; Stålhammar-Carlemalm, Margaretha; Lindahl, Gunnar

    2015-10-01

    The M protein of Streptococcus pyogenes, a major bacterial virulence factor, has an amino-terminal hypervariable region (HVR) that is a target for type-specific protective antibodies. Intriguingly, the HVR elicits a weak antibody response, indicating that it escapes host immunity by two mechanisms, sequence variability and weak immunogenicity. However, the properties influencing the immunogenicity of regions in an M protein remain poorly understood. Here, we studied the antibody response to different regions of the classical M1 and M5 proteins, in which not only the HVR but also the adjacent fibrinogen-binding B repeat region exhibits extensive sequence divergence. Analysis of antisera from S. pyogenes-infected patients, infected mice, and immunized mice showed that both the HVR and the B repeat region elicited weak antibody responses, while the conserved carboxy-terminal part was immunodominant. Thus, we identified a correlation between sequence variability and weak immunogenicity for M protein regions. A potential explanation for the weak immunogenicity was provided by the demonstration that protease digestion selectively eliminated the HVR-B part from whole M protein-expressing bacteria. These data support a coherent model, in which the entire variable HVR-B part evades antibody attack, not only by sequence variability but also by weak immunogenicity resulting from protease attack. © 2015 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.

  4. Sequence variability is correlated with weak immunogenicity in Streptococcus pyogenes M protein

    Science.gov (United States)

    Lannergård, Jonas; Kristensen, Bodil M; Gustafsson, Mattias C U; Persson, Jenny J; Norrby-Teglund, Anna; Stålhammar-Carlemalm, Margaretha; Lindahl, Gunnar

    2015-01-01

    The M protein of Streptococcus pyogenes, a major bacterial virulence factor, has an amino-terminal hypervariable region (HVR) that is a target for type-specific protective antibodies. Intriguingly, the HVR elicits a weak antibody response, indicating that it escapes host immunity by two mechanisms, sequence variability and weak immunogenicity. However, the properties influencing the immunogenicity of regions in an M protein remain poorly understood. Here, we studied the antibody response to different regions of the classical M1 and M5 proteins, in which not only the HVR but also the adjacent fibrinogen-binding B repeat region exhibits extensive sequence divergence. Analysis of antisera from S. pyogenes-infected patients, infected mice, and immunized mice showed that both the HVR and the B repeat region elicited weak antibody responses, while the conserved carboxy-terminal part was immunodominant. Thus, we identified a correlation between sequence variability and weak immunogenicity for M protein regions. A potential explanation for the weak immunogenicity was provided by the demonstration that protease digestion selectively eliminated the HVR-B part from whole M protein-expressing bacteria. These data support a coherent model, in which the entire variable HVR-B part evades antibody attack, not only by sequence variability but also by weak immunogenicity resulting from protease attack. PMID:26175306

  5. Understanding the immunogenicity and antigenicity of nanomaterials: Past, present and future

    Energy Technology Data Exchange (ETDEWEB)

    Ilinskaya, Anna N.; Dobrovolskaia, Marina A., E-mail: marina@mail.nih.gov

    2016-05-15

    Nanoparticle immunogenicity and antigenicity have been under investigation for many years. During the past decade, significant progress has been made in understanding what makes a nanoparticle immunogenic, how immune cells respond to nanoparticles, what consequences of nanoparticle-specific antibody formation exist and how they challenge the application of nanoparticles for drug delivery. Moreover, it has been recognized that accidental contamination of therapeutic protein formulations with nanosized particulate materials may contribute to the immunogenicity of this type of biotechnology products. While the immunological properties of engineered nanomaterials and their application as vaccine carriers and adjuvants have been given substantial consideration in the current literature, little attention has been paid to nanoparticle immuno- and antigenicity. To fill in this gap, we herein provide an overview of this subject to highlight the current state of the field, review past and present research, and discuss future research directions. - Highlights: • Most engineered nanomaterials are not immunogenic per se. • Generation of nanoparticle-specific antibody can be T-cell dependent or independent. • Antibodies can be generated to particle core, terminal groups or surface coatings. • Engineered and accidental nanomaterials have distinct contribution to immunogenicity. • Tunable physicochemical properties make each nanoparticle unique.

  6. Identification of the immunogenic spore and vegetative proteins of Bacillus anthracis vaccine strain A16R.

    Directory of Open Access Journals (Sweden)

    Xiankai Liu

    Full Text Available Immunoproteomics was used to screen the immunogenic spore and vegetative proteins of Bacillus anthracis vaccine strain A16R. The spore and vegetative proteins were separated by 2D gel electrophoresis and transferred to polyvinylidene difluoride membranes, and then western blotting was performed with rabbit immune serum against B.anthracis live spores. Immunogenic spots were cut and digested by trypsin. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry was performed to identify the proteins. As a result, 11 and 45 immunogenic proteins were identified in the spores and vegetative cells, respectively; 26 of which have not been reported previously. To verify their immunogenicity, 12 of the identified proteins were selected to be expressed, and the immune sera from the mice vaccinated by the 12 expressed proteins, except BA0887, had a specific western blot band with the A16R whole cellular lytic proteins. Some of these immunogenic proteins might be used as novel vaccine candidates themselves or for enhancing the protective efficacy of a protective-antigen-based vaccine.

  7. Design and scale-up of an oxidative scrubbing process for the selective removal of hydrogen sulfide from biogas

    Energy Technology Data Exchange (ETDEWEB)

    Krischan, J., E-mail: jutta_krischan@hotmail.com [Vienna University of Technology, Institute of Chemical Engineering, Getreidemarkt 9/166, 1060 Vienna (Austria); Makaruk, A., E-mail: aleksander.makaruk@tuwien.ac.at [Vienna University of Technology, Institute of Chemical Engineering, Getreidemarkt 9/166, 1060 Vienna (Austria); Harasek, M., E-mail: michael.harasek@tuwien.ac.at [Vienna University of Technology, Institute of Chemical Engineering, Getreidemarkt 9/166, 1060 Vienna (Austria)

    2012-05-15

    Highlights: Black-Right-Pointing-Pointer Alkaline oxidative scrubbing proved for biogas desulfurization Black-Right-Pointing-Pointer Effect of operating conditions on hydrogen sulfide removal efficiency. Black-Right-Pointing-Pointer Minimization of caustic and oxidant consumption. Black-Right-Pointing-Pointer Process control via pH, redox potential and conductivity measurement. Black-Right-Pointing-Pointer Investigation of long-term behavior of pilot plant operation. - Abstract: Reliable and selective removal of hydrogen sulfide (H{sub 2}S) is an essential part of the biogas upgrading procedure in order to obtain a marketable and competitive natural gas substitute for flexible utilization. A promising biogas desulfurization technology has to ensure high separation efficiency regardless of process conditions or H{sub 2}S load without the use or production of toxic or ecologically harmful substances. Alkaline oxidative scrubbing is an interesting alternative to existing desulfurization technologies and is investigated in this work. In experiments on a stirred tank reactor and a continuous scrubbing column in laboratory-scale, H{sub 2}S was absorbed from a gas stream containing large amounts of carbon dioxide (CO{sub 2}) into an aqueous solution prepared from sodium hydroxide (NaOH), sodium bicarbonate (NaHCO{sub 3}) and hydrogen peroxide (H{sub 2}O{sub 2}). The influence of pH, redox potential and solution aging on the absorption efficiency and the consumption of chemicals was investigated. Because of the irreversible oxidation reactions of dissolved H{sub 2}S with H{sub 2}O{sub 2}, high H{sub 2}S removal efficiencies were achieved while the CO{sub 2} absorption was kept low. At an existing biogas upgrading plant an industrial-scale pilot scrubber was constructed, which efficiently desulfurizes 180 m{sup 3}/h of raw biogas with an average removal efficiency of 97%, even at relatively high and strongly fluctuating H{sub 2}S contents in the crude gas.

  8. Immunogenicity of biologically-derived therapeutics: assessment and interpretation of nonclinical safety studies.

    Science.gov (United States)

    Ponce, Rafael; Abad, Leslie; Amaravadi, Lakshmi; Gelzleichter, Thomas; Gore, Elizabeth; Green, James; Gupta, Shalini; Herzyk, Danuta; Hurst, Christopher; Ivens, Inge A; Kawabata, Thomas; Maier, Curtis;