Zhonghua Liu Xing Bing Xue Za Zhi, 1997 Feb, 18(1), 5 - 7 {Detection of north-Asia tick-borne spotted fever in ticks and rodents along the Heilongjiang river-side by restriction fragment length polymorphism of PCR products}; Chen M et al.; In order to elucidate the natural foci of North-Asia tick-borne spotted fever along the bank of Heilongjiang river, we used PCR/RFLP to detect spotted fever group rickettsiae in ticks and rodents . The results showed that the wild samples of Dermacentor silvarum, Haemaphysalis concinna and Apodemus agrarius, Microtus fortis, Clethrionomys rufocanus and Ondatra zibethica were all positive with amplification, but typhus rickettsiae, tsutsugamushi fever rickettsiae and Q fever rickettsiae were all negative . Futher RFLP analysis of amplified products with PstI and Rsal demonstrated that their restriction endonuclease profiles were identical to Rickettsia sibirica, but were different from the other prototype strains of SFG rickettsiae, suggesting the possible existance of natural foci of North-Asia tick borne spotted fever in these areas. J Neurol, 1998 Oct, 245(10), 665 - 8 Murine typhus presenting as subacute meningoencephalitis; Masalha R et al.; Murine typhus is a febrile systemic illness, presenting with headache and undulating fever . Neurological involvement is considered a rare complication . During 1994 and 1995, 34 patients admitted to our hospital were diagnosed as having murine typhus . Five of these patients presented with a syndrome of subacute "aseptic" meningitis or meningoencephalitis . Three had bilateral papilloedema and 2 had focal neurological signs . None had a rash or other systemic findings suggestive of rickettsial disease . The diagnosis was based on serum and cerebrospinal fluid serology and on prompt response to doxycycline therapy . These cases suggest that neurological involvement in murine typhus is more common than previously suspected and that murine typhus should be included in the differential diagnosis of subacute meningitis in endemic areas. Scott Med J, 1998 Aug, 43(4), 116 - 7 Visual loss in a returning traveller with tick typhus; McCarron B et al.; Rickettsial diseases are increasingly found world-wide and should be considered in febrile patients returning from abroad . This case report describes the vasculitic complications of a patient returning from the Republic of South Africa with tick typhus. Klin Med (Mosk), 1998, 76(7), 32 - 3 {The rheological properties of the blood in patients with tick-borne typhus}; Nikulina MA et al.; Rheological characteristics of blood were studied in 50 patients with north Asian tick typhoid varying in severity and duration . In addition to standard diagnosis--verification tests, blood macrorheological and microrheological examinations were made (blood viscosity, hematocrit and red cell deformability and aggregation, respectively) . It was found that both in the acute disease and recovery there were changes in blood and plasma viscosity red cell hardness . This suggests introduction of rheoprotectors and desaggregants into combined therapy of the above typhoid. Przegl Epidemiol, 1998, 52(1-2), 205 - 14 {Central anti-typhus committee (August 1, 1919-March 5, 1920)}; Wieckowska E; During the first period of the independence of Poland, just after the first World War (1919-1921), the fight against ramped epidemics of acute infectious diseases was a main priority . The most important task of the Ministry of Public Health was the organization of the control of infectious diseases, and especially typhus . In 1919, the government named the Central Anti-Typhus Committee . However, the Committee was a collective institution without necessary competences and resources and its efforts to control typhus epidemics have been unsuccessful . At the end of 1919, there was a dramatic spread of typhus especially in the eastern parts of the country, still suffering from the war . In March 1920, the Central Anti-Typhus Committee has been replaced by the Extraordinary Epidemic Commissariat which has been endowed with special, emergency staff and resources . The Commissariat was headed by Prof . Emil Godlewski, who was soon nicknamed "tyhus tsar"; for the most affected regions competent regional commissars were appointed . The legal ground of the Extra ordinary Epidemic Commissariat was the parliament bill on 14th July 1920 . This body took over from the Public Health Minister responsibilities for the fight against epidemics . The work of Commissariat had stopped the epidemics and improved epidemical status of Poland which could be seen from 1923 onwards. Int J Syst Bacteriol, 1998 Jul, 48 Pt 3, 839 - 49 Phylogenetic analysis of spotted fever group rickettsiae by study of the outer surface protein rOmpA; Fournier PE et al.; Rickettsiae are classified in the order Rickettsiales and have been included in the alpha subclass of the class Proteobacteria on the basis of 16S rRNA gene sequence comparison . To estimate the evolutionary forces that have shaped the members of the spotted fever group (SFG) rickettsiae, the ompA gene (apart from the tandem repeat units), encoding an antigenic high-molecular-mass membrane protein specific for the group, was amplified and sequenced from 21 isolates . The phylogenetic relationship between SFG rickettsiae were inferred from the comparison of both the gene and derived protein sequences, using the parsimony, neighbor-joining and maximum-likelihood methods . Three strongly supported phylogenetic sub-groups were distinguished: first, the Rickettsia conorii complex (R . conorii Malish, R . conorii M1, R . conorii Moroccan, R . conorii Indian tick typhus, Astrakhan fever rickettsia and Israeli tick typhus rickettsia); second, a cluster including Rickettsia africae, strain S, Rickettsia parkeri, Rickettsia sibirica and 'Rickettsia mongolotimonae'; and, third, a cluster including Rickettsia aeschlimannii, Rickettsia rhipicephali, Rickettsia massiliae, Bar 29 and Rickettsia montanensis . Rickettsia rickettsii, Rickettsia japonica, Rickettsia slovaca and Thai tick typhus rickettsia did not cluster with any other Rickettsia species . To test whether positive selection was responsible for sequences diversity, rates of synonymous and nonsynonymous nucleotide substitutions were compared for Rickettsia ompA alleles and indicated that this gene is undergoing neutral evolution. J Med Entomol, 1998 Jul, 35(4), 551 - 5 A new ecology for scrub typhus associated with a focus of antibiotic resistance in rice farmers in Thailand; Tanskul P et al.; Following the documentation of chloramphenicol-resistant and doxycycline-resistant strains of Orientia tsutsugamushi (Hyashi) in northern Thailand, we conducted ecological and epidemiological studies near the houses of patients hospitalized with antibiotic-resistant infections . New associations between chiggers, rodents, and O . tsutsugamushi in active rice agriculture areas, an ecological habitat not described previously, are reported . Rattus rattus (L.) was the most common species (representing 85.8% of the 1,433 rodents processed), followed by Rattus losea (Swinhoe) (9.4%), Bandicota indica (Bechstein) (3.6%), and Rattus argentiventer (Robinson and Kloss) (1.3%) . O . tsutsugamushi was isolated from 30% of the R . rattus and R . losea, 29% of the B . indica, and 33% of the R . argentiventer collected . Mean minimum infection rates were 0.03 in Leptotrombidium chiangraiensis Tanskul & Linthicum, a new species of chigger, and 0.002 in Leptotrombidium imphalum (Vercammen-Grandjean & Langston), a chigger species not previously associated with scrub typhus transmission . Efficient vertical and horizontal transmission of O . tsutsugamushi by L . chiangraiensis and L . imphalum was demonstrated . During a 19-mo period from October 1993 to April 1995, the overall prevalence of human IgM and IgG antibody to O . tsutsugamushi was 25.5 and 47.3%, respectively . L . chiangraiensis and L . imphalum are incriminated as vectors of O . tsutsugamushi in a rice field habitat associated with a focus of antibiotic resistance. J Med Entomol, 1998 Jul, 35(4), 474 - 8 Detection of a spotted fever group rickettsia in Amblyomma cajennense (Acari: Ixodidae) in south Texas; Billings AN et al.; Thai tick typhus rickettsia (strain TT-118), a spotted fever group rickettsia of indeterminant pathogenicity, was isolated from a mixed pool of larval Ixodes and Rhipicephalus ticks collected from Thailand in 1962 . Here we report the surprising finding of a spotted fever group rickettsia with closest sequence homology to the Thai tick typhus rickettsia in Amblyomma cajennense (F.) ticks from south Texas . Sequence analysis was performed on segments of 3 genes that differentiate rickettsial species; all 3 genes sequenced, the 17-kDa, glta, and rompA, when compared with those of other rickettsiae, showed the highest degree of similarity to the Thai tick typhus rickettsia with 99.5, 99.5, and 100% homology, respectively . This is the 1st finding of a rickettsial species in A . cajennense ticks in Texas and the United States . If this rickettsia is pathogenic, exposure to infected A . cajennense ticks may pose a previously unrecognized health risk to people who have been fed upon by these ticks. Transfusion, 1998 Jul, 38(7), 680 - 9 Recovery and viability of Orientia tsutsugamushi from packed red cells and the danger of acquiring scrub typhus from blood transfusion; Casleton BG et al.; BACKGROUND: The purpose of this study was to determine whether infective Orientia tsutsugamushi, the etiologic agent of scrub typhus, could survive normal blood banking processing and storage procedures . STUDY DESIGN AND METHODS: Mononuclear cells isolated from whole blood by density gradient centrifugation were inoculated with O . tsutsugamushi, Karp strain . Infection of the mononuclear cells was confirmed by Giemsa stain, direct fluorescent antibody assay, and polymerase chain reaction using primers specific for the groESL operon of O . tsutsugamushi . The quantity of rickettsial particles in each preparation was determined by direct counts from the Giemsa-stained preparations . Infected mononuclear cells were returned to their respective aliquots of packed red blood cells, which were then either stored at 4 degrees C or glycerolized and frozen at -70 degrees C . RESULTS: Rickettsiae survived up to 10 days (but not 30 days) of refrigerated storage and 45 days of frozen storage, as determined by inoculation of mice with 0.5-mL aliquots of the blood components . Infection of the mice was determined by illness, death, direct fluorescent antibody assay of peritoneal smears, polymerase chain reaction of blood, and enzyme-linked immunosorbent assay detection of antibodies in plasma . CONCLUSION: Because the quantity of rickettsiae injected into the mice was comparable to the quantity reported in the literature for human blood during natural infections, scrub typhus could present a risk in blood collected from donors in endemic areas . This may especially be true, because people can be rickettsemic before illness, after successful antibiotic treatment, and chronically after resolution of disease. J Vector Ecol, 1998 Jun, 23(1), 1 - 46 Vectors vs . humans in Australia--who is on top down under? An update on vector-borne disease and research on vectors in Australia; Russell RC; Australia has a diversity of vectors and vector-borne human diseases . Mosquito-borne arboviruses are of greatest concern, but there are issues with other vector and pathogen systems . Mosquitoes were responsible for more than 35,000 cases of Ross River virus during 1991-1997 . Barmah Forest virus is increasing nationwide, and unidentified bunyaviruses suspected of causing illness have been isolated . Cases of Murray Valley encephalitis have occurred in 14 of the past 20 years in northern Australia . Dengue is a continuing problem for northern Queensland, with various serotypes being active . Japanese encephalitis has appeared in the Torres Strait Islands and threatens mainland Australia . Although malaria is eradicated, almost 1,000 cases are imported annually and occasional cases of local transmission occur . With ticks, paralysis in children occurs annually in eastern Australia . Tick typhus (Queensland Tick Typhus--Rickettsia australis) occurs down the east coast, and (Flinders Island Spotted Fever--Rickettsia honei) in Bass Strait and probably Tasmania . Lyme disease is reported but its presence is controversial . Fleas were responsible for a recent outbreak of murine typhus (Rickettsia typhi) in Western Australia . Mites cause scrub typhus (Orientia tsutsugamushi), and there was a recent fatality in the Northern Territory . Overall, resources for investigation and control of vector-borne disease have generally been meager . However, various avenues of basic and applied research have been pursued, and have included investigations into mosquito ecology, vector competence, disease epidemiology, and vector control . Disease surveillance programs vary between states, and mosquito control programs are organized and effective in only a few regions . There are concerns for import of vectors such as Aedes albopictus and export of pathogens such as Ross River virus; the former has occurred but the species has not become established, and the latter has occurred and has resulted in a major outbreak in the South Pacific . The predicted scenarios of increased temperature and rainfall with global warming are also causing concern for increases in vector-borne diseases, particularly the endemic arboviruses . Interest by health authorities is gravitating more towards epidemiological reporting and less towards public health action . In many respects, humans have much to do to get 'on top' of vectors and their pathogens 'down under' in Australia. Ann N Y Acad Sci, 1998 Jun 29, 849, 11 - 20 Genetic analysis of isolates of the spotted fever group of rickettsiae belonging to the R . conorii complex; Dasch GA et al.; The cytoplasmic 120 kDa antigen genes of 9 isolates of Rickettsia conorii (RC), 12 isolates of R . africae (RA), and 3 isolates of Israeli tick typhus rickettsiae (ISTT) were compared for restriction fragment length polymorphisms (RFLP) present in portions of the open reading frame amplified by polymerase chain reaction (PCR) . Initially, DNAs from 13 species or serotypes of spotted fever group rickettsiae were used to select restriction enzymes (RE) that detected RFLP in gene fragments amplified with primer pairs 483WF/1514R and 764F/3409R . Among the R . conorii complex isolates, Dpn II gave RFLP differentiating all three serotypes . Unique RE patterns were obtained for RC with Bsr I and Hinf I, for RA with Mwo I, Pst I and Ssp I, and for ISTT with Hpa II . While RFLP typing of the 120 kDa gene permitted rapid separation of R . conorii complex isolates into three groups corresponding to the RC, RA, and ISTT rOmp serotypes, additional intragroup genetic variation was also detected in all three serotypes. Clin Diagn Lab Immunol, 1998 Jul, 5(4), 519 - 26 Expression and refolding of truncated recombinant major outer membrane protein antigen (r56) of Orientia tsutsugamushi and its use in enzyme-linked immunosorbent assays; Ching WM et al.; The variable 56-kDa major outer membrane protein of Orientia tsutsugamushi is the immunodominant antigen in human scrub typhus infections . The gene encoding this protein from Karp strain was cloned into the expression vector pET11a . The recombinant protein (r56) was expressed as a truncated nonfusion protein (amino acids 80 to 456 of the open reading frame) which formed an inclusion body when expressed in Escherichia coli BL21 . Refolded r56 was purified and compared to purified whole-cell lysate of the Karp strain of O . tsutsugamushi by immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) for reactivity with rabbit sera prepared against eight antigenic prototypes of O . tsutsugamushi as well as several other species of Rickettsiales and nonrickettsial antigens . Refolded r56 exhibited broad reactivity with the rabbit antisera against the Orientia prototypes, and the ELISA reactions with the r56 and Karp whole-cell lysate antigens correlated well (r = 0.81, n = 22, sensitivity compared to that of standard ELISA of 91%) . Refolded r56 did not react with most antisera against other rickettsial species or control antigens (specificity = 92%, n = 13) using a positive cutoff value determined with eight uninfected rabbit sera . Refolded r56 was evaluated further by ELISA, using 128 sera obtained from patients with suspected scrub typhus from Korat, Thailand, and 74 serum specimens from healthy Thai soldiers . By using the indirect immunoperoxidase assay as the reference assay, the recombinant antigen exhibited a sensitivity and specificity of 93% or greater for detection of both IgG and IgM in the ELISA at 1:400 serum dilution . These results strongly suggest that purified r56 is a suitable candidate for replacing the density gradient-purified, rickettsia-derived, whole-cell antigen currently used in the commercial dipstick assay available in the United States. Zh Mikrobiol Epidemiol Immunobiol, 1998 Mar-Apr, (2), 62 - 5 {Development and use of erythrocyte diagnosticums for the detection of rickettsiae and antibodies to them}; Misenzhnikov AV; The hemosensitizing activity of different fractions of antirickettsial sera, obtained from horses in the process immunization (primary sera) and remote reimmunization (reimmune sera), was studied . The study revealed that in the process of hemosensitization the leading role was played by IgM of primary sera and IgG of reimmune sera, the latter having the most active hemosensitizing properties . The inhibiting action of ballast proteins on the process of hemosensitization was demonstrated . On the model of antirickettsial sera obtained at different stages of the immunization of animals with R.prowazekii the possibility of using the reaction of antigen neutralization, made with the use of different working doses of the antigen, for the differentiation of primary and repeated immune response was shown . The mechanism of such modified variant of the reaction of antigen neutralization is considered and the possibility of using it for the differentiation of epidemic typhus and Brill's disease is discussed. Zh Mikrobiol Epidemiol Immunobiol, 1998 Mar-Apr, (2), 54 - 8 {Immunobiological properties of phospholipid antigens of Rickettsia prowazekii incorporated into rickettsial liposomal preparations}; Timasheva OA et al.; In this article materials on obtaining rickettsial liposomal preparations on the basis of R.prowazekii phospholipid antigen and chemical typhus vaccine are presented . Electron microscopic studies revealed the formation of liposomes in this system . Liposomal preparations were not hemotoxic and produced no toxic action in experiments on guinea pigs and white mice . Phospholipid antigens incorporated into liposomal preparations were found to produce a potentiating effect on the immunogenic properties of chemical typhus vaccine . The adjuvant properties of rickettsial phospholipids incorporated into liposomes on the basis chemical typhus vaccine were registered. Am J Trop Med Hyg, 1998 Jun, 58(6), 786 - 9 Laboratory evaluation of a dot-blot enzyme immunoassay for serologic confirmation of illness due to Rickettsia conorii; Broadhurst LE et al.; Of the 169 United States Army soldiers who deployed on a field training exercise to a remote area of Botswana for two weeks in January 1992, more than 30% developed a febrile illness within five days of their return . A diagnosis of South African tick typhus was suggested by soldiers' exposure to ticks, as well as the presence of eschars and vesicles at the site of tick bites, and tender regional lymphadenopathies . This high attack rate, experienced during such a short exposure period, emphasizes the hazard of illness due to Rickettsia conorii to persons visiting endemic areas . A rapid, diagnostic, semiquantitative enzyme immunoassay (DS) for detection of IgG and IgM antibodies to R . conorii was performed on 209 acute and convalescent sera from soldiers in the outbreak and on 75 control sera . For the acute sera from soldiers meeting the probable case definition of having both regional lymphadenopathy and tick bite eschar, as judged by an IgG indirect fluorescent antibody (IFA) test, the resulting sensitivity and specificity of the DS test were 100% and 48%, respectively . In the analysis of the acute sera, the DS test identified as reactive more of the probable cases (62%) than either the IgG (16%) or IgM (55%) IFAs . This simple and rapid diagnostic test could be useful in establishing a preliminary diagnosis of R . conorii rickettsiosis in remote settings when immediate confirmation by IFA is impossible. Parassitologia, 1998 Jun, 40(1-2), 137 - 47 Eradication, control or neither? Hookworm vs malaria strategies and Rockefeller Public Health in Mexico; Birn AE; Malaria's epidemiological importance in Mexico greatly exceeded that of hookworm, but the Rockefeller Foundation (RF) paid far more attention to hookworm . Although the RF collaborated with malaria campaigns around the world, malaria was only incidental to the RF's activities in Mexico . The hookworm campaign, on the other hand, involved the RF at every stage, from conceptualization and design to financing, hiring, and day-to-day administration . This paper seeks to understand why the RF's involvement in Mexico differed for the two diseases and what the organizational, political, and health implications were for these divergent approaches . Beginning in the mid 1920s the Mexican government developed a modest anti-larval service, periodically draining and filling ditches and swamps, dusting Paris green, petrolizing stagnant water, and administering quinine . Following the RF's 1927 shift towards scientific investigation, it began to sponsor small-scale malaria research, collecting climatological, entomological, epidemiological, and clinical information . The Mexican government eagerly petitioned the RF to join a national effort, but it was reluctant to become involved . A National Malaria Campaign was established in 1935 under President Lazaro Cardenas to coordinate education, sanitary engineering, and treatment . The popular Campaign followed RF strategies even without its direct participation . Meanwhile, the RF avidly pursued modest malaria research in Mexico, funding U.S . investigators to conduct experiments on pesticides, mosquito-trapping, and controversially, watering methods for rice . These efforts culminated in the world's first field trial of DDT against louse-borne typhus and later as a residual spray for malaria . In the end the RF used Mexico as a convenient locale for scientific research that had global implications but only an incidental relationship to Mexico's own Malaria Campaign . Likewise, the RF's much more active hookworm program was more a means than an end, leading not to eradication of the disease, but to Mexico's commitment to modern public health organization and methods. Emerg Infect Dis, 1998 Apr-Jun, 4(2), 179 - 86 Rickettsial pathogens and their arthropod vectors; Azad AF et al.; Rickettsial diseases, important causes of illness and death worldwide, exist primarily in endemic and enzootic foci that occasionally give rise to sporadic or seasonal outbreaks . Rickettsial pathogens are highly specialized for obligate intracellular survival in both the vertebrate host and the invertebrate vector . While studies often focus primarily on the vertebrate host, the arthropod vector is often more important in the natural maintenance of the pathogen . Consequently, coevolution of rickettsiae with arthropods is responsible for many features of the host-pathogen relationship that are unique among arthropod-borne diseases, including efficient pathogen replication, long-term maintenance of infection, and transstadial and transovarial transmission . This article examines the common features of the host-pathogen relationship and of the arthropod vectors of the typhus and spotted fever group rickettsiae. Trop Med Int Health, 1998 Mar, 3(3), 242 - 8 Electron-microscopic examination of Rickettsia tsutsugamushi-infected human liver; Pongponratn E et al.; A 33 year-old Thai woman was diagnosed with scrub typhus infection according to clinical symptoms, eschar lesions compatible with the disease, and specific antibody to Rickettsia tsutsugamushi detected by indirect immunoperoxidase . Percutaneous transhepatic needle biopsies were taken before and 7 days after treatment with tetracycline to study the pathology of the liver . The liver tissue was evaluated by light microscopy, using H & E and Pinkerton's stains, and by transmission electron microscopy (TEM) . Before treatment it showed reactive hepatitis . Rickettsia organisms within the hepatocytes and sinusoids detected by Pinkerton's stain appeared as tiny bright-red organisms . By TEM, the rod-shaped double-membrane Rickettsiae appeared intact in the cytoplasm of Kupffer's cells and hepatocytes . After tetracycline treatment, moderate levels of acidophilic and ballooning liver cells were observed . The degree of cytoplasmic organelle damage varied, including fatty metamorphosis, depletion of glycogen granules, loss of the mitochondrial cristae, dilatation of endoplasmic reticulum and cytoplasmic vacuolation . Rickettsia organisms cannot be visualized by Pinkerton's stain but were detected by TEM, in markedly vacuolated hepatocytes, in congested sinusoids and in Kupffer's cells . Intranuclear Rickettsia were discovered in the endothelial nucleus, showing various degrees of injury . Some were mildly degenerated, while others exhibited clumping of nucleoprotein at the cytoplasm periphery and large vacuolation centrally . Many indented organisms were found, and binary fission during Rickettsiae multiplication was always affected . Electron-microscopic examination of hepatic injury associated with scrub typhus is rare . This is the first ultrastructural localization of Rickettsiae in the infected human liver. Int Ophthalmol, 1997, 21(3), 121 - 6 Retinal manifestations of acute murine typhus; Hudson HL et al.; PURPOSE: To report the ocular manifestations of acute serologically confirmed murine typhus . METHODS: A retrospective analysis of the clinical history, photography and fluorescein angiography of two patients with acute murine typhus with ocular involvement was conducted . RESULTS: A 38 year old male and a 49 year old female were included in the study . Both complained of fever, headache, rash, night sweats and pulmonary symptoms . They had noted the recent onset of diminished visual acuity and floaters . Examination of the posterior pole revealed mild optic nerve head edema (in one patient), intraretinal hemorrhages and small localized areas of retinal whitening . The history confirmed that both patients had been exposed to fleas and the serologic testing was positive for Rickettsia typhi . The systemic and ocular findings resolved after the use of systemic antibiotics . CONCLUSION: Rickettsial diseases such as murine typhus should be included in the differential diagnosis of otherwise healthy individuals who present with an acute systemic febrile illness and retinitis or neuroretinitis . SUMMARY STATEMENT: The clinical features of two patients with serologically proven acute murine typhus with ocular involvement are presented . Both patients presented with a retinal whitening that resolved after treatment. Acta Med Port, 1998 Jan, 11(1), 81 - 5 {Murine typhus in Portugal}; Andre E et al.; Murine typhus or endemic typhus is a wide spread infectious disease, with a low prevalence in developed countries, but surely underdiagnosed . Its relative benignity, the similarity to other infectious diseases and the discretion of its epidemiologic chain, as well as the usual unexpectedness of its existence, makes its diagnosis more difficult . The clinical presentation and evolution of this case illustrate the necessity of being aware of this nosological entity. Am J Trop Med Hyg, 1998 Apr, 58(4), 513 - 8 Molecular and serologic survey of Orientia tsutsugamushi infection among field rodents in southern Cholla Province, Korea; Song HJ et al.; Field rodents were collected from six areas in southern Cholla Province, Korea from October to December 1993 . Twenty-eight (24%) of the 119 Apodemus agrarius were seropositive (> 1:10) for Orientia tsutsugamushi by the passive hemagglutination assay (PHA) . Of the seropositive cases, 11 specimens had antibody titers greater than 1:80 . No seropositive specimens were found among the eight Crocidura lasiura collected . On the other hand, the polymerase chain reaction (PCR) amplified about 520 basepairs of a gene encoding the 56-kD protein from the genomic DNA of 12 strains of O . tsutsugamushi tested . This target DNA sequence was amplified from the 11 (8.7%) blood specimens of A . agrarius, and one of the eight C . lasiura also showed evidence of O . tsutsugamushi infection by PCR . Only one of the PCR-positive samples was also PHA-positive . These results suggest that the PCR combined with a serologic assay more accurately detects the degree of infection of rodents with rickettsiae-causing scrub typhus in epidemiologic surveys. Scand J Infect Dis, 1997, 29(6), 634 - 35 Scrub typhus associated with multiorgan failure: a case report; Chi WC et al.; The spectrum of clinical severity for scrub typhus ranges from inapparent, mild, to severe or fatal . The pathologic changes are focal or disseminated multiorgan vasculitis of the small blood vessels, a fact that helps explain the great diversity of clinical manifestations that can be encountered . We reported a case of scrub typhus with unusual and serious multiorgan involvement, including tubulointerstitial nephritis (TIN) with acute renal failure (ARF), interstitial pneumonitis with adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), liver function impairment, upper gastrointestinal bleeding, prolonged hyperamylasaemia and hyperlipasaemia . Chloramphenicol administration rapidly altered the clinical course, but with sequelae of renal impairment and prolonged hyperamylasaemia and hyperlipasaemia for 10 months. Scand J Infect Dis, 1997, 29(6), 632 - 3 Murine typhus presenting with multiple white dots in the retina; Lu TM et al.; The retinal manifestations of murine typhus have rarely been reported . We report a case of murine typhus with multiple retinal white dots, which are similar to the presentation of multiple evanescent white dot syndrome. Nihon Kyobu Shikkan Gakkai Zasshi, 1997 Dec, 35(12), 1368 - 71 {Sero-negative tsutsugamushi disease (scrub typhus) diagnosed by polymerase chain reaction}; Sugita M et al.; We report a case of sero-negative tsutsugamushi disease diagnosed by polymerase chain reaction (PCR) . A 54-year-old man who worked in Nagano prefecture presented with flu-like symptoms that did not respond to cephalosporin therapy . On admission to another hospital, chest roentgenography revealed abnormal shadows; liver dysfunction was also present . Despite therapy, the patient's condition gradually worsened and he was transferred to our intensive care unit . Erythema on all extremities and scabs on the right medial femoral region and the dorsum of the left foot suggested a diagnosis of tsutsugamushi disease . We administered minocycline and gave percutaneous cardiopulmonary support for adult respiratory distress syndrome . Despite all efforts, the patient died . Although serologic tests were not positive, Karp strains of R . tsutsugamuschi were identified on PCR amplification . Autopsy revealed evidence of acute hemorrhagic pancreatitis, which has not been reported previously in tsutsugamushi disease . We conclude that PCR techniques may be useful in confirming a diagnosis of early tsutsugamushi disease. J Intern Med, 1998 Feb, 243(2), 177 - 9 Imported rickettsioses: think of murine typhus; Van Der Kleij FG et al.; 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, especially in the elderly and when late recognized . We present a patient with murine typhus that illustrates the wide variety of symptoms in this disease, which makes diagnosis difficult . However, if one keeps the possibility of murine typhus in mind, it is easily diagnosed and treated. Southeast Asian J Trop Med Public Health, 1997 Sep, 28(3), 666 - 8 Antibodies to Orientia tsutsugamushi in soldiers in northeastern Thailand; Frances SP et al.; The prevalence and incidence of antibodies to Orientia tsutsugamushi, the etiologic agent of scrub typhus, in Thai soldiers living and working near the Thai-Cambodian border in Si Sa Ket Province was investigated . The point prevalence of antibodies varied from 0 to 4.1% . The incidence of antibodies, calculated from individuals who seroconverted following a negative result in a previous bleeding 3 to 5 months earlier, was 4.21% (9/214) in January 1992, 0 in April 1992 and 3.76% (8/213) in September 1992 . An annual infection rate of 2.66% was estimated. S Afr Med J, 1998 Jan, 88(1), 50 - 3 The epidemic of Athens, 430-426 BC; Retief FP et al.; The Athenian epidemic of 430-426 BC, at the outbreak of the Peloponnesian War, caused the death of the great statesman, Pericles, decimated the population and contributed significantly to the decline and fall of classical Greece . In his remarkable documentation of the epidemic, Thucydides (who survived the disease) not only left us a clear clinical picture of the pestilence but also identified its infectious nature and the fact that it conferred at least partial immunity on survivors . As confirmed by a large number of scholars who studied the subject, Thucydides' description does not accurately fit any existing disease, but we suggest that analysis of the signs and symptoms, considered in conjunction with significant epidemiological evidence, narrows down the many possibilities to epidemic typhus, plague, arboviral disease (e.g . Rift Valley fever) and smallpox . Typhus and smallpox fit best, but we favour the latter for reasons given . Unless further primary sources of information become available (and this seems most unlikely), productive speculation as to the cause of Thucydides' epidemic has probably reached the end of the road. Ann Acad Med Singapore, 1997 Nov, 26(6), 794 - 800 Scrub typhus in the Western Pacific region; Silpapojakul K; Scrub typhus is widely endemic in Asia . Man's behaviour and climatic changes greatly influenced the occurrence of the disease . Increasing prevalences of scrub typhus have been reported from some Asian countries and may coincide with the widespread use of beta-lactam antibiotics or to improve diagnostic facilities and/or more urbanisation into rural areas . Many cases acquired in Asia surfaced in Europe and America . The disease probably is overlooked among paediatric patients . Most patients with scrub typhus present with acute fever of unknown origin (acute FUO) . Eschars are rare among Southeast Asian patients . Complications usually develop after the first week of illness . The complications include pneumonitis, meningoencephalitis, renal failure and jaundice . Improved serologic and molecular diagnostic tests are now available . Although drug-resistant strain of Orientia tsutsugamushi has been reported, the infection usually responds to simple but unpopular drugs such as doxycycline or chloramphenicol. Med Trop (Mars), 1997, 57(3 Suppl), 23 - 7 {Tropical animal and human rickettsial infections}; Brouqui P; Advances in molecular biology have provided tools that have greatly clarified our knowledge of rickettsial diseases . Most rickettsias have been reclassified in the alpha subgroup of proteobacteria . Four groups of rickettsias have been identified: the spotted fever group, the typhus group, Ehrlichia, and Bartonella . Although still considered as a rickettsia, Coxiella burnetti, the agent causing Q fever, has been reclassified separately in the gamma subdivision of proteobacteria . Recognition of rickettsial disease is still based mainly on clinical manifestations (rash, eschar, and scratching sores) . Little progress has been made in serologic testing . Indirect immunofluorescence is the most common technique . Diagnostic techniques based on molecular biology are currently available in only a small number of laboratories . Treatment with tetracyclines is indicated but prophylaxis through proper hygiene is the most effective approach. J Infect Dis, 1998 Mar, 177(3), 800 - 2 Performance of a dot blot immunoassay for the rapid diagnosis of scrub typhus in a longitudinal case series; Watt G et al.; A rapid dipstick test for scrub typhus was prospectively evaluated in Chiangrai, northern Thailand . Sera from 162 patients with fever of unclear etiology were tested by a dot blot immunoassay using two different antigen concentrations . Dipsticks coated with lower concentration of antigen lacked sensitivity compared with the indirect immunoperoxidase test . Dipsticks with higher antigen concentration had increased sensitivity that was equivalent to that of the immunoperoxidase test . By increasing the antigen concentration on the dipstick, sensitivity increased from 67% to 100%, positive predictive value increased from 90% to 93%, and negative predictive value rose from 92% to 100% . The specificity of both antigen concentrations was 98% . This study establishes that scrub typhus can be confirmed serologically by use of a dipstick assay and that serodiagnosis can be effectively tailored to a target population. Lik Sprava, 1997 Sep-Oct, (5), 155 - 7 {The seasonal characteristics of the course of abdominal typhus}; Zinchuk OM; Seasonal fluctuations were studied in the incidence of characteristic abdominal fever symptoms, such as headache, insomnia, asthenia, skin pallor, roseolous eruptions, protracted fever, drop in blood pressure, relative bradycardia, dicrotia, typhoid tongue, enlargement of the liver and spleen, meteorism, constipation, palpable crepitation in the right iliac region, manifest leucopenia . Some symptoms occurred with almost equal frequency in different seasons of the year . In adults, severity of some typhoid symptoms was the greatest, duration the longest, degree the highest in spring, followed, in decreasing rank order by autumn > summer > winter; in children: spring > summer > autumn > winter. Zh Mikrobiol Epidemiol Immunobiol, 1997 Nov-Dec, (6), 30 - 6 {A prognostic assessment of louse-borne typhus (Rickettsia prowazekii infection) in Russia}; Onishchenko GG et al.; From the 1950s to 1974 R.prowazekii infection was registered on the territory of Russia, mainly in the form of Brill's disease, represented by some individual cases in the focus of infection . In 0.25% of all of cases rickettsiosis was linked with group outbreaks of the family character (14 events), reflecting the epidemic form of the disease . From 1974 until the present time the correlation between the sources of infection and the infestation of the population with lice dropped below the critical level, ensuring the transmission of the infective agent among the susceptible human population . This led to the steady disappearance of rickettsiosis (a decrease in the number of rickettsiosis cases from several thousand in the 60s to less than 100 in 1991) due to natural demographic processes . After the disintegration of the USSR, the migration of the population from some regions, especially from those where military conflicts took place, did not affect this process . The return of the epidemic form of rickettsiosis in Russia is impossible. Clin Diagn Lab Immunol, 1997 Nov, 4(6), 753 - 63 Distribution of immunogenic epitopes on the two major immunodominant proteins (rOmpA and rOmpB) of Rickettsia conorii among the other rickettsiae of the spotted fever group; Xu W et al.; Forty-four monoclonal antibodies were raised against strain Seven, the type strain of Rickettsia conorii . Of these 44 monoclonal antibodies, 13, 27, and 4 were demonstrated to be directed against the 116-kDa protein (rOmpA), the 124-kDa protein (rOmpB), and lipopolysaccharide-like antigen, respectively . The antiprotein monoclonal antibodies were found to be directed against 29 distinct epitopes, which were located on the two major immunodominant proteins discussed above . Further analysis showed that strain-specific epitopes were located on the rOmpA protein and species- and subgroup-specific epitopes were located on the rOmpB protein . R . conorii Manuel, Indian tick typhus rickettsia, and Kenya tick typhus rickettsia also possessed all 29 epitopes, whereas the other rickettsiae of the spotted fever group (SFG) expressed between 3 and 25 epitopes, with the exception of Rickettsia helvetica, R . akari, and R . australis which did not possess any epitopes . Additional analyses by Western immunoblotting confirmed that the epitopes shared among the SFG rickettsiae were located on the same two high-molecular-mass proteins as on R . conorii . However, although epitopes on the R . conorii rOmpB protein were expressed on the rOmpB proteins of most other SFG rickettsiae, some were found on the rOmpA proteins of R . aeschlimannii, R . rickettsii, and R . rhipicephali . Both proteins possessing the common epitopes were found to have different sizes in the SFG rickettsial species . The different distributions of common epitopes in the SFG rickettsiae were also used to build a taxonomic dendrogram, which demonstrated that all the R . conorii strains formed a relatively independent cluster within the SFG rickettsiae and was generally consistent with previously proposed taxonomies. Microbiol Immunol, 1997, 41(10), 815 - 8 Intracytoplasmic localization of antigenic heat-stable 120- to 130-kilodalton proteins (PS120) common to spotted fever group rickettsiae demonstrated by immunoelectron microscopy; Uchiyama T; Immunoelectron microscopy demonstrated antigenic heat-stable 120- to 130-kilodalton proteins (PS120) of spotted fever group (SFG) rickettsiae with antiserum against recombinant PS120 of Rickettsia japonica . In the case of R . japonica, a major part of the protein was shown to be localized outside the electron-lucent nucleoid-like region in the cytoplasm of the organisms . The other SFG rickettsiae represented a similar localization of the PS120 antigens cross-reactive to that of R . japonica . On the other hand, a typhus group rickettsia demonstrated no antigens cross-reactive to the PS120 of SFG rickettsiae. Infect Immun, 1997 Dec, 65(12), 5250 - 6 Mapping of antigenic determinant regions of the Bor56 protein of Orientia tsutsugamushi; Seong SY et al.; The 56-kDa protein (Bor56) of Orientia tsutsugamushi is an immunoprotective antigen and is the target molecule of neutralizing antibodies . This antigen is recognized by almost all of the serum antibodies produced by patients in the convalescence phase of scrub typhus . We expressed the Bor56 open reading frame in Escherichia coli and generated from it a series of deletion constructs as MalE fusion proteins . Antibody-binding domains were characterized by using patient sera, mouse monoclonal antibodies (MAbs), and Bor56-immunized-mouse sera . None of the antibodies bound to a fusion protein containing the carboxy-terminal 140 amino acids (aa) of the Bor56 protein, suggesting that the carboxy-terminal domain of Bor56 is not exposed on the surface of the molecule . Human immunoglobulin M (IgM) antibodies predominantly bound to antigenic domain I (AD I; amino acids {aa} 19 to 113) and AD III (aa 243 to 328) . Human IgG antibodies also showed preferential binding to AD I . The epitope recognized by strain-specific MAb (KI4) or group-specific MAb (KI57) was mapped to AD II (aa 142 to 203) . Mouse serum antibodies, elicited by immunization with deletion mutants, consistently bound to AD III . Moreover, the carboxy-terminal 140 aa of the Bor56 protein did not elicit an antibody response in C3H/HeDub mice . A model of the antigenic structure of Bor56 is presented and discussed . These results suggest that antigenic fragments from AD I and AD III are useful in the induction of humoral immunity against O . tsutsugamushi . These antigenic analyses provide an important foundation for further analyses of the neutralizing-antibody responses generated during rickettsial infections . They also provide potential peptide substrates for diagnostic assays and vaccine strategies. Am J Trop Med Hyg, 1997 Nov, 57(5), 569 - 70 Short report: surveillance of rickettsial infections in Indonesian military personnel during peace keeping operations in Cambodia; Corwin AL et al.; Indonesian peacekeepers in Cambodia provided a unique study population to estimate the threat of rickettsial exposure to Rickettsia typhi (murine typhus), Orientia tsutsugamushi, (scrub typhus), and R . conorii (spotted fever) for the region . Prescreening prevalence measure showed a large proportion (36%) of soldiers with antibodies to R . typhi . Predeployment prevalence for antibodies to O . tsutsugamushi was 8%, with no evidence of background R . conorii infections . Actual seroconversions of R . typhi (3) and O . tsutsugamushi (1), attributed to exposure(s) in Cambodia, translated into annualized incidence rates of 24 and 8 per 1,000 per year, respectively . Surveillance of rickettsial infections and/or disease is particularly warranted in Cambodia with recent recognition of drug-resistant scrub typhus in neighboring Thailand. Trans R Soc Trop Med Hyg, 1997 Jul-Aug, 91(4), 425 - 8 Comparative evaluation of four serodiagnostic tests for scrub typhus in Thailand; Pradutkanchana J et al.; The commercial dot-blot enzyme-linked immunosorbent assay Dip-S-Ticks dipstick test was compared with the indirect immunoperoxidase (IIP) and Weil-Felix (WF) tests for the diagnosis of scrub typhus, using the indirect immunofluorescent antibody test (IFA) as the reference standard . With a panel of 117 positive and 75 negative sera, the dipstick test was 94% sensitive and 98.7% specific at a cut-off value of one or more positive dots . The IIP was 90.6% sensitive and 100% specific at a cut-off titre of 1:400, and was more sensitive than the IFA with acute sera (79.6% vs . 68.5% at a titre > or = 1:400) . All 3 were superior to the WF, which lacked sensitivity . The dipstick assay was easy to perform and did not require sophisticated electrical equipment, and the results were available within one hour . It is therefore suitable for use in rural Thailand, where scrub typhus is common. Mod Pathol, 1997 Oct, 10(10), 1038 - 42 Immunohistochemical diagnosis of typhus rickettsioses using an anti-lipopolysaccharide monoclonal antibody; Walker DH et al.; A monoclonal antibody directed against an epitope on the lipopolysaccharide of typhus-group rickettsiae was developed for the purpose of detecting this heat-stable, proteinase-resistant antigen in formalin-fixed, paraffin-embedded tissues . Rickettsia prowazekii organisms were identified in endothelium and macrophages in sections of the brains of three Egyptian men who died of epidemic louse-borne typhus in Cairo during World War II and in the brain from a recent case of typhus fever acquired in Burundi . R . typhi organisms were identified in endothelial cells from a fatal case of murine typhus and in experimentally infected mice . This approach is applicable not only to the study of archival tissues and experimental animal models but also could be used to establish a timely diagnosis of typhus-group rickettsiosis by immunohistochemical examination of cutaneous biopsies of rash lesions during the acute stage of illness. Srp Arh Celok Lek, 1997 Jul-Aug, 125(7-8), 191 - 6 {Migration and health}; Litvinjenko S; In the last decades of this century we are witnesses of frequent crises in different parts of the world produced by internal disturbance and wars . These crises, together with natural disasters, poverty and hunger, follow the history of mankind often forcing huge population groups to leave their homes . The harmful health consequences are among negative effects of migrations . While stable populations have well-tried routines for maintaining health, migrations mean abandoning such support systems . The increased exposure to harmful factors contributes more to the bad health condition of the migrant population . Setting of newcomers and local people together in the same homes, reduction in food and heating resources, drug shortage as well as importation of new infectious agents, may also endanger health of the native population . These observations have also been confirmed by Yugoslav experience . Depending on the fact whether a migration is elemental or organized i.e . dependent on its place in the large scale between these two extreme endpoints, the size of risk is also dependent on the consequences and degree of their difficulty . Mass health disturbances occur during migrations of the population from war regions, migrations from areas of natural disasters, mass pilgrimage, migrations of seasonal workers and migrations of armies during wars . However, even in these difficult times and conditions, a good organization can contribute to the mitigation of harmful consequences caused by these migrations . For instance, in 1942 there was an epidemic of typhus fever in Bosnia when many refugees crossed the Drina river on the way to Serbia escaping from Ustasha terrorism . At the Serbian side there were checkpoints where the refugees could taka a bath and where their laundry and clothing were depediculated with dry air, and after a two-week quarantine they could continue to Serbian provinces without making new foci of typhus fever . The most vulnerable and numerous group of refugees is usually composed of women, children and old persons . One of the largest migrations took place over the period from 1991 to 1995, when about 1,500,000 people left the war areas of the former Yugoslavia, Bosnia-Herzegovina and Croatia . Of that number, about 700.000 refugees came to Yugoslavia . In August 1995 during an unprecedented exile from the Kninska krajina region (Croatia) over 200,000 people left their homes . During the arrival of refugees and expelled persons health teams offered first aid to these unlucky persons at reception points: drinking water, food, emergency care and indispensable clothing . The next step in their task was to move refugees into families i.e . into collective camps and centres . As in similar situations, this migration had also its negative effects on health of the refugees . At this time, however, the situation was aggravated by international economic sanctions imposed to Yugoslavia although Yugoslavia has accepted and received more refugees than all European countries together . In 1992 a special refugees Law was promulgated in Yugoslavia . In this Law, among other things, it was stated that "the organized reception, temporary lodging, nutrition, appropriate health care, material and other sort of help" will be secured to refugees . The increased infant mortality rate in Yugoslavia may be ascribed to migrations . After several years of decrease it was in constant rise over the period from 1991 to 1995 (Table 1) . Disturbed mental balance, loosing of ethic norms, feeling of hopelessness and despair, and underestimation of the risk of infections among refugees, contributed to the rise of promiscuity and increase in sexually transmitted diseases . Thus, the number of registered cases of symphills in the period 1991-1995 was six times greater than in previous years . The number of gonorrhea cases was twice greater in this period than before that time . At the same time, it should be emphasized that the number of recorded cases was smaller than it w Emerg Infect Dis, 1997 Jul-Sep, 3(3), 357 - 60 Jail fever (epidemic typhus) outbreak in Burundi; Raoult D et al.; We recently investigated a suspected outbreak of epidemic typhus in a jail in Burundi . We tested sera of nine patients by microimmunofluorescence for antibodies to Rickettsia prowazekii and Rickettsia typhi . We also amplified and sequenced from lice gene portions specific for two R . prowazekii proteins: the gene encoding for citrate synthase and the gene encoding for the rickettsial outer membrane protein . All patients exhibited antibodies specific for R . prowazekii . Specific gene sequences were amplified in two lice from one patient . The patients had typical clinical manifestations, and two died . Molecular techniques provided a convenient and reliable means of examining lice and confirming this outbreak . The jail-associated outbreak predates an extensive ongoing outbreak of louse-borne typhus in central eastern Africa after civil war and in refugee camps in Rwanda, Burundi (1), and Zaire. Am J Trop Med Hyg, 1997 Jul, 57(1), 91 - 5 Seroepidemiologic evidence for murine and scrub typhus in Malang, Indonesia; Richards AL et al.; Indonesian military personnel stationed in Malang, East Java were among troops deployed to central Cambodia as part of the United Nations' Transition Authority Cambodia peace-keeping operation in 1992 . Predeployment blood samples obtained from a cohort of Indonesian soldiers indicated a high prevalence of antibodies to antigens of Rickettsia typhi or Orientia (formerly Rickettsia) tsutsugamushi, the etiologic agents for murine and scrub typhus, respectively . To evaluate the potential risk of these rickettsial diseases in the Malang area, a subsequent seroepidemiologic survey was conducted . This study involved civilian personnel residing within one of three Malang kelurahans (neighborhoods) representing urban, suburban, and rural communities . The heads-of-households from 197 homes completed a detailed epidemiologic survey . In addition, blood samples were collected from 464 individuals residing within the households surveyed . Examination of civilian blood samples disclosed that 34.7% and 1.3% of the study participants were seroreactive to R . typhi and O . tsutsugamushi, respectively . These results were similar to those obtained earlier from the military samples . In addition, assessment of 78 blood samples obtained from peridomestic rodents trapped from within or near the households surveyed showed that 28 were reactive to R . typhi antigens and four were reactive to O . tsutsugamushi antigens . These data indicate that military and civilian personnel living in the Malang area of East Java are at risk of infection with rickettsiae that are antigenically indistinguishable from those that cause murine and scrub typhus. Tidsskr Nor Laegeforen, 1997 Jun 30, 117(17), 2447 - 9 {Endemic typhus imported to Norway}; Jensenius M et al.; Murine typhus, caused by Rickettsia typhi, is an important zoonosis in all parts of the world . The disease is transmitted from rodents to humans by fleas . In this article we describe the first three cases of serologically proven murine typhus imported into Norway during the 1990s . The patients were Norwegian tourists who had visited respectively Guinea-Bissau, Crete and Thailand . They all became acutely ill with fever, chills and severe headache 1-10 days after return to Norway . None of them had a rash . Two patients were admitted to hospital, and one was treated with ciprofloxacin for suspected typhoid fever . All the patients recovered without sequelae . The diagnosis of murine typhus was based on detection of IgM-anti-bodies against R typhi in serum samples during reconvalescence. J Vector Ecol, 1997 Jun, 22(1), 13 - 22 The fleas (Siphonaptera) of Tennessee; Durden LA et al.; Thirty-three species of fleas are recorded from the state of Tennessee . New state records are reported for two species, the pulicid fleas Euhoplopsyllus glacialis affinis and Pulex simulans . Two species of fleas with catholic feeding habits appear to be especially widespread and abundant in Tennessee . These are the pulicid Ctenocephalides felis which parasitizes cats, dogs, humans, opossums, and other medium to large sized mammals, and the hystrichopsyllid Ctenophthalmus pseudagyrtes which is associated with several species of small mammals, particularly shrews, moles, voles, and native mice . For a southeastern state, Tennessee has a relatively rich flea fauna . The figure of 33 flea species recorded here for Tennessee is higher than documented figures for other southeastern states (17 species for Alabama, 19 for Florida, 20 for Georgia, 12 for Mississippi, 18 for North Carolina, 19 for South Carolina) . This is largely because several species with boreal origins inhabit the higher elevations characteristic of the Appalachian Mountains in the eastern part of the state . Although plague is not enzootic as far east as Tennessee, and murine typhus is rare of absent, suitable flea vectors inhabit the state and one abundant flea species, C . felis, is a pest because it feeds on companion animals and humans. J Med Entomol, 1997 May, 34(3), 368 - 71 A new species of Leptotrombidium (Acari:Trombiculidae) collected in active rice fields in northern Thailand; Tanskul P et al.; Leptotrombidium (Leptotrombidium) chiangraiensis Tanskul & Linthicum is described and illustrated as new from specimens collected from the rodents Rattus rattus (L., 1758), Rattus argentiventer (Robinson & Kloss, 1916), Rattus losea (Swinhoe, 1870), and Bandicota indica (Bechstein, 1800) in Chiangrai Province northern Thailand . The new species was collected in active rice fields and adjacent fruit plantation areas . The etiological agent of scrub typhus, Orientia (formerly Rickettsia) tsutsugamushi (Hayashi), has been isolated from patients who live and work in the same habitat where L . chiangraiensis is the predominant Leptotrombidium species. J Clin Microbiol, 1997 Apr, 35(4), 1034 - 5 Use of enzyme-linked immunosorbent assay techniques with cross-reacting human sera in diagnosis of murine typhus and spotted fever; Keysary A et al.; Enzyme-linked immunosorbent assay (ELISA) techniques for the determination of immunoglobulin G to rickettsial lipopolysaccharides were developed . These techniques provide a simple and convenient way to serodiagnose Mediterranean spotted fever and murine typhus with a single serum dilution . The results of the ELISAs correlated with the indirect immunofluorescence assay titers of cross-reacting sera. Infect Immun, 1997 Apr, 65(4), 1541 - 5 Induction of homologous immune response to Rickettsia tsutsugamushi Boryong with a partial 56-kilodalton recombinant antigen fused with the maltose-binding protein MBP-Bor56; Seong SY et al.; Although the 56-kDa protein of Rickettsia tsutsugamushi has been presumed to play important roles in generating protective immunity against scrub typhus, studies of this protein have been impeded . We used the recombinant 56-kDa protein of R . tsutsugamushi Boryong fused with the maltose-binding protein of Escherichia coli (MBP-Bor56) to analyze its ability to induce protective immunity in a C3H/HeDub murine model . Intraperitoneal immunization of mice with MBP-Bor56 resulted in an increase in the 50% minimal lethal dose of more than 160 times compared with that for the control mice . Splenic mononuclear cells from the mice immunized with MBP-Bor56 showed a dose-dependent pattern of lymphocyte proliferation response and secreted gamma interferon and interleukin-2 when stimulated with irradiated R . tsutsugamushi Boryong, which is a cytokine profile of Th1 cells . High titers of antibody to R . tsutsugamushi were also demonstrated by indirect immunofluorescent-antibody testing . These findings suggest that the 56-kDa protein of R . tsutsugamushi is one of the candidates for a vaccine against scrub typhus. Trans R Soc Trop Med Hyg, 1997 Mar-Apr, 91(2), 133 - 4 Epidemic typhus in a prison in Burundi; Bise G et al.; The International Committee of the Red Cross investigated an outbreak of fever of unknown origin in Ngozi prison, Burundi, which resulted in a crude mortality rate of 2.61% in January 1996 . A definite diagnosis of epidemic typhus caused by Rickettsia prowazekii was established by enzyme-linked immunosorbent assay using specific antigens . Control measures included complete cleansing of the prison with cyfluthrine, shaving and dusting all prisoners with permethrin 0.5% dusting powder, and replacement of all mattresses and clothes . All prisoners and guards received a single dose of doxycyline (100 mg) simultaneously . The crude mortality rate dropped abruptly to 1.27% in February 1996 and remained at or below 0.5% from March onwards . Health authorities and medical agencies working in Burundi need to consider epidemic typhus in the differential diagnosis of fever of unknown origin in order to be able to take appropriate control measures in time. Clin Infect Dis, 1997 Mar, 24(3), 436 - 40 Central nervous system involvement in patients with scrub typhus; Pai H et al.; Scrub typhus, which is caused by Orientia tsutsugamushi, is a systemic illness that causes generalized vasculitis . The central nervous system (CNS) is the most crucial target in other rickettsial diseases; however, there have been several reports of encephalitis or meningitis without direct evidence of rickettsial invasion of the CNS in cases of scrub typhus . To investigate CNS involvement in cases of scrub typhus, we analyzed the CSF profiles (cell count and levels of protein and glucose) and amplified rickettsial DNA in CSF specimens by means of nested polymerase chain reaction (PCR) for 25 patients with the infection . Mild pleocytosis was present in 48% of the patients: CSF white blood cell counts ranged from 0 to 110/mm3 (mean {+/- SD} count, 16.3 +/- 27.0/mm3), and the mean (+/- SD) lymphocyte proportion was 51.9% +/- 23.9% . The CSF protein level was increased (>50 mg/dL) in seven patients . Nested PCR amplified six products from the 25 CSF specimens: four of the products were Boryong genotypes, and two were Karp genotypes . The results of this study suggest that O . tsutsugamushi does invade the CSF and that scrub typhus should be considered one of the causes of mononuclear meningitis in areas of endemicity. J Formos Med Assoc, 1997 Mar, 96(3), 213 - 6 Life-threatening scrub typhus with meningoencephalitis and acute respiratory distress syndrome; Fang CT et al.; A 21-year-old man presented with fever, rash, seizure, stiff neck and rapidly progressive bilateral pulmonary infiltrates . Cerebrospinal fluid (CSF) study revealed pleocytosis with predominant polymorphonuclear cells, and hypo-glycorrhachia . Status epilepticus occurred, followed by acute respiratory distress syndrome with respiratory failure . Blood and CSF cultures for bacteria were negative, but an indirect immunofluorescence assay revealed a fourfold rise in antibody to Rickettsia tsutsugamushi in paired serum and a 1:2560 (+) IgM antibody titer . Severe scrub typhus with meningoencephalitis and extensive pneumonitis was diagnosed . The patient survived after intravenous minocycline therapy and intensive care, including aggressive seizure control, supportive mechanical ventilation and avoidance of fluid overloading . He had a nearly complete recovery . Practicing physicians in Taiwan should be aware of this reportable disease and its potentially serious complications if not promptly diagnosed and treated. Am Psychol, 1997 Feb, 52(2), 140 - 2 Behavioral and social sciences at the Centers for Disease Control and Prevention . Critical disciplines for public health; Snider DE Jr et al.; The mission of the Centers for Disease Control and Prevention (CDC) is to promote health and quality of life by preventing and controlling disease, injury, and disability . Fifty years ago, CDC's efforts were focused on epidemiologic and laboratory studies of malaria, typhus, and plague . Today, CDC's activities cover a broad range of diseases and conditions, and a broader range of disciplines are required to address these diverse public health problems . The behavioral and social sciences have a critical role to play in helping the public understand risk group characteristics and the frequency, context, and determinants of risky behaviors and in developing, implementing, and assessing prevention programs . CDC is taking steps to foster an environment in which behavioral and social sciences can flourish and to integrate these sciences into all of CDC's prevention activities . Other articles in this section describe the breath and nature of the contributions of behavioral and social sciences at CDC. J Obstet Gynaecol Res, 1997 Feb, 23(1), 75 - 8 Pregnancy with scrub typhus and vertical transmission: a case report; Suntharasaj T et al.; Scrub typhus is a rickettsian disease which is seldom found in pregnancy . A 31-year-old, 34 weeks pregnant woman presented with fever, chill and cough for 6 weeks . Fetal jeopardy was found then a cesarean section was performed to deliver a 2,200 g male with hepatosplenomegaly . The mother's diagnosis was confirmed by positive Weil-Felix (OXK titer 1:320) and scrub typhus (titer 1:1600) tests . Vertical transmission was also demonstrated by a positive scrub typhus IgM in her child. Microbiol Immunol, 1997, 41(6), 503 - 7 Prevalence of genotypes of Orientia tsutsugamushi in patients with scrub typhus in Miyazaki Prefecture; Horinouchi H et al.; The genotypes of Orientia tsutsugamushi in patients with scrub typhus in Miyazaki Prefecture were examined by polymerase chain reaction (PCR) and the restriction fragment length polymorphism method . Specific patterns for genotypes Irie, Hirano, Tazume and Yoshimura were detected in 26, 6, 5 and 2 of 39 DNA samples obtained from peripheral blood mononuclear cells, respectively . DNA sequences of the PCR products from the Tazume strain were genetically very close to the Hirano strain and the Yoshimura strain was also very close to the Karp strain . Furthermore, the DNA sequences from the Irie and Tazume strains were completely homologous to the reported sequences of the Kawasaki and Kuroki strains, respectively. Microbiol Immunol, 1997, 41(6), 437 - 43 Isolation of a new Orientia tsutsugamushi serotype; Seong SY et al.; Orientia tsutsugamushi, the etiological agent of scrub typhus, is an antigenically diverse organism and many serologically distinct strains have been identified . The 56 kDa protein of O . tsutsugamushi, a major protein in the outer membrane, has been thought to be responsible for this antigenic variability . A strain of O . tsutsugamushi isolated in Korea cross-reacted with both Gilliam strain-specific and Karp strain-specific monoclonal antibodies . When its 56 kDa protein gene was cloned and analyzed, its sequence showed variation especially between 1,200 and 1,250 bp, showing that this isolate is a new O . tsutsugamushi strain. Emerg Infect Dis, 1997 Jan-Mar, 3(1), 73 - 6 Knowledge-based patient screening for rare and emerging infectious/parasitic diseases: a case study of brucellosis and murine typhus; Carter CN et al.; Many infectious and parasitic diseases, especially those newly emerging or reemerging, present a difficult diagnostic challenge because of their obscurity and low incidence . Important clues that could lead to an initial diagnosis are often overlooked, misinterpreted, not linked to a disease, or disregarded . We constructed a computer-based decision support system containing 223 infectious and parasitic diseases and used it to conduct a historical intervention study based on field investigation records of 200 cases of human brucellosis and 96 cases of murine typhus that occurred in Texas from 1980 through 1989 . Knowledge-based screening showed that the average number of days from the initial patient visit to the time of correct diagnosis was significantly reduced (brucellosis-from 17.9 to 4.5 days, p = 0.0001, murine typhus-from 11.5 to 8.6 days, p = 0.001) . This study demonstrates the potential value of knowledge-based patient screening for rare infectious and parasitic diseases. Am J Trop Med Hyg, 1997 Jan, 56(1), 38 - 43 Evaluation of an enzyme-linked immunosorbent assay in Thai scrub typhus patients; Suwanabun N et al.; We report the development of an improved enzyme-linked immunosorbent assay (ELISA) to detect Orientia (formerly Rickettsia) tsutsugamushi antibody in human sera . Results were compared with a standard test, the indirect immunoperoxidase assay (IIP) . Control serum samples were collected from 96 American soldiers and 198 Royal Thai Army soldiers with no recent history of clinical illness . Sera were examined from 79 febrile, Thai scrub typhus patients presenting at Chiang Rai (76) and Bangkraui Nontaburi (3) Provincial hospitals (cases confirmed by elevated IIP IgG levels > or = 1:1,600, IgM levels > or = 1:400, or presence of an eschar) . The mean + 2 SD, used for the upper limit of normal reactions in the IgG ELISA, was 0.10 for U.S . soldiers and 0.42 for Thai soldiers . Using the 0.10 cutoff value, 29% of the asymptomatic Thai soldiers would be designated as antibody positive . Variability of IgG ELISA values was greater in the Thai soldier group than in American soldiers, possibly reflecting previous exposure to O . tsutsugamushi . In the Thai patients, there was a significant correlation between IIP titers and single serum dilution (1:100) ELISA values (IgG, r = 0.75, n = 104; P < 0.0005; IgM, r = 0.70, n = 75; P < 0.0005) and between IIP titers and ELISA titers (IgG, r = 0.87, n = 103; P < 0.0005; IgM, r = 0.76, n = 75; P < 0.0005) . The single serum dilution ELISA was as effective as the titration in determining presence of specific antibodies . The O . tsutsugamushi ELISA is a rapid and objective test amenable to accurately testing the large numbers of sera often obtained in seroepidemiologic investigations. Eur J Epidemiol, 1997 Jan, 13(1), 109 - 11 Domestic cats as indicators of the presence of spotted fever and typhus group rickettsiae; Matthewman L et al.; Using indirect immunofluorescence assays, sera from cats in Zimbabwe (n = 119) and South Africa (n = 52) were found to contain antibodies reactive with Rickettsia conorii (34% and 19% respectively) and R . typhi (7% and 10% respectively) . These results indicate that cats may become infected with members of the spotted fever and typhus groups of rickettsiae and that cats can, therefore, be used as indicators of the presence of these organisms. Eur J Epidemiol, 1997 Jan, 13(1), 79 - 86 Occurrence of high ratio of males after introduction of minocycline in a colony of Leptotrombidium fletcheri infected with Orientia tsutsugamushi; Takahashi M et al.; In colonies of Leptotrombidium fletcheri mites infected with Orientia tsutsugamushi (Ot), the agent of scrub typhus, males rarely appear . In the present study, the development of a high ratio of males was observed after introduction of minocycline (MC) . A high dose of MC was injected subcutaneously into a mouse, and by feeding unfed larvae from an infected mite colony on this mouse, the Ot in the mites were successfully killed . Of a total of 130 unfed larvae attached to the mouse, 29 developed into females; of these, 9 laid an average of 112.4 eggs/female . Unfed larvae in the succeeding generations were attached to untreated mice . All adults in the P and F1 generation were females, and males started to appear at the F2 generation . The ratio of males to females was 332:7, 108:13, 263:61 and 71:9 at the F2, F3, F4 and F5 generations, respectively . These data suggest that Ot in the ovary or gonad may suppress the development of males. J Clin Microbiol, 1997 Jan, 35(1), 243 - 7 Characterization of a spotted fever group Rickettsia from Ixodes ricinus ticks in Sweden; Nilsson K et al.; A spotted fever group rickettsia isolated from the common tick, Ixodes ricinus, was genetically characterized by PCR and genomic sequencing . This study was performed with nymphal and adult ticks collected in southern and central Sweden . I . ricinus is the only North European tick species of medical importance which is regularly collected from humans . No species of the genus Rickettsia has previously been found in Scandinavian ticks, nor has any case of domestic rickettsial infection in humans or animals been reported . According to the nucleotide sequencing, the present Rickettsia sp . belongs to the spotted fever group of rickettsiae . Ticks are the most common arthropod reservoirs and vectors of the rickettsiae of this group . Among 748 ticks investigated, 13 (1.7%) were positive for a Rickettsia sp . Borrelia burgdorferi was detected in 52 (7%) of the ticks, a prevalence similar to or somewhat lower than that previously been recorded in other Swedish studies . There was no evidence of ehrlichial or chlamydial DNA in these ticks . The Rickettsia sp . was further characterized by 16S ribosomal DNA (rDNA) sequencing and restriction fragment length polymorphism (RFLP) . The 16S rDNA sequencing resulted in a sequence identical to that described for Rickettsia helvetica, but the pattern obtained with RFLP of the citrate synthetase gene diverged from previously known patterns . The rickettsial agent of one tick which was positive by PCR was confirmed by transmission electron microscopy . The morphology of this rickettsia was similar to that of the spotted fever and typhus group rickettsiae . This represents the first documented isolate of a Rickettsia sp . from Swedish ticks. Am J Trop Med Hyg, 1996 Dec, 55(6), 685 - 92 Biological and genetic characterization of Rickettsia sibirica strains isolated in the endemic area of the north Asian tick typhus; Balayeva NM et al.; Restriction fragment length polymorphism (RFLP) analysis of polymerase chain reaction-amplified gene fragments was used to characterize 24 isolates of spotted fever group rickettsiae previously identified as Rickettsia sibirica from their serologic properties . These strains were obtained in Russia between 1946 and 1991 from humans and different species of Ixodid ticks . The RFLP analysis was performed using amplified DNA products obtained with a genus-specific primer pair derived from the R . prowazekii citrate synthase gene and two group-specific primer pairs from the R . rickettsii 190-kD and 120-kD surface protein antigen genes followed by Alu I, Pst I, and Rsa I restriction endonuclease digestions . Although some differences were detected in biological characteristics among the examined strains, only a single R . sibirica genotype was found with these molecular tools of identification. Am J Trop Med Hyg, 1996 Nov, 55(5), 556 - 9 Antibodies to Orientia tsutsugamushi in Thai soldiers; Eamsila C et al.; Thai soldiers who were conscripted, Royal Thai Army forces, professional Border Patrol Police, or local militia (Thai Rangers) located in any of seven provinces of Thailand were bled in April and again, four months later, in July 1989 . In 1991, soldiers from five different locations in southern Thailand were bled once, in July . Serum samples were tested by indirect fluorescent antibody assay for antibody to Orientia (formerly Rickettsia) tsutsugamushi, etiologic agent of scrub typhus, with any titer > or = 1:50 considered positive . Prior to field exercises, prevalence of antibody varied significantly between different types of units, ranging between 18.6% for Thai Rangers and 6.8% for the Royal Thai Army . The April prevalence, July prevalence, and incidence varied significantly by province in 1989, with highest incidence being 14.5% in Kanchanaburi and the lowest 0% in Utraladit . The prevalence in southern Thailand in 1991 varied between 1.6% and 6.8% . The data demonstrate that O . tsutsugamushi is widely distributed in Thailand and that military activity consisting of field exercises that simulate combat conditions significantly expose soldiers to infection. Clin Infect Dis, 1996 Nov, 23(5), 1168 - 70 Infection with human immunodeficiency virus does not influence the clinical severity of scrub typhus; Kantipong P et al.; Infection by Orientia (formerly Rickettsia) tsutsugamushi causes scrub typhus, a severe febrile disease common in Asia . Both scrub typhus and AIDS are prevalent in northern Thailand . Therefore, we prospectively investigated the impact of infection due to human immunodeficiency virus (HIV) on the severity of the clinical syndrome produced by O . tsutsugamushi . The severity of scrub typhus was objectively graded on admission of patients to the hospital, and serologies for antibodies to HIV were performed . Fourteen (16%) of 86 patients with scrub typhus were infected with HIV; the median T helper cell count was 70/mm3 . There were no significant differences between HIV-infected patients and non-HIV-infected patients in severity scores or other admission characteristics . O . tsutsugamushi was isolated in blood samples from 48.6% of patients without HIV infection and in blood samples from 14.3% of HIV-infected patients (P < .05 x 2 test) . The clinical manifestations of O . tsutsugamushi infection, unlike those due to some other intracellular pathogens, are not unusually severe in immunocompromised patients with AIDS. Lik Sprava, 1996 Oct-Dec, (10-12), 101 - 4 {Current problems in the laboratory control of louse-borne typhus infection in Ukraine}; Klymchuk MD; Surveys designed to study spread of typhus infection (persistent form and Brill's disease), and state of laboratory diagnosis in Ukraine showed an important role the laboratory diagnosis plays in the system of epidemiological surveillance aimed at preventing epidemic typhus . Main trends of activities on perfection of the system of laboratory control of the infection under present-day conditions are outlined. Ned Tijdschr Geneeskd, 1996 Sep 21, 140(38), 1912 - 5 {Back again: the clothes louse (Pediculus humanus var . corporis)}; van der Laan JR et al.; In two homeless men aged 38 and 32 years, who suffered from itching, infestation with body lice (Pediculus humanus var . corporis, a.k.a . clothes lice) was diagnosed . This infestation is rare in the Netherlands . In 1993 and 1994 and infection with body lice was registered 41 times in 31 patients at the clinic for homeless of the Community Health Service of Utrecht . The body louse can be seen by the naked eye . Treatment is by hygienic measures, pediculicides if necessary, and by prevention . Important to recognize is that P . humanus can be the vector of trench fever (Bartonella quintana), relapsing fever and typhus. Southeast Asian J Trop Med Public Health, 1996 Sep, 27(3), 580 - 3 Diagnosis of scrub typhus in Malaysian aborigines using nested polymerase chain reaction; Tay ST et al.; A rapid diagnostic system for scrub typhus using nested polymerase chain reaction (PCR) was applied to clinical samples from Malaysian Aborigines . Whole blood from twenty-four patients suspected of scrub typhus infection were tested using nested polymerase chain reaction and sera were evaluated by the indirect immunoperoxidase test . Antibody responses towards Rickettsia tsutsugamushi were observed in seventeen patients with the majority having high titers of IgG antibodies . Seven patients were seronegative . The nested PCR amplified R . tsutsugamushi DNA from six patients, of which two were negative serologically and four had high titers of IgG antibodies . Second samples collected seven days after treatment were negative by PCR testing . Nested PCR is highly sensitive and specific and may be used to provide rapid confirmation of scrub typhus cases in endemic region. QJM, 1996 Aug, 89(8), 623 - 9 Liver involvement in murine typhus; Silpapojakul K et al.; Liver involvement was retrospectively evaluated in 137 patients with murine typhus . Fifteen (10.9%) were jaundiced . One patient had been subjected to cholecystectomy after misdiagnosis of acute cholecystitis . Serum aminotransferase levels were abnormal in 48/52 measurements, and there were elevations of > 5-fold in 14 patients . Liver biopsies and/or necropsies from four jaundiced patients showed portal tract and sinusoidal infiltrates, cloudy swelling/and necrosis of the hepatocytes and occasional pseudogranuloma formation . There were striking mitoses even in the early stage, suggesting rapid hepatocellular regeneration . Haemolytic diseases (G6PD deficiency or haemoglobinopathies), alcoholism, and a second infection probably also contributed to the pathogenesis of jaundice in murine typhus . This rickettsiosis should be included among differential diagnoses of acute hepatitis in patients exposed to areas endemic for Rickettsia typhi. J Clin Microbiol, 1996 Aug, 34(8), 1944 - 8 Improved plaque assays for Rickettsia prowazekii in Vero 76 cells; Policastro PF et al.; Typhus group rickettsiae, including Rickettsia prowazekii and R . typhi, produce visible plaques on primary chick embryo fibroblasts and low-passage mouse embryo fibroblasts but do not form reproducible plaques on continuous cell culture lines . We tested medium overlay modifications for plaque formation of typhus group rickettsiae on the continuous fibroblast cell line Vero76 . A procedure involving primary overlay with medium at pH 6.8, which was followed 2 to 3 days later with secondary overlay at neutral pH containing 1 microgram of emetine per ml and 20 micrograms of NaF per ml, resulted in visible plaques at 7 to 10 days postinfection . A single-step procedure involving overlay with medium containing 50 ng of dextran sulfate per ml also resulted in plaque formation within 8 days postinfection . These assays represent reproducible and inexpensive methods for evaluating the infectious titers of typhus group rickettsiae, cloning single plaque isolates, and testing the susceptibilities of rickettsiae to antibiotics. Mikrobiol Z, 1996 Jul-Aug, 58(4), 80 - 5 {Transplacental transmission of the causative agent in experimental rickettsial infection}; Kurganova II et al.; It was shown in the experiments on the model of typhus infection in guinea-pigs that the pathogenic organism can be inherited by foetus from the mother's organism in the period of acute infection . It is confirmed by the presence of positive seroconversion in 86% of born offsprings and the character of the immunity response after the control infection that is the initial formation of immunoglobulins of form G (Ig G) . At the same time there was no such a transfer of pathogenic organisms in 14% of offsprings . This fact is testified by the absence of seroconversion and the initial formation of immunoglobulins of form M (Ig M) with following formation of immunoglobulins of form G (Ig G) after control infection rickettsia Prowazekii. Med J Aust, 1996 Jul 1, 165(1), 24 - 6 A cluster of murine typhus cases in Western Australia; O'Connor LF et al.; Measures to control rodents have resulted in a decreased incidence of murine typhus, but it is also likely that it is being underdiagnosed because many medical practitioners do not include it in their differential diagnosis of pyrexia of unknown origin . Four recent cases are described, and historical aspects of this disease in Australia are presented. Kansenshogaku Zasshi, 1996 Jun, 70(6), 561 - 8 {Spotted fever group rickettsiosis and vectors in Kanagawa prefecture}; Katayama T et al.; Primer pairs for PCR were designed from the gene encoding the 17,000-molecular-weight genus-common antigen of Rickettsia japonica, Rickettsia rickettsii, Rickettsia conorii, Rickettsia typhi and Rickettsia prowazekii . Primers R1, R2 were designed for amplifying the genomic DNA from spotted fever group (SFG) rickettsiae and epidemic typhus rickettsiae . Primers Rj5, Rj10 were designed for amplifying the genomic DNA from only R . japonica . Using the primers R1, R2, about a 540-bp fragment was observed by amplifying the genomic DNA from R . japonica, R . rickettsii, R . conorii, Thai tick typhus TT-118, Rickettsia sibirica, Rickettsia montana, Rickettsia askari, R . typhi, R . prowazekii and Katayama strain isolated from the patient infected with SFG rickettsiae . Using the primers Rj5, Rj10, the 357-bp fragment was observed by amplifying the genomic DNA from R . japonica and Katayama strain . Therefore, the Katayama strain was identified to belong to R . japonica . With primers R1, R2 and Rj5, Rj10, 537 bp and 357 bp bands were amplified from blood of the patients infected with SFG rickettsiae in Kanagawa prefecture . These findings indicate that the causative agent of SFG rickettsiosis in these two patients was R . japonica . The ticks, Ixodes ovatus and Haemaphysalis flava, were collected by out field research in Kanagawa prefecture . With primers R1, R2 and Rj5, Rj10, 537 bp and 357 bp were amplified from these ticks . This indicates that I . ovatus and H . flava were the vector of R . japonica in Kanagawa prefecture . Also, with the primers R1, R2, about a 540 bp fragment was amplified but with primers Rj5, Rj10, no fragments were amplified from I . ovatus and H . flava . Therefore, these ticks may have SFG rickettsiae other than R . japonica and epidemic typhus rickettsiae. Am J Trop Med Hyg, 1996 Jun, 54(6), 647 - 51 Genotypic identification of Rickettsia tsutsugamushi by restriction fragment length polymorphism analysis of DNA amplified by the polymerase chain reaction; Horinouchi H et al.; We combined the nested polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) for genotypic identification of Rickettsia tsutsugamushi . Four primers were selected from the DNA sequence of the gene encoding a 56-kD serotype-specific antigen of the Karp strain . Nested PCR produced rickettsia-specific products of approximately 0.6 kb in the amplification of DNA prepared from three reference strains (Gilliam, Karp, and Kato) and two prototype strains (Irie and Hirano) prevalent in the Miyazaki Prefecture of Japan . When the nested PCR products obtained from these five strains were digested with Hha I, profiles specific to each strain were generated . Fourteen of 17 DNA samples of peripheral blood mononuclear cells from patients with scrub typhus tested positive in the nested-PCR, providing a rickettsia-specific band . The serotype of infected rickettsia of 10 patients were diagnosed as Irie and those of four patients were diagnosed as Hirano by indirect immunofluorescence methods . The fragment profiles of the PCR products of these 14 patients after digestion with Hha I corresponded closely with those serotypes . However, the PCR products from two of four samples, which were similar to Hirano strain by a serologic method and by the pattern of digestion with Hha I, produced different RFLP profiles upon further digestion with Hinf I and Alu I . These results may suggest that genetic variation exists within serotypes . Genotypic identification of R . tsutsugamushi by means of PCR-RFLP using three restriction enzymes is apparently useful. Am J Trop Med Hyg, 1996 Apr, 54(4), 413 - 7 Genotypic identification of murine typhus Rickettsia in rats and their fleas in an endemic area of Greece by the polymerase chain reaction and restriction fragment length polymorphism; Tselentis Y et al.; Forty-nine cases of murine typhus were diagnosed in recent years in residents of several communities around the city of Chalkis, the capital of the Prefecture of Evia . (Euboea) Evia is an island connected to central mainland Greece by a bridge . To investigate the endemicity of murine typhus in this area, 226 fleas (Xenopsylla cheopis) and blood samples were collected from 53 rats (Rattus norvegicus) trapped in this area . The polymerase chain reaction followed by restriction fragment length polymorphism analysis (PCR-RFLP) was used to detect and identify Rickettsia typhi, the etiologic agent murine typhus, in the rat blood samples (buffy coat cells) as well as in their fleas . An indirect immunofluorescent antibody (IFA) assay was performed to detect antibodies against R . typhi in rat serum samples . The presence of R . typhi in both fleas and rat blood samples was demonstrated . The frequency of infection for X . cheopis was 4%, while 18% of the rats had buffy coat cells infected, and 92% of the rat sera tested by IFA were positive for anti-R . typhi antibodies . The present work is the first successful application of PCR-RFLP in a field study of naturally infected rats and their fleas in Europe. Infect Immun, 1996 Apr, 64(4), 1413 - 9 Identification and characterization of epitopes on the 120-kilodalton surface protein antigen of Rickettsia prowazekii with synthetic peptides; Ching WM et al.; The 120-kDa surface protein antigens (SPAs) of typhus rickettsiae are highly immunogenic and have been shown to be responsible for the species-specific serological reactions of the typhus group rickettsiae . To study the immunochemistry of these proteins, overlapping decapeptides encompassing the whole protein were synthesized on derivatized polyethylene pins . A modified enzyme-linked immunosorbent assay was used to identify epitopes recognized by rabbit hyperimmune antisera to Rickettsia prowazekii SPA . Eight distinct epitopes were mapped by this method in three regions . Four of the epitopes, which were located in the carboxyterminus of mature processed SPA, were strongly competitively inhibited by native folded SPA but not by intact rickettsiae, suggesting that they were on the SPA surface but not exposed on the rickettsial surface . Three of these epitopes were present on both R . prowazekii and Rickettsia typhi SPAs . The immunoreactivities of five epitopes were further characterized by synthesizing modified peptides . Glycine substitution experiments determined the critical residues in the epitopes . The dependence of binding of the peptide epitopes to the polyclonal antisera was mapped to single residues . The limited number and weak reactivity of linear peptide epitopes observed with human and rabbit sera, possibly due to a lack of the methylated amino acids which are present in rickettsia-derived SPA, suggest that the present approach will not provide useful synthetic antigens for diagnosis of typhus infections. Southeast Asian J Trop Med Public Health, 1996 Mar, 27(1), 139 - 44 ELISA-based colorimetric detection of Rickettsia tsutsugamushi DNA from patient sera by nested polymerase chain reaction; Shieh GJ et al.; A rapid diagnostic system for scrub typhus was established using colorimetric detection of nested polymerase chain reaction (PCR) . This system relied on binding the amplified DNA via a sequence in one of oligodeoxyribonucleotide to the DNA-binding protein GCN4 coated on the well of a micotiter dish . The primer pairs used for the nested PCR were designed on the basis of the homologous nucleotide sequence of the gene that encodes the 56 kDa antigen of serovariants . With this colorimetric PCR, diagnosis can be performed easily from serum samples of patients before the antibody titer increases or in the early stage of the disease . Furthermore, these positive results are able to be confirmed by pathogenic isolation. J Med Entomol, 1996 Mar, 33(2), 232 - 5 Laboratory tests of arthropod repellents against Leptotrombidium deliense--noninfected and infected with Rickettsia tsutsugamushi--and noninfected L . fletcheri (Acari: Trombiculidae); Frances SP et al.; Laboratory tests were conducted to compare the response of noninfected Leptotrombidium deliense Sambon and Leptotrombidium fletcheri (Womersley & Heaslip) and L . deliense naturally infected with Rickettsia tsutsugamushi, the etiologic agent of scrub typhus, to 8 chemical repellents and toxicants . Low concentrations of permethrin, dimethylphthalate, diethyl methylbenzamide, benzyl benzoate, di-n-propyl 2,5-pyridine-dicarboxylate, 1-(3-Cyclohexen-1-yl-carbonyl)-2-methylpiperidine (AI3-37220), 2-hydroxymethyl-cyclohexyl acetic acid lactone, and a high concentration of dibutylphthalate (DBP) were toxic for noninfected larvae of both species tested . The median effective knockdown time for all chemicals, except 1% AI3-37220 and 5% permethrin, were longer against infected L . deliense than uninfected larvae of the same species . However, the results indicate that low concentrations of all chemicals, except DBP, should be effective against 2 important vectors of scrub typhus. Eur J Epidemiol, 1996 Feb, 12(1), 85 - 9 Serological examination of human and animal sera from six countries of three continents for the presence of rickettsial antibodies; Kovacova E et al.; Forty samples each of human sera collected in Guinea Bissau, Cape Verde, El Salvador and Iran, and animal sera (goat and cattle from Sri Lanka and sheep from Tanzania) were examined for the presence of antibodies to typhus group (TG) rickettsiae, spotted fever group (SFG) rickettsiae and Coxiella burnetii by enzyme-linked immunosorbent assay (ELISA) and indirect fluorescent antibody (IFA) test . Of human sera tested, a higher proportion of positive sera were found with ELISA and IFA test for TG, SFG rickettsiae and C . burnetii in El Salvador (42.5 vs 20.0%, 40.0 vs 32.5%, and 27.5 vs 27.5%, respectively) and in Iran (25.0 vs 15.0%, 45.0 vs 27.5%, and 27.5 vs 25.0%, respectively), than in Guinea Bissau and Cape Verde, where they were less than 20.0% except for antibodies to SFG rickettsiae in Guinea Bissau (25.0% with ELISA and 20.0% with IFA test) . While all animal sera were negative for the presence of antibodies to TG rickettsiae, a high proportion of sera from Sri Lanka reacted in ELISA and IFA test with SFG rickettsiae and C . burnetii (37.5 vs 20.0% and 27.5 vs 25.0% for goat sera, and 40.0 vs 30.0%, and 17.5 vs 15.0% for cattle sera, respectively) . The results obtained indicate that the studied rickettsial diseases can be spread in given territories and may pose a public health problem requiring greater attention than has been paid so far . The suitability of ELISA and IFA test for serological survey of rickettsial antibodies is discussed. Bull Soc Pathol Exot, 1996, 89(3), 204 - 8 {Fever of unknown origin (FUO) in the camps of Rwandan refugees in the Goma region of in Zaire (September 1994)}; Rey JL et al.; After the outbreaks of cholera, dysenteriae, meningitidis of which the rwandese refugees have been the victims in August and September 1994 in the camps of the Goma's area (Zaire), the medical teams were confronted with a great number of fevers of unknown origin . In order to explore the possible etiologies, we have conducted a cases/controls study (n = 96) . Clinically, the cases occur more frequently than controls headache (p < 0.001), splenomegaly (p = 0.02) and neutropeny (p < 0.001) Serologically, it has been constated non significantly difference between cases and controls, but prevalence of HIV-1 infections (19 and 6%) and arbovirus (23 and 10%) infections are very high . Arbovirosis could explain, partially or associated with HIV and tuberculosis, the presence of these fevers undeterminated more than malaria or typhus epidemic. Microbiol Immunol, 1996, 40(3), 233 - 6 Expression and purification of the crystalline surface layer protein of Rickettsia typhi; Hahn MJ et al.; The crystalline surface layer (S-layer) protein (SLP) of Rickettsia typhi is known as the protective antigen against murine typhus . We previously reported a cloning and sequence analysis of the SLP gene of R . typhi (slpT) and showed that the open reading frame of this gene encodes both the SLP and a 32-kDa protein . To express only the SLP from this gene, the putative signal sequence and the 32-kDa protein portion were removed from the slpT . This protein was expressed in Escherichia coli as a fusion protein, consisting of the SLP and maltose binding protein . The recombinant protein reacted strongly with polyclonal antiserum of a patient with murine typhus. J Homosex, 1996, 31(4), 1 - 28 Homosexual inmates in the Buchenwald Concentration Camp; Roll W; The treatment of homosexual inmates in Nazi concentration camps is a subject which was largely ignored by historians in both West and East Germany after the war . Not until the 1980s, when research began to focus on some of the lesser-known victims of Nazi terror, did attention shift to the fate of homosexuals . This process can be seen clearly at the Buchenwald Memorial in the former GDR, the site of the persecution and also the death of considerable numbers of prisoners identified by the pink triangle on their clothing . The persecution of homosexuals in Nazi Germany began in 1933, even before Buchenwald was built in 1937 . The Nazis aimed to eradicate homosexuality, which they saw as a threat to the survival of the German people . Incarceration in concentration camps like Buchenwald marked a stage in the radicalization of Nazi policy against homosexuals . There they were subjected to the harshest conditions and treated as the lowest of the low in the camp hierarchy . They were continually exposed to the terror of the SS but also the latent prejudices of the rest of the camp population . The culminating points of their maltreatment in Buchenwald were the use of homosexuals in experiments to develop immunization against typhus fever and the attempt by an SS doctor to "cure" homosexuality through the implantation of sexual hormones. Ciba Found Symp, 1996, 200, 8 - 16; discussion 16-21, 46-7 Vector insects and their control; Lehane MJ; This paper emphasizes the huge influence that vector-transmitted disease has on humans using plague, epidemic typhus and nagana as examples . The continuing need for vector control in campaigns against insect-transmitted disease is shown by reference to current control programmes mounted against Chagas' disease, onchocerciasis, lymphatic filariasis and nagana . These successful campaigns have not been reliant on new breakthroughs but on the forging of available tools into effective strategies widely and efficiently used by the control authorities, and the long-lasting political commitment to the success of the schemes in question . A brief mention is made of current fashions in vector control research and that great care needs to be taken by policy-makers to achieve a balance between long-term research aiming at the production of fundamentally new control technologies and operational research aiming to forge the often highly effective tools we already have into sound control strategies. Scand J Infect Dis, 1996, 28(4), 411 - 2 Transmission of scrub typhus by needlestick from a patient receiving pefloxacin; Jee HG et al.; A nurse experience a needlestick during the care of a patient with scrub typhus, treated with pefloxacin (400 mg twice daily) and cefazolin . Seven days after the needlestick, pain and erythematous swelling developed at the tip of her left fourth finger, the site of the needlestick . Fever and headache developed 10 days later, and her skin lesion became a small vesicle surrounded by a dark erythematous area . The diagnosis of scrub typhus was made by a rising indirect immunofluorescent antibody titre, and her illness was improved with doxycycline. Zh Mikrobiol Epidemiol Immunobiol, 1996 Jan-Feb, (1), 31 - 3 {The mathematical modelling of the possible morbidity from epidemic louse-borne typhus under current conditions}; Lukin EP et al.; On the basis of their earlier formula for modeling the possible development of the epidemic process of louse-borne exanthematous typhus the authors have calculated the probability of the development of such process for high indices (10 -- 12 % of convalescents with louse contamination rate among them reaching 20 -- 40 %) characterizing this process . The number of sources of this infection (primary patients), as well as the rate of increase and scale of louse contamination of the population, are of prime importance for the prognostication of the development of the epidemic. J Formos Med Assoc, 1995 Dec, 94 Suppl 2, S112 - 9 {Isolation of Rickettsia tsutsugamushi from the blood samples of patients in Taiwan}; Chen HL et al.; Scrub typhus, an acute febrile eruptive disease caused by Rickettsia tsutsugamushi, is one of the most commonly reported communicable diseases in Taiwan . However, information about the epidemic trends of scrub typhus in Taiwan is still very limited . Therefore, this study was performed to isolate the causative agent and determine the prevalence of three different serotypes . From June 1992 to December 1994, lymphocyte cell cultures were grown from different regions of Taiwan . Cell cultures were assayed for R . tsutsugamuhi via immuno-fluorescence, using antisera against Gillian, Karp and Kato strains . Thirty-three of the specimens were positive for R . tsutsugamushi, including one from Keelung, 23 from Taitung, 2 from Kinmen and 7 from Lienjan . Of these, 15 were classified as Gillian-related types, 10 were Karp-related types and 8 were not positively classified . These results indicate Gilliam-and Karp-related serotype are more prevalent than the Kato-related serotype in Taiwan. Trans R Soc Trop Med Hyg, 1995 Nov-Dec, 89(6), 625 - 8 Rapid, simple serodiagnosis of murine typhus; Silpapojakul K et al.; The dot-blot enzyme-linked immunosorbent assay (dot-ELISA) was compared to latex agglutination (LA) and the Weil-Felix OX-19 test for the diagnosis of murine typhus using the indirect immunofluorescent antibody (IFA) test as the 'gold standard' . With a panel of 74 positive and 47 negative sera, the dot-ELISA was 98% specific and 74% sensitive at a cut-off value of the second dot . With acute sera, latex agglutination was 100% specific and 74% sensitive at a cut-off titre of > or = 1:64 . Both tests were more sensitive than the OX-19 test, which was 98% specific and 56% sensitive at a titre of > or = 1:320 . Both dot-ELISA and latex agglutination were comparable and the results were available within one hour of testing . The rapidity, ease in performance and minimal requirement for electrical instruments made these 2 tests suitable for the diagnosis of murine typhus in countries where sophisticated laboratory facilities are lacking. Antimicrob Agents Chemother, 1995 Nov, 39(11), 2406 - 10 In vitro effectiveness of azithromycin against doxycycline-resistant and -susceptible strains of Rickettsia tsutsugamushi, etiologic agent of scrub typhus; Strickman D et al.; In an effort to find a potential alternative treatment for scrub typhus, we evaluated the effectiveness of the standard drug doxycycline and the new macrolide azithromycin against a doxycycline-susceptible strain (Karp) and a doxycycline-resistant strain (AFSC-4) of Rickettsia tsutsugamushi . The antibiotics were tested in an in vitro assay system in which infected mouse fibroblast cells (L929) were incubated for 3 days in various concentrations of the drugs . Rickettsial growth was evaluated by direct visual counts of rickettsiae in Giemsastained cells or by flow cytometry . Initial tests were conducted at the concentration of each antibiotic considered to be the upper breakpoint for susceptibility (16 micrograms/ml for doxycycline and 8 micrograms/ml for azithromycin) . Growth of both Karp and AFSC-4 was strongly inhibited with both antibiotics, as measured by visual counts, although the percentage of cells infected with AFSC-4 in the presence of doxycycline was three times greater than the percentage of cells infected with Karp but was only 60% as great as the percentage of cells infected with Karp in the presence of azithromycin . Flow cytometry confirmed that rickettsial growth occurred in the absence of antibiotics, but it failed to detect it in the presence of high concentrations of either drug . Visual counts of rickettsial growth at lower concentrations of the antibiotics (0.25 to 0.0078 microgram/ml) showed that the Karp strain was 16 times more susceptible that the AFSC-4 strain to doxycycline . Azithromycin was much more effective than doxycycline against AFSC-4, inhibiting rickettsial growth at 0.0156 microgram/ml to levels below that achieved by 0.25 microgram of doxycycline per ml . Azithromycin was also more effective than doxycycline against the Karp strain, causing greater reductions in the number of rickettsiae per cell at lower concentrations . If in vivo testing confirms the in vitro effectiveness of azithromycin, it may prove to be the drug of choice for the treatment of scrub typhus in children and pregnant women, who should not take doxycycline, and in patients with refractory disease from locations where doxycycline-resistant strains of R . tsutsugamushi have been found . When tested in an in vitro assay system, azithromycin was more effective than doxycycline against doxycycline-susceptible and -resistant strains of R . tsutsugamushi. J Med Entomol, 1995 Nov, 32(6), 843 - 6 Seasonal development of Leptotrombidium akamushi (Acari: Trombiculidae) under field temperatures; Takahashi M et al.; Engorged larvae of Leptotrombidium akamushi (Brumpt), a vector of scrub typhus, were reared in small plastic containers placed on the ground and fed fresh eggs of the collembolan Sinella curviseta Brook . Engorged larvae obtained in October developed into deutonymphs through protonymphs approximately 1 mo before winter and became dormant in the cold winter season (approximately 3 mo) . Most deutonymphs developed into tritonymphs in April and adults in May . Females began laying eggs in mid-June and the numbers of unfed larvae showed a peak in August . The mites reared from July rapidly developed into adults by August, and laid eggs in September . Larvae were most abundant in October, and adults became dormant in the winter . The same adults laid eggs from early May to late June and, upon hatching, the larval population peaked in early July of the 2nd summer . Most larvae died before the 2nd winter . Eggs hatched approximately 3 wk after oviposition and longevity of unfed larvae was 2 mo . Because of this very short incubation period, L . akamushi larvae occur in the summer, whereas L . pallidum Nagayo, Miyagawa, Mitamura & Tamiya, and L . scutellare Nagayo, Miyagawa, Mitamura, Tamiya & Tenjin occur in the autumn, although 3 species lay eggs from May to August. Zhonghua Yi Xue Za Zhi (Taipei), 1995 Sep, 56(3), 205 - 10 Scrub typhus complicating acute respiratory distress syndrome: a report of two cases; Lee WS et al.; Scrub typhus is a zoonotic disease, caused by Rickettsia tsutsugamushi, in which humans are accidental hosts . Although it is an acute febrile illness, severe complications of this disease are very rare since the introduction of specific antibiotic therapy . The authors report two cases of scrub typhus complicating acute respiratory distress syndrome . The first case progressed to multiple organ failure, and the patient expired . In the second case, the patient recovered and was discharged . These two cases were proved to be scrub typhus by their travel history or their having lived in endemic area, clinical manifestations, an eschar and indirect immunofluorescent antibody test . For a good prognosis, early diagnosis and early treatment of this disease are important. Clin Infect Dis, 1995 Sep, 21(3), 506 - 10 Short-course doxycycline treatment versus conventional tetracycline therapy for scrub typhus: a multicenter randomized trial; Song JH et al.; To assess the clinical efficacy of short-course doxycycline in the treatment of scrub typhus, we compared conventional 7-day tetracycline therapy with 3-day doxycycline therapy in 116 patients . Patients were randomized to receive either tetracycline (500 mg four times daily; n = 50) or doxycycline (100 mg twice daily; n = 66) and were followed for 4 weeks after the completion of treatment . The cure rate was 100% in the tetracycline group and 93.9% in the doxycycline group (P > .05) . The two groups did not differ significantly in terms of the interval required for defervescence or for the alleviation of symptoms . There were no relapses in either group . These data suggest that 3-day doxycycline therapy is as effective as conventional 7-day tetracycline therapy for the cure of scrub typhus and the prevention of relapses. J Gastroenterol Hepatol, 1995 Jul-Aug, 10(4), 484 - 7 Granulomatous hepatitis associated with scrub typhus; Chien RN et al.; A 56 year old patient with scrub typhus infection having unusual presentation of hepatic injury resembling acute hepatitis is described . The clinical features of fever, headache, eschar, lymphadenopathy, lymphocytosis and high Rickettsia tsutsugamushi immunofluorescence titres confirmed the diagnosis of scrub typhus . Acute hepatitis was proven by hepatic biochemical tests and liver biopsy . The patient had a complete recovery soon after antibiotic treatment . The presentation of this case suggests that scrub typhus infection should be included in the list of differential diagnosis of acute hepatitis or granulomatous hepatitis, at least in the Asian Pacific region where scrub t