NCBISkiptomaincontentSkiptonavigationResourcesHowToAboutNCBIAccesskeysMyNCBISignintoNCBISignOutTryoutPMCLabsandtelluswhatyouthink.LearnMore.JournalListTropMedInfectDisv.3(1);2018MarPMC6136623TropMedInfectDis.2018Mar;3(1):11.Publishedonline2018Jan25.doi: 10.3390/tropicalmed3010011PMCID:PMC6136623PMID:30274409ScrubTyphus:NoLongerRestrictedtotheTsutsugamushiTriangleJuJiangandAllenL.Richards*AuthorinformationArticlenotesCopyrightandLicenseinformationDisclaimerViralandRickettsialDiseasesDepartment,NavalMedicalResearchCenter,503RobertGrantAvenue,SilverSpring,MD20910,USA;[email protected]*Correspondence:[email protected];Tel.:+1-301-319-7668Received2017Dec1;Accepted2018Jan21.Copyright©2018bytheauthors.LicenseeMDPI,Basel,Switzerland.ThisarticleisanopenaccessarticledistributedunderthetermsandconditionsoftheCreativeCommonsAttribution(CCBY)license(http://creativecommons.org/licenses/by/4.0/).ThisarticlehasbeencitedbyotherarticlesinPMC.Scrubtyphusisthemostimportantrickettsialdiseaseintheworld.ItspreviousendemicregionwasconsideredtobeinAsia,AustraliaandislandsintheIndianandPacificOceans;thisareawasreferredtoastheTsutsugamushiTriangle.Accumulationofserological,molecular,genetic,andculturedatahaveshownthatnotonlyisscrubtyphusnotlimitedtotheTsutsugamushiTriangle,butcanbecausedbyorientiaeotherthanOrientiatsutsugamushi.Thisreviewdescribesevidencecurrentlyavailablethatwillbeinstrumentaltoresearchers,healthcareprovidersandmedicalleadersindevelopingnewresearchprojects,performingdiagnosis,andpreventingscrubtyphusinlocationsnotpreviouslythoughttobeendemic.Keywords:scrubtyphus,Orientiatsutsugamushi,TsutsugamushiTriangle,endemicregionScrubtyphusistoday’smostimportantrickettsialdisease,worldwide.Approximatelyonemillioncasesoccureachyear,andoveronebillionpeopleareatriskofdisease[1].Scrubtyphusisamildtolife-threateningdiseasewithafatalityratewithouttreatmentashighas50%.Diseasepresentationconsistsofabrupthighfever,severeheadache,lymphadenopathy,generalizedmyalgia,eschar,andrash

SkiptomaincontentAdvertisementSearchallBMCarticlesSearchDownloadPDFResearcharticleOpenAccessPublished:18February2021AnoutbreakinvestigationofscrubtyphusinNepal:confirmationoflocaltransmissionMeghnathDhimal1 na1,ShyamPrakashDumre2,3 na1,GunaNidhiSharma4,5,PratikKhanal1,6,KamalRanabhat6,7,LalanPrasadShah7,BibekKumarLal4,RunaJha8,BishnuPrasadUpadhyaya8,BhimAcharya4,SanjayaKumarShrestha9,SilasA.Davidson10,PiyadaCharoensinphon10&KhemB.Karki1,6 BMCInfectiousDiseasesvolume 21,Article number: 193(2021)Citethisarticle2809Accesses2CitationsMetricsdetailsAbstractBackgroundScrubtyphusisalargelyignoredtropicaldiseaseandaleadingcauseofundifferentiatedfebrileillnessintheareasoftsutsugamushitrianglecausedbyOrientiatsutsugamushi.ItisfrequentlydiagnosedinSouthAsiancountries,althoughclearepidemiologicalinformationisnotavailablefromNepal.Afterthe2015earthquakeinNepal,asuddenupsurgeinscrubtyphuscaseswasreported.Theobjectiveofthisstudywastoinvestigateepidemiologyofscrubtyphusanditscausativeagentsinhumans,animals,andchiggermitestounderstandtheongoingtransmissionecology.MethodsScrubtyphuscaseswithconfirmeddiagnosisthroughoutthecountrywereincludedintheanalysis.StudieswereconcentratedintheChitwandistrict,thesiteofamajoroutbreakin2016.Additionalnation-widedatafrom2015to2017availablefromthegovernmentdatabaseincludedtoanalysethediseasedistributionbygeographicalmapping.ResultsFrom2015to2017,1239scrubtyphuscaseswereconfirmedwiththelargestoutbreakoccurringin2016with831(67.1%)cases.Thecasefatalityratewas5.7%in2015whichdeclinedto1.1%in2017.Anationwideoutbreakofscrubtyphuswasdeclaredasthecasesweredetectedin52outofthe75districtsofNepal.SeasonaltrendwasobservedwithapeakduringAugustandSeptember.Inadditiontothehumancases,thepresenceofO.tsutsugamushiwasalsoconfirmedinanimals(rodents)andchiggermites(Leptotrombidiumimphalum)fromtheoutbreakareasofsouthernNepal.ConclusionThedetectionofO.tsutsugamushiinhumans,animals,andchiggermitesfromoutbreaklocationsandwide-spreadreportsofscrubtyphusthroughoutthecountrycons

ScrubtyphusFromWikipedia,thefreeencyclopediaJumptonavigationJumptosearchDiseasecausedbyO.tsutsugamushiMedicalconditionScrubtyphusOthernamesBushtyphusOrientiatsutsugamushiSpecialtyInfectiousdiseaseScrubtyphusorbushtyphusisaformoftyphuscausedbytheintracellularparasiteOrientiatsutsugamushi,aGram-negativeα-proteobacteriumoffamilyRickettsiaceaefirstisolatedandidentifiedin1930inJapan.[1][2]Althoughthediseaseissimilarinpresentationtootherformsoftyphus,itspathogenisnolongerincludedingenusRickettsiawiththetyphusbacteriaproper,butinOrientia.Thediseaseisthusfrequentlyclassifiedseparatelyfromtheothertyphi.Contents1Signsandsymptoms2Causes3Diagnosis4Treatment5Vaccine6History7Seealso8References9ExternallinksSignsandsymptoms[edit]Signsandsymptomsincludefever,headache,musclepain,cough,andgastrointestinalsymptoms.MorevirulentstrainsofO.tsutsugamushicancausehemorrhagingandintravascularcoagulation.Morbilliformrash,eschar,splenomegaly,andlymphadenopathiesaretypicalsigns.Leukopeniaandabnormalliverfunctiontestsarecommonlyseenintheearlyphaseoftheillness.Pneumonitis,encephalitis,andmyocarditisoccurinthelatephaseofillness.IthasparticularlybeenshowntobethemostcommoncauseofacuteencephalitissyndromeinBihar,India.[3]Causes[edit]Scrubtyphusistransmittedbysomespeciesoftrombiculidmites("chiggers",particularlyLeptotrombidiumdeliense),[4]whicharefoundinareasofheavyscrubvegetation.Themitesfeedoninfectedrodenthostsandsubsequentlytransmittheparasitetootherrodentsandhumans.Thebiteofthismiteleavesacharacteristicblackescharthatisusefultothedoctorformakingthediagnosis.[citationneeded]Scrubtyphusisendemictoapartoftheworldknownasthetsutsugamushitriangle(afterO.tsutsugamushi).[2]ThisextendsfromnorthernJapanandfar-easternRussiainthenorth,totheterritoriesaroundtheSolomonSeaintonorthernAustraliainthesouth,andtoPakistanandAfghanistaninthewest.[5]ItmayalsobeendemicinpartsofSouthAmerica.[6]Thepreciseincidenceofthediseaseisunknown,asdiagnosticfacilitiesarenotavailableinmuchofitslargenativerange,whichspansvastregionso

NCBISkiptomaincontentSkiptonavigationResourcesHowToAboutNCBIAccesskeysMyNCBISignintoNCBISignOutTryoutPMCLabsandtelluswhatyouthink.LearnMore.JournalListIndianJDermatolv.62(5);Sep-Oct2017PMC5618834IndianJDermatol.2017Sep-Oct;62(5):478–485.doi: 10.4103/ijd.IJD_388_17PMCID:PMC5618834PMID:28979009ScrubTyphus:AnEmergingThreatSayantaniChakrabortyandNilenduSarma1SayantaniChakrabortyFromtheDepartmentofDermatology,R.G.KarMedicalCollege,Kolkata,WestBengal,IndiaFindarticlesbySayantaniChakrabortyNilenduSarma1DepartmentofDermatology,Dr.B.C.RoyPostgraduateInstituteofPediatricScience,Kolkata,WestBengal,IndiaFindarticlesbyNilenduSarmaAuthorinformationArticlenotesCopyrightandLicenseinformationDisclaimerFromtheDepartmentofDermatology,R.G.KarMedicalCollege,Kolkata,WestBengal,India1DepartmentofDermatology,Dr.B.C.RoyPostgraduateInstituteofPediatricScience,Kolkata,WestBengal,IndiaAddressforcorrespondence:Dr.NilenduSarma,PNColony,SapuiPara,Bally,Howrah-711227,WestBengal,India.E-mail:moc.liamg@amrasudnelinReceived2017Aug;Accepted2017Aug.Copyright:©2017IndianJournalofDermatologyThisisanopenaccessarticledistributedunderthetermsoftheCreativeCommonsAttribution-NonCommercial-ShareAlike3.0License,whichallowsotherstoremix,tweak,andbuildupontheworknon-commercially,aslongastheauthoriscreditedandthenewcreationsarelicensedundertheidenticalterms.ThisarticlehasbeencitedbyotherarticlesinPMC.ScrubtyphusiscausedbyOrientiatsutsugamushi(formerlyRickettsia)andistransmittedtohumansbyanarthropodvectoroftheTrombiculidaefamily(LeptotrombidiumdelienseandL.akamushi).Itisthemostcommonre-emergingRickettsialinfectioninIndiaandmanyotherSouthEastAsiancountries.Infact,scrubtyphusisconfinedgeographicallytotheAsiaPacificregion,abillionpeopleareatriskandnearlyamillioncasesarereportedeveryyear.Scrubtyphusappearsparticularlytobedistributedinthetsutsugamushitrianglewhichisdistributedoveraverywideareaof13millionkm2boundbyJapanintheeast,throughChina,thePhilippines,tropicalAustraliainthesouth,andwestthroughIndia,Pakistan,possibly

SkipdirectlytositecontentSkipdirectlytopageoptionsSkipdirectlytoA-ZlinkTyphusFeversSectionNavigationCDCHomeFacebookTwitterLinkedInSyndicateScrubTyphusMinusRelatedPagesOnThisPageSignsandSymptomsDiagnosisandTestingTreatmentPreventionScrubtyphus,alsoknownasbushtyphus,isadiseasecausedbyabacteriacalledOrientiatsutsugamushi.Scrubtyphusisspreadtopeoplethroughbitesofinfectedchiggers(larvalmites).Themostcommonsymptomsofscrubtyphusincludefever,headache,bodyaches,andsometimesrash.MostcasesofscrubtyphusoccurinruralareasofSoutheastAsia,Indonesia,China,Japan,India,andnorthernAustralia.Anyonelivinginortravelingtoareaswherescrubtyphusisfoundcouldgetinfected.SignsandSymptomsSymptomsofscrubtyphususuallybeginwithin10daysofbeingbitten.Signsandsymptomsmayinclude:Figure1.EscharatsiteofchiggerbiteFeverandchillsHeadacheBodyachesandmusclepainAdark,scab-likeregionatthesiteofthechiggerbite(alsoknownaseschar)Mentalchanges,rangingfromconfusiontocomaEnlargedlymphnodesRashPeoplewithsevereillnessmaydeveloporganfailureandbleeding,whichcanbefatalifleftuntreated.DiagnosisandTestingThesymptomsofscrubtyphusaresimilartosymptomsofmanyotherdiseases.Seeyourhealthcareproviderifyoudevelopthesymptomslistedaboveafterspendingtimeinareaswherescrubtyphusisfound.Ifyouhaverecentlytraveled,tellyourhealthcareproviderwhereandwhenyoutraveled.Yourhealthcareprovidermayorderbloodteststolookforscrubtyphusorotherdiseases.Laboratorytestingandreportingofresultscantakeseveralweeks,soyourhealthcareprovidermaystarttreatmentbeforeresultsareavailable. TopofPageTreatmentScrubtyphusshouldbetreatedwiththeantibioticdoxycycline.Doxycyclinecanbeusedinpersonsofanyage.Antibioticsaremosteffectiveifgivensoonaftersymptomsbegin.Peoplewhoaretreatedearlywithdoxycyclineusuallyrecoverquickly. TopofPagePreventionFigure2.Adultandlarvalchiggers(mites)ontheheadofapinNovaccineisavailabletopreventscrubtyphus.Reduceyourriskofgettingscrubtyphusbyavoidingcontactwithinfectedchiggers.Whentravelingtoareaswherescrubtyphusiscommon,avoidareaswithlotsofvegetatio

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跳到主要內容區塊MENU::網站導覽首頁English聯絡我們電子報訂閱::最新消息所有消息國際重要疫情資訊最新活動公告中心簡介成立沿革計畫目的線上報名衛教資訊所有類別衛教資訊旅遊小常識旅遊常見問答集留遊學專區疾病介紹衛教文章衛教品衛教影片懶人包門診服務旅遊醫學門診表旅遊醫學合作醫院出版品下載所有出版品下載旅遊醫學通訊民眾叢書醫護叢書教育訓練教材下載所有教材團體衛教上課講義醫五學生上課講義導遊領隊上課講義醫護培訓課程上課講義活動花絮所有花絮民眾衛教導遊領隊相關活動醫護培訓課程常見問題所有常見問題門診常見Q&A黃熱病常見Q&A留學與體檢Q&A傷寒與副傷寒Q&A狂犬病Q&A阿米巴原蟲Q&A白喉、百日咳、破傷風Q&A流行性腦脊髓膜炎Q&A開放COVID-19疫苗自費接種問答輯網站連結滿意度調查SatisfactionSurvey::衛教資訊全部分類旅遊小常識旅遊常見問答集留遊學專區疾病介紹衛教文章衛教品衛教影片懶人包首頁最新消息疾病介紹2016/01/29認識恙蟲病 認識恙蟲病防疫醫師蔡懷德/陳如欣 前言2005年，台灣某8歲女童因高燒6天、頭痛、腹痛及嘔吐而就醫。

由於嚴重腹痛，一開始診斷為盲腸炎並進行手術，術後持續高燒。

檢查發現血中白血球數為7,000/mm3，血小板72,000/mm3，AST及ALT為100~200U/L。

住院一段時間後，發現左肩胛處有一個0.2x0.2cm的焦痂。

病人陸續出現呼吸窘迫症候群、無菌性腦膜炎及急性肝腎衰竭，並於住院後第5天死亡。

個案的血清，經檢驗證實為恙蟲病IgM及IgG陽性；死後解剖，證實血液、肝、腎、心、肺及腦膜檢體的PCR或組織切片免疫染色，皆呈現恙蟲病陽性反應。

回溯個案的旅遊史，病人於發病2週前，於東部的森林區遊樂時，曾遭蟲子叮咬。

恙蟲病是什麼病?有那麼可怕嗎?恙蟲病(Scrubtyphus)又名叢林型斑疹傷寒，或Tsutsugamushidisease(tsutsu:惡疾;mushi:恙蟲)。

感染後常表現出種種非特異性的症狀，易與其它急性發熱疾病混淆，若無適當的處置，可能進展到多重器官衰竭而死亡！反之，若能瞭解其感染途徑、事先防範，或者及早警覺、正確治療，則預後十分良好。

 地理分布恙蟲病廣泛分布於亞洲。

巴基斯坦、中國大陸、香港、日本、東南亞、澳洲等地，全年都有地方性的病例[1-2](見圖1)，特別好發在春夏兩季，大多都在郊外進行登山等戶外活動時受到感染。

每年全球病例數超過一百萬例；其他國家也有因前往流行地旅遊而感染的境外移入病例報告。

 台灣恙蟲病的流行狀況近幾年來，台灣每年平均有460多例的本土確定病例，其中2005及2007年分別有1例死亡個案。

各縣市之每年全人口盛行率，超過十萬分之一者，依次是:連江縣、金門縣、澎湖縣、花蓮縣、台東縣、南投縣、高雄市、宜蘭縣、高雄縣、屏東縣、新竹市、台中市、台北市。

每年個案數由4月份開始增加，於暑假達到高峰。

感染多半與戶外活動有關，如掃墓、踏青等等。

 病原及病媒恙蟲病之病原為立克次體Orientiatsutsugamushi，已知血清型多於30種[1]。

恙蟲病是經由恙蟎幼蟲(chigger)所傳佈，並不會直接人傳人。

台灣已知的恙蟎種類有30多種，其中以地里恙蟎(Leptotrombidiumdeliense)為主[1]。

恙蟎幼蟲很小，肉眼幾乎看不見。

Chigger多爬行於土壤上，或停留於植物表面，如雜草之尖端，再伺機落入經過之動物或人類身上並吸取其組織液，叮咬處可能會出現焦痂(eschar)。

 症狀及鑑別經恙蟎叮咬後，潛伏期大約為1~3週[3]，而後出現相關症狀：(1)高燒、寒顫:發燒1週後，軀幹部可能出現暗紅的丘疹(見圖2)，並擴大至四肢，數天後消失；(2)叮咬部位產生無痛性焦痂(見圖3):有時不易發現；(3)可能伴隨:頭痛、盜汗、咳嗽、肌肉疼痛及結膜充血，鄰近被叮咬處出現淋巴結腫大(4)嚴重者可能進展至肺炎、急性心肌炎、急性肝腎衰竭，甚至死亡。

焦痂是恙蟲病感染的一大特色，但找不到焦痂，並不能排除恙蟲病感染的可能性。

依據台東馬偕醫院的研究，只有69%的病例找得到焦痂[4]。

且恙蟎因口器短小，較喜歡叮咬皮膚柔軟處；如腰部、生殖器、腋下、乳房及眼周圍等[5](也曾在病患腳底或是頭皮處發現)，因此要找焦痂，需要翻開病患的衣物，並在上述各處仔細尋找。

由於恙蟲病的症狀