DOCSLIB.ORG

Infectious Diseases and the Development of Health Systems in Thailand

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Infectious Diseases and the Development of Health Systems in Thailand 20 Infectious Diseases and the Development of Health Systems in Thailand Visanu Thamlikitkul1, Viroj Tangcharoensathien2, and Natth Bhamarapravati3 1 Siriraj Hostpital, Mahidol University, Bangkok, Thailand 2Ministry of Public Health, Nonthaburi, Thailand 3 Mahidol University Salaya, Nakhonpathom, Thailand HISTORY AND CURRENT STATUS with emerging infectious diseases, especially OF INFECTIOUS DISEASES HIV/ AIDS, and re-emerging diseases such IN THAILAND as leptospirosis. Several emerging infectious diseases originating in neighboring countries Infectious diseases have been a major such as severe acute respiratory syndrome public health problem in Thailand for the past (SARS), avian flu, and Nipah virus infections several centuries. Most infectious diseases in are also a threat to Thai people. Moreover, in­ earlier days were food and water-borne dis­ fectious diseases due to drug resistant micro­ eases, vector-borne diseases, and infectious organisms e.g., drug resistant Streptococcus diseases related to poor sanitation (Wright and pneumoniae, methicillin-resistant Staphylo­ Breakspears, 1903; Beek, 2001). Some infec­ coccus aureus, and multi-drug resistant gram­ tious diseases have now been eradicated, for negative bacilli have also been increasing. example smallpox. The last case of small­ There are 47 infectious diseases docu­ pox in Thailand was documented in 1962. mented in the current Thai Communicable Some diseases have been brought under con­ Diseases Act. These include cholera, plaque, trol by vaccines, such as diphtheria, pertus­ smallpox, yellow fever, meningococcal in­ sis, tetanus, poliomyelitis, and measles. How­ fections, diphtheria, pertussis, tetanus, po­ ever many infectious diseases continue to be liomyelitis, measles, rubella, mumps, chicken public health problems such as acute respi­ pox, influenza, encephalitis, dengue fever, ratory tract infections, acute diarrhea, tuber­ rabies, hepatitis, hemorrhagic conjunctivi­ culosis, dengue hemorrhagic fever, malaria, tis, food poisoning, dysentery, amoebia­ endemic infectious diseases such as melioido­ sis, typhoid fever, paratyphoid fever, typhUS sis, and parasitic infestation e.g., opisthorchi­ fever due to Rickettsia prowazekii, scrub ty­ asis. Like other countries, Thailand is faced phus, murine typhus, tuberculosis, leprosy, Y. Lu et al. (eds.), AIDS in Asia 269 © Springer Science+Business Media New York 2004 270 INFECTIOUS DISEASES AND THE DEVEWPMENI OF HEALTH SYSTEMS IN THAILAND malaria, anthrax, trichinosis, yaws, lep­ therefore be considered as a minimum esti­ tospirosis, syphilis, gonorrhea, non-specific mate of what is probably the actual reality. urethritis, chancroid, granuloma inguinalae, lymphogranuloma venereum, relapsing fever, Acute Gastroenteritis acute diarrhea, chronic tropical ulcer, filari­ asis, mY/AIDS, acute flaccid paralysis and Acute gastroenteritis includes acute di­ SARS. Five diseases are classified as danger­ arrhea, food poisoning, dysentery and severe ous diseases, namely cholera, plaque, small­ diarrhea. Cholera was the major leading cause pox, yellow fever, and SARS. Any cases of of morbidity and mortality in Thailand in the the following diseases must be reported to the 1900s. An epidemic of cholera in 1890 re­ local health authority: cholera, plaque, small­ sulted in moving the Thai capital from Uthong pox, yellow fever, diphtheria, tetanus neona­ to Krungsri Ayudaya. The morbidity rate of torum, poliomyelitis, encephalitis, rabies, acute gastroenteritis per 100,000 population typhUS fever due to Rickettsia prowazekii, an­ has been increasing, from 264 in 1977 to 1800 thrax, trichinosis, meningococcal infections, in 1991, to 2000 in 2002 as shown in Figure 1. yaws, acute flaccid paralysis, and SARS. However the case fatality rate has been de­ According to the official documents of creasing, from 0.5% in 1977-1978 to 0.1 % or the Ministry of Public Health (MoPH) on less since 1982. The decrease in the case fa­ the Burden of Disease and Injuries in Thai­ tality rate was primarily due to improvements land in 1999, infectious diseases comprised in sanitation and personal hygiene, and oral 21 % of the total of 9.6 million Disability Ad­ rehydration therapy. justed Life Years (2 million DALYs) (MoPH, Acute gastroenteritis is still a common Thailand, 2002; MoPH, Thailand, 2003a). cause of morbidity and mortality in children mv/ AIDS accounted for a majority of the under age five. The common micro-organisms infectious disease burden, with 1.3 million causing acute gastroenteritis documented by DALY s, or 72% of the total infectious disease stool or rectal swab cultures in 1998 and in burden. The other major infectious diseases 1999 collected from 23 hospitals located in that contributed to the DALY s in Thailand all regions of Thailand revealed that 18%- were acute respiratory tract infections in chil­ 38% were Salmonella (more than 90% were dren, and tuberculosis. Although HIV/ AIDS non-typhoidal Salmonella), 21 %-36% were has been the major infectious disease prob­ Vibrio parahemolyticus, 8-12% were Es­ lem in Thailand over the past decade, it will cherichia coli, 9%-22% were Shigella (most be addressed elsewhere. This chapter will fo­ of them were Shigella sonnei and Shigella cus primarily on epidemiology and the cur­ flexneri), 2%-5% were Aeromonas 2%-3% rent status of infectious diseases other than were Plesiomonas and 3%-5% were Vibrio HIV/ AIDS in Thailand over the past several cholerae (Ministry of Public Health (MoPH), decades, during which time a disease surveil­ Thailand, 1998; MoPH, Thailand, multiple lance system has been well established. Some years). There were nine major outbreaks of major infectious diseases under surveillance cholera during 1900 to 1980, which infected will be described. Morbidity and mortality more than 80,000 patients and caused more data for most of the infectious diseases de­ than 30,000 deaths. The case fatality rate de­ scribed in this chapter come from the annual creased from 72% in 1918 to 3% in 1980. The epidemiological surveillance report prepared first six major outbreaks were caused by the by the Bureau of Epidemiology, Department Vibrio cholerae serogroup 01 biotype clas­ of Disease Control, MoPH from 1977 to 2002. sical whereas the Vibrio cholerae serogroup It should be mentioned that the morbidity and 01 biotype El-Tor serotype Ogawa and Inaba mortality data collected by the MoPH is likely was the cause of the cholera since 1963. El to be an under-estimate, and this data should Tor cholera usually causes less severe diarrhea INFECTIOUS DISEASES AND THE DEVELOPMENT OF HEALTH SYSTEMS IN THAILAND 271 -+- case/loo,OOO "0- OCFR("-) ~~~ ______________________________________~~~~--~~~0.7 2900 2'100 0.6 o-.q 2000 0.5 , 1600 . 0.4 1200 0 0.3 ., 900 0.2 '100 \. ...,0-0..""0-0. 0.1 t>.. -O" -0_--0_0..-.0. 77 79 91 83 as 87 99 91 "'EAR. FIGURE 1. Morbidity and case fatality rate (CFR) for acute gastroenteritis (Ministry of Public Health, Thailand, 1997-2002) with a much lower case fatality rate than clas­ cholerae serotype Ogawa was susceptible to sical cholera. Vibrio cholerae serotype Ogawa tetracycline and co-trimoxazole prior to 1996. was a predominant serotype during 1993- Since 1996, more than 70% of Vibrio cholerae 1994 epidemic, whereas serotype Inaba has serotype Ogawa have been resistant to co­ been the most common serotype ever since. trimoxazole. Resistance to tetracycline was The cholera epidemics during 1992 and up to 50% in 2000 and then declined to 10% 1994 were caused by Vibrio cholerae non-Ol in 2002. Most strains of the Vibrio cholerae (0139) and since that time this strain of Vib­ serotype Inaba were still sensitive to tetra­ rio cholerae has been found only rarely. Di­ cycline and co-trimoxazole. Vibrio cholerae arrheagenic E.coli strains isolated from pa­ 0139 was usually resistant to co-trimoxazole tients with acute diarrhea in 1998 were en­ but still sensitive to tetracycline. Almost teropathogenic E.coli (86%), enteroaggrega­ all strains of Vibrio cholerae were sensitive tive E.coli (11 %), enterotoxigenic E.coli (2%) to fluoroquinolones. Antibiotic susceptibil­ and enteroinvasive E.coli (1 %). Less than ity profiles of Vibrio cholerae, non-typhoidal 50% of Shigella isolated from stools was Salmonella ShigellaAeromonas against ampi­ sensitive to ampicillin, tetracycline and co­ cillin, tetracycline and co-trimoxazole may trimoxazole whereas 40% to 75% of non­ vary according to geographical areas and typhoidal Salmonella was sensitive to ampi­ species of the organism. Vibrio parahemolyti­ cillin and co-trimoxazole. Nearly all strains of cus is almost always sensitive to tetracycline, non-typhoidal Salmonella and Shigella were co-trimoxazole, and fluoroquinolones. sensitive to fluoroquinolones and third gener­ Studies of acute gastroenteritis in chil­ ation cephalosporins (MoPH, Thailand, 1998; dren have elucidated many trends and charac­ MoPH, Thailand, 1999; Isenbarger et al., teristics of the disease. Campylobacter jejuni 2002). Susceptibility of Aeromonas to ampi­ was isolated in 27% of children present­ cillin, co-trimoxazole and norfloxacin were ing with dysentery at Children's Hospital in 10%, 70%, and 85% respectively. The Vibrio Bangkok during 1998-2000. Campylobacter 272 INFECTIOUS DISEASES AND THE DEVELOPMENT OF HEALTH SYSTEMS IN THAILAND ' -0' 0.. _l00.000chl~""""'~Y'" 2100 .----~-----------------------__, 7 .0 6.~ l!1OO o·--·~.. 6.0 p . ' ~.~ 1700 " 5.0 1~ •• 15 • . 0 l.3OO , 3.5 , 3.0 1100 '0_ -0 2 . ~ !IOO ~---------------------------~----~----~290 91
Load more

Recommended publications
  • CD Alert Monthly Newsletter of National Centre for Disease Control, Directorate General of Health Services, Government of India
    CD Alert Monthly Newsletter of National Centre for Disease Control, Directorate General of Health Services, Government of India May - July 2009 Vol. 13 : No. 1 SCRUB TYPHUS & OTHER RICKETTSIOSES it lacks lipopolysaccharide and peptidoglycan RICKETTSIAL DISEASES and does not have an outer slime layer. It is These are the diseases caused by rickettsiae endowed with a major surface protein (56kDa) which are small, gram negative bacilli adapted and some minor surface protein (110, 80, 46, to obligate intracellular parasitism, and 43, 39, 35, 25 and 25kDa). There are transmitted by arthropod vectors. These considerable differences in virulence and organisms are primarily parasites of arthropods antigen composition among individual strains such as lice, fleas, ticks and mites, in which of O.tsutsugamushi. O.tsutsugamushi has they are found in the alimentary canal. In many serotypes (Karp, Gillian, Kato and vertebrates, including humans, they infect the Kawazaki). vascular endothelium and reticuloendothelial GLOBAL SCENARIO cells. Commonly known rickettsial disease is Scrub Typhus. Geographic distribution of the disease occurs within an area of about 13 million km2 including- The family Rickettsiaeceae currently comprises Afghanistan and Pakistan to the west; Russia of three genera – Rickettsia, Orientia and to the north; Korea and Japan to the northeast; Ehrlichia which appear to have descended Indonesia, Papua New Guinea, and northern from a common ancestor. Former members Australia to the south; and some smaller of the family, Coxiella burnetii, which causes islands in the western Pacific. It was Q fever and Rochalimaea quintana causing first observed in Japan where it was found to trench fever have been excluded because the be transmitted by mites.
    [Show full text]
  • The Difference in Clinical Characteristics Between Acute Q Fever and Scrub Typhus in Southern Taiwan
    International Journal of Infectious Diseases (2009) 13, 387—393 http://intl.elsevierhealth.com/journals/ijid The difference in clinical characteristics between acute Q fever and scrub typhus in southern Taiwan Chung-Hsu Lai a,b, Chun-Kai Huang a, Hui-Ching Weng c, Hsing-Chun Chung a, Shiou-Haur Liang a, Jiun-Nong Lin a,b, Chih-Wen Lin d, Chuan-Yuan Hsu d, Hsi-Hsun Lin a,* a Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1 E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, 824 Taiwan, Republic of China b Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung County, Taiwan, Republic of China c Department of Health Management, I-Shou University, Kaohsiung County, Taiwan, Republic of China d Section of Gastroenterology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan, Republic of China Received 14 April 2008; received in revised form 17 July 2008; accepted 29 July 2008 Corresponding Editor: Craig Lee, Ottawa, Canada KEYWORDS Summary Acute Q fever; Objective: To identify the differences in clinical characteristics between acute Q fever and scrub Coxiella burnetii; typhus in southern Taiwan. Scrub typhus; Methods: A prospective observational study was conducted in which serological tests for acute Q Orientia tsutsugamushi; fever and scrub typhus were performed simultaneously regardless of which disease was suspected Clinical characteristics; clinically. From April 2004 to December 2007, 80 and 40 cases of serologically confirmed acute Q Taiwan fever and scrub typhus, respectively, were identified and included in the study for comparison.
    [Show full text]
  • Scrub Typhus and Molecular Characterization of Orientia Tsutsugamushi from Central Nepal
    pathogens Article Scrub Typhus and Molecular Characterization of Orientia tsutsugamushi from Central Nepal Rajendra Gautam 1, Keshab Parajuli 1, Mythili Tadepalli 2, Stephen Graves 2, John Stenos 2,* and Jeevan Bahadur Sherchand 1 1 Department of Microbiology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu 44600, Nepal; [email protected] (R.G.); [email protected] (K.P.); [email protected] (J.B.S.) 2 Australian Rickettsial Reference Laboratory, Geelong, VIC 3220, Australia; [email protected] (M.T.); [email protected] (S.G.) * Correspondence: [email protected]; Tel.: +61-342151357 Abstract: Scrub typhus is a vector-borne, acute febrile illness caused by Orientia tsutsugamushi. Scrub typhus continues to be an important but neglected tropical disease in Nepal. Information on this pathogen in Nepal is limited to serological surveys with little information available on molecular methods to detect O. tsutsugamushi. Limited information exists on the genetic diversity of this pathogen. A total of 282 blood samples were obtained from patients with suspected scrub typhus from central Nepal and 84 (30%) were positive for O. tsutsugamushi by 16S rRNA qPCR. Positive samples were further subjected to 56 kDa and 47 kDa molecular typing and molecularly compared to other O. tsutsugamushi strains. Phylogenetic analysis revealed that Nepalese O. tsutsugamushi strains largely cluster together and cluster away from other O. tsutsugamushi strains from Asia and elsewhere. One exception was the sample of Nepal_1, with its partial 56 kDa sequence clustering Citation: Gautam, R.; Parajuli, K.; more closely with non-Nepalese O. tsutsugamushi 56 kDa sequences, potentially indicating that Tadepalli, M.; Graves, S.; Stenos, J.; homologous recombination may influence the genetic diversity of strains in this region.
    [Show full text]
  • IAP Guidelines on Rickettsial Diseases in Children
    G U I D E L I N E S IAP Guidelines on Rickettsial Diseases in Children NARENDRA RATHI, *ATUL KULKARNI AND #VIJAY Y EWALE; FOR INDIAN A CADEMY OF PEDIATRICS GUIDELINES ON RICKETTSIAL DISEASES IN CHILDREN COMMITTEE From Smile Healthcare, Rehabilitation and Research Foundation, Smile Institute of Child Health, Ramdaspeth, Akola; *Department of Pediatrics, Ashwini Medical College, Solapur; and #Dr Yewale Multispeciality Hospital for Children, Navi Mumbai; for Indian Academy of Pediatrics “Guidelines on Rickettsial Diseases in Children” Committee. Correspondence to: Dr Narendra Rathi, Consultant Pediatrician, Smile Healthcare, Rehabilitation & Research Foundation, Smile Institute of Child Health, Ramdaspeth, Akola, Maharashtra, India. [email protected]. Objective: To formulate practice guidelines on rickettsial diseases in children for pediatricians across India. Justification: Rickettsial diseases are increasingly being reported from various parts of India. Due to low index of suspicion, nonspecific clinical features in early course of disease, and absence of easily available, sensitive and specific diagnostic tests, these infections are difficult to diagnose. With timely diagnosis, therapy is easy, affordable and often successful. On the other hand, in endemic areas, where healthcare workers have high index of suspicion for these infections, there is rampant and irrational use of doxycycline as a therapeutic trial in patients of undifferentiated fevers. Thus, there is a need to formulate practice guidelines regarding rickettsial diseases in children in Indian context. Process: A committee was formed for preparing guidelines on rickettsial diseases in children in June 2016. A meeting of consultative committee was held in IAP office, Mumbai and scientific content was discussed. Methodology and results were scrutinized by all members and consensus was reached.
    [Show full text]
  • Clinical Presentation of Scrub Typhus During a Major Outbreak in Central Nepal
    ORIGINAL ARTICLE ASIAN JOURNAL OF MEDICAL SCIENCES Clinical presentation of scrub typhus during a major outbreak in central Nepal Arun Sedhain1, Gandhi R Bhattarai2 1Associate Professor, Department of Medicine, Nephrology unit, Chitwan Medical College, Bharatpur, Chitwan, Nepal, 2Director, Health Services Research, United Health Group, OptumInsight, CT, USA. Submitted: 15-04-2017 Revised: 23-05-2017 Published: 01-07-2017 ABSTRACT Background: Scrub typhus, an emerging rickettsial disease caused by the organism Access this article online Orientiatsutsugamushi, is associated with multi-organ involvement. We prospectively Website: studied the clinical manifestations of the disease during a major outbreak in central http://nepjol.info/index.php/AJMS part of Nepal. Aims and Objective: This study was carried out with an aim to analyze the clinical presentations, laboratory parameters, complications and outcomes of scrub DOI: 10.3126/ajms.v8i4.17163 2091-0576 typhus. Materials and Methods: A prospective observational study was conducted in the E-ISSN: P-ISSN: 2467-9100 Department of Medicine in a tertiary teaching hospital. A total of 1398 patients admitted with acute febrile illness were subjected for Scrub Typhus Detect™ IgM ELISA test, among which 502 (35.90%) patients tested positive and were included in the study. Acute kidney injury was defined according to KDIGO guideline. Statistical analysis was done with SAS University Studio package using t-test for continuous variables and chi-square test for categorical variables. Results: Mean age of the patients was 30.37±18.81 years with 26.29% in the pediatric age group (<14 years). Females comprised of 55.98% of the patients. Majority (97.98%) of the patients were seen between July to November.
    [Show full text]
  • MEDICAL GRAND ROUNDS Parkland Memorial Hospital February 23
    MEDICAL GRAND ROUNDS Parkland Memorial Hospital February 23, 1967 HAS YOUR PATIENT BEEN TO VIETNAM? DISEASES TO BE CONSIDERED 11 Progress, far from consisting in change, depends upon retentiveness •.. when experience is not retained, infancy is perpetual. Those who cannot remember the past are condemned to repeat it. 11 Non-Surgical Medical Problems I. Prevalent Disease Problems in US Troops A. Malaria B. Diarrheal Disease 1. Non-specific gastroenteritis 2. Bacillary dysentery- Shigellosis more prevalent in northern half of country 3. Amebiasis - At least 5 cases of hepatic amebic abscesses have been seen C. Venereal Disease: Gonorrhea 7~/o, lymphogranuloma venereum not uncommon. Syphilis relatively uncommon. Chancroid 10-2~/o. D. Respiratory Disease: Mostly URI and bronchitis. E. Skin Disease: Tinea cruris common. Severe mycotic external otitis common. Immersion foot. II. Uncommon But Potentially Epidemic or Serious Disease Problems in US Troops A. Plague B. Cholera C. Dengue D. Leptospirosis E. Scrub typhus F. Rabies G. Infectious hepatitis H. Me 1 i o i dos i s I . F i 1 i arias is J, (?) Schistosomiasis K. (?) Tropical Sprue I I I. Prevalent Disease Problems Among Civilians With Lesser Importance for US Troops A. Tuberculosis: 10 to 20% of the population have open cavitary pulmonary tuberculosis B. Leprosy: There are 100,000 registered patients c. Intestinal Parasites: Hookworm 'is very prevalent D. Trachoma: Estimated 80% of the population is infected at some time 2 TABLE I MORBIDITY REPORTS (Incidence rates i n number/1000/annum) (Jan. 1965- May 1966) Malaria 27.7 Amebiasis 3.4 Bacillary dysentery 5.0 Gastroenteritis - non-specific 68.6 Fever of unknown origin 32.9 Dengue 4.8 Respiratory disease 70.9 Infectious hepatitis 4.9 Scrub typhus 2.
    [Show full text]
  • FUO Cases Showing Prevalence of Scrub Typhus: a Comparative Study by ELISA and Rapid Test in a Tertiary Care Hospital in Andhra Pradesh, India
    Int.J.Curr.Microbiol.App.Sci (2015) 4(2): 632-640 ISSN: 2319-7706 Volume 4 Number 2 (2015) pp. 632-640 http://www.ijcmas.com Original Research Article FUO Cases Showing Prevalence of Scrub Typhus: A Comparative Study by ELISA and Rapid Test in a Tertiary Care Hospital in Andhra Pradesh, India Ponugoti Munilakshmi1*, M.Venkata Krishna2, Maria Sindhura John1, T.Deepa1, G.Avinash1 and P.Sreenivasulu Reddy1 1Department of Microbiology, Narayana Medical College, Nellore-524003, A.P 2Department of Paediatrics, Narayana Medical College, Nellore-524003, A.P *Corresponding author A B S T R A C T Fever of unknown origin (FUO) has multiple causes. Scrub typhus is less known cause of FUO in India. There was high mortality in undiagnosed cases of FUO which lead to the diagnosis of scrub typhus. Scrub typhus is a rickettsial infection K e y w o r d s which is caused by Orientia tsutsugamushi and transmitted by the bite of the chigger of a mite. Present study done to know the prevalence of scrub typhus as a Fever of causative factor in FUO cases by detection of IgM antibodies by ELISA and rapid unknown test. This study was done over a period of six months in Narayana medical college origin, and hospital. 223 serum samples of FUO cases were analysed for IgM antibodies Orientia to Orientia tsutsugamushi along with dengue, malaria, typhoid, tuberculosis and tsutsugamushi, brucellosis. Scrub typhus IgM antibodies by ELISA were detected in 93 (41.7%) Elisa-enzyme patients. Scrub typhus positivity was significantly higher among female in linked immune comparison to males.
    [Show full text]
  • 9: Infections in the Returned Traveller
    Infectious MJDiseasesA Practice Essentials InfectiousMJA Practice Diseases Essentials 9: Infections in the returned traveller David F M Looke and Jennifer M B Robson Remember to consider serious yet treatable diseases, such as malaria STUDIES SHOW that almost 50% of travellers returning to Europe and North America from the tropics experience Abstract health problems related to their travel, and that 8% consult ■ The usual presentation of a returned traveller is with The Medical Journal of Australia ISSN:1 0025-729X 19 August 2002 doctors either abroad or on return. Figures are not availa- a particular syndrome — fever, respiratory infection, ble for177 Australian 4 212-219 travellers but are probably similar. The ©The Medical Journal of Australia 2002 www.mja.com.au diarrhoea, eosinophilia, or skin or soft tissue infection — mostMJA common Practice diseasesEssentials —in Infectioustravellers Diseases to the tropics are or for screening for asymptomatic infection. travellers’ diarrhoea (35% incidence per month of travel), ■ Fever in a returned traveller requires prompt investigation followed by acute respiratory infections (1.4%), giardiasis to prevent deaths from malaria; diagnosis of malaria may (0.7%) and other infections (including hepatitis, amoebiasis require up to three blood films over 36–48 hours. and gonorrhoea).1 Australian travellers increasingly visit tropical and developing countries and may present with ■ Diarrhoea is the most common health problem in infections that are rare in Australia. travellers and is caused predominantly by bacteria; Pre-travel health assessment and planning can prevent or persistent diarrhoea is less likely to have an infectious ameliorate some of these problems (Box 1). Useful informa- cause, but its prognosis is usually good.
    [Show full text]
  • Evidence of Q Fever and Rickettsial Disease in Chile
    Tropical Medicine and Infectious Disease Article Evidence of Q Fever and Rickettsial Disease in Chile Teresa Tapia 1, John Stenos 2 , Roberto Flores 1, Oscar Duery 1, Rodrigo Iglesias 1, Maria Fernanda Olivares 3, Doris Gallegos 3, Cristian Rosas 4, Heidi Wood 5, Johanna Acevedo 3 , Pamela Araya 1, Stephen R. Graves 2 and Juan Carlos Hormazabal 1,* 1 Bacteriology, Sub-Department of Infectious Diseases, Department Biomedical Laboratory, Public Health Institute of Chile, Santiago 7780050, Chile; [email protected] (T.T.); rhfl[email protected] (R.F.); [email protected] (O.D.); [email protected] (R.I.); [email protected] (P.A.) 2 Australian Rickettsial Reference Laboratory, Barwon Health, Geelong, VIC 3220, Australia; [email protected] (J.S.); [email protected] (S.R.G.) 3 Departamento de Epidemiología, DIPLAS, Ministerio de Salud de Chile, Santiago 8320123, Chile; [email protected] (M.F.O.); [email protected] (D.G.); [email protected] (J.A.) 4 SEREMI de Salud Región de Los Lagos, Ministerio de Salud de Chile, Osorno 5290000, Chile; [email protected] 5 Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada; [email protected] * Correspondence: [email protected]; Tel.: +56-(2)-25755417 Received: 9 March 2020; Accepted: 13 May 2020; Published: 11 June 2020 Abstract: Q fever and rickettsial diseases occur throughout the world and appear to be emergent zoonoses in Chile. The diagnosis of these diseases is currently uncommon in Chile, as their clinical presentations are non-specific and appropriate diagnostic laboratory assays are of limited availability.
    [Show full text]
  • Seroprevalence and Clinical Features of Scrub Typhus Among Febrile Patients Attending a Referral Hospital in Kathmandu, Nepal
    Tropical Medicine and Infectious Disease Article Seroprevalence and Clinical Features of Scrub Typhus among Febrile Patients Attending a Referral Hospital in Kathmandu, Nepal Anil Pokhrel 1 , Binod Rayamajhee 2, Saroj Khadka 1 , Sandeep Thapa 3, Samjhana Kapali 1 , Sher Bahadur Pun 4, Megha Raj Banjara 1, Prakash Joshi 5 , Binod Lekhak 1 and Komal Raj Rijal 1,* 1 Central Department of Microbiology, Tribhuvan University, Kirtipur 44618, Nepal; [email protected] (A.P.); [email protected] (S.K.); [email protected] (S.K.); [email protected] (M.R.B.); [email protected] (B.L.) 2 Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Kathmandu 44700, Nepal; [email protected] 3 Kathmandu Centre for Genomic Research Laboratory (KCGRL), Kathmandu 44700, Nepal; [email protected] 4 Sukraraj Tropical and Infectious Disease Hospital, Kathmandu 44600, Nepal; [email protected] 5 Kanti Children’s Hospital, Kathmandu 44600, Nepal; [email protected] * Correspondence: [email protected] Abstract: (1) Background: Scrub typhus (ST) is endemic to Nepal. It is often underdiagnosed and misdiagnosed due to non-specific clinical presentation coupled with limited microbiological facilities, leading to adverse clinical outcomes. This study aimed to assess the seroprevalence of scrub typhus in febrile patients attending Sukraraj Tropical and Infectious Disease Hospital (STIDH), Nepal, Citation: Pokhrel, A.; Rayamajhee, from August 2018 to April 2019. (2) Materials and Method: Blood/serum samples and clinical B.; Khadka, S.; Thapa, S.; Kapali, S.; and demographic data of adult febrile patients (≥19 years) who attended or were referred to the Pun, S.B.; Banjara, M.R.; Joshi, P.; hospital were collected after obtaining written informed consent from the participants excluding Lekhak, B.; Rijal, K.R.
    [Show full text]
  • Scrub Typhus Complicated by ARDS, Myocarditis, and Encephalitis Imported to Oman from Nepal
    case report Oman Medical Journal [2019], Vol. 34, No. 3: 254-256 Scrub Typhus Complicated by ARDS, Myocarditis, and Encephalitis Imported to Oman from Nepal Asmaa Sabr Mahdi 1*, Sulien Mubarak Al-Khalili2, Chao Chien Chung3, Mariya Molai1, Hashim Ibrahim1, Petersen Eskild1, Faryal Khamis1 and Pandak Nenad1 1Infectious Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman 2Medical Microbiology, Oman Medical Specialty Board, Muscat, Oman 3Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland, US ARTICLE INFO ABSTRACT Article history: Scrub typhus is a potentially fatal rickettsial infection caused by Orientia tsutsugamushi. Received: 11 December 2017 It is an obligate intracellular Gram-negative bacterium transmitted by the bite of infected Accepted: 27 March 2018 chigger larva. The disease is distributed from Asia to the Pacific islands, and this region Online: is known as the Tsutsugamushi Triangle. A 28-year-old man was admitted to the Royal DOI 10.5001/omj.2019.48 Hospital with a four-day history of fever, headache, rigors, anorexia, and a nonspecific macular rash. Clinical presentation, laboratory results as well as epidemiological data Keywords: Scrub Typhus; Orientia indicated that this might be a case of scrub typhus. Additional serology tests confirmed Tsutsugamushi; Acute the presumed diagnosis, and the patient was successfully treated with empirical therapy. Respiratory Distress Syndrome. Untreated scrub typhus has high mortality and early diagnosis and adequate treatment can prevent the potentially fatal outcome of the disease. crub typhus is a potentially fatal rickettsial a diffuse maculopapular rash. A black crusted skin infection. Usually, it presents as acute febrile lesion was present on his left upper arm [Figure 1].
    [Show full text]
  • Tularemia in a Park, Philadelphia, Pennsylvania
    LETTERS Tularemia in a by PCR and culture, and 1 was posi- submitted to BOL for F. tularensis test- tive by PCR alone; F. tularensis was ing by PCR and culture. None of these Park, Philadelphia, identifi ed only in animals found dead. readily available surveillance activities Pennsylvania The 2 woodchucks tested negative by resulted in identifying tularemia except PCR and culture. The 2004 isolate and in the rabbits found dead in the zoolog- To the Editor: Tularemia is a 2006 isolates were identifi ed by CDC ical park. Additionally, no cases of hu- bacterial zoonosis caused by the gram- as type A F. tularensis and were found man tularemia were reported to PDPH negative, nonmotile coccobacillus genetically identical by pulsed-fi eld during this period, despite distribution Francisella tularensis, which is en- gel electrophoresis. of a health alert to medical providers to demic in lagomorphs in North America These additional 2006 positive heighten clinical suspicion for the dis- (1,2). Tularemia is considered a pos- fi ndings triggered efforts to use avail- ease. Furthermore, the organism was sible biological weapon of terrorism able resources to identify other tula- not detected by routine environmental (Centers for Disease Control and Pre- remia sources: the Philadelphia De- monitoring of air samples by the city’s vention [CDC] category A) because of partment of Public Health (PDPH) BioWatch sensors. its high infectivity, ease of dissemina- heightened surveillance for tularemia Even though this limited investi- tion, and considerable ability to cause by requesting that other city agen- gation failed to identify additional F. illness and death in humans (3).
    [Show full text]