Na-Ra Yun

Scrub Typhus Meningitis or Meningoencephalitis

Orientia tsutsugamushi induces vasculitis leading to symptoms of systemic organ invasion including meningitis and meningoencephalitis. We conducted a retrospective case-control study of scrub typhus patients to investigate the clinical and laboratory features of patients with scrub typhus meningitis or meningoencephalitis, and the therapeutic outcomes, and to determine the predictor factors. Cases were 22 patients with scrub typhus meningitis or meningoencephalitis, and controls were 303 patients without meningitis or meningoencephalitis. Multivariate analysis showed that the presence of pneumonitis was associated with the occurrence of scrub typhus meningitis and meningoencephalitis (odds ratio [OR] 8.9; P < 0.001; confidence interval [CI] 2.9-27.2). Although appropriate antimicrobials such as doxycycline agents were administered at an early stage, meningitis or meningoencephalitis still occurred in some cases. Physicians should be aware that meningitis or meningoencephalitis may develop during appropriate drug therapy such as doxycycline. Close observation and great care are essential for patients with risk factors, particularly pneumonitis.

Scrub typhus hepatitis confirmed by immunohistochemical staining

Scrub typhus is an acute febrile disease caused by Orientia tsutsugamushi (O. tsutsugamushi). We report herein the case of a woman who presented with fever and elevated serum levels of liver enzymes and who was definitively diagnosed with scrub typhus by histopathological examination of liver biopsy specimens, serological tests and nested polymerase chain reaction. Immunohistochemical staining using a monoclonal anti-O. tsutsugamushi antibody showed focally scattered positive immunoreactions in the cytoplasm of some hepatocytes. This case suggests that scrub typhus hepatitis causes mild focal inflammation due to direct liver damage without causing piecemeal necrosis or interface hepatitis. Thus, scrub typhus hepatitis differs from acute viral hepatitis secondary to liver damage due to host immune responses, which causes severe lobular disarray with diffuse hepatocytic degeneration, necrosis and apoptosis as well as findings indicative of hepatic cholestasis, such as hepatic bile plugs or brown pigmentation of hepatocytes.

Scrub Typhus and Cerebrovascular Injury: A Phenomenon of Delayed Treatment?

Abstract. Three patients diagnosed with scrub typhus through serology and polymerase chain reaction tests, experienced delayed administration of effective antibiotics after the appearance of symptoms, presented with subdural hemorrhage, intracerebral hemorrhage, or cerebral infarction in the late acute phase. Orientia tsutsugamushi should be considered as a causal or provoking factor for cerebrovascular accidents in regions where scrub typhus is endemic, especially in those who receive delayed treatment.

Accuracy of Conventional PCR Targeting the 16S rRNA Gene with the Ot-16sRF1 and Ot-16sRR1 Primers for Diagnosis of Scrub Typhus: a Case-Control Study

ABSTRACT We retrospectively evaluated the accuracy of conventional PCR targeting the 16S rRNA gene (16S C-PCR) using the Ot-16sRF1/Ot-16sRR1 primers for diagnosing scrub typhus. The diagnosis of Orientia tsutsugamushi infection by 16S C-PCR presented an increased sensitivity of 87.0% and specificity of 100% compared with those obtained with other targets and is thus a simple and clinically useful method with good diagnostic accuracy.

A Population-Based, Nationwide Cross-Sectional Study on Influenza Vaccination Status among Cancer Survivors in Korea.

Cancer survivors are at increased risk of developing influenza-related complications. The purpose of this study was to investigate the vaccination coverage among cancer survivors in Korea using the Korea National Health and Nutrition Examination Survey (KNHANES). Adult cancer survivors were selected from fourth (2007–2009) and fifth (2010–2012) KNHANES (n = 1156) datasets. General characteristics, cancer-related data, and influenza vaccination status were collected using self-report questionnaires. Chi-square tests and multiple logistic regression analyses were performed to investigate the association between influenza vaccination coverage and associated factors. Overall, 51% of survivors were vaccinated. Vaccine prevalence exceeded 75% in those more than 65 years but was only 26% in survivors aged 19–44. Increasing age, low frequency of alcohol consumption, having poor self-rated health, and having a shorter duration since cancer diagnosis were significant predictors of vaccination status among cancer survivors under 65 years of age. Influenza vaccine coverage remains much lower than recommended among cancer survivors, particularly in the younger age groups. Further study is needed to determine the factors that contribute to the lack of vaccination in cancer survivors, despite their increased risk for influenza.

Assessment of Efflux Activity Using H33342 Accumulation in Tigecycline-Resistant Acinetobacter baumannii Clinical Isolates

Background: Tigecycline resistance has emerged recently and has shown diverse mechanisms. The aim of this study was to assess the role of efflux activity in tigecycline resistance in 120 clinical isolates of A. baumannii using two methods: the H33342 accumulation assay and adeB real-time reverse transcriptase polymerase chain reaction. In addition, we analyzed the correlation between the expression level of adeB and H33342 accumulation level. Methods: A. baumannii clinical isolates was divided into tigecycline-resistant (49 strains), intermediate (40 strains), and susceptible (31 strains) groups. The H33342 accumulation was measured in the absence or presence of the efflux pump inhibitor carbonyl cyanide 3-chlorophenylhydrazone (CCCP). Real-time RTPCR was performed to determine the relative expression of the adeB gene in A. baumannii clinical isolates. Results: The level of H33342 accumulation in the resistant group was relatively lower than those in the other groups. The addition of CCCP caused a significantly increased fold change in H33342 accumulation in the tigecycline-resistant group. Significant difference in the fold change level in H33342 accumulation was found between tigecycline-susceptible and resistant isolates. Those findings support the role of efflux pumps of which substrates are H33342 in the resistance of tigecycline. Significant differences in the relative expression levels of adeB were shown between tigecycline-susceptible and resistant groups also. Conclusion: The results showed that several efflux pumps of which substrates were H33342 can contribute to tigecycline resistance. The adeB overexpression can also contribute to tigecycline resistance. It is possible that efflux pumps other than adeB efflux pumps contribute to tigecycline resistance because there was no correlation between fold change level in H33342 accumulation and adeB expression level. (Ann Clin Microbiol 2017;20:90-96)

1691The Relevance of Biopsy in Tuberculosis Patients without Human Immunodeficiency Virus Infection

Background. Although chronic granulomatous inflammation(CGI) with concomitant caseous necrosis(CN) is a typical histological feature of tuberculosis(TB), few studies have investigated its frequency or various pathologic findings in the setting of a TB-positive sampleidentified other possible TB pathological findings in patients without CN or CGI. Methods. The medical records of 231 HIV-negative, culture-positive TB patients who presented at Chosun University Hospital and underwent biopsy from January 2002 to December 2011 were studied retrospectively. After the frequency of TB-specific pathological findings was determined, a pathologist reanalyzed the findings and reclassified suspected TB into ‘possible TB pathologic findings.’ Results. The initial biopsy interpretation revealed that 63 (34.8%) of 181 patients with pulmonary TB had caseating granulomas, 36 (19.9%) had only CGI, and six (3.3%) had only CN. Among the 46 patients with extrapulmonary TB, 16 (34.8%) had only caseating granulomas and 14 (30.4%) had only CGI. Of the patients with pulmonary and extrapulmonary TB, 58% and 65.2% had either CN or CGI, respectively. More patients who underwent percutaneous lung biopsy had CGI or CN (76.3%) than did the patients who underwent transbronchial lung biopsy (53.6%). The reanalysis confirmed all CN cases of the first interpretation, and 20 (95.2%) of 21 non-CN cases were reclassified as possible CN. Eleven cases ( four pulmonary, seven extrapulmonary) were reclassified as ‘possible TB pathologic findings’ from just necrosis. Conclusion. Biopsy results in TB-diagnosed patients revealed that caseating granuloma was present in only one-third of pulmonary and extrapulmonary TB cases. Even in cases where only necrosis is identified, CN may be present. Thus, clinicians should recognize that some cases reported as other types of necrosis may in fact be CN Disclosures. All authors: No reported disclosures.