minocycline and Scrub-Typhus

Inadequate treatment of scrub typhus results in severe complications such as septic shock and is also associated with a high median mortality rate of 6%. However, there has been no conclusive evidence about the superiority of different antibiotics in managing scrub typhus in terms of efficacy and tolerability.. We conducted a network meta-analysis (NMA) using the frequentist method. The included participants were pediatric and adult patients infected with scrub typhus. The primary outcome was the cure rate in the patients included. The subgroup analysis was done according to pediatric or adult patients.. Overall, 14 randomized controlled trials (RCTs) with 1264 participants were included in this study. The NMA revealed that all the investigated antibiotics were associated with cure rates similar to those of doxycycline. The chloramphenicol and minocycline were ranked to be associated with the highest cure rate in the pediatric subgroup and adult subgroup, respectively. Second-generation quinolones, including ofloxacin, ciprofloxacin, and chloramphenicol, were associated with significantly lower adverse event rates than doxycycline.. The current updated NMA provides evidence for the efficacy of chloramphenicol and minocycline in scrub typhus management. However, future large-scale RCTs with longer follow-up times are warranted.

Topics: Adult; Anti-Bacterial Agents; Child; Chloramphenicol; Doxycycline; Humans; Minocycline; Network Meta-Analysis; Orientia tsutsugamushi; Randomized Controlled Trials as Topic; Scrub Typhus

Scrub typhus is associated with various clinical symptoms. However, the pathogenesis of scrub typhus infection remains to be elucidated. A 73-year-old man was admitted to our hospital with consciousness disturbance and suspected meningoencephalitis. The patient's laboratory data showed deterioration and were indicative of hemophagocytic lymphohistiocytosis (HLH). A whole body examination to detect the trigger disease revealed an eschar, which is a characteristic of scrub typhus, on his back. His symptoms showed dramatic improvement after the administration of minocycline (MINO). This case report highlights that the clinical course of a case of scrub typhus meningoencephalitis that was cured with MINO.

Topics: Aged; Diagnosis, Differential; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Meningoencephalitis; Minocycline; Scrub Typhus

Scrub typhus is a zoonosis caused by Orientia tsutsugamushi (O. tsutsugamushi) occurring mainly in autumn in Korea. The need of new antibiotics has arisen with a report on strains resistant to antibiotics and chronic infection. This study aims to identify susceptibility of tigecycline in-vitro as a new therapeutic option for O. tsutsugamushi. Antibacterial activity of tigecycline against the O. tsutsugamushi was compared with doxycycline using flow cytometry assay. The inhibitory concentration 50 (IC₅₀) was 3.59×10⁻³ μg/mL in doxycycline-treated group. Whereas in 0.71×10⁻³ μg/mL tigecycline-treated group. These findings indicate that tigecycline may be a therapeutic option for the treatment of scrub typhus.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Inhibitory Concentration 50; Minocycline; Orientia tsutsugamushi; Scrub Typhus; Tigecycline

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

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; China; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Male; Middle Aged; Minocycline; Pregnancy; Retrospective Studies; Scrub Typhus; Time Factors; Treatment Outcome; Young Adult

Topics: Acute-Phase Reaction; Anti-Bacterial Agents; Biomarkers; Bronchoalveolar Lavage Fluid; Diagnostic Imaging; Humans; Immunoglobulin G; Male; Middle Aged; Minocycline; Orientia tsutsugamushi; Pneumonia, Bacterial; Scrub Typhus; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Diagnosis, Differential; Female; Fever of Unknown Origin; Humans; Japan; Minocycline; Scrub Typhus; Treatment Outcome

An 85-year-old female farmer was admitted to our hospital for fever, general fatigue, and skin rash. Cephalosporin was not effective and minocycline was dramatically effective. An eschar was discovered on her inguinal region after the defervescence. Laboratory examination of serum taken 12 days after onset of the illness showed elevated titers of antibodies against the Shimokoshi strain of Orientia tsutsugamushi. The gene sequence analysis of specimen from the patient's eschar revealed high similarity to the Shimokoshi strain by nested polymerase chain reaction. Therefore, this patient was diagnosed as a case of Shimokoshi-type tsutsugamushi disease, which has not previously been reported in Western Japan. Recently, cases of this type have also been confirmed in northeastern Japan, suggesting the need for further epidemiological studies.

Topics: Administration, Intravenous; Aged, 80 and over; Antibodies, Bacterial; Ceftriaxone; Female; Humans; Japan; Minocycline; Orientia tsutsugamushi; Polymerase Chain Reaction; Scrub Typhus

We present an unusual case of a patient with scrub typhus who developed acalculous cholecystitis, aseptic meningitis and mononeuritis multiplex. The patient was successfully treated with oral minocycline. To our knowledge, this is the first report of mononeuritis multiplex caused by scrub typhus.

Topics: Abdomen; Acalculous Cholecystitis; Administration, Oral; Aged; Anti-Bacterial Agents; Female; Humans; Knee; Meningitis, Aseptic; Minocycline; Mononeuropathies; Radiography, Abdominal; Scrub Typhus; Skin; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography

Topics: Aged; Female; Humans; Minocycline; Orientia tsutsugamushi; Scrub Typhus; Treatment Outcome

Scrub typhus is an acute febrile disease for which synthetic tetracycline antibiotics are efficacious. However, no clinical studies have compared oral doxycycline with intravenous minocycline for treatment of scrub typhus.. We conducted a retrospective analysis in patients diagnosed with noncomplicated scrub typhus by serologic or molecular methods from August 2001 to July 2007. We compared the efficacy of intravenous minocycline with oral doxycycline for treatment of noncomplicated scrub typhus in these patients.. Forty seven cases receiving tetracycline antibiotics for the treatment of noncomplicated scrub typhus were included. There was no statistically significant difference for the response rate between the 25 cases receiving intravenous minocycline (96%) and the 22 cases receiving oral doxycycline (91%) (p=0.909). Kaplan-Meier curve with a long-rank test for the time to defervescence showed no statistically significant difference between minocycline therapy (mean 30 hours; range 4-124 hours) and doxycycline therapy (mean 32.4 hours; range 4-144 hours) (p=0.860). After multivariate Cox regression models, the time to defervescence was only affected by Acute Physiology and Chronic Health Evaluation II score (hazard ratio 0.868; p=0.016). Nearly all patients (93.6%) became afebrile within 72 hours after use of tetracycline antibiotics. Prolonged hospitalization (> 7 days) was correlated with the timing to start tetracycline antibiotics after admission.. Both antibiotics have similar efficacy for the treatment of noncomplicated scrub typhus. Nearly all cases responding to both antibiotics became afebrile within 3 days.

Topics: Administration, Intravenous; Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Doxycycline; Female; Humans; Male; Middle Aged; Minocycline; Retrospective Studies; Scrub Typhus; Treatment Outcome

A 65-year-old-woman complained of lumbago from the end of March 2008. Three weeks later, she visited a local clinic because of high fever, and she was given a diagnosis of urinary tract infection. Although levofloxacin was given, her condition did not improve and she was referred to the urology department of our hospital. Two days after hospitalization, she rapidly developed respiratory failure. Chest CT revealed bilateral pleural effusion, interlobular septal thickening, diffuse ground-glass opacities and mediastinal lymphadenopathy. We suspected scrub typhus because we noticed a localized necrotic skin lesion on her left lower leg. When minocycline was administered, both her clinical condition and radiographic imaging promptly improved. Because lung involvement with scrub typhus is very rare in Japan, we report this case of scrub typhus with various lung findings.

Topics: Aged; Female; Humans; Lung Diseases; Minocycline; Scrub Typhus

Six cases of scrub typhus (tsutsugamushi disease) were reported to the Shizuoka Prefecture Hamamatsu City public health center during the seven years from 2001 to 2007. The content of the clinical record of the five cases were investigated. High serum titers of antibody to Gilliam-type Orientia tsutsugamushi were detected by immunofluorescense assay in most of these patients. Fever, rash, headache and relative bradycardia seen at a high frequency. On peripheral blood smear examination, atypical lymphocytes were detected in 3 cases. Serum electrolyte examination revealed hyponatremia in 4 (80%) patients; SIADH was suspected in one of these cases. All the patients improved promptly following start of therapy with intravenous or oral minocycline.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Biomarkers; Female; Humans; Hyponatremia; Immunoglobulin G; Immunoglobulin M; Japan; Male; Middle Aged; Minocycline; Orientia tsutsugamushi; Retrospective Studies; Scrub Typhus; Serologic Tests; Time Factors; Treatment Outcome

Topics: Aged, 80 and over; Anti-Bacterial Agents; Biomarkers; Duodenal Ulcer; Gastrointestinal Hemorrhage; Humans; Immunoglobulin M; Male; Minocycline; Orientia tsutsugamushi; Scrub Typhus; Serologic Tests; Treatment Outcome

A 64-year-old man visited our clinic with a 9-day history of headache and fever. He had frequent, severe, electric shock-like pain in his left eye, forehead, and scalp. The body temperature was 37.1 degrees. Cranial nerve functions were intact. Limb weakness and stiff neck were absent. There were injection of the conjunctiva, a red rash on the trunk, and an eschar in the axilla. Abnormal laboratory findings included AST 40 IU, ALT 44 IU, CRP 16.0 mg/dl, WBC 11,090/microl, and proteinuria. CT scan was unremarkable. The cerebrospinal fluid (CSF) showed 2 polymorphs/microl, 6 lymphocytes/microl, 65 mg/dl of glucose, and 42 mg/dl of protein. A diagnosis of scrub typhus was made. Treatment with minocycline brought about prompt disappearance of the fever and dramatic clinical improvement. Increased antibody titers confirmed the diagnosis. Although almost all patients present with high fever and severe headache, only a small number of patients have CSF pleocytosis. The present case illustrates that pain in scrub typhus is, on rare occasions, indistinguishable from trigeminal neuralgia. Neurologists should have a high index of suspicion in patients with fever and headache during the epidemic season and should be familiar with the systemic symptoms and signs.

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Fever; Headache; Humans; Male; Middle Aged; Minocycline; Scrub Typhus; Treatment Outcome; Trigeminal Neuralgia

Topics: Aged; Anti-Bacterial Agents; Female; Genitalia, Female; Humans; Lymphohistiocytosis, Hemophagocytic; Minocycline; Parvoviridae Infections; Parvovirus B19, Human; Scrub Typhus; Treatment Outcome

A 74-year-old Japanese man with scrub typhus presented without the typical symptom of high fever and subsequently developed the complication of acute respiratory distress syndrome. It was suspected that exposure occurred at the river side of Kinugawa, Tochigi Prefecture, Japan. His body temperature was below 38.0 degrees C. After intensive supportive care and minocycline therapy, he dramatically recovered. With the increase in popularity of outdoor recreation, scrub typhus can be found in clinics all over Japan. Physicians should therefore be aware of the manifestations of the disease and the necessity of early treatment in suspected cases.

Topics: Aged; Anti-Bacterial Agents; Body Temperature; Humans; Male; Minocycline; Respiratory Distress Syndrome; Scrub Typhus

We treated a case of Tsutsugamushi disease diagnosed by polymerase chain reaction (PCR) using a scab specimen at the bite site of trombiculid mites. Otherwise the diagnosis could not be confirmed by serum antibody test nor the PCR test of blood. The genome of Rickettsia tsutsugamushi was detected and identified as the Kawasaki serotype strain. An attempt to extract the genome from the scab has not been reported, thus our data suggest that the scab is a useful specimen to confirm the diagnosis of Tsutsugamushi disease.

Topics: Animals; Anti-Bacterial Agents; Bites and Stings; DNA, Bacterial; Female; Genome, Bacterial; Humans; Middle Aged; Minocycline; Orientia tsutsugamushi; Polymerase Chain Reaction; Scrub Typhus; Trombiculidae

Tsutsugamushi disease is characterized by the early appearance of a black crust at the bitten area and the subsequent development of macular or macropapular rush on the whole body with high fever. While treatment with tetracycline derivatives and chloramphenicols is effective, delayed diagnosis or inappropriate treatment will lead to fatality. In this report, we describe two typical cases of tsutsugamushi disease and discuss other incidences in Kanagawa Prefecture, Japan, in 1998. One of the present two patients was diagnosed to be a case of the new type by Kawasaki strain of Rickettsia tsutsugamushi, while responsible strain was not identified for the other case. Since the disease is spreading widely even to suburban areas, we emphasize the need to consider the possible diagnosis of tsutsugamushi disease in patients with generalized eruption and high fever.

Topics: Anti-Bacterial Agents; Female; Humans; Incidence; Japan; Middle Aged; Minocycline; Population Surveillance; Scrub Typhus; Treatment Outcome

Topics: Anti-Bacterial Agents; Cytokines; Humans; In Vitro Techniques; Macrophages; Minocycline; Scrub Typhus

Tsutsugamushi disease is widely spread throughout Japan. A case of tsutsugamushi disease was seen in October, 1996. A 64-year-old male developed typical symptoms of tsutsugamushi disease with Rickettsia tsutsugamushi, after he returned to Japan from Cheju Island, Korea. Not only in Japan but also in other Asian countries including Korea, China, Taiwan, and Thailand, tsutsugamushi disease is one of the most important rickettsial diseases carried by ticks or mites. If a traveller returning from an Asian country has symptoms such as high fever, skin eruption, and lymphadenitis, we should suspect that he is suffering from tsutsugamushi disease and should search if he has an eschar on any area of his body. We should not forget that tsutsugamushi disease is an imported disease. Patients of tsutsugamushi disease often have hematological disorders. They are sometimes referred to the hematological section of the hospital. Hematologists should be familiar with this disease.

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Humans; Korea; Male; Middle Aged; Minocycline; Orientia tsutsugamushi; Scrub Typhus; Serologic Tests; Travel

Topics: Anti-Bacterial Agents; Child; Child, Preschool; DNA, Bacterial; Humans; Male; Minocycline; Orientia tsutsugamushi; Polymerase Chain Reaction; Scrub Typhus

We report a case of tsutsugamushi disease found in south western Shikoku. A 64-year-old male who lived in Towa Village in Kochi, developed a fever and headache on April 6, 1994, and was admitted to Uwajima City Hospital on April 15, with a ten-day history of illness. He had an eschar on the right anterior side of the breast and an enlargement of the right axillary lymph node, without a rash. Laboratory data showed mild liver injury and atypical lymphocytes with 6% in peripheral blood. After his blood was drawn for rickettsial isolation, the minocycline was administered. His symptoms improved rapidly and was discharged in good condition. We successfully isolated the causative agent, Rickettsia tsutugamushi, and designated it as the Shiba strain. High antibody titer against the Kato, Karp and Gilliam strains was detected in serum on admission and increased during the course of the disease. In Shikoku, tsutsugamushi disease is rare and only 13 cases were reported during last ten years. Especially in south western district of Shikoku, there have been no case reported since 1960. This case is important epidemiologically and suggests that we should pay attention to this disease.

Topics: Anti-Bacterial Agents; Humans; Japan; Male; Middle Aged; Minocycline; Orientia tsutsugamushi; Scrub Typhus

The presence of Rickettsia tsutsugamushi DNA in peripheral blood mononuclear cells of eight patients with tsutsugamushi disease was determined by the polymerase chain reaction during antibiotic treatment with minocycline or doxycycline. Rickettsia tsutsugamushi DNA was detectable in all samples from these patients collected the day before treatment began. After the initiation of chemotherapy, all samples tested positive on the third or fourth day, and one sample tested positive on the eighth day, showing a slow action of the drugs against the rickettsia within cells. Immune responses against R. tsutsugamushi also seemed to be important for eradication of the pathogens, as suggested by patients' high antibody titers.

Topics: Aged; Aged, 80 and over; Antibodies, Bacterial; Base Sequence; DNA Primers; DNA, Bacterial; Doxycycline; Electrophoresis, Agar Gel; Female; Fluorescent Antibody Technique; Humans; Leukocytes, Mononuclear; Male; Middle Aged; Minocycline; Molecular Sequence Data; Orientia tsutsugamushi; Polymerase Chain Reaction; Scrub Typhus

A 64-year-old male was admitted to our division because of fever. After admission, the patient was given beta-lactam antibiotics intravenously because he had no eruption and eschar. However, the fever continued, and he became unconsciousness and DIC appeared. We diagnosed the patient as Tsutsugamushi disease from indirect fluorescent antibody technique. Minocycline was excellently effective. Several reports of Tsutsugamushi disease without eruption have been given, so we must always be careful of Tsutsugamushi disease.

Topics: Antibodies, Bacterial; Erythema; Humans; Male; Middle Aged; Minocycline; Orientia tsutsugamushi; Scrub Typhus

Scrub typhus is still prevalent on Penghu Islands. We herein report a case in a pregnant woman who had been to Yi-Lan County in Taiwan. The patient responded well to Minocycline (Minocin) therapy without complication. Her newborn baby was found not complicated with the disease. The relative literature is reviewed.

Topics: Adult; Female; Humans; Minocycline; Pregnancy; Pregnancy Complications, Infectious; Scrub Typhus

Topics: Benzamidines; Disseminated Intravascular Coagulation; Guanidines; Humans; Hydrocortisone; Male; Meningitis; Middle Aged; Minocycline; Pulmonary Fibrosis; Scrub Typhus