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Rickettsioses in the central hills of Sri Lanka: serological evidence of increasing burden of spotted fever group.
Int J Infect Dis. 2013 Nov; 17(11):e988-92.IJ

Abstract

OBJECTIVES

To study the epidemiology, clinical features, and changing pattern of rickettsial infections on the western slopes of the hilly Central Province of Sri Lanka over 6 years.

METHODS

All patients with rickettsial infections who presented to the Teaching Hospital, Peradeniya were studied prospectively from January 2002 to December 2007. An immunofluorescent antibody assay (IFA) was used to confirm the diagnosis.

RESULTS

Of the 371 clinical cases of rickettsial infection, 122 underwent IFA to confirm the diagnosis. Species-specific IgG antibodies were positive in 105/122 (86.1%) cases: 43/105 (40.9%) to Rickettsia conorii and 6/105 (5.7%) to Orientia tsutsugamushi, with mixed antibody reactivity to more than one antigen in 56/105 (53.3%) cases, including Rickettsia typhi in 27/105 (25.7%). Among those with mixed IgG reactivity, IgM assays were used to detect pathogens responsible for acute infections. Finally, a total of 55 spotted fever group (SFG) infections, seven scrub typhus infections, and one case of murine typhus were identified. Of the 105 positive cases, 53 (50.5%) were male and 52 (49.5%) were female, and the mean age was 40 years (range 11-83 years). In the SFG patients, 13/55 (24%) had severe vasculitis with fern leaf type skin necrosis and 17/55 (31%) had arthritis. Three patients (5%) had an altered level of consciousness. A patient with scrub typhus had transient deafness. None of the 105 patients had an eschar.

CONCLUSIONS

It appears that SFG rickettsioses are on the rise in the hilly Central Province of Sri Lanka, whilst murine typhus and scrub typhus are present at a lower rate.

Authors+Show Affiliations

Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23871280

Citation

Kularatne, S A M., et al. "Rickettsioses in the Central Hills of Sri Lanka: Serological Evidence of Increasing Burden of Spotted Fever Group." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 17, no. 11, 2013, pp. e988-92.
Kularatne SA, Rajapakse RP, Wickramasinghe WM, et al. Rickettsioses in the central hills of Sri Lanka: serological evidence of increasing burden of spotted fever group. Int J Infect Dis. 2013;17(11):e988-92.
Kularatne, S. A., Rajapakse, R. P., Wickramasinghe, W. M., Nanayakkara, D. M., Budagoda, S. S., Weerakoon, K. G., Edirisinghe, J. S., & Premaratna, R. (2013). Rickettsioses in the central hills of Sri Lanka: serological evidence of increasing burden of spotted fever group. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 17(11), e988-92. https://doi.org/10.1016/j.ijid.2013.05.014
Kularatne SA, et al. Rickettsioses in the Central Hills of Sri Lanka: Serological Evidence of Increasing Burden of Spotted Fever Group. Int J Infect Dis. 2013;17(11):e988-92. PubMed PMID: 23871280.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rickettsioses in the central hills of Sri Lanka: serological evidence of increasing burden of spotted fever group. AU - Kularatne,S A M, AU - Rajapakse,R P V J, AU - Wickramasinghe,W M R S, AU - Nanayakkara,D M, AU - Budagoda,S S, AU - Weerakoon,K G A D, AU - Edirisinghe,J S, AU - Premaratna,R, Y1 - 2013/07/17/ PY - 2012/11/27/received PY - 2013/03/31/revised PY - 2013/05/30/accepted PY - 2013/7/23/entrez PY - 2013/7/23/pubmed PY - 2014/5/9/medline KW - Orientia tsutsugamushi KW - Rickettsia typhi KW - Rickettsial infections KW - Spotted fever group rickettsiae KW - Sri Lanka KW - Vasculitis SP - e988 EP - 92 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int J Infect Dis VL - 17 IS - 11 N2 - OBJECTIVES: To study the epidemiology, clinical features, and changing pattern of rickettsial infections on the western slopes of the hilly Central Province of Sri Lanka over 6 years. METHODS: All patients with rickettsial infections who presented to the Teaching Hospital, Peradeniya were studied prospectively from January 2002 to December 2007. An immunofluorescent antibody assay (IFA) was used to confirm the diagnosis. RESULTS: Of the 371 clinical cases of rickettsial infection, 122 underwent IFA to confirm the diagnosis. Species-specific IgG antibodies were positive in 105/122 (86.1%) cases: 43/105 (40.9%) to Rickettsia conorii and 6/105 (5.7%) to Orientia tsutsugamushi, with mixed antibody reactivity to more than one antigen in 56/105 (53.3%) cases, including Rickettsia typhi in 27/105 (25.7%). Among those with mixed IgG reactivity, IgM assays were used to detect pathogens responsible for acute infections. Finally, a total of 55 spotted fever group (SFG) infections, seven scrub typhus infections, and one case of murine typhus were identified. Of the 105 positive cases, 53 (50.5%) were male and 52 (49.5%) were female, and the mean age was 40 years (range 11-83 years). In the SFG patients, 13/55 (24%) had severe vasculitis with fern leaf type skin necrosis and 17/55 (31%) had arthritis. Three patients (5%) had an altered level of consciousness. A patient with scrub typhus had transient deafness. None of the 105 patients had an eschar. CONCLUSIONS: It appears that SFG rickettsioses are on the rise in the hilly Central Province of Sri Lanka, whilst murine typhus and scrub typhus are present at a lower rate. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/23871280/Rickettsioses_in_the_central_hills_of_Sri_Lanka:_serological_evidence_of_increasing_burden_of_spotted_fever_group_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(13)00210-5 DB - PRIME DP - Unbound Medicine ER -