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Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India.
PLoS Negl Trop Dis. 2018 03; 12(3):e0006346.PN

Abstract

BACKGROUND

Acute Encephalitis Syndrome (AES) is a major seasonal public health problem in Bihar, India. Despite efforts of the Bihar health department and the Government of India, burden and mortality of AES cases have not decreased, and definitive etiologies for the illness have yet to be identified.

OBJECTIVES

The present study was undertaken to study the specific etiology of AES in Bihar.

METHODS

Cerebrospinal fluid and/or serum samples from AES patients were collected and tested for various pathogens, including viruses and bacteria by ELISA and/or Real Time PCR.

FINDINGS

Of 540 enrolled patients, 33.3% (180) tested positive for at least one pathogen of which 23.3% were co-positive for more than one pathogen. Most samples were positive for scrub typhus IgM or PCR (25%), followed by IgM positivity for JEV (8.1%), WNV (6.8%), DV (6.1%), and ChikV (4.5%).M. tuberculosis and S. pneumoniae each was detected in ~ 1% cases. H. influenzae, adenovirus, Herpes Simplex Virus -1, enterovirus, and measles virus, each was detected occasionally. The presence of Scrub typhus was confirmed by PCR and sequencing. Bihar strains resembled Gilliam-like strains from Thailand, Combodia and Vietnam.

CONCLUSION

The highlights of this pilot AES study were detection of an infectious etiology in one third of the AES cases, multiple etiologies, and emergence of O. tsutsugamushi infection as an important causative agent of AES in India.

Authors+Show Affiliations

Department of Microbiology, King George's Medical University, Lucknow, India.Department of Microbiology, King George's Medical University, Lucknow, India.Department of Microbiology, King George's Medical University, Lucknow, India.Department of Microbiology, King George's Medical University, Lucknow, India.Department of Microbiology, King George's Medical University, Lucknow, India.Department of Microbiology, Patna Medical College, Patna, Bihar, India.Department of Pediatrics, Patna Medical College, Patna, Bihar, India.Department of Microbiology, Patna Medical College, Patna, Bihar, India.Department of Microbiology, King George's Medical University, Lucknow, India.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29590177

Citation

Jain, Parul, et al. "Emergence of Orientia Tsutsugamushi as an Important Cause of Acute Encephalitis Syndrome in India." PLoS Neglected Tropical Diseases, vol. 12, no. 3, 2018, pp. e0006346.
Jain P, Prakash S, Tripathi PK, et al. Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India. PLoS Negl Trop Dis. 2018;12(3):e0006346.
Jain, P., Prakash, S., Tripathi, P. K., Chauhan, A., Gupta, S., Sharma, U., Jaiswal, A. K., Sharma, D., & Jain, A. (2018). Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India. PLoS Neglected Tropical Diseases, 12(3), e0006346. https://doi.org/10.1371/journal.pntd.0006346
Jain P, et al. Emergence of Orientia Tsutsugamushi as an Important Cause of Acute Encephalitis Syndrome in India. PLoS Negl Trop Dis. 2018;12(3):e0006346. PubMed PMID: 29590177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India. AU - Jain,Parul, AU - Prakash,Shantanu, AU - Tripathi,Piyush K, AU - Chauhan,Archana, AU - Gupta,Shikha, AU - Sharma,Umesh, AU - Jaiswal,Anil K, AU - Sharma,Devraj, AU - Jain,Amita, Y1 - 2018/03/28/ PY - 2017/10/29/received PY - 2018/02/25/accepted PY - 2018/04/09/revised PY - 2018/3/29/pubmed PY - 2018/6/19/medline PY - 2018/3/29/entrez SP - e0006346 EP - e0006346 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 12 IS - 3 N2 - BACKGROUND: Acute Encephalitis Syndrome (AES) is a major seasonal public health problem in Bihar, India. Despite efforts of the Bihar health department and the Government of India, burden and mortality of AES cases have not decreased, and definitive etiologies for the illness have yet to be identified. OBJECTIVES: The present study was undertaken to study the specific etiology of AES in Bihar. METHODS: Cerebrospinal fluid and/or serum samples from AES patients were collected and tested for various pathogens, including viruses and bacteria by ELISA and/or Real Time PCR. FINDINGS: Of 540 enrolled patients, 33.3% (180) tested positive for at least one pathogen of which 23.3% were co-positive for more than one pathogen. Most samples were positive for scrub typhus IgM or PCR (25%), followed by IgM positivity for JEV (8.1%), WNV (6.8%), DV (6.1%), and ChikV (4.5%).M. tuberculosis and S. pneumoniae each was detected in ~ 1% cases. H. influenzae, adenovirus, Herpes Simplex Virus -1, enterovirus, and measles virus, each was detected occasionally. The presence of Scrub typhus was confirmed by PCR and sequencing. Bihar strains resembled Gilliam-like strains from Thailand, Combodia and Vietnam. CONCLUSION: The highlights of this pilot AES study were detection of an infectious etiology in one third of the AES cases, multiple etiologies, and emergence of O. tsutsugamushi infection as an important causative agent of AES in India. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/29590177/Emergence_of_Orientia_tsutsugamushi_as_an_important_cause_of_Acute_Encephalitis_Syndrome_in_India_ L2 - http://dx.plos.org/10.1371/journal.pntd.0006346 DB - PRIME DP - Unbound Medicine ER -