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Scrub Typhus and the Misconception of Doxycycline Resistance.
Clin Infect Dis. 2020 05 23; 70(11):2444-2449.CI

Abstract

Scrub typhus, a neglected infectious disease caused by the obligate intracellular bacterium Orientia tsutsugamushi, is a major cause of fever across the Asia Pacific region with more than a billion people at risk. Treatment with antibiotics such as doxycycline or chloramphenicol is effective for the majority of patients. In the 1990s, reports from northern Thailand raised a troubling observation; some scrub typhus patients responded poorly to doxycycline, which investigators attributed to doxycycline resistance. Despite the controversial nature of these reports, independent verification was neglected, with subsequent studies speculating on the role of doxycycline resistance in contributing to failure of treatment or prophylaxis. In this review, we have outlined the evidence for drug-resistant Orientia tsutsugamushi, assessed the evidence for doxycycline resistance, and highlight more recent findings unsupportive of doxycycline resistance. We conclude that doxycycline resistance is a misconception, with treatment outcome likely to be determined by other bacterial, host, and pharmacological factors.

Authors+Show Affiliations

Mahidol -Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.Mahidol -Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.Mahidol -Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.

Pub Type(s)

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

Language

eng

PubMed ID

31570937

Citation

Wangrangsimakul, Tri, et al. "Scrub Typhus and the Misconception of Doxycycline Resistance." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 70, no. 11, 2020, pp. 2444-2449.
Wangrangsimakul T, Phuklia W, Newton PN, et al. Scrub Typhus and the Misconception of Doxycycline Resistance. Clin Infect Dis. 2020;70(11):2444-2449.
Wangrangsimakul, T., Phuklia, W., Newton, P. N., Richards, A. L., & Day, N. P. J. (2020). Scrub Typhus and the Misconception of Doxycycline Resistance. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 70(11), 2444-2449. https://doi.org/10.1093/cid/ciz972
Wangrangsimakul T, et al. Scrub Typhus and the Misconception of Doxycycline Resistance. Clin Infect Dis. 2020 05 23;70(11):2444-2449. PubMed PMID: 31570937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Scrub Typhus and the Misconception of Doxycycline Resistance. AU - Wangrangsimakul,Tri, AU - Phuklia,Weerawat, AU - Newton,Paul N, AU - Richards,Allen L, AU - Day,Nicholas P J, PY - 2019/07/31/received PY - 2019/09/27/accepted PY - 2019/10/2/pubmed PY - 2021/1/7/medline PY - 2019/10/2/entrez KW - Orientia tsutsugamushi KW - scrub typhus KW - doxycycline KW - resistance KW - treatment outcomes SP - 2444 EP - 2449 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 70 IS - 11 N2 - Scrub typhus, a neglected infectious disease caused by the obligate intracellular bacterium Orientia tsutsugamushi, is a major cause of fever across the Asia Pacific region with more than a billion people at risk. Treatment with antibiotics such as doxycycline or chloramphenicol is effective for the majority of patients. In the 1990s, reports from northern Thailand raised a troubling observation; some scrub typhus patients responded poorly to doxycycline, which investigators attributed to doxycycline resistance. Despite the controversial nature of these reports, independent verification was neglected, with subsequent studies speculating on the role of doxycycline resistance in contributing to failure of treatment or prophylaxis. In this review, we have outlined the evidence for drug-resistant Orientia tsutsugamushi, assessed the evidence for doxycycline resistance, and highlight more recent findings unsupportive of doxycycline resistance. We conclude that doxycycline resistance is a misconception, with treatment outcome likely to be determined by other bacterial, host, and pharmacological factors. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/31570937/Scrub_Typhus_and_the_Misconception_of_Doxycycline_Resistance_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciz972 DB - PRIME DP - Unbound Medicine ER -