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__NOTOC__
__NOTOC__
{{Infobox disease
'''For patient information, click [[Scrub typhus (patient information)|here]]'''
| Name            = Scrub typhus
{{Scrub typhus}}
| Image          = Orientia tsutsugamushi.JPG
{{CMG}}
| Caption        = [[Orientia tsutsugamushi]]
| DiseasesDB      = 31715
| ICD10          = {{ICD10|A|75|3|a|75}}
| ICD9            = {{ICD9|081.2}}
| ICDO            =
| OMIM            =
| MedlinePlus    = 
| MeshID          = D012612
}}


==Overview==
{{SK}} Bush typhus
'''Scrub typhus''' or '''Bush typhus'''<!-- Australian Term: See pic + caption on [[Battle of Buna–Gona]] -->  is a form of [[typhus]] caused by the [[intracellular parasite]] ''[[Orientia tsutsugamushi]]'', a [[Gram-negative]] [[α-proteobacterium]] of [[family (biology)|family]] [[Rickettsiaceae]] first isolated and identified in 1930 in Japan.<ref name="pmid18281226">{{cite journal
|author=Tseng BY, Yang HH, Liou JH, Chen LK, Hsu YH
|title=Immunohistochemical study of scrub typhus: a report of two cases
|journal=Kaohsiung J. Med. Sci. |volume=24 |issue=2 |pages=92–8 |year=2008
|month=February |pmid=18281226
|doi= 10.1016/S1607-551X(08)70103-7
|url=http://ajws.elsevier.com/ajws_pubmed/pubmed_switch.asp?journal_issn=1607-551X&art_pub_year=2008&%20art_pub_month=02&art_pub_vol=24&art_sp=92
}}</ref><ref
name="medscape">[http://emedicine.medscape.com/article/971797-overview Pediatric Scrub Typhus], accessdate: 16 October 2011</ref>


Although the disease is similar in presentation to other forms of [[typhus]], its [[pathogen]] is not anymore included in [[genus]] ''[[Rickettsia]]'' with the typhus bacteria proper, but in ''[[Orientia]]''. The disease is thus frequently classified separately from the other typhi.
==[[Scrub typhus overview|Overview]]==


== Causes and geographical distribution ==<!-- "Tsutsugamushi triangle" redirects here -->
==[[Scrub typhus historical perspective|Historical Perspective]]==
Scrub typhus is transmitted by some species of trombiculid mites ("[[Harvest mite|chiggers]]", particularly ''[[Leptotrombidium deliense]]''),<ref>{{cite journal
|title=Detection of ''Orientia tsutsugamushi'' (Rickettsiales: Rickettsiaceae) in unengorged chiggers (Acari: Trombiculidae) from Oita Prefecture, Japan, by nested polymerase chain reaction|author=Pham XD, Otsuka Y, Suzuki H, Takaoka H|journal=J Med Entomol|volume=38|issue=2|year=2001|pages=308–311|url=http://www.ingentaconnect.com/content/esa/jme/2001/00000038/00000002/art00029?crawler=true|pmid=11296840
|doi=10.1603/0022-2585-38.2.308}}</ref> which are found in areas of heavy scrub vegetation.  The bite of this mite leaves a characteristic black [[eschar]] that is useful to the doctor for making the diagnosis.


Scrub typhus is endemic to a part of the world known as the '''tsutsugamushi triangle''' (after ''[[Orientia tsutsugamushi|O. tsutsugamushi]]'')<ref name="medscape"/>. This extends from northern Japan and far-eastern Russia in the north, to the territories around the [[Solomon Sea]] into northern Australia in the south, and to Pakistan and Afghanistan in the west.<ref>{{cite journal|author=Seong S, Choi M &amp; Kim I|title=''Orientia tsutsugamushi'' infection: overview and immune responses
==[[Scrub typhus pathophysiology|Pathophysiology]]==
|journal=Microbes and Infection|volume=3
|issue=1
|pages=11–21|year=2001
|doi=10.1016/S1286-4579(00)01352-6|pmid=11226850}}</ref>


The precise incidence of the disease is unknown, as diagnostic facilities are not available in much of its large native range which spans vast regions of equatorial jungle to the sub-tropics.  In rural Thailand and in Laos, murine and scrub typhus accounts for around a quarter of all adults presenting to hospital with fever and negative blood cultures<ref>{{cite journal
==[[Scrub typhus causes|Causes]]==
|author=Phongmany S
|title=Rickettsial infections and fever, Vientiane, Laos
|journal=Emerging Infect. Dis. |volume=12 |issue=2 |pages=256–62 |year=2006 |month=February |pmid=16494751 |url=http://www.cdc.gov/ncidod/EID/vol12no02/05-0900.htm
|author-separator=,
|author2=Rolain JM
|author3=Phetsouvanh R
|display-authors=3
|doi=10.3201/eid1202.050900
|last4=Blacksell
|first4=SD
|last5=Soukkhaseum
|first5=V
|last6=Rasachack
|first6=B
|last7=Phiasakha
|first7=K
|last8=Soukkhaseum
|first8=S
|last9=Frichithavong
|first9=K
|pmc=3373100}}</ref>
<ref>{{cite journal
|author=Suttinont C
|title=Causes of acute, undifferentiated, febrile illness in rural Thailand: results of a prospective observational study |journal=Ann Trop Med Parasitol.
|volume=100 |issue=4 |pages=363–70 |year=2006 |month=June |pmid=16762116 |doi=10.1197/136485906X112158 |doi_brokendate=2010-03-19
|author-separator=,
|author2=Losuwanaluk K
|author3=Niwatayakul K
|display-authors=3
|last4=Hoontrakul
|first4=S
|last5=Intaranongpai
|first5=W
|last6=Silpasakorn
|first6=S
|last7=Suwancharoen
|first7=D
|last8=Panlar
|first8=P
|last9=Saisongkorh
|first9=W }}</ref>  The incidence in Japan has fallen over the past few decades, probably due to land development driven decreasing exposure, and many prefectures report fewer than 50 cases per year.<ref>{{cite journal
|author=Katayama T, Hara M, Furuya Y, Nikkawa T, Ogasawara H
|title=Scrub typhus (tsutsugamushi disease) in Kanagawa Prefecture in 2001–2005
|journal=Jpn J Infect Dis. |volume=59 |issue=3 |pages=207–8 |year=2006 |month=June |pmid=16785710 |url=http://www.nih.go.jp/JJID/59/207.html}}</ref>
<ref>{{cite journal
|author=Yamamoto S, Ganmyo H, Iwakiri A, Suzuki S
|title=Annual incidence of tsutsugamushi disease in Miyazaki prefecture, Japan in 2001-2005 |journal=Jpn J Infect Dis. |volume=59 |issue=6 |pages=404–5 |year=2006 |month=December |pmid=17186964 |url=http://www.nih.go.jp/JJID/59/404.html}}</ref>
It affects females more than males in [[Korea]], but not in [[Japan]],<ref name="pmid18362409">{{cite journal |author=Bang HA, Lee MJ, Lee WC
|title=Comparative research on epidemiological aspects of tsutsugamushi disease (scrub typhus) between Korea and Japan
|journal=Jpn J Infect Dis |volume=61 |pages=148–50 |year=2008 |pmid=18362409 |url=http://www.nih.go.jp/JJID/61/148.html |issue=2}}</ref> and this is conjectured to be because sex-differentiated cultural roles have women tending garden plots more often, thus being exposed to plant tissues inhabited by chiggers.
The incidence is increasing day-by-day in southern part of Indian Peninsula.


== Symptoms and signs ==
==[[Scrub typhus differential diagnosis|Differentiating Scrub typhus from other Diseases]]==
Symptoms include [[fever]], [[headache]], muscle pain, [[cough]], and [[gastrointestinal]] symptoms. More virulent strains of ''O. tsutsugamushi'' can cause [[hemorrhaging]] and [[intravascular coagulation]]. Maculopapular rash, [[eschar]], [[splenomegaly]] and [[Lymphadenopathy|lymphadenopathies]] are typical signs. [[Leukopenia]] and abnormal liver function tests are commonly seen in the early phase of the illness. [[Pneumonitis]], [[encephalitis]], and [[myocarditis]] occur in the late phase of illness.


Acute scrub typhus appears to improve viral loads in patients with [[HIV]].<ref>{{cite journal
==[[Scrub typhus epidemiology and demographics|Epidemiology and Demographics]]==
|author=Watt G|title=HIV-1 suppression during acute scrub-typhus infection|journal=Lancet|year=2000|volume=356|issue=9228|pages=475–479|doi=10.1016/S0140-6736(00)02557-5|pmid=10981892
|author-separator=,
|author2=Kantipong P
|author3=de Souza M
|display-authors=3
|last4=Chanbancherd
|first4=Penprapa
|last5=Jongsakul
|first5=Krisada
|last6=Ruangweerayud
|first6=Ronnatrai
|last7=Loomis-Price
|first7=Lawrence D
|last8=Polonis
|first8=Victoria
|last9=Myint
|first9=Khin Saw}}</ref>  This interaction is refused by an in vitro study.<ref>{{cite journal
|author=Moriuchi M, Tamura A, Moriuchi H.|title=In vitro reactivation of human immunodeficiency virus-1 upon stimulation with scrub typhus rickettsial infection|journal=Am J Trop Med Hyg|year=2003|volume=68|issue=5|pages=557–561|doi=
|pmid=12812345}}</ref>


== Diagnosis ==
==[[Scrub typhus risk factors|Risk Factors]]==
In endemic areas, diagnosis is generally made on clinical grounds alone.  Where there is doubt, the diagnosis may be confirmed by a laboratory test such as [[serology]].


The choice of laboratory test is not straightforward, and all currently available tests have their limitations.<ref name="Koh2010">{{cite journal|author=Koh GCKW, Maude RJ, Paris DH, Newton PN, &amp; Blacksell SD|title=Diagnosis of Scrub Typhus|journal=Am J Trop Med Hyg|year=2010|volume=82|pages=368&ndash;370|pmid= 20207857|doi=10.4269/ajtmh.2010.09-0233|issue=3|pmc=2829893}}</ref> The cheapest and most easily available serological test is the [[Weil-Felix test]], but this is notoriously unreliable.<ref name="Pradutkanchana">{{cite journal
==[[Scrub typhus screening|Screening]]==
|author=Pradutkanchana J
|title=Comparative evaluation of four serodiagnostic tests for scrub typhus in Thailand
|journal=Trans R Soc Trop Med Hyg
|volume=91
|issue=4
|pages=425–8
|year=1997
|pmid=9373640
|doi=10.1016/S0035-9203(97)90266-2
|author-separator=,
|author2=Silpapojakul K
|author3=Paxton H
|display-authors=3
|last4=Pradutkanchana
|first4=Sukone
|last5=Kelly
|first5=Daryl J.
|last6=Strickman
|first6=Daniel}}</ref>  The gold standard is [[indirect immunofluorescence]],<ref>{{cite journal
|author=Bozeman FM &amp; Elisberg BL
|title=Serological diagnosis of scrub typhus by indirect immunofluorescence
|journal=Proc Soc Exp Biol Med
|volume=112
|pages=568–73
|year=1963
|pmid=14014756}}</ref> but the main limitation of this method is the availability of fluorescent microscopes, which are not often available in resource-poor settings where scrub typhus is endemic.  Indirect immunoperoxidase (IIP) is a modification of the standard IFA method that can be used with a light microscope,<ref>{{cite journal
|author=Yamamoto S &amp; Minamishima Y
|year=1982
|title=Serodiagnosis of tsutsugamushi fever (scrub typhus) by the indirect immunoperoxidase technique
|journal=J Clin Microbiol
|volume=15
|issue=6
|pages=1128–l
|pmid=6809786
|pmc=272264}}</ref> and the results of these tests are comparable to those from IFA.<ref name="Pradutkanchana"/><ref>{{cite journal
|author=Kelly DJ, Wong PW, Gan E, Lewis GE Jr
|title=Comparative evaluation of the indirect immunoperoxidase test for the serodiagnosis of rickettsial disease
|journal=Am J Trop Med Hyg
|year=1988
|volume=38
|issue=2
|pages=400–6
|pmid=3128129}}</ref>  Rapid bedside kits have been described that produce a result within one hour, but the availability of these tests are severely limited by their cost.<ref name="Pradutkanchana"/>  Serological methods are most reliable when a fourfold-rise in antibody titre is looked for.  If the patient is from a non-endemic area, then diagnosis can be made from a single acute serum sample.<ref>{{cite journal|author=Blacksell SD|title=Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to a lot of confusion|journal=Clin Infect Dis|volume=44|issue=3|pages=391–401|year=2007|doi=10.1086/510585|pmid=17205447|author-separator=,|author2=Bryant NJ|author3=Paris|author4=DH|display-authors=4|last5=Sakoda|first5=Y.|last6=Day|first6=N. P. J.}}</ref>  In patients from endemic areas, this is not possible because antibodies may be found in up to 18% of healthy individuals.<ref>{{cite journal|title=Antibodies to ''Orientia tsutsugamushi'' in Thai soldiers|journal=Am J Trop Med Hyg|volume=55|issue=5|pages=556–9|year=1996|pmid=8940989|author=Eamsila C|author-separator=,|author2=Singsawat P|author3=Duangvaraporn A|display-authors=3|last4=Strickman|first4=D}}</ref>


Other methods include culture and [[polymerase chain reaction|PCR]], but these are not routinely available<ref>{{cite journal
==[[Scrub typhus natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
|author=Watt G, Parola P
|title=Scrub typhus and tropical rickettsioses
|journal=Curr Opin Infect Dis
|volume=16
|issue=5
|year=2003
|pages=429–436
|pmid=14501995
|doi=10.1097/00001432-200310000-00009}}</ref> and the results do not always correlate with serological testing,<ref>{{cite journal|author=Tay ST, Nazma S, Rohani MY|title=Diagnosis of scrub typhus in Malaysian aborigines using nested polymerase chain reaction|journal=Southeast Asian J Trop Med Public Health|year=1996|volume=27|issue=3|pages=580–3|pmid=9185274}}</ref><ref>{{cite journal|title=Usefulness of nested PCR for the diagnosis of scrub typhus in clinical practice: A prospective study|journal=Am J Trop Med Hyg|volume=75|issue=3|year=2006|pages=542–545|pmid=16968938|last1=Kim|first1=DM|last2=Yun|first2=NR|last3=Yang|first3=TY|last4=Lee|first4=JH|last5=Yang|first5=JT|last6=Shim|first6=SK|last7=Choi|first7=EN|last8=Park|first8=MY|last9=Lee|first9=SH}}</ref><ref>{{cite journal |author=Sonthayanon P |title=Rapid diagnosis of scrub typhus in rural Thailand using polymerase chain reaction |journal=Am. J. Trop. Med. Hyg. |volume=75 |issue=6 |pages=1099–102 |year=2006 |month=December |pmid=17172374 |doi= |url= |author-separator=, |author2=Chierakul W |author3=Wuthiekanun V |display-authors=3 |last4=Blacksell |first4=SD |last5=Pimda |first5=K |last6=Suputtamongkol |first6=Y |last7=Pukrittayakamee |first7=S |last8=White |first8=NJ |last9=Day |first9=NP}}</ref> and are affected by prior antibiotic treatment.<ref>{{cite journal|author=Kim DM, Byun JN|title=Effects of Antibiotic Treatment on the Results of Nested PCRs for Scrub Typhus|journal=J Clin Microbiol|year=2008|volume=46|issue=10|pages=3465–|pmid=18716229|doi=10.1128/JCM.00634-08|pmc=2566087}}</ref> The currently available diagnostic methods  have been summarised.<ref name="Koh2010"/>


== Treatment ==
==Diagnosis==
Without treatment, the disease is often fatal. Since the use of antibiotics, case fatalities have decreased from 4%–40% to less than 2%.


The drug most commonly used is [[doxycycline]]; but [[chloramphenicol]] is an alternative.  Strains that are resistant to doxycycline and to chloramphenicol are common in northern Thailand.<ref>{{cite journal
[[Scrub typhus history and symptoms|History and Symptoms]] | [[Scrub typhus physical examination|Physical Examination]] | [[Scrub typhus laboratory findings|Laboratory Findings]] | [[Scrub typhus other imaging findings|Imaging Findings]] | [[Scrub typhus other diagnostic studies|Other Diagnostic Studies]]
|author=Watt G
|title=Scrub typhus infections poorly responsive to antibiotics in northern Thailand
|journal=Lancet
|volume=348
|issue=9020
|pages=86–89
|year=1996
|doi=10.1016/S0140-6736(96)02501-9
|pmid=8676722
|author-separator=,
|author2=Chouriyagune C
|author3=Ruangweerayud R
|display-authors=3
|last4=Watcharapichat
|first4=Pochaman
|last5=Phulsuksombati
|first5=Duangporn
|last6=Jongsakul
|first6=Krisada
|last7=Teja-Isavadharm
|first7=Paktiya
|last8=Bhodhidatta
|first8=Dharadhida
|last9=Corcoran
|first9=Kevin D}}</ref><ref>{{cite journal
|author=Kollars TM
|title=Short report: variation in the 56-kD type-specific antigen gene of ''Orientia tsutsugamushi'' isolated from patients in Thailand
|journal=Am J Trop Med Hyg
|volume=68
|issue=3
|pages=299–300
|year=2003
|pmid=12685633
|author-separator=,
|author2=Bodhidatta D
|author3=Phulsuksombati D
|display-authors=3
|last4=Tippayachai
|first4=B
|last5=Coleman
|first5=RE}}</ref>  [[Rifampin]] and [[azithromycin]]<ref>{{cite journal|author=Phimda K|title=Doxycycline versus Azithromycin for Treatment of Leptospirosis and Scrub Typhus|journal=Antimicrob Agents Chemother|year=2007|volume=51|issue=9|pages=3259–63|pmid=17638700|doi=10.1128/AAC.00508-07|pmc=2043199|author-separator=,|author2=Hoontrakul S|author3=Suttinont C|display-authors=3|last4=Chareonwat|first4=S.|last5=Losuwanaluk|first5=K.|last6=Chueasuwanchai|first6=S.|last7=Chierakul|first7=W.|last8=Suwancharoen|first8=D.|last9=Silpasakorn|first9=S.}}</ref> are alternatives.<ref>{{cite journal |author=Panpanich R, Garner P |title=Antibiotics for treating scrub typhus |journal=Cochrane Database Syst Rev |issue=1 |pages=CD002150 |year=2009 |doi=10.1002/14651858.CD002150 |pmid=10796680 |editor1-last=Panpanich |editor1-first=Ratana}}</ref> Azithromycin is an alternative in children<ref>{{cite journal|author=Mahajan SK, Rolain J-M, Sankhyan N, Kaushal RK, Raoult D|title=Pediatric scrub typhus in Indian Himalayas|journal=Indian Journal of Pediatrics|volume=75|pages=947–9|year=2008|doi=10.1007/s12098-008-0186-3|pmid=18810342|issue=9}}</ref> and pregnant women with scrub typhus,<ref>{{cite journal|title=Azithromycin Activities against Orientia tsutsugamushi Strains Isolated in Cases of Scrub Typhus in Northern Thailand |journal=Antimicrob Agents Chemother|year=1999|pages=2817–2818|volume=43|issue=11|pmid=10543774|last1=Watt|first1=G|last2=Kantipong|first2=P|last3=Jongsakul|first3=K|last4=Watcharapichat|first4=P|last5=Phulsuksombati|first5=D|pmc=89570}}</ref><ref>{{cite journal|author=Choi EK, Pai H|title=Azithromycin therapy for scrub typhus during pregnancy|journal=Clin Infect Dis|year=1998|volume=27|issue=6|pages=1538–9|pmid=9868680|doi=10.1086/517742}}</ref><ref name="Kim2006">{{cite journal|author=Kim YS, Lee HJ, Chang M, Son SK, Rhee YE, Shim SK|title=Scrub typhus during pregnancy and its treatment: a case series and review of the literature|journal=Am J Trop Med Hyg|year=2006|volume=75|issue=5|pages=955–9|pmid=17123995}}</ref> and when doxycycline-resistance is suspected.<ref>{{cite journal|title=Efficacy of azithromycin for treatment of mild scrub-typhus infections in South Korea|url=http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102265576.html|journal=Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother|year=2003|volume=43|pages=abstract no. L–182|author1=<Please add first missing authors to populate metadata.>}}</ref> [[Ciprofloxacin]] cannot be used safely in pregnancy and is associated with stillbirths and miscarriage.<ref name="Kim2006"/><ref>{{cite journal|author=Mathai E, Rolain JM, Verghese L, Mathai M, Jasper P, Verghese G, Raoult D|title=Case reports: scrub typhus during pregnancy in India|journal=Trans R Soc Trop Med Hyg|year=2003|volume=97|issue=5|pages=570–2|pmid=15307429|doi=10.1016/S0035-9203(03)80032-9}}</ref>
Combination therapy with doxycycline and [[rifampicin]] is not recommended due to possible antagonism.<ref>{{cite journal
|author=Watt G
|title=Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial
|journal=Lancet
|volume=356
|issue=9235
|year=2000
|pages=1057–1061
|doi=10.1016/S0140-6736(00)02728-8
|pmid=11009140
|author-separator=,
|author2=Kantipong P
|author3=Jongsakul K
|display-authors=3
|last4=Watcharapichat
|first4=Pochaman
|last5=Phulsuksombati
|first5=Duangporn
|last6=Strickman
|first6=Daniel
}}</ref>


Other drugs that may be effective are [[clarithromycin]], [[roxithromycin]], and the [[fluoroquinolones]], but there is no clinical evidence on which to recommend their use.  [[Azithromycin]] or chloramphenicol is useful for infection in children or pregnant women.
==Treatment==


== Vaccine ==
[[Scrub typhus medical therapy|Medical Therapy]] | [[Scrub typhus primary prevention|Primary Prevention]] | [[Scrub typhus secondary prevention|Secondary Prevention]] | [[Scrub typhus cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Scrub typhus future or investigational therapies|Future or Investigational Therapies]]
There are currently no licensed vaccines available.<ref>{{cite book|author=Arguin PM, Kozarsky PE, Reed C (eds.)|title=CDC Health Information for International Travel, 2008|publisher=Mosby|year=2008|url=http://wwwn.cdc.gov/travel/yellowBookCh4-Rickettsial.aspx|isbn=0-323-04885-4|chapter-url=Chapter 4: Rickettsial Infections}}</ref>


An early attempt to create a scrub typhus [[vaccine]] occurred in the [[United Kingdom]] in 1937 (with the [[Wellcome Foundation]] infecting around 300,000 [[cotton rat]]s  in a classified project called "Operation Tyburn"), but the vaccine was not used.<ref name="urlAWIC Newsletter: The Cotton Rat In Biomedical Research">{{cite web |url=http://www.nal.usda.gov/awic/newsletters/v5n2/5n2princ.htm#toc5 |title=AWIC Newsletter: The Cotton Rat In Biomedical Research |format= |work= |accessdate=}}</ref>  The first known batch of scrub typhus vaccine actually used to inoculate human subjects was despatched to India for use by Allied Land Forces, South-East Asia Command (A.L.F.S.E.A.) in June 1945.  By December 1945, 268,000 cc. had been despatched.<ref>{{cite journal|journal=Hansard|title=Far East Report|date=2 April 1946|url=http://hansard.millbanksystems.com/written_answers/1946/apr/02/scrub-typhus-vaccine-far-east|author1=<Please add first missing authors to populate metadata.>}}</ref>  The vaccine was produced at Wellcomes laboratory at Ely Grange, Frant, Sussex.  An attempt to verify the efficacy of the vaccine by using a placebo group for comparison was vetoed by the military commanders, who objected to the experiment.<ref>{{cite journal |author=Thomson Walker W |title=Scrub Typhus Vaccine |journal=Br Med J |year=1947 |volume=1 |issue=4501 |pages=484–7 |pmc=2053023 |pmid=20248030 |doi=10.1136/bmj.1.4501.484}}</ref>
==Case Studies==


It is now known that there is enormous antigenic variation in ''Orientia tsutsugamushi'' strains,<ref>{{cite journal|author=Shirai A|title=''Rickettsia tsutsugamushi'' strains found in chiggers collected in Thailand|journal=Southeast Asian J Trop Med Public Health|volume=12|issue=1|pages=1–6|year=1981|pmid=6789455|author-separator=,|author2=Tanskul PL|author3=Andre|author4=RG|display-authors=4|last5=Huxsoll|first5=DL}}</ref><ref>{{cite journal
[[Scrub typhus case study one|Case #1]]
|author=Kang JS, Chang WH
|title=Antigenic relationship among the eight prototype and new serotype strains of Orientia tsutsugamushi revealed by monoclonal antibodies
|journal=Microbiol Immunol
|year=1999
|volume=43
|issue=3
|pages=229–34
|pmid=10338191
}}</ref> and immunity to one strain does not confer immunity to another.  Any scrub typhus vaccine should give protection to all the strains present locally, in order to give an acceptable level of protection.  A vaccine developed for one locality may not be protective in another locality, because of antigenic variation.  This complexity continues to hamper efforts to produce a viable vaccine.<ref name="Kelly2009">{{cite journal
|author=Kelly DJ, Fuerst PA, Ching W-M, Richards AL
|title=Scrub typhus: The geographic distribution of phenotypic and genotypic variants of ''Orientia tsutsugamushi''
|year=2009
|volume=48
|issue=s3
|page=S203–S230
|doi=10.1086/596576
|journal=Clinical Infectious Diseases
|pmid=19220144
|pages=S203–30
|unused_data=Clin Infect Dis
}}</ref>
 
== History ==
[[File:Buna.jpg|250px|thumb|right|An Australian soldier, Private George "Dick" Whittington, is aided by [[Papuan peoples|Papuan]] orderly Raphael Oimbari, near Buna on 25 December 1942. Whittington died in February 1943 from the effects of ''''bush typhus''''. (Picture by ''[[Life (magazine)|Life]]'' photographer [[George Silk]])]]
Severe epidemics of the disease occurred among troops in [[Burma]] and [[Ceylon]] during [[World War II]] (WWII).<ref name="isbn0-485-26318-1">{{cite book
|author=Audy JR
|title=Red mites and typhus
|publisher=University of London, Athlone Press
|location=London
|year=1968
|pages=
|isbn=0-485-26318-1 }}</ref>  Several members of the U.S. Army's 5307th Composite Unit ([[Merrill's Marauders]]) died of the disease; and before 1944, there were no effective antibiotics or vaccines available.<ref>{{cite book
|author=Kearny CH
|title=Jungle Snafus...And Remedies
|publisher=Oregon Institute of Science &amp; Medicine
|location=Cave Junction, Oregon
|year=1997
|page=309
|isbn=1-884067-10-7}}</ref><ref>{{cite book |author=Smallman-Raynor M, Cliff AD
|title=War epidemics: an historical geography of infectious diseases in military conflict and civil strife, 1850–2000
|publisher=Oxford University Press
|location=Oxford
|year=2004
|pages=489–91
|isbn13=9780198233640
|isbn=0-19-823364-7}}</ref>
 
World war II provides some indicators that the disease is endemic to undeveloped areas in all of [[Oceania]] in the [[Pacific Ocean theater of World War II|Pacific Theater]], although war records frequently lack assured diagnoses to desired by epidemiological statics&mdash;and many records of "high fever" evacuations were also likely to be other tropical illnesses. In the chapter entitled "The Green War", [[General MacArthur]]'s biographer [[William Manchester]] identifies that the disease was one of a number debilitating afflictions affecting both sides on [[New Guinea]]<ref name="Caesar1">{{Cite book
|author=[[William Manchester]]
|title=[[American Caesar]]
|year=1978|publisher= Little Brown Company
| pages= 297–298|isbn=0-316-54498-1|chapter=The Green War
}}
</ref> in the running bloody [[Kokoda Track campaign|Kokoda battles]] over unbelievably harsh terrains under incredible hardships&mdash; fought during a six month span<ref>Manchester, p. Six months to recapture Buna and Gona from July 21–22, 1942</ref> all along the [[Kokoda Track]] in 1942-43, and mentions that to be hospital evacuated, Allied soldiers (who cycled forces) had to run a fever of 102°F&mdash;and that sickness casualties outnumbered weapons inflicted casualties 5:1.<ref name="Caesar1"/> Similarly, the illness was a casualty producer in all the jungle fighting of the land battles of [[New Guinea campaign]] and [[Guadalcanal campaign]]. Where the allies had bases, they could remove and cut back vegetation or use DDT as a prophylaxis area barrier treatment, so tick induced sickness rates in forces off the front lines was diminished.
 
The disease was also a problem for US troops stationed in Japan after WWII, and was variously known as "Shichitō fever" (by troops stationed in the [[Izu Islands|Izu Seven Islands]]) or "Hatsuka fever" (Chiba prefecture).<ref>{{cite journal |author=Ogawa M |title=Scrub typhus in Japan: Epidemiology and clinical features of cases reported in 1998 |journal=Am J Trop Med Hyg. |volume=67 |issue=2 |pages=162–5 |date=1 August 2002|pmid=12389941 |url=http://www.ajtmh.org/cgi/pmidlookup?view=long&pmid=12389941 |author-separator=, |author2=Hagiwara T |author3=Kishimoto T |display-authors=3 |last4=Shiga |first4=S |last5=Yoshida |first5=Y |last6=Furuya |first6=Y |last7=Kaiho |first7=I |last8=Ito |first8=T |last9=Nemoto |first9=H }}</ref>
 
== See also ==
* [[List of mites associated with cutaneous reactions]]
 
== References ==
{{Reflist|2}}
 
== External links ==
* {{Internet Archive film clip|id=TsutsugamushiPrevention1945|description=of the 1945 United States training film "Tsutsugamushi Prevention"}}


{{Bacterial diseases}}
{{Bacterial diseases}}
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[[Category:Bacterium-related cutaneous conditions]]
[[Category:Bacterium-related cutaneous conditions]]
[[Category:Zoonoses]]
[[Category:Zoonoses]]
[[Category:Disease]]


[[bg:Японска речна треска]]
[[bg:Японска речна треска]]

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