Next Article in Journal / Special Issue
Rickettsia felis: A Review of Transmission Mechanisms of an Emerging Pathogen
Previous Article in Journal
Application of PCR-Based Tools to Explore Strongyloides Infection in People in Parts of Northern Australia
Previous Article in Special Issue
Clinical Manifestations and Outcomes of Rickettsia australis Infection: A 15-Year Retrospective Study of Hospitalized Patients
Article Menu

Export Article

Open AccessReview
Trop. Med. Infect. Dis. 2017, 2(4), 63; doi:10.3390/tropicalmed2040063

The Historical Case for and the Future Study of Antibiotic-Resistant Scrub Typhus

1
Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910, USA
2
Department of Evolution, Ecology and Organismal Biology, The Ohio State University, Columbus, OH 43210, USA
*
Author to whom correspondence should be addressed.
Received: 29 November 2017 / Revised: 6 December 2017 / Accepted: 11 December 2017 / Published: 15 December 2017
(This article belongs to the Special Issue The Past and Present Threat of Rickettsial Diseases)
View Full-Text   |   Download PDF [540 KB, uploaded 15 December 2017]   |  

Abstract

Scrub typhus is an acute, and sometimes fatal, human febrile illness, typically successfully treated using chloramphenicol or one of the tetracyclines. Over the past several years, descriptions of strains of Orientia tsutsugamushi with reduced susceptibility to antibiotics have appeared. Because case-fatality ratios approached 50% during the pre-antibiotic era, antibiotic-resistant scrub typhus is concerning. Herein, we review the data on resistant scrub typhus, describe how the theoretical existence of such resistance is affected by interpretation of treatment outcomes, and propose a plan to further identify whether true drug resistance is present and how to deal with drug resistance if it has evolved. Limited resistance is not unambiguous, if present, and antibiotic resistance in scrub typhus is not a dichotomous trait. Rather, evidence of resistance shows a continuous gradation of increasing resistance. The availability of genomes from isolates of O. tsutsugamushi allows the search for loci that might contribute to antibiotic resistance. At least eighteen such loci occur in all genomes of O. tsutsugamushi examined. One gene (gyrA) occurs as a quinolone-resistant form in the genome of all isolates of O. tsutsugamushi. At least 13 other genes that are present in some members of the genus Rickettsia do not occur within O. tsutsugamushi. Even though reports of scrub typhus not responding appropriately to chloramphenicol or a tetracycline treatment have been in the literature for approximately 23 years, the existence and importance of antibiotic-resistant scrub typhus remains uncertain. View Full-Text
Keywords: scrub typhus; Orientia; O. tsutsugamushi; antibiotic resistance; antibiotic resistance genes; genome comparison scrub typhus; Orientia; O. tsutsugamushi; antibiotic resistance; antibiotic resistance genes; genome comparison
Figures

Figure 1

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

Scifeed alert for new publications

Never miss any articles matching your research from any publisher
  • Get alerts for new papers matching your research
  • Find out the new papers from selected authors
  • Updated daily for 49'000+ journals and 6000+ publishers
  • Define your Scifeed now

SciFeed Share & Cite This Article

MDPI and ACS Style

Kelly, D.J.; Fuerst, P.A.; Richards, A.L. The Historical Case for and the Future Study of Antibiotic-Resistant Scrub Typhus. Trop. Med. Infect. Dis. 2017, 2, 63.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Metrics

Article Access Statistics

1

Comments

[Return to top]
Trop. Med. Infect. Dis. EISSN 2414-6366 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top