title: Inappropriateness of quinolone in scrub typhus treatment due to gyrA mutation in Orientia tsutsugamushi Boryong strain.
abstract: The use of quinolone for treatment of rickettsial diseases remains controversial. Recent clinical studies suggest that quinolone is not as effective as others in patients with rickettsial diseases including scrub typhus, although the mechanism is not well understood. In this study, we evaluated the mutation in gyrA associated with quinolone resistance. We prospectively enrolled scrub typhus patients, collected blood samples and clinical data from October, 2010 to November, 2011. Among the 21 patients enrolled, one initially received ciprofloxacin for 3 days but was switched to doxycycline due to clinical deterioration. We obtained the gyrA gene of Orientia tsutsugamushi from 21 samples (20 Boryong strain, 1 Kato strain) and sequenced the quinolone resistance-determining region. All of 21 samples had the Ser83Leu mutation in the gyrA gene, which is known to be associated with quinolone resistance. This suggests that quinolones may be avoided for the treatment of serious scrub typhus.
authors.affiliation: Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Hee-Chang
authors.initials: HC
authors.lastname: Jang
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Choi
authors.forename: Mi-Ok
authors.initials: MO
authors.lastname: Jang
authors.forename: Joon-Hwan
authors.initials: JH
authors.lastname: Ahn
authors.forename: Uh-Jin
authors.initials: UJ
authors.lastname: Kim
authors.forename: Seung-Ji
authors.initials: SJ
authors.lastname: Kang
authors.forename: Jong-Hee
authors.initials: JH
authors.lastname: Shin
authors.forename: Hyon E
authors.initials: HE
authors.lastname: Choy
authors.forename: Sook-In
authors.initials: SI
authors.lastname: Jung
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Park
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000595:Amino Acid Sequence; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D027081:DNA Gyrase / Q000235:genetics*; D004318:Doxycycline / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D012285:Orientia tsutsugamushi / Q000145:classification / Q000201:enzymology / Q000235:genetics*; D010802:Phylogeny; D011446:Prospective Studies; D012612:Scrub Typhus / Q000188:drug therapy*; D016415:Sequence Alignment; D017422:Sequence Analysis, DNA
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D002939:Ciprofloxacin; D027081:DNA Gyrase; D004318:Doxycycline
keywords: Genotype; Quinolone Resistance; Rickettsia; Scrub Typhus