title: Scrub typhus caused by Orientia tsutsugamushi Kawasaki-related genotypes in Shandong Province, northern China.
abstract: Orientia tsutsugamushi, the causative agent of scrub typhus, is an obligate intracellular bacterium and characterized by dramatic genetic diversity. To elucidate the genotypes of O. tsutsugamushi populating in patients in Shandong Province, a new epidemic zone in China, we sequenced partial of the 56-kDa type-specific antigen gene (TSA) and identified the genotypes of 43 O. tsutsugamushi samples from human patients confirmed with scrub typhus from 2010 to 2013. All of the 43 sequences are in the same clade, 39 of them are in one branch and the other four sequences, nominated as SH1002, SH1306, SH1309, and SH1307 are in four separate branches. To clarify the clinical characterizations caused by Kawasaki-related genotypes, we studied the clinical profiles of these 43 scrub typhus patients. Most patients (88.1%) were farmers lived in rural areas. They presented with fever (100.0%), headache (79.1%), dizziness (32.6%), generalized myalgia (48.8%), fatigue (53.5%), anorexia (53.5%), facial flushing (23.3%), conjunctival congestion (11.6%), skin rashes (58.1%) and lymphadenopathy (23.3%). Eschar (97.7%) was quite common in patients, which provided doctors with a luminous clue for diagnosis of scrub typhus. Thrombocytopenia was seen in 23.1% of patients, and three patients (7.0%) had bronchopneumonia. There was no death report in Shandong Province during the study period. The present study provides beneficial data for clinical, serological, and molecular diagnosis of scrub typhus infections, and also provides foundations for subsequent studies.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
authors.forename: Luyan
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Institute for Bacterial Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250012, China.
authors.forename: Zhenwang
authors.initials: Z
authors.lastname: Bi
authors.affiliation: Institute for Bacterial Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250012, China.
authors.forename: Zengqiang
authors.initials: Z
authors.lastname: Kou
authors.affiliation: Tai'an Center for Disease Control and Prevention, Tai'an 271000, China.
authors.forename: Huili
authors.initials: H
authors.lastname: Yang
authors.affiliation: Tai'an Center for Disease Control and Prevention, Tai'an 271000, China.
authors.forename: Aihua
authors.initials: A
authors.lastname: Zhang
authors.affiliation: Yiyuan Center for Disease Control and Prevention, Zibo 256100, China.
authors.forename: Shoufeng
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Tai'an Center for Disease Control and Prevention, Tai'an 271000, China.
authors.forename: Xiangpeng
authors.initials: X
authors.lastname: Meng
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China. Electronic address: ztzhao@sdu.edu.cn.
authors.forename: Zhongtang
authors.initials: Z
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D000942:Antigens, Bacterial / Q000235:genetics; D002681:China / Q000453:epidemiology; D058872:Epidemics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D012285:Orientia tsutsugamushi / Q000145:classification* / Q000235:genetics*; D010802:Phylogeny; D012612:Scrub Typhus / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000942:Antigens, Bacterial
keywords: 56-kDa type specific antigen gene; Orientia tsutsugamushi; Phylogenetic analysis; Scrub typhus