title: Scrub typhus, a disease with increasing threat in Guangdong, China.
abstract: There has been a rapid increase in the number of scrub typhus cases in Guangdong Province, China. For this reason, an epidemiologic study was conducted to understand the characteristics of scrub typhus epidemics in Guangdong. From 2006 to 2013, the incidence of human cases increased from 0.4321 to 3.5917 per 100,000 with a bimodal peak in human cases typically occurring between May and November. To detect the prevalence of Orientia tsutsugamushi among suspected human cases and rodents, we performed ELISA tests of IgM/IgG and nested PCR tests on 59 whole blood samples from the suspected cases and 112 spleen samples from the rodents. Suspected cases tested positive for anti-O. tsutsugamushi IgM and IgG 66.1% (39/59) and 50.8% (30/59) of the time, respectively. Additionally, 20.3% (12/59) of blood samples and 13.4% (15/112) of spleen samples were positive for PCR. Phylogenetic analysis revealed that there were four definable clusters among the 27 nucleotide sequences of the 56-kDa antigen genes: 44.4% Karp (12/27), 25.9% Kato (7/27), 22.2% Gilliam (6/27) and 7.4% TA763 (2/27). We concluded many suspected cases may result in diagnostic errors; therefore, it is necessary to perform laboratory tests on suspected cases in hospitals. The high infection rate of O. tsutsugamushi among the limited rodents tested suggested that further rodent sampling throughout the province is necessary to further define high-risk areas. Furthermore, the multiple co-circulating genotypes of O. tsutsugamushi play a key role in the pervasiveness of scrub typhus in the Guangdong area.
authors.affiliation: Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People's Republic of China.
authors.forename: Wu
authors.initials: W
authors.lastname: De
authors.affiliation: Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People's Republic of China.
authors.forename: Kou
authors.initials: K
authors.lastname: Jing
authors.affiliation: Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People's Republic of China.
authors.forename: Zhang
authors.initials: Z
authors.lastname: Huan
authors.affiliation: Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People's Republic of China.
authors.forename: Zhou Hui
authors.initials: ZH
authors.lastname: Qiong
authors.affiliation: Metabiota, Inc., San Francisco, California, United States of America.
authors.forename: Corina
authors.initials: C
authors.lastname: Monagin
authors.affiliation: Department of Biological Sciences, Humboldt State University, Arcata, California 95521, United States of America.
authors.forename: Zhong Jian
authors.initials: ZJ
authors.lastname: Min
authors.affiliation: Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People's Republic of China.
authors.forename: Huang
authors.initials: H
authors.lastname: Ping
authors.affiliation: Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People's Republic of China.
authors.forename: Ke Chang
authors.initials: KC
authors.lastname: Wen
authors.affiliation: Institute of Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong, Guangzhou, People's Republic of China.
authors.forename: Lin Jin
authors.initials: LJ
authors.lastname: Yan
mesh_terms: D000818:Animals; D002681:China / Q000453:epidemiology; D005843:Geography; D006801:Humans; D015994:Incidence; D008969:Molecular Sequence Data; D058889:Molecular Typing; D012285:Orientia tsutsugamushi / Q000145:classification* / Q000235:genetics*; D010802:Phylogeny; D011159:Population Surveillance; D015995:Prevalence; D012612:Scrub Typhus / Q000453:epidemiology* / Q000382:microbiology*; D062211:Spatio-Temporal Analysis