title: An outbreak of scrub typhus in military personnel despite protocols for antibiotic prophylaxis: doxycycline resistance excluded by a quantitative PCR-based susceptibility assay.
abstract: Scrub typhus is caused by the obligate intracellular bacterium Orientia tsutsugamushi and is endemic to many countries in the Asia-Pacific region, including tropical Australia. We describe a recent large outbreak amongst military personnel in north Queensland. A total of 45 clinical cases were identified (36% of all potentially exposed individuals). This occurred despite existing military protocols stipulating the provision of doxycycline prophylaxis. Doxycycline resistance in O. tsutsugamushi has been described in South-East Asia, but not Australia. In one case, O. tsutsugamushi was cultured from eschar tissue and blood. Using quantitative real-time PCR to determine susceptibility to doxycycline for the outbreak strain, a minimum inhibitory concentration (MIC) of ≤0.04 μg/mL was found, indicating susceptibility to this agent. It seems most probable that failure to adhere to adequate prophylaxis over the duration of the military exercise accounted for the large number of cases encountered rather than doxycycline resistance.
authors.affiliation: University of Queensland, UQ Centre for Clinical Research, Brisbane, QLD, Australia; Department of Microbiology, NSW Health Pathology-Pathology North, Newcastle, NSW, Australia; Department of Immunology and Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia. Electronic address: p.harris@uq.edu.au.
authors.forename: Patrick N A
authors.initials: PNA
authors.lastname: Harris
authors.affiliation: Townsville Public Health Unit, Queensland Health, Townsville, Queensland, Australia.
authors.forename: Csongor
authors.initials: C
authors.lastname: Oltvolgyi
authors.affiliation: Department of Microbiology, NSW Health Pathology-Pathology North, Newcastle, NSW, Australia; Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia.
authors.forename: Aminul
authors.initials: A
authors.lastname: Islam
authors.affiliation: Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia.
authors.forename: Hazizul
authors.initials: H
authors.lastname: Hussain-Yusuf
authors.affiliation: Department of Immunology and Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Loewenthal
authors.affiliation: Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia.
authors.forename: Gemma
authors.initials: G
authors.lastname: Vincent
authors.affiliation: Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Stenos
authors.affiliation: Department of Microbiology, NSW Health Pathology-Pathology North, Newcastle, NSW, Australia; Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Graves
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D004196:Disease Outbreaks; D004318:Doxycycline / Q000494:pharmacology* / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D008826:Microbial Sensitivity Tests; D008889:Military Personnel; D012285:Orientia tsutsugamushi / Q000187:drug effects / Q000302:isolation & purification*; D011793:Queensland / Q000453:epidemiology; D060888:Real-Time Polymerase Chain Reaction; D012612:Scrub Typhus / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline
keywords: Doxycycline; Microbial sensitivity testing; Orientia tsutsugamushi; Scrub typhus