Coagulation and inflammation in scrub typhus and murine typhus—a prospective comparative study from Laos

Scrub typhus (caused by Orientia tsutsugamushi) and murine typhus (caused by Rickettsia typhi) cause up to 28% of febrile episodes in Thailand and Laos. The current understanding of coagulation and inflammation in the pathogenesis of these clinically very similar vasculotropic diseases is limited. T...

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Bibliographic Details
Published in:Clinical microbiology and infection Vol. 18; no. 12; pp. 1221 - 1228
Main Authors: Paris, D.H., Chansamouth, V., Nawtaisong, P., Löwenberg, E.C., Phetsouvanh, R., Blacksell, S.D., Lee, S.J., Dondorp, A.M., Newton, P.N., van der Poll, T., Levi, M., Day, N. P.J.
Format: Journal Article
Language:English
Published: Oxford, UK Elsevier Ltd 01.12.2012
Blackwell Publishing Ltd
Wiley-Blackwell
Elsevier Limited
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Bacterial diseases
Biological and medical sciences
Biomarkers - analysis
Blood Coagulation
Child
Child, Preschool
Coagulation
Comparative studies
Female
Human bacterial diseases
Humans
Infectious Diseases
inflammation
Inflammation - pathology
Laos
Male
Medical sciences
Middle Aged
murine typhus
Orientia tsutsugamushi
Orientia tsutsugamushi - pathogenicity
pathophysiology
Prospective Studies
Rickettsia typhi
Rickettsia typhi - pathogenicity
Rickettsial diseases
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
scrub typhus
Scrub Typhus - pathology
Tropical bacterial diseases
Typhus, Endemic Flea-Borne - pathology
vasculitis
Young Adult
Asia
Laos
murine typhus
inflammation
vasculitis
Coagulation
pathophysiology
Laos
scrub typhus
Scrub typhus
Murine typhus
Rickettsialosis
Pathophysiology
Cardiovascular disease
Inflammation
Infection
Vascular disease
Vasculitis
Rickettsial infection
Bacteriosis
Comparative study
ISSN:1198-743X, 1469-0691, 1469-0691
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Summary:Scrub typhus (caused by Orientia tsutsugamushi) and murine typhus (caused by Rickettsia typhi) cause up to 28% of febrile episodes in Thailand and Laos. The current understanding of coagulation and inflammation in the pathogenesis of these clinically very similar vasculotropic diseases is limited. This study compared human in vivo changes in 15 coagulation, inflammation and endothelial activation markers in prospectively collected admission and follow-up samples of 121 patients (55 scrub typhus, 55 murine typhus, and 11 typhus-like illness) and 51 healthy controls from Laos. As compared with controls, all but one of the markers assessed were significantly affected in typhus patients; however, the activation patterns differed significantly between scrub and murine typhus patients. The levels of markers of coagulation activation and all inflammatory cytokines, except for interleukin-12, were significantly higher in patients with scrub typhus than in those with murine typhus. In patients with murine typhus, however, the levels of endothelium-derived markers were significantly higher. Anticoagulant factors were inhibited in both typhus patient groups. This is the first study demonstrating that, in scrub typhus, in vivo coagulation activation is prominent and is related to a strong proinflammatory response, whereas in murine typhus, changes in coagulant and fibrinolytic pathways are suggestive of endothelial cell perturbation. These data suggest that, although late-stage endothelial infection is common in both diseases, the in vivo pathogenic mechanisms of R. typhi and O. tsutsugamushi could differ in the early phase of infection and may contribute to disease differentiation.
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Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms
ISSN:1198-743X
1469-0691
1469-0691
DOI:10.1111/j.1469-0691.2011.03717.x