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Co-Infection of Scrub Typhus and Human Granulocytic Anaplasmosis in Korea, 2006

Journal of Korean Medical Science 2019년 34권 39호 p.257 ~ 257
 ( Kim Jeong-Han ) - Seoul National University College of Medicine Department of Internal Medicine

 ( Lee Chang-Seop ) - Chonbuk National University Medical School Department of Internal Medicine
 ( Moon Chi-Sook ) - Inje University College of Medicine Department of Internal Medicine
 ( Kwak Yee-Gyung ) - Inje University College of Medicine Department of Internal Medicine
 ( Kim Baek-Nam ) - Inje University College of Medicine Department of Internal Medicine
 ( Kim Eu-Suk ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Kang Jae-Myung ) - Pohang St. Mary s Hospital Department of Internal Medicine
 ( Park Wan-Beom ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Oh Myoung-Don ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Park Sang-Won ) - Seoul National University College of Medicine Department of Internal Medicine

Abstract


Background: Scrub typhus, severe fever with thrombocytopenia syndrome (SFTS) and human granulocytic anaplasmosis (HGA) are important arthropod-borne infectious diseases in Korea and share a common point that they are transmitted by arthropod bites mostly during outdoor activities and there are considerable overlaps of epidemiologic and clinical features at presentation. We investigated the co-infection of these infections.

Methods: The study subjects were patients with laboratory-confirmed scrub typhus who were enrolled retrospectively in 2006. SFTS virus (SFTSV) infection was confirmed by a reverse transcriptase polymerase chain reaction (PCR) to amplify partial L segment of SFTSV for molecular diagnosis. HGA was confirmed by a nested PCR to amplify 16S rRNA gene of Anaplasma phagocytophilum. Direct sequencing of the positive PCR products was performed. Clinical features of co-infected subjects were described.

Results: One-hundred sixty-seven patients with scrub typhus were included in the analysis. Co-infection of A. phagocytophilum was identified in 4.2% of scrub typhus patients (7/167). The route of co-infection was uncertain. The co-infected patients had not different clinical manifestations compared to the patients with scrub typhus only. All the study subjects were negative for SFTSV.

Conclusion: We found retrospective molecular evidence of the co-infection of scrub typhus and HGA in Korea. HGA may be more prevalent than expected and need to be considered as an important differential diagnosis of febrile patients in Korea.

키워드

Scrub Typhus; Severe Fever with Thrombocytopenia Syndrome; Human Granulocytic Anaplasmosis; Anaplasma phagocytophilum; Co-Infection
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