Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster
Abstract
1. Author Summary
2. Introduction
3. Cluster of Cases
4. Index Case
5. Case Verification
6. Methods
6.1. Laboratory Investigation
6.1.1. Molecular Detection by Real-Time Quantitative PCR (qPCR) and Nested PCR
6.1.2. Genotyping
6.1.3. Rickettsial Serology Testing by Indirect Immunoperoxidase Test
6.2. Entomology Investigation
6.2.1. Collection of On-Host Chiggers
6.2.2. Screening of Orientia spp. DNA
6.3. Ethics Statement
7. Results
7.1. Demography, Clinical Presentations, and Laboratory Results
7.2. PCR and Genotyping of Orientia Tsutsugamushi in Chiggers and Patients
8. Discussion
9. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Year | 12.2024 | 1.2025 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Date | 3rd | 5th | 7th | 11th | 12th | 13th | 15th | 20th | 22nd | 26th | 27th | 9th |
Onset of Index Case (1M) | X | |||||||||||
Onset of 2nd Case (2M) | X | |||||||||||
1st Notiification Leptospirosis Case | X | |||||||||||
2nd Notification of Leptospirosis Case | X | |||||||||||
ACD Leptospirosis | X | |||||||||||
Declaration of Probable Leptospirosis Outbreak | X | |||||||||||
Onset of 3rd Case (3M) | X | |||||||||||
Onset of 4th Case (4F) | X | |||||||||||
Entomology study was carried out | X | |||||||||||
PCR Urine for leptospirosis sent to IMR | X | |||||||||||
3rd Notification of Leptospirosis Case | X | |||||||||||
All result come negative include Urine PCR | X | |||||||||||
Discussion with EIP specialist | X | |||||||||||
Further history—positive history of maculopapular rash and resolved eschar (4F) | X | |||||||||||
PCR Rickettsia and IIP serology were taken | X | |||||||||||
Result IIP serology positive | X | |||||||||||
Flood at the oil palm plantation | X | X | X | X |
Characteristic | n = 5 (100%) |
---|---|
Age group (years) | |
20–34 | 4 (80.0) |
35–60 | 1 (20.0) |
Citizenship | |
Citizens | 3 (60.0) |
Non-citizens | 2 (40.0) |
Gender | |
Male | 4 (80.0) |
Female | 1 (20.0) |
Ethnic group | |
Orang Asli | 3 (60.0) |
Foreigner | 2 (40.0) |
Status hospital admission | |
Admitted | 3 (60.0) |
Not admitted | 2 (40.0) |
Clinical findings | |
Fever | 5 (100.0) |
Myalgia | 3 (60.0) |
Headache | 4 (80.0) |
Cough | 3 (60.0) |
Loss of appetite | 4 (80.0) |
Shortness of breath | 1 (20.0) |
Eschar | 1 (20.0) |
Lymphadenopathy | 1 (20.0) |
Laboratory Test | 1M | 2M | 3M | 4F | 5M | |
---|---|---|---|---|---|---|
Biochemistry | ||||||
Total white cell | 17 | 13 | 7 | Not done | Not done | |
Platelet | 173 | 137 | 106 | Not done | Not done | |
AST | 120 | 61 | 547 | Not done | Not done | |
ALP | 84 | 47 | 595 | Not done | Not done | |
Creatine kinase | 5139 | 109 | 272 | Not done | Not done | |
Antigen and Antibody Detection | ||||||
Dengue NS1, IgG, IgM Combo rapid test | Negative | Negative | Negative | Not done | Not done | |
Leptospirosis IgM serology test | Positive | Positive | Positive | Not done | Not done | |
Microagglutination test (MAT) | Negative | Negative | Negative | Not done | Not done | |
Microscopy test | ||||||
Blood film for malarial parasite (BFMP) | Negative | Negative | Negative | Not done | Not done | |
Molecular Test | ||||||
Leptospira PCR | Negative | Negative | Not done | Not done | Not done | |
ST PCR (Urine) | 56 kDA gene | Positive | Negative | Not done | Not done | Not done |
47 kDA gene | Positive | Negative | Not done | Not done | Not done | |
ST PCR (Blood) | 56 kDA gene | Negative | Negative | Not done | Not done | Not done |
47 kDA gene | Negative | Negative | Not done | Not done | Not done |
Antigen | Antibody | 9 January 2024: 1st Sample | 24 January 2024: 2nd Sample | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
1M | 2M | 3M | 4F | 5M | 1M | 2M | 3M | 4F | 5M | ||
S | IgG | ‡ | ‡ | ‡ | • | ‡ | |||||
T | IgM | ‡ | ‡ | ‡ | • | ||||||
E | IgG | • | • | ||||||||
T | IgM | • | • | ||||||||
T | IgG | • | • | ||||||||
T | IgM | • | • | • | • | ||||||
ST: scrub typhus | ET: endemic typhus | TT: tick typhus | |||||||||
<1;50 | 1;100 | 1;400 | 1;1600 | ||||||||
1;200 | 1;800 | >1;1600 |
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Ramli, S.R.; Arifin, N.; Ismail, M.F.; Hii, S.Y.F.; Sulaiman, N.S.; Lah, E.F.C.; Nik Abdul Aziz, N.A.H. Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster. Trop. Med. Infect. Dis. 2025, 10, 208. https://doi.org/10.3390/tropicalmed10080208
Ramli SR, Arifin N, Ismail MF, Hii SYF, Sulaiman NS, Lah EFC, Nik Abdul Aziz NAH. Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster. Tropical Medicine and Infectious Disease. 2025; 10(8):208. https://doi.org/10.3390/tropicalmed10080208
Chicago/Turabian StyleRamli, Siti Roszilawati, Nuridayu Arifin, Mohd Fahmi Ismail, Shirley Yi Fen Hii, Nur Suffia Sulaiman, Ernieenor Faraliana Che Lah, and Nik Abdul Hadi Nik Abdul Aziz. 2025. "Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster" Tropical Medicine and Infectious Disease 10, no. 8: 208. https://doi.org/10.3390/tropicalmed10080208
APA StyleRamli, S. R., Arifin, N., Ismail, M. F., Hii, S. Y. F., Sulaiman, N. S., Lah, E. F. C., & Nik Abdul Aziz, N. A. H. (2025). Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster. Tropical Medicine and Infectious Disease, 10(8), 208. https://doi.org/10.3390/tropicalmed10080208