Biomedical subjects

D Strickman

Publications and source records attributed to D Strickman.

At least 37 records · Page 2Linked to original sources

PubMed1997

Antibodies to Orientia tsutsugamushi in soldiers in northeastern Thailand.

The prevalence and incidence of antibodies to Orientia tsutsugamushi, the etiologic agent of scrub typhus, in Thai soldiers living and working near the Thai-Cambodian border in Si Sa Ket Province was investigated. The point prevalence of antibodies varied from 0 to 4.1%. The incidence of antibodies, calculated from individuals who seroconverted following a negative result in a previous bleeding 3 to 5 months earlier, was 4.21% (9/214) in January 1992, 0 in April 1992 and 3.76% (8/213) in September 1992. An annual infection rate of 2.66% was estimated.

Antibodies, Bacterial↗

PubMed1996

Scrub typhus infections poorly responsive to antibiotics in northern Thailand.

BACKGROUND: Rickettsia tsutsugamushi, the aetiological agent of scrub typhus, is common in Asia and readily infects visitors to areas where disease transmission occurs. Rapid defervescence after antibiotic treatment is so characteristic that it is used as a diagnostic test for R tsutsugamushi infection. Reports from local physicians that patients with scrub typhus in Chiangrai, northern Thailand responded badly to appropriate antibiotic therapy prompted us to do a prospective clinical evaluation and antibiotic susceptibility testing of human rickettsial isolates. METHODS: The clinical response to doxycycline treatment in patients with early, mild scrub typhus in northern Thailand was compared with the results of treatment in Mae Sod, western Thailand. Prototype and naturally occurring strains of R tsutsugamushi were tested for susceptibility to chloramphenicol and doxycycline in mice and in cell culture. FINDINGS: By the third day of treatment, fever had cleared in all seven patients from Mae Sod, but in only five of the 12 (40%) from Chiangrai (p < 0.01). Median fever clearance time in Chiangrai (80 h; range 15-190) was significantly longer than in Mae Sod (30 h; range 4-58; p < 0.005). Conjunctival suffusion resolved significantly more slowly in Chiangrai (p < 0.05). Antibiotics prevented death in mice infected by Chiangrai strains of R tsutsugamushi less often than after infection by the prototype strain (p < 0.05). Only one of three Chiangrai strains tested in cell culture was fully susceptible to doxycycline. INTERPRETATION: Chloramphenicol-resistant and doxycycline-resistant strains of R tsutsugamushi occur in Chiangrai, Thailand. This is the first evidence of naturally occurring antimicrobial resistance in the genus Rickettsia.

Administration, Oral↗

PubMed1996

Antibodies to Orientia tsutsugamushi in Thai soldiers.

Thai soldiers who were conscripted, Royal Thai Army forces, professional Border Patrol Police, or local militia (Thai Rangers) located in any of seven provinces of Thailand were bled in April and again, four months later, in July 1989. In 1991, soldiers from five different locations in southern Thailand were bled once, in July. Serum samples were tested by indirect fluorescent antibody assay for antibody to Orientia (formerly Rickettsia) tsutsugamushi, etiologic agent of scrub typhus, with any titer > or = 1:50 considered positive. Prior to field exercises, prevalence of antibody varied significantly between different types of units, ranging between 18.6% for Thai Rangers and 6.8% for the Royal Thai Army. The April prevalence, July prevalence, and incidence varied significantly by province in 1989, with highest incidence being 14.5% in Kanchanaburi and the lowest 0% in Utraladit. The prevalence in southern Thailand in 1991 varied between 1.6% and 6.8%. The data demonstrate that O. tsutsugamushi is widely distributed in Thailand and that military activity consisting of field exercises that simulate combat conditions significantly expose soldiers to infection.

Antibodies, Bacterial↗

PubMed1995

Field evaluation of four repellents against Leptoconops americanus (Diptera: Ceratopogonidae) biting midges.

Four repellents, deet, AI3-37220, AI3-35765, and CIC-4, prepared as 12.5% ethanol solutions, were evaluated against biting midges on Stansbury Islands, UT. Leptoconops americanus Carter was the only species that was biting human volunteers during the study. This species bit primarily on the ears at rates up to 840 bites per hour. All four repellents significantly reduced the number of bites on treated volunteers. AI3-37220 consistently provided the longest period of protection, giving 97 and 74% protection at 4 and 8 h, respectively. In a direct statistical comparison, AI3-37220 significantly outperformed deet. CIC-4 and AI3-35765 were the least effective repellents, providing 45-47% protection 8 h after application.

Animals↗

PubMed1995

In vitro effectiveness of azithromycin against doxycycline-resistant and -susceptible strains of Rickettsia tsutsugamushi, etiologic agent of scrub typhus.

In an effort to find a potential alternative treatment for scrub typhus, we evaluated the effectiveness of the standard drug doxycycline and the new macrolide azithromycin against a doxycycline-susceptible strain (Karp) and a doxycycline-resistant strain (AFSC-4) of Rickettsia tsutsugamushi. The antibiotics were tested in an in vitro assay system in which infected mouse fibroblast cells (L929) were incubated for 3 days in various concentrations of the drugs. Rickettsial growth was evaluated by direct visual counts of rickettsiae in Giemsastained cells or by flow cytometry. Initial tests were conducted at the concentration of each antibiotic considered to be the upper breakpoint for susceptibility (16 micrograms/ml for doxycycline and 8 micrograms/ml for azithromycin). Growth of both Karp and AFSC-4 was strongly inhibited with both antibiotics, as measured by visual counts, although the percentage of cells infected with AFSC-4 in the presence of doxycycline was three times greater than the percentage of cells infected with Karp but was only 60% as great as the percentage of cells infected with Karp in the presence of azithromycin. Flow cytometry confirmed that rickettsial growth occurred in the absence of antibiotics, but it failed to detect it in the presence of high concentrations of either drug. Visual counts of rickettsial growth at lower concentrations of the antibiotics (0.25 to 0.0078 microgram/ml) showed that the Karp strain was 16 times more susceptible that the AFSC-4 strain to doxycycline. Azithromycin was much more effective than doxycycline against AFSC-4, inhibiting rickettsial growth at 0.0156 microgram/ml to levels below that achieved by 0.25 microgram of doxycycline per ml. Azithromycin was also more effective than doxycycline against the Karp strain, causing greater reductions in the number of rickettsiae per cell at lower concentrations. If in vivo testing confirms the in vitro effectiveness of azithromycin, it may prove to be the drug of choice for the treatment of scrub typhus in children and pregnant women, who should not take doxycycline, and in patients with refractory disease from locations where doxycycline-resistant strains of R. tsutsugamushi have been found. When tested in an in vitro assay system, azithromycin was more effective than doxycycline against doxycycline-susceptible and -resistant strains of R. tsutsugamushi.

Animals↗

PubMed1995

Rickettsia tsutsugamushi infection in cell culture: antibiotic susceptibility determined by flow cytometry.

Recent unpublished reports from northern Thailand of severe and sometimes fatal cases of scrub typhus, despite appropriate antibiotic therapy, suggest that resistance may occur. Current antibiotic susceptibility methods that use direct microscopic counts of Giemsa-stained cells or mouse protection assays are slow, labor-intensive, and expensive. We explored the use of flow cytometry to measure rickettsial infection in vitro in L-929 cells treated with and without doxycycline, ciprofloxacin, erythromycin, and chloramphenicol. It was possible to detect the rickettsiae down to a level of 83% of the cells infected, mean of 37 rickettsiae per cell, and 40% of cells with too many rickettsiae to count. This level of sensitivity was sufficient to determine the inhibitory effect of all four drugs at standard screening concentrations. At lower concentrations of doxycycline, flow cytometry detected inhibition of rickettsial growth at a concentration of 6.25 x 10(-2) micrograms/ml but not at 6.25 x 10(-3) micrograms/ml, suggesting that the minimum inhibitory concentration is somewhere between these two values. The data from this study show that flow cytometry permits the rapid screening of numerous rickettsial isolates for their susceptibility to a variety of antibiotics, but that visual counts of infected cells provide a more precise indication of rickettsial growth.

Animals↗

PubMed1995

Meteorological effects on the biting activity of Leptoconops americanus(Diptera: Ceratopogonidae).

Collections of biting Leptoconops americanus were made at half-hour intervals throughout the daylight hours on Stansbury Island, UT, during 9 days in May, 1993. The most favorable conditions for biting (> or = 90 bites on the ears in 15 min) included temperatures higher than 15 degrees C, minimum wind (< 5 kph), minimum cloud cover, maximum sun, and no rain. Temperatures below 10 degrees C or the presence of rain prevented almost all biting. Higher winds and cloudiness decreased biting activity, but did not eliminate it if other conditions were favorable. Although not statistically significant, there was some suggestion from the data that higher temperatures (> 25 degrees C) reduced biting. The flies did not appear to be more numerous at any particular part of the day; the biting rate simply followed meteorological conditions at the time. Ambient light varied between 1 and 10,000 foot candles during the study, with high biting rates (76 and 99 bites per 15 min) observed at levels as low as 80-100 foot candles.

Animals↗

PubMed1995

Effectiveness of a dot-blot immunoassay of anti-Rickettsia tsutsugamushi antibodies for serologic analysis of scrub typhus.

We compared a commercially available dot-blot immunoassay system with the indirect immunofluorescence assay (IFA) in tests of known negative and known positive sera from scrub typhus cases. Using a panel of 100 sera from patients with various rickettsial and nonrickettsial infections, we observed that the IFA was 99% specific and the dipstick assay was 98% specific. In tests of 91 sera (30 negative and 61 positive for scrub typhus antibodies) from a study of febrile patients in Malaysia, using the standard of an IFA titer < 1:64 as negative, an IFA titer > 1:128 as positive, and an IFA titer = 1:64 as either positive or negative (supported by clinical records), dipsticks were 83% specific and 90% sensitive. The quantitative correlation of the dipsticks to IFA titers was confirmed by significant differences in geometric means of inverse IFA titers corresponding to the number of positive dipstick spots (no dots = 8.5, one dot = 43.3, two dots = 206.7, and three dots = 676.9). The assay would enable physicians and public health workers who deal with patients to quickly diagnose and appropriately treat most cases of the disease, especially in areas of high prevalence where the proportion of false-positive results to true-positive results would be low.

Antibodies, Bacterial↗

PubMed1994

ELISA for detecting dengue and Japanese encephalitis viral antigen in mosquitoes.

An indirect ELISA has been developed for detecting two viruses in triturated, experimentally infected mosquitoes: dengue (DEN) in Aedes aegypti (L.) and Ae. albopictus (Skuse) and Japanese encephalitis (JE) viral antigen in Culex tritaeniorhynchus Giles. DEN antigen from four strains of the virus, representing each of the four serotypes, and JE antigen were captured with a polyclonal anti-flavivirus IgG and detected with a monoclonal antibody (4G2) that reacts with all flaviviruses. Minimum viral titres detectable by the flavivirus antigen-capture ELISA, measured as multiples of the dose infecting 50% of mosquitoes (MID50), were 10(6.4), 10(4.5), 10(6.3), 10(6.9) and < or = 10(6.9) MID50/ml for DEN 1, DEN 2, DEN 3, DEN 4 and JE, respectively. Pools of up to 100 larvae or adults of Ae. aegypti and Ae. albopictus did not reduce the sensitivity of the ELISA to DEN 1, 2, 3 or 4. The results indicate that the antigen-capture ELISA could readily screen for DEN antigen in individual and pooled mosquitoes.

Aedes↗

PubMed1994

Life-threatening scrub typhus in a traveler returning from Thailand.

Scrub typhus is not one of the more commonly encountered diseases in travelers returning from Asia, but it deserves more consideration in view of its severity and the availability of specific chemotherapy and chemoprophylaxis. We describe a case of scrub typhus that was associated with coma and multiorgan failure in a traveler returning to the United States from Thailand. The diagnosis was made only retrospectively despite a travel history and clinical signs that suggested infection with Rickettsia tsutsugamushi. No specific therapy was given, and marked neurological impairment persisted 6 months after the beginning of the illness. An increased awareness of scrub typhus is a prerequisite for recommending prophylaxis and instituting prompt therapy.

Coma↗

PubMed1994

Rickettsia tsutsugamushi in chiggers (Acari: Trombiculidae) associated with rodents in central Thailand.

Chiggers were collected from rodents trapped at two military bases located 10 km apart in central Thailand. One site was swampy and nearly treeless and the other site was well-drained and partially wooded. Although 13 species of chiggers were collected, only three species were found to be positive for Rickettsia tsutsugamushi (Hayashi) Ogata using a direct fluorescent antibody test: Blankaartia acuscutellaris Walch (7.3% infected), Leptotrombidium delinese Walch (3.1% infected), and an undescribed species of Ascoschoengastia near A. indica Hirst (1.2% infected). This was the first record of R. tsutsugamushi in B. acuscutellaris. The Ascoschoengastia species occurred with equal frequency at the two study sites, L. deliense occurred more frequently at the well-drained site, and B. acuscutellaris occurred more frequently at the swampy site. Results suggest that there are important foci of scrub typhus in central Thailand and that B. acuscutellaris may be a vector in this area.

Animals↗

PubMed1994

First cases of spotted fever group rickettsiosis in Thailand.

The first three cases of spotted fever group rickettsiosis from Thailand are reported. The patients presented with fever, headache, lymphadenopathy, and petechial maculopapular rash. One patient also had an eschar and overt evidence of confusion. An indirect fluorescent antibody test, an indirect immunoperoxidase test, and an enzyme-linked immunosorbent assay demonstrated a broad, strong reactions of the sera of the patients with spotted fever group rickettsia antigens of many species, but not with antigens of typhus or scrub typhus rickettsiae. All three patients responded to treatment with a single dose of doxycycline.

Adult↗

PubMed1994

Prevalence of antibodies to rickettsiae in the human population of suburban Bangkok.

Following a report of three cases of scrub typhus in suburban Bangkok, we performed a serosurvey in the patients' communities. Both IgG and IgM antibodies were measured in an indirect immunoperoxidase assay, using separate spots of antigen from Rickettsia tsutsugamushi (scrub typhus), R. typhi (murine typhus), and TT-118 spotted fever group rickettsiae. Of 215 people donating blood, antibody levels indicative of most recent exposure to R. tsutsugamushi were most prevalent (21%), followed by R. typhi (8%), and TT-118 (4%). Seroprevalence suggesting most recent exposure to R. tsutsugamushi varied by location (range 13-31%), gender (26% of females and 13% of males), age (61-80-year-old individuals were the highest, with a prevalence of 38%), and contact with orchards and orchid farms (29% of those with extensive contact, 38% of those with occasional contact, and 10% of those with no contact). These patterns indicated that exposure to R. tsutsugamushi was related to occupation and behavior, as has been observed in areas of rural transmission. Expansion of metropolitan Bangkok has created a situation in which people employed in agriculture live with people employed in the city. As a result, a serosurvey in suburban Bangkok reveals evidence of murine typhus, which is usually transmitted in urban areas, as well as scrub and tick typhus, which are usually transmitted in rural areas.

Adolescent↗

PubMed1994

Evaluation of permethrin-treated military uniforms for personal protection against malaria in northeastern Thailand.

A trial to compare the effect of military clothing treated by high-pressure spray with permethrin or placebo on the incidence of malaria in Royal Thai Army troops was conducted in northeastern Thailand. Bioassays of treated clothing using laboratory-reared Anopheles dirus females showed permethrin remained in the treated fabric for up to 90 days. Both permethrin- and placebo-treated uniform shirts provided > 84% protection from biting An. dirus in laboratory bioassays for the duration of the study. In laboratory tests, knockdown of An. dirus exposed to permethrin-treated cloth fell to < 20% after 3 hand washes, despite the presence of 28.7-59.9% of the original dose of permethrin. The use of permethrin-treated uniforms without adjunct application of topical repellents did not reduce malaria in Thai troops in an operational setting where incidence during 6 months was as high as 412 cases/1,000 in spite of chemoprophylaxis and use of untreated bednets.

Adult↗

PubMed1994

Pathology of Rickettsia tsutsugamushi infection in Bandicota savilei, a natural host in Thailand.

Following rodent surveys in a rice-growing area of central Thailand where we found Bandicota savilei, B. indica, and Rattus rattus infected with Rickettsia tsutsugamushi, we performed a study of pathogenesis of R. tsutsugamushi in laboratory-reared B. savilei. Eight animals were injected with saline and 19 animals were injected with 4.0 x 10(6) mouse 50% lethal dose units of a strain of R. tsutsugamushi isolated from a human in central Thailand. Animals were evaluated at intervals for IgG and IgM antibodies to R. tsutsugamushi by an indirect immunoperoxidase assay, the presence of the pathogen in liver and spleen by murine inoculation, and the pathology of representative tissues by gross and microscopic examination. The infected animals began to show internal evidence of mild illness 7-14 days after inoculation, and exhibited no changes in behavior. Total white blood cell counts decreased on day seven (including lymphocytes and polymorphonuclear leukocytes), followed by an almost equal increase on day 14. Gross pathology noted at necropsy was limited to slight liver and spleen enlargement accompanied by low numbers of abscesses and fibrinous tags present in the abdominal cavity. In addition to the gross morphologic changes, histopathologic lesions noted were all mild, consisting of vasculitis of the lung, activation of the mononuclear phagocyte system, abdominal mesothelial cell hyperplasia, and peritonitis. Rickettsiae were isolated from liver and spleen on days 0, 7, and 14, but not thereafter. Specific antibody response was first observed on day 14, peaked on day 21, and it decreased to levels observed in uninfected animals between days 120 and 180.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1993

Distribution of container-inhabiting Aedes larvae (Diptera: Culicidae) at a dengue focus in Thailand.

A Thai village with dengue transmission was surveyed for Aedes aegypti (L.) and Ae. albopictus (Skuse) larvae at the end of the rainy season. All containers (1,819) in 186 households were surveyed, recording the presence of larvae, container type, level of water, kind of cover, and location. The number of positive containers was proportional to the total number of containers in a household. Standard water jars (approximately 200 liters) contributed 57% and small water jars (< 100 liters) contributed 16% of the total infested containers. Each of the other 10 container types contributed < or = 10% of the total infested containers and were not statistically different from each other. Containers inside houses were infested significantly more often than were those outdoors, those under elevated houses or roofs, or those in bathrooms. Unexpectedly, standard water jars located outdoors that were covered with commercial metal lids were infested significantly more often than were uncovered jars.

Aedes↗

PubMed1993

Blood-feeding patterns of Aedes aegypti (Diptera: Culicidae) collected in a rural Thai village.

Aedes aegypti (L.) were collected by aspiration once each week from in and around houses in a rural village in Chachoengsao Province. Thailand, during May 1990 to June 1991. Of the 1,230 specimens analyzed with a sandwich ELISA, 73% reacted to one or more of the seven hosts which we tested. Eighty-eight percent (789/896) of all detectable meals were identified as being from a single host (human). Patent multiple meals (double and triple), of which one was always human, were detected in 7% (66/896) of the specimens. The probability of feeding on a human, either as a single host or in a patent mixed meal, was > 0.90 during 12 of the 14 mo of the study; this probability never dropped below 0.85. The probability of Ae. aegypti taking multiple blood meals during a single gonotrophic cycle varied widely from 0.0 to 1.0. The possibility is discussed, including epidemiological significance, that there are seasonal fluctuations in the frequency of multiple feeding by Ae. aegypti and that multiple feeding increases in concert with seasonal trends for dengue infections of humans in Thailand.

Aedes↗

PubMed1993

Laboratory demonstration of oviposition by Aedes aegypti (Diptera: Culicidae) in covered water jars.

In Thailand, ceramic jars (135-200 liters) covered by aluminum lids commonly are used to store water for household use. In laboratory cages, gravid female Aedes aegypti (L.) were able to enter and oviposit in a covered water jar. Although the aluminum lid was not a complete barrier to gravid females, it reduced the number of eggs oviposited by 77%. A vertically oriented foam rubber ring which was compressed between the lip of the jar and the flange of the lid effectively sealed the jar against ovipositing mosquitoes.

Aedes↗