Key words : Tsutsugamushi disease, Rickettsia tsutsugamushi, serotype

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1 Key words : Tsutsugamushi disease, Rickettsia tsutsugamushi, serotype

2 Table 1 Characteristics of 44 patients with tsutsugamushi disease according to serotype of in- fected R. tsutsugarnushi

3 Table 2 Laboratory test results according to serotype of infected R. tsutsugamushi

4 Fig. 1 Correlation between platelet count and erythrocyte sedimentation rate. Samples from both serotypes were examined. (Number of samples was 25). Fig. 2 Correlation between GPT values and day of illness in the acute stage (closed circle with a regression line), added with values after minocycline treatment (plus sign, no regression line). Panel A is for the Irie-type, panel B is for the Hirano-type. Three patients in the Irie-type lack the data after minocycline treatment and one in the Hirano-type. A B

7 9) Kawamori F, Akiyama M, Sugieda Two-step polymerase chain reaction M et al. : for diagnosis of scrub typhus and identification of antigenic veriants of Rickettsia tsutsugamushi. J Vet Med Sci 1993 ; 55 : ) Horinouchi H, Murai K, Okayama A, Nagatomo Y, Tachibana N, Tsubouchi H : Genotypic identification of Rickettsia tsutsugamushi by restriction fragment length polymorphism analysis of DNA amplified by the polymerase chain reaction. Am J Trop Med Hyg 1996 ; 54 : ) Furuya Y, Yoshida Y, Katayama T, Yamamoto S, Kawamura A Jr : Serotypespecific amplification of Rickettsia tsutsugamu- 2) Kawamura A Jr : Antigenic variants of Rickettsia tsutsugamushi. Clinical Aspects. Path- J Clin Microbiol 1993 ; 31 : shi DNA by nested polymerase chain reaction. ogenicity. In: Kawamura A Jr, Tanaka H, Tamura A, ed. Tsutsugamushi disease. Tokyo University Press, Tokyo, 1995 ; 65, 94-95, ) Walker DH, Mattern WD: Rickettsial Vasculitis. Amer Heart J 1980 ; 100: ) American College of Chest Physitians/Society of Critical Care Medicine Consensus Confer- Committee : Definition for sepsis and ence organ failure and guide lines for the use of innovative therapies in sepsis. Crit Care Med 1992 ; 20 : ) Kobayashi Y, Tachibana N, Matsumoto I, Koyama T : Isolation of very low virulence strain of Rickettsia tsutsugamushi by the use of 19) Osterman JV : Rickettsiae and Hosts. Acta cyclophosphamide-treated mice. In : Kazar J, Virol 1985 ; 29 : ed. Proceedings of the 2nd international symposium on rickettsia and rickettsial diseases. Diversity of immuno-dominant 56-kDa type- 20) Ohashi N, Nashimoto H, Ikeda H, Tamura A : Bratislava, 1976 ; specific antigen(tsa) of Rickettsia tsutsugamushi. J Biol Chem 1992 ; 267:

8 Analysis of Clinical Severity of Tsutsugamushi Disease According to the Serotype of Pathogenic Rickettsia We compared the severity of clinical symptoms and laboratory test results of tsutsugamushi disease patients in Oita Prefecture according to the serotype of infected R. tsutsugamushi. Of the 45 patients, except one with the Karp-type, who were suffering in Oita Prefecture between 1992 and 1994, 20 were the Irie-type and 24 were the Hirano-type. There was no apparent difference with regard to clinical symptoms between the two groups of patients. Laboratory tests showed that CRP increased almost equally in the two groups. The ESR level was slightly higher in the Irie-type patients than in the Hirano-type, but did not differ significantly between the two groups. Both leukocyte count in the acute stage and platelet count decreased in the Hirano-type, as compared with those of normal ranges in the Irie-type. GPT values elevated in proportion to the day of illness in the acute stage. This trend continued after the initiation of specific chemotherapy in the Hirano-type. The median GOT, GPT and LDH values were 71, 65 and 709 IU/ l for the patients in the Hirano-type, as compared with 37, 36.5 and for the patients in the Irie-type, respectively. Above results show that the Hirano-type rickettsiae produces a more severe illness than the Irie-type ricketsia. Platelet count had a significant correlation with ESR, suggesting the pathophysiologic changes leading to disseminated intravascular coagulation, a symptom of severe tsutsugamushi disease. There may be common causes in leukopenia and thrombopenia, as being suggested by the significant correlation between leukocyte count and platelet count.

Key words: Antibodies to Leptospira, Tokyo, Uveitis

Key words: Antibodies to Leptospira, Tokyo, Uveitis Fig. 1 Distribution of Antibody Titers in Age Decade Fig. 3 Distribution of Antibody Titers in each Strain Fig. 2 Correlation between Antibody Titers