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4. * Orientia tsutsugamushi Kingdom BacteriaPhylum Proteobacteria Class Alpha Proteobacteria Order Rickettsiales Family Rickettsiaceae Genus Orientia Species O. tsutsugamushi Obligately intracellular parasite Obligately intracellular parasite Gram negative Gram negative Coccobacillus Coccobacillus 0.5-0.7 μ m × 1.2-2.5 μ m 0.5-0.7 μ m × 1.2-2.5 μ m Lack of peptidoglycan & Lack of peptidoglycan & lipopolysaccharide lipopolysaccharide No Flagella, Endospores, slime No Flagella, Endospores, slime layer layer Giemsa stain Giemsa stain Table 1. Scientific classification of O. tsutsugamushi. Date source; Wikipedia Figure 1. Giemsa stain of O. tsutsugamushi. Date source; Tamura A, Ohashi N, Urakami H, Miyamura S(1995) Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen nov, as Orientia tsutsugamushi comb. nov. Int J Syst Bacteriol 45: 589-591.

5. Phylogenetic tree showing the phylogenetic position of O.tsutsugamushi based on sequence comparison of the citrate synthase- encoding gene. Date source; Tamura A, Ohashi N, Urakami H, Miyamura S(1995) Classification of Rickettsia tsutsugamushi in a new genus, Orientia gen nov, as Orientia tsutsugamushi comb. nov. Int J Syst Bacteriol 45: 589-591

6. * Figure 2. Leptotrombidium sp., vector of O. tsutsugamushi. Data source; www.lookfordiagnosis.com Kingdom AnimaliaPhylum Arthropoda Class Arachnida Order Trombidiformes Family Trombiculidae Genus Leptotrombidium Table 2. Scientific classification of Leptotrombidium sp. Data source; Wikipedia Figure 3. The route of infection. Data source; www.lookfordiagnosis.com

7. * The bite of larval trombiculid mites (chiggers). The bite of larval trombiculid mites (chiggers). Chiggers attach, take a blood meal over several hours, and then detach, often leaving a pruritic rash. Chiggers attach, take a blood meal over several hours, and then detach, often leaving a pruritic rash. Incubation Period: Usually 10-12 days; abrupt onset of illness Incubation Period: Usually 10-12 days; abrupt onset of illness 6-21 days after infected larval mite bite.

8. Figure 4. Geographic distribution of scrub typhus. Data source; www.lookfordiagnosis.com * Figure 5. Occurrence state of scrub typhus in S. Korea. 2010-2011. Data source; www.kostat.go.kr

9. * 1. High fever, headache, sweats during a week 1. High fever, headache, sweats during a week Cough, myalgia, conjunctival injection Cough, myalgia, conjunctival injection Figure 6. Conjunctival injection. Data source; http://blog.naver.com/ kkwife?Redirect=Log&logNo=137336721

10. * 2. In 3-7days, a transient (few days) pale macular 2. In 3-7days, a transient (few days) pale macular to maculopapular rash may be observed, most prominent on the trunk and spreading to the extremities. Figure 7. Maculopapular rash. Data source; http://blog.naver.com/ kkwife?Redirect=Log&logNo=137336721

11. * 3. Eschar develops at the site of mite bite and lymphadenopathy in nodes draining area may be prominent. The recognition of cutaneous findings varies greatly. 5-10mm. 3. Eschar develops at the site of mite bite and lymphadenopathy in nodes draining area may be prominent. The recognition of cutaneous findings varies greatly. 5-10mm. Figure 8. The eschar (the site of mite bite) in Tsutsugamushi disease (scrub typhus). Data source; http://www.yamagiku.co.jp/pathology/case/case168.htm

12. * Figure 9. Sites that manifest an eschar in scrub typhus patients. Abbreviations : a, male front; b, male back; c, female front; d, female back. Date source; Kim DM, Won KJ, Park CY, Yu KD, Kim HS, Yang TY, Lee JH, Kim HK, Song HJ, Lee SH, and Shin H. Distribution of eschars on the body of scrub typhus patients : A prospective study. Am J Trop Med Hyg 76(5):806-9, 2007.

13. * 4. In severely ill patients, serious complications such as interstitial pneumonia, acute renal failure, meningoencephalitis, gastrointestinal bleeding, and multiple organ failure may develop when diagnosis is delayed and can even lead to death. 4. In severely ill patients, serious complications such as interstitial pneumonia, acute renal failure, meningoencephalitis, gastrointestinal bleeding, and multiple organ failure may develop when diagnosis is delayed and can even lead to death. * The microbes are released from the host cells by being covered with the host cell membrane, like the budding form of enveloped viruses. → Vasculitis → Serious complications The microbes are released from the host cells by being covered with the host cell membrane, like the budding form of enveloped viruses. → Vasculitis → Serious complications

14. * 1. Skin rash, eschar 1. Skin rash, eschar 2. Serological test 2. Serological test 3. Isolation of bacteria 3. Isolation of bacteria 4. PCR 4. PCR 5. Biopsy 5. Biopsy Figure 10. Furuya Y, Yoshida Y, Katayama T, Kawamori F, Yamamoto S,Ohashi N, Tamura A, Kawamura A, Jr. (1991) Specific amplification of Rickettsia tsutsugamushi DNA from clinical specimens by polymerase chain reaction. J Clin Microbiol 29:2628-2630.

15. * No vaccine No vaccine Doxycycline (200 mg/d in adults, 3 to 7 days) Doxycycline (200 mg/d in adults, 3 to 7 days) Tetracycline, Chloramphenicol Tetracycline, Chloramphenicol Pregnant women – Rifampin (600-900 mg/d) or Azithromycin (500 mg/d, first day, then 250 mg/d) Pregnant women – Rifampin (600-900 mg/d) or Azithromycin (500 mg/d, first day, then 250 mg/d)

16. * 1. Avoid going to such places like farms, areas abundant of bushes, rodents and domestic animals. 1. Avoid going to such places like farms, areas abundant of bushes, rodents and domestic animals. 2. To eliminate the source of infection is mainly rodent & cut off the route of transmission to eradicate weeds. 2. To eliminate the source of infection is mainly rodent & cut off the route of transmission to eradicate weeds. 3. Personal protective avoid sitting or lying in the stream on the grass, drying clothes on a weed shrub. 3. Personal protective avoid sitting or lying in the stream on the grass, drying clothes on a weed shrub. 4. Wear long sleeves and pants or use muff when doing farm work. 4. Wear long sleeves and pants or use muff when doing farm work. 5. Use repellent when you go to farm. 5. Use repellent when you go to farm. 6. When back to home, bath promptly and wash clothes. 6. When back to home, bath promptly and wash clothes.

17. * 1. Hyo-Soon Park1, Jung-Hee Lee1, Kwang-Hoon Jin1, Won-Jong Jang1, Kyung-Hee Park1, Yoon- Hoh Kook2 and Seung-Hyun Lee1:Rapid Identification of Rickettsiae using the Real-Time PCR. Journal of Bacteriology and Virology 2008. Vol. 38, No. 4 p.221 – 226 1. Hyo-Soon Park1, Jung-Hee Lee1, Kwang-Hoon Jin1, Won-Jong Jang1, Kyung-Hee Park1, Yoon- Hoh Kook2 and Seung-Hyun Lee1:Rapid Identification of Rickettsiae using the Real-Time PCR. Journal of Bacteriology and Virology 2008. Vol. 38, No. 4 p.221 – 226 2. Dong-Min Kim, M.D.: Clinical Features and Diagnosis of Scrub Typhus. DOI : 10.3947/ic.2009.41.6.315 2. Dong-Min Kim, M.D.: Clinical Features and Diagnosis of Scrub Typhus. DOI : 10.3947/ic.2009.41.6.315 3. Akira tamura, Norio ohashi, Hiroshi urakami, and Sadao miyamura: Classification of Rickettsia tsutsugamushi in New Genus, Orientia gen. nov., as Orientia tsutsugamushi comb. Nov. International Journal of Systematic Bacteriology, July 1995, p. 589-591. Vol. 45, No.3 3. Akira tamura, Norio ohashi, Hiroshi urakami, and Sadao miyamura: Classification of Rickettsia tsutsugamushi in New Genus, Orientia gen. nov., as Orientia tsutsugamushi comb. Nov. International Journal of Systematic Bacteriology, July 1995, p. 589-591. Vol. 45, No.3 4. Orientia tsutsugamushi.178S TRANSFUSION Volume 49, August 2009 Supplement 4. Orientia tsutsugamushi.178S TRANSFUSION Volume 49, August 2009 Supplement 5. Scrub Typhus: Prevention and Control. From the Deptt. of Community Medicine LLRM Medical College, Meerut,UP 250004 IndiaCorrespondence to : Dr. Ritesh Sharma, Resident, Deptt. of Community Medicine LLRM Medical College, Meerut,UP 250004-India. Vol. 12 No. 2, April-June 2010 5. Scrub Typhus: Prevention and Control. From the Deptt. of Community Medicine LLRM Medical College, Meerut,UP 250004 IndiaCorrespondence to : Dr. Ritesh Sharma, Resident, Deptt. of Community Medicine LLRM Medical College, Meerut,UP 250004-India. Vol. 12 No. 2, April-June 2010 6. Chan-KiMin,1 Jae-Seong Yang,2 Sanguk Kim,2 Myung-Sik Choi,1 6. Chan-KiMin,1 Jae-Seong Yang,2 Sanguk Kim,2 Myung-Sik Choi,1 Ik-Sang Kim,1 and Nam-Hyuk Cho1: Genome-Based Construction of theMetabolic Pathways of Orientia tsutsugamushi and Comparative Analysis within the Rickettsiales Order. Hindawi Publishing Corporation. Comparative and Functional Genomics Volume 2008, Article ID 623145, 14 pages doi:10.1155/2008/623145 7. www.wikipedia.org 7. www.wikipedia.org 8. www.lookfordiagnosis.com 8. www.lookfordiagnosis.com 9. www.kostat.go.kr 9. www.kostat.go.kr 10. http://blog.naver.com/kkwife?Redirect=Log&logNo=137336721 10. http://blog.naver.com/kkwife?Redirect=Log&logNo=137336721 11. http://www.yamagiku.co.jp/pathology/case/case168.htm 11. http://www.yamagiku.co.jp/pathology/case/case168.htm 12. http://www.keephealthy24.com/%ef%bb%bfhow-to-prevent-scrub-typhus/ 12. http://www.keephealthy24.com/%ef%bb%bfhow-to-prevent-scrub-typhus/ 13. http://blog.daum.net/luck5194/6050955 13. http://blog.daum.net/luck5194/6050955

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