Revisiting the Overlooked Infection: Rickettsioses

Authors

  • Khie Chen Lie 1. Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 2. Member of Antimicrobial Stewardship Committee, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Erni Juwita Nelwan 1. Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 2. Member of Antimicrobial Stewardship Committee, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Adeline Pasaribu Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Sharifah Shakinah Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Robert Sinto 1. Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 2. Member of Antimicrobial Stewardship Committee, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Leonard Nainggolan 1. Division of Tropical and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 2. Member of Antimicrobial Stewardship Committee, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Keywords:

internal medicine, tropical disease, infection, rickettsioses

Abstract

The prevalence of human Rickettsioses cases in Indonesia is unknown and could probably be underestimated. The high prevalence of seropositive Rickettsia sp. was reported in small mammals (as vectors) and humans. In Indonesia, a recent study in patients with acute fever revealed that the prevalence of Rickettsioses is 10%. Many cases of Rickettsioses were often misdiagnosed with dengue fever, enteric fever, or leptospirosis due to their overlapping clinical manifestation. The limitation of point of care testing in Indonesia hindered the adequacy of diagnosis confirmation. Appropriate empirical or definitive treatment with macrolide, mainly doxycycline, is preferable compared to other broad-spectrum antibiotics, such as cephalosporin or quinolones. Moreover, when left untreated, Rickettsioses may deteriorate progressively to fatal outcomes, such as meningitis, sepsis, and even death. The awareness of health care practitioners, the availability of confirmatory rapid diagnostic tests and adequate treatment choices are important in eradicating this disease.

References

Raoult D. Introduction to Rickettsioses, Ehrlichioses, and Anaplasmoses. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 9th ed. Philadelphia: Elsevier, Inc; 2020. p. 2344–8.

Walker D, Dumler J, Blanton L, et al. Rickettsial diseases. In: Jameson JL, Kasper DL, Longo DL, Fauci AS, Hauser SL, Loscalzo J, editors. Harrison’s principles of internal medicine. 20th ed. Philadelphia: McGraw Hill Education; 2018. p. 1303–5.

Raoult D, Roux V. Rickettsioses as paradigms of new or emerging infectious diseases. Clin Microbiol Rev. 1997;10(4):694–719.

Portillo A, De Sousa R, Santibáñez S, et al. Guidelines for the detection of Rickettsia spp. Vector-Borne Zoonotic Dis. 2017;17(1):23–32.

Lokida D, Hadi U, Lau CY, et al. Underdiagnoses of Rickettsia in patients hospitalized with acute fever in Indonesia: Observational study results. BMC Infect Dis. 2020;20(1):1–12.

Gasem MH, Kosasih H, Tjitra E, et al. An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia. PLoS Negl Trop Dis. 2020;14(1):1–17. Available from: http://dx.doi.org/10.1371/journal.pntd.0007927

Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis - United States a practical guide for health care and public health professionals. MMWR Recomm Reports. 2016;65(2):1–44.

Paris DH, Kelly DJ, Fuerst PA, et al. A brief history of the major Rickettsioses in the Asia–Australia–Pacific region: A capstone review for the special issue of TMID. Trop Med Infect Dis. 2020;5(4):165.

Quintal D. Historical aspects of the rickettsioses. Clin Dermatol. 1996;14(3):237–42.

Richards AL, Rahardjo E, Soeatmadji DW, et al. Rickettsial diseases: Risk for Indonesia. Bul Penelit Kesehat. 1995;23(3 Sept).

Nicholson WL, Paddock CD. Rickettsial diseases (including spotted fever & typhus fever Rickettsioses, scrub Typhus, Anaplasmosis, and Ehrlichioses) [Internet]. 2019 [cited 2021 Nov 17]. Available from: https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/rickettsial-including-spotted-fever-and-typhus-fever-rickettsioses-scrub-typhus-anaplasmosis-and-ehr

Richards AL, Soeatmadji DW, Widodo MA, et al. Seroepidemiologic Evidence for murine and scrub typhus in Malang, Indonesia. Am J Trop Med Hyg. 1997;57(1):91–5. Available from: https://www.ajtmh.org/view/journals/tpmd/57/1/article-p91.xml

Richards AL, Ratiwayanto S, Rahardjo E, et al. Serologic evidence of infection with ehrlichiae and spotted fever group rickettsiae among residents of Gag Island, Indonesia. Am J Trop Med Hyg. 2003;68(4):480–4.

Barbara KA, Farzeli A, Ibrahim IN, et al. Rickettsial infections of fleas collected from small mammals on four Islands in Indonesia. J Med Entomol. 2010;47(6):1173–8.

Takeshita N, Imoto K, Ando S, et al. Murine typhus in two travelers returning from Bali, Indonesia: An underdiagnosed disease. J Travel Med. 2010;17(5):356–8.

Stockdale AJ, Weekes MP, Kiely B, at al. Case report: Severe typhus group rickettsiosis complicated by pulmonary edema in a returning traveler from Indonesia. Am J Trop Med Hyg. 2011;85(6):1121–3.

Widjaja S, Williams M, Winoto I, et al. Geographical assessment of Rickettsioses in Indonesia. Vector-Borne Zoonotic Dis. 2016;16(1):20–5.

Chrispal A, Boorugu H, Gopinath KG, et al. Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Trop Doct. 2010;40:129–33.

Biswal M, Krishnamoorthi S, Bisht K, et al. Rickettsial diseases: Not uncommon causes of acute febrile illness in India. Trop Med Infect Dis. 2020;5(2).

Wangdi K, Kasturiaratchi K, Nery SV, et al. Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in south and Southeast Asia: A systematic review. BMC Infect Dis. 2019;19(1):1–17.

Tam PYI, Obaro SK, Storch G. Challenges in the etiology and diagnosis of acute febrile illness in children in low- and middle- income countries. J Pediatric Infect Dis Soc. 2016;5(2):190–205.

Sudarmono P, Aman AT, Arif M, et al. Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study. Lancet Glob Heal. 2017;5(2):e157–67.

Suttinont C, Losuwanaluk K, Niwatayakul K, et al. Causes of acute, undifferentiated, febrile illness in rural Thailand: Results of a prospective observational study. Ann Trop Med Parasitol. 2006;100(4):363–70.

Phongmany S, Rolain JM, Phetsouvanh R, et al. Rickettsial infections and fever, Vientiane, Laos. Emerg Infect Dis. 2006;12(2):256–62.

Gordon Smith CE, Van Peenen PFD, Koesharjono C, et al. Antibodies against murine typhus in sera from Indonesians. Trans R Soc Trop Med Hyg. 1977;71(4):297–9. Available from: https://doi.org/10.1016/0035-9203(77)90103-1

Dennis DT, Hadi TR, Brown RJ, et al. A survey of scrub and murine typhus in the Ancol section of Jakarta, Indonesia. Southeast Asian J Trop Med Public Health. 1981;12(4):574–80.

Suputtamongkol Y, Suttinont C, Niwatayakul K, et al. Epidemiology and clinical aspects of rickettsioses in Thailand. Ann N Y Acad Sci. 2009;1166:172–9.

Stewart AGA, Smith S, Binotto E, et al. The epidemiology and clinical features of rickettsial diseases in North Queensland, Australia: Implications for patient identification and management. PLoS Negl Trop Dis. 2019;13(7).

Mawuntu AHP, Johar E, Anggraeni R, et al. Rickettsia felis identified in two fatal cases of acute meningoencephalitis. PLoS Negl Trop Dis. 2020;14(2):1–10. Available from: http://dx.doi.org/10.1371/journal.pntd.0007893

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Published

2023-01-10

How to Cite

Lie, K. C., Nelwan, E. J., Pasaribu, A., Shakinah, S., Sinto, R., & Nainggolan, L. (2023). Revisiting the Overlooked Infection: Rickettsioses. Acta Medica Indonesiana, 54(4), 647. Retrieved from https://www.actamedindones.org/index.php/ijim/article/view/2068

Issue

Vol. 54 No. 4 (2022): Acta Medica Indonesiana

Section

SPECIAL ARTICLE

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