An outbreak of scrub typhus in military personnel despite protocols for antibiotic prophylaxis: doxycycline resistance excluded by a quantitative PCR-based susceptibility assay

Scrub typhus is caused by the obligate intracellular bacterium Orientia tsutsugamushi and is endemic to many countries in the Asia–Pacific region, including tropical Australia. We describe a recent large outbreak amongst military personnel in north Queensland. A total of 45 clinical cases were ident...

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Bibliographic Details
Published in:Microbes and infection 2016-06, Vol.18 (6), p.406-411
Main Authors: Harris, Patrick N.A., Oltvolgyi, Csongor, Islam, Aminul, Hussain-Yusuf, Hazizul, Loewenthal, Mark R., Vincent, Gemma, Stenos, John, Graves, Stephen
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis - methods
Disease Outbreaks
Doxycycline
Doxycycline - pharmacology
Doxycycline - therapeutic use
Guideline Adherence
Humans
Microbial sensitivity testing
Microbial Sensitivity Tests
Military Personnel
Orientia tsutsugamushi
Orientia tsutsugamushi - drug effects
Orientia tsutsugamushi - isolation & purification
Queensland - epidemiology
Real-Time Polymerase Chain Reaction
Scrub typhus
Scrub Typhus - epidemiology
Scrub Typhus - prevention & control
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Summary:Scrub typhus is caused by the obligate intracellular bacterium Orientia tsutsugamushi and is endemic to many countries in the Asia–Pacific region, including tropical Australia. We describe a recent large outbreak amongst military personnel in north Queensland. A total of 45 clinical cases were identified (36% of all potentially exposed individuals). This occurred despite existing military protocols stipulating the provision of doxycycline prophylaxis. Doxycycline resistance in O. tsutsugamushi has been described in South-East Asia, but not Australia. In one case, O. tsutsugamushi was cultured from eschar tissue and blood. Using quantitative real-time PCR to determine susceptibility to doxycycline for the outbreak strain, a minimum inhibitory concentration (MIC) of ≤0.04 μg/mL was found, indicating susceptibility to this agent. It seems most probable that failure to adhere to adequate prophylaxis over the duration of the military exercise accounted for the large number of cases encountered rather than doxycycline resistance.
ISSN:1286-4579
1769-714X
DOI:10.1016/j.micinf.2016.03.006