Two of the fatal cases involved delayed
antirickettsial therapy after the patients were misdiagnosed with group A streptococcus.
Interferon-y and rickettsia-induced killing of macrophage-like cells is inhibited by
antirickettsial antibodies and does not require the respiratory burst.
All patients with clinically suspected scrub typhus received
antirickettsial drugs (doxycycline and/ or azithromycin) empirically.
The use of mosquito inoculation system for testing the efficacy of
antirickettsial drugs.
In addition, rickettsial bacteria, whereas susceptible to OTC, often require higher therapeutic doses of OTC than other
antirickettsial compounds (Coetzee et al.
"Children generally improve markedly after starting
antirickettsial therapy--as demonstrated by, on average, defervescence within 2 days and hospital discharge within 5 days.
Before the discovery of effective
antirickettsial drugs, 13% of children with RMSF died [3].
Detection of growing rickettsiae was monitored by using Gimenez staining and an immunofluorescence assay of cells collected after centrifuging the medium and staining with rabbit
antirickettsial hyperimmunserum and Alexa Fluor 488 goat antirabbit immunoglobulin (Ig) G (H+L) conjugate (Invitrogen, Carlsbad, CA, USA) as secondary antibody (Figure).
The GeoSentinel questionnaire does not contain queries about case management, but in December 2008 all sites were requested to estimate the percentage of their patients with rickettsial diseases who received treatment with
antirickettsial drugs (e.g., doxycycline) during the study period.
Antirickettsial antimicrobial agents were not given at any stage during the illness.