{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:21:15Z","timestamp":1791573675202,"version":"4.3.4"},"reference-count":27,"publisher":"American Society for Microbiology","issue":"2","license":[{"start":{"date-parts":[[2009,2,1]],"date-time":"2009-02-01T00:00:00Z","timestamp":1233446400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2009,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                    , the cause of scrub typhus, is a major pathogen in the Asia-Pacific region. The severity of infection ranges from mild features to multiorgan failure and death. The aim of this prospective study was to define the\n                    <jats:italic>O. tsutsugamushi<\/jats:italic>\n                    loads in the blood samples of patients with scrub typhus on the day of hospital admission and to determine whether this was associated with disease severity. Quantitation was performed using a real-time PCR assay targeting the 16S rRNA gene of\n                    <jats:italic>O. tsutsugamushi<\/jats:italic>\n                    . A total of 155 patients with a confirmed diagnosis of scrub typhus had a median (interquartile range [IQR], range)\n                    <jats:italic>O. tsutsugamushi<\/jats:italic>\n                    DNA load in blood of 13 (0 to 334, 0 to 310,253) copies\/ml. This included 74 patients who had undetectable bacterial loads. An analysis of bacterial load versus clinical features for all 155 patents demonstrated that duration of illness (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.001), presence of eschar (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.004), and concentrations of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.001 for all three) were positively correlated with bacterial load. Patients who died had a significantly higher bacterial load than those who survived (mean [standard deviation] values: 17,154 [12.7] versus 281 [5.2] copies\/ml;\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.001). This study has demonstrated a relationship between bacterial load and disease severity in adults with scrub typhus.\n                  <\/jats:p>","DOI":"10.1128\/jcm.01927-08","type":"journal-article","created":{"date-parts":[[2008,12,17]],"date-time":"2008-12-17T20:45:28Z","timestamp":1229546728000},"page":"430-434","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":109,"title":["Association of High\n                    <i>Orientia tsutsugamushi<\/i>\n                    DNA Loads with Disease of Greater Severity in Adults with Scrub Typhus"],"prefix":"10.1128","volume":"47","author":[{"given":"Piengchan","family":"Sonthayanon","sequence":"first","affiliation":[{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wirongrong","family":"Chierakul","sequence":"additional","affiliation":[{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanaporn","family":"Wuthiekanun","sequence":"additional","affiliation":[{"name":"Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kriangsak","family":"Phimda","sequence":"additional","affiliation":[{"name":"Medical Department, Udon Thani Regional Hospital, Udon Thani, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasithon","family":"Pukrittayakamee","sequence":"additional","affiliation":[{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas P.","family":"Day","sequence":"additional","affiliation":[{"name":"Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon J.","family":"Peacock","sequence":"additional","affiliation":[{"name":"Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","first-page":"845","volume":"35","year":"2004","unstructured":"Aung, T., W. 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Hyg."},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.inf.0000260253.22994.61"},{"key":"e_1_3_2_7_2","first-page":"2366","volume":"90","year":"2007","unstructured":"Chanta, C., K. Triratanapa, P. Ratanasirichup, and W. Mahaprom. 2007. Hepatic dysfunction in pediatric scrub typhus: role of liver function test in diagnosis and marker of disease severity. J. Med. Assoc. Thai.90:2366-2369.","journal-title":"J. Med. Assoc. Thai."},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1665-2681(19)31998-2"},{"key":"e_1_3_2_9_2","first-page":"44","volume":"86","year":"2002","unstructured":"Hackett, S. J., M. Guiver, J. Marsh, J. A. Sills, A. P. J. Thomson, E. B. Kaczmarski, and C. A. Hart. 2002. Meningococcal bacterial DNA load at presentation correlates with disease severity. Arch. Dis. Child.86:44-46.","journal-title":"Arch. Dis. Child."},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2005.73.667"},{"key":"e_1_3_2_11_2","first-page":"1","year":"1995","unstructured":"Kawamura, A., Jr. 1995. Tsutsugamushi disease: an overview, p. 1-34. In A. Kawamura, Jr., H. Tanaka, and A. Tamura (ed.), Tsutsugamushi disease. 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