{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T19:15:05Z","timestamp":1785870905582,"version":"3.56.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T00:00:00Z","timestamp":1690243200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001843","name":"Science and Engineering Research Board","doi-asserted-by":"crossref","award":["CRG\/2020\/001471"],"award-info":[{"award-number":["CRG\/2020\/001471"]}],"id":[{"id":"10.13039\/501100001843","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Scrub typhus is a vector borne disease which in a proportion of patients causes multiorgan involvement and death if untreated. Infecting genotype and virulence factors play a role in severity of infection and outcome. The current prospective cohort study was undertaken to elucidate the severity of illness in scrub typhus patients and to identify the circulating genotypes in Karnataka, India. A total of 214 patients of either gender from 9 districts of Karnataka and one patient each from Andhra Pradesh and Kerala, India were enrolled in the study. With a predefined severity criterion, 132 patients were segregated to the severe group. Multi organ involvement was seen in 59 (44.69%) patients. Phylogenetic analysis revealed JG-v like (48.97%), Karp-like (26.53%), JG-like (22.44%), and Kato-like (2.04%) strains in Karnataka. Patients infected with<jats:italic>Orientia tsutsugamushi<\/jats:italic>Karp-like strains had respiratory involvement (69.2%), cardiovascular involvement (46.2%) and thrombocytopenia (23.1%) and required higher hospital resource utilization.<\/jats:p>","DOI":"10.1371\/journal.pone.0289126","type":"journal-article","created":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T17:36:15Z","timestamp":1690306575000},"page":"e0289126","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Clinical, laboratory, and molecular epidemiology of Orientia tsutsugamushi infection from Southwestern India"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5823-7252","authenticated-orcid":true,"given":"Kiran","family":"Chunduru","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9488-6054","authenticated-orcid":true,"given":"Manoj","family":"A. R.","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhadra","family":"Poornima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9040-5252","authenticated-orcid":true,"given":"Manjunatha","family":"Hande H.","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mridula","family":"M","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4040-5649","authenticated-orcid":true,"given":"George M.","family":"Varghese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramakrishna","family":"Devaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6399-1129","authenticated-orcid":true,"given":"Kavitha","family":"Saravu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,7,25]]},"reference":[{"key":"pone.0289126.ref001","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1258\/td.2010.090452","article-title":"Scrub typhus: an unrecognized threat in South India\u2013clinical profile and predictors of mortality.","volume":"40","author":"A Chrispal","year":"2010","journal-title":"Trop Doct."},{"key":"pone.0289126.ref002","doi-asserted-by":"crossref","first-page":"417","DOI":"10.4103\/0971-5916.159279","article-title":"DHR-ICMR Guidelines for diagnosis & management of Rickettsial diseases in India","volume":"141","author":"M Rahi","year":"2015","journal-title":"Indian J Med Res"},{"key":"pone.0289126.ref003","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1038\/modpathol.3880385","article-title":"Identification of the Target Cells of Orientia tsutsugamushi in Human Cases of Scrub Typhus.","volume":"14","author":"CG Moron","year":"2001","journal-title":"Mod Pathol."},{"key":"pone.0289126.ref004","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1186\/s13256-019-2299-x","article-title":"Scrub typhus with multi-organ dysfunction syndrome and immune thrombocytopenia: a case report and review of the literature.","volume":"13","author":"W Li","year":"2019","journal-title":"J Med Case Reports"},{"key":"pone.0289126.ref005","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ijid.2014.02.009","article-title":"Clinical profile and improving mortality trend of scrub typhus in South India.","volume":"23","author":"GM Varghese","year":"2014","journal-title":"Int J Infect Dis"},{"key":"pone.0289126.ref006","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3390\/tropicalmed3010011","article-title":"Scrub Typhus: No Longer Restricted to the Tsutsugamushi Triangle","volume":"3","author":"J Jiang","year":"2018","journal-title":"Trop Med Infect Dis"},{"key":"pone.0289126.ref007","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3201\/eid2101.140580","article-title":"Molecular epidemiology and genetic diversity of Orientia tsutsugamushi from patients with scrub typhus in 3 regions of India","volume":"21","author":"GM Varghese","year":"2015","journal-title":"Emerg Infect Dis"},{"key":"pone.0289126.ref008","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.3346\/jkms.2016.31.8.1190","article-title":"Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance.","volume":"31","author":"Y-J Kim","year":"2016","journal-title":"J Korean Med Sci."},{"key":"pone.0289126.ref009","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1111\/tmi.13322","article-title":"Antibody response following scrub typhus infection: clinical cohort study","volume":"24","author":"W-P Schmidt","year":"2019","journal-title":"Trop Med Int Health TM IH"},{"key":"pone.0289126.ref010","doi-asserted-by":"crossref","first-page":"S203","DOI":"10.1086\/596576","article-title":"Scrub Typhus: The Geographic Distribution of Phenotypic and Genotypic Variants of Orientia tsutsugamushi","volume":"48","author":"DJ Kelly","year":"2009","journal-title":"Clin Infect Dis"},{"key":"pone.0289126.ref011","doi-asserted-by":"crossref","first-page":"185","DOI":"10.4103\/0972-9062.184858","article-title":"Molecular confirmation of scrub typhus infection and characterization of Orientia tsutsugamushi genotype from Karnataka, India.","volume":"53","author":"M Koraluru","year":"2016","journal-title":"J Vector Borne Dis"},{"key":"pone.0289126.ref012","doi-asserted-by":"crossref","first-page":"e0006346","DOI":"10.1371\/journal.pntd.0006346","article-title":"Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India.","volume":"12","author":"P Jain","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0289126.ref013","doi-asserted-by":"crossref","first-page":"438","DOI":"10.4103\/ijmm.IJMM_19_267","article-title":"Phylogenetic diversity of Orientia tsutsugamushi isolates in patients with scrub typhus in Bengaluru, India.","volume":"37","author":"SK Chunchanur","year":"2019","journal-title":"Indian J Med Microbiol"},{"key":"pone.0289126.ref014","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/1348-0421.12268","article-title":"Diagnostic validation of selected serological tests for detecting scrub typhus","volume":"59","author":"M Koraluru","year":"2015","journal-title":"Microbiol Immunol"},{"key":"pone.0289126.ref015","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1128\/jcm.31.6.1637-1640.1993","article-title":"Serotype-specific amplification of Rickettsia tsutsugamushi DNA by nested polymerase chain reaction","volume":"31","author":"Y Furuya","year":"1993","journal-title":"J Clin Microbiol"},{"key":"pone.0289126.ref016","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1093\/molbev\/msy096","article-title":"MEGA X: Molecular Evolutionary Genetics Analysis across Computing Platforms","volume":"35","author":"S Kumar","year":"2018","journal-title":"Mol Biol Evol"},{"key":"pone.0289126.ref017","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1056\/NEJMoa2208449","article-title":"Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus","volume":"388","author":"GM Varghese","year":"2023","journal-title":"N Engl J Med"},{"key":"pone.0289126.ref018","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ijid.2019.04.030","article-title":"Genetic diversity of Orientia tsutsugamushi strains from patients in north India","volume":"84","author":"A Kumar","year":"2019","journal-title":"Int J Infect Dis"},{"key":"pone.0289126.ref019","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4103\/0972-9062.159504","article-title":"Molecular detection of scrub typhus in Tirupati, Andhra Pradesh, India.","volume":"52","author":"K Usha","year":"2015","journal-title":"J Vector Borne Dis"},{"key":"pone.0289126.ref020","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.actatropica.2007.07.013","article-title":"Development of a real-time PCR assay for the diagnosis of scrub typhus cases in India and evidence of the prevalence of new genotype of O. tsutsugamushi","volume":"104","author":"D Bakshi","year":"2007","journal-title":"Acta Trop"},{"key":"pone.0289126.ref021","author":"K P Anitha","year":"2017","journal-title":"Occurrence of Orientia Tsutsugamushi Genotypes in Areas of Union Territory of Puducherry and Tamil Nadu State, India."},{"key":"pone.0289126.ref022","doi-asserted-by":"crossref","first-page":"e22731","DOI":"10.1371\/journal.pone.0022731","article-title":"Differences in clinical features according to Boryoung and Karp genotypes of Orientia tsutsugamushi.","volume":"6","author":"D-M Kim","year":"2011","journal-title":"PloS One"},{"key":"pone.0289126.ref023","first-page":"124","article-title":"Phylogenetic clustering of 4 prevalent virulence genes in Orientia tsutsugamushi isolates from human patients","volume":"48","author":"H Chu","year":"2010","journal-title":"J Microbiol Seoul Korea"},{"key":"pone.0289126.ref024","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.micpath.2005.08.004","article-title":"Survival of two Orientia tsutsugamushi bacterial strains that infect mouse macrophages with varying degrees of virulence","volume":"39","author":"M Fukuhara","year":"2005","journal-title":"Microb Pathog"},{"key":"pone.0289126.ref025","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S1995-7645(12)60036-4","article-title":"Scrub typhus: pathophysiology, clinical manifestations and prognosis","volume":"5","author":"S Rajapakse","year":"2012","journal-title":"Asian Pac J Trop Med"},{"key":"pone.0289126.ref026","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1177\/0049475514530688","article-title":"A prospective study on distribution of eschar in patients suspected of scrub typhus.","volume":"44","author":"K Munegowda","year":"2014","journal-title":"Trop Doct"},{"key":"pone.0289126.ref027","first-page":"36","article-title":"Scrub typhus infection, not a benign disease: an experience from a tertiary care center in Northern India.","volume":"92","author":"D Jain","year":"2019","journal-title":"Med Pharm Rep"},{"key":"pone.0289126.ref028","first-page":"24","article-title":"Outbreak of scrub typhus in Pondicherry.","volume":"58","author":"M Vivekanandan","year":"2010","journal-title":"J Assoc Physicians India"},{"key":"pone.0289126.ref029","doi-asserted-by":"crossref","first-page":"e0009619","DOI":"10.1371\/journal.pntd.0009619","article-title":"The burden of scrub typhus in India: A systematic review.","volume":"15","author":"E Devasagayam","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0289126.ref030","doi-asserted-by":"crossref","DOI":"10.4172\/1948-5948.1000265","article-title":"Scrub Typhus and Leptospirosis: The fallacy of Diagnosing with IgM Enzyme Linked Immunosorbant Assay.","volume":"08","author":"N Gupta","year":"2016","journal-title":"J Microb Biochem Technol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0289126","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T23:44:02Z","timestamp":1729813442000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0289126"}},"subtitle":[],"editor":[{"given":"Nayyar","family":"Iqbal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,7,25]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0289126","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,25]]}}}