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

Microbes Infect. 2016 Jun;18(6):406-411. doi: 10.1016/j.micinf.2016.03.006. Epub 2016 Mar 19.

Abstract

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.

Keywords: Doxycycline; Microbial sensitivity testing; Orientia tsutsugamushi; Scrub typhus.

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis / methods*
  • Disease Outbreaks*
  • Doxycycline / pharmacology*
  • Doxycycline / therapeutic use
  • Guideline Adherence
  • Humans
  • Microbial Sensitivity Tests
  • Military Personnel
  • Orientia tsutsugamushi / drug effects
  • Orientia tsutsugamushi / isolation & purification*
  • Queensland / epidemiology
  • Real-Time Polymerase Chain Reaction
  • Scrub Typhus / epidemiology*
  • Scrub Typhus / prevention & control

Substances

  • Anti-Bacterial Agents
  • Doxycycline