Q Fever and Scrub Typhus, Taiwan | CDC EID

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Volume 15, Number 10–October 2009
Dispatch
Acute Q Fever and Scrub Typhus, Southern Taiwan
Chung-Hsu Lai, Yen-Hsu Chen, Jiun-Nong Lin, Lin-Li Chang, Wei-Fang Chen, and Hsi-Hsun Lin
Author affiliations: E-Da Hospital and I-Shou University, Kaoh siung City, Taiwan (C.-H. Lai, J-.N. Lin, W.-F. Chen, H.-H. Lin); Kaohsiung Medical University, Kaohsiung City (C.-H. Lai, Y-H. Chen, J.-N. Lin, L.-L. Chang); and National Yang-Ming University, Taipei, Taiwan (H.-H. Lin)

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Abstract
Acute Q fever and scrub typhus are zoonoses endemic to southern Taiwan. Among the 137 patients with acute Q fever (89, 65.0%) or scrub typhus (43, 31.4%), we identified 5 patients (3.6%) who were co-infected with Coxiella burnetii and Orientia tsutsugamushi.

Q fever is a worldwide zoonosis in humans caused by Coxiella burnetii infection. Ticks are the main arthropod vectors of C. burnetii; the major animal reservoirs include goats, sheep, cattle, and domestic cats. Humans are infected mainly by inhaling organism-contaminated aerosols (1). Scrub typhus, caused by Orientia tsutsugamushi infection, is endemic to eastern Asia and the western Pacific region. O. tsutsugamushi is transmitted vertically in mites (particularly Leptotrombidium species) by the transovarial route, and horizontally in rodents through trombiculid larval (chigger) bites. Humans contract scrub typhus by being bitten by chiggers infected with O. tsutsugamushi; such bites occur accidentally during agriculture or field recreational activities (2).

Although the major arthropod vectors, animal reservoirs, and routes of transmission to humans are different for C. burnetii and O. tsutsugamushi, co-infection may occur when humans have been exposed to an environment where arthropod vectors and animal reservoirs are prevalent. In southern Taiwan, acute Q fever and scrub typhus are endemic zoonoses (3–5), and co-infection with the 2 pathogens may occur. We report 5 cases of co-infection with the agents of acute Q fever and scrub typhus.

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