Increased endothelial and macrophage markers are associated with disease severity and mortality in scrub typhus.

[scrub typhus]

Scrub typhus is endemic in the Asia -Pacific region . Mortality is high even with treatment , and further knowledge of the immune response during this infection is needed . This study was aimed at comparing plasma levels of monocyte /macrophage and endothelial related inflammatory markers in patients and controls in South India and to explore a possible correlation to disease severity and clinical outcome .Plasma levels of ALCAM , VCAM-1 , sCD 163 , sCD 14 , YKL-40 and MIF were measured in scrub typhus patients (n Â =Â 129 ), healthy controls (n Â =Â 31 ) and in infectious disease controls (n Â =Â 31 ), both in the acute phase and after recovery , by enzyme immunoassays .Patients had markedly elevated levels of all mediators in the acute phase , differing from both healthy and infectious disease controls . During follow-up levels of ALCAM , VCAM-1 , sCD 14 and YKL-40 remained elevated compared to levels in healthy controls . High plasma ALCAM , VCAM-1 , sCD 163 , sCD 14 , and MIF , and in particular YKL-40 were all associated with disease severity and ALCAM , sCD 163 , MIF and especially YKL-40 , were associated with mortality .Our findings show that scrub typhus is characterized by elevated levels of monocyte /macrophage and endothelial related markers . These inflammatory markers , and in particular YKL-40 , may contribute to disease severity and clinical outcome .

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scrub typhus

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