Human infection due to Nocardiopsis, an actinomycete, is rare and the majority of those infections are due to Nocardiopsis dassonvillei. This agent has been implicated in cutaneous, pulmonary, eye and disseminated infections. It has never been isolated from the nose or any nasal infection. We report here a rare case of nasal vestibular abscess due to N. dassonvillei in an adult diabetic patient. The bacterium was identified on the basis of morphological and biochemical characteristics, and confirmed by sequencing the 16S rRNA and hsp65 genes. The patient was successfully treated with clarithromycin and levofloxacin. Though N. dassonvillei infections may be rare, the study highlights that it may cause a wide spectrum of disease manifestations, and laboratories should take care to isolate and identify the easily treatable pathogen.

Orientia tsutsugamushi (Ots) is an obligate, intracellular, mite-transmitted human pathogen which causes scrub typhus. Understanding the diversity of Ots antigens is essential for designing specific diagnostic assays and efficient vaccines. The protective immunodominant type-specific 56 kDa antigen (TSA) of Ots varies locally and across its geographic distribution. TSA contains four hypervariable domains. We bioinformatically analyzed 345 partial sequences of TSA available from India, most of which contain only the three variable domains (VDI-III) and three spacer conserved domains (SVDI, SVDII/III, SVDIII). The total number (152) of antigenic types (amino acid variants) varied from 14–36 in the six domains of TSA that we studied. Notably, 55% (787/1435) of the predicted CD4 T-cell epitopes (TCEs) from all the six domains had high binding affinities (HBA) to at least one of the prevalent Indian human leukocyte antigen (HLA) alleles. A surprisingly high proportion (61%) of such TCEs were from spacer domains; indeed 100% of the CD4 TCEs in the SVDI were HBA. TSA sequences from India had more antigenic types (AT) than TSA from Korea. Overall, >90% of predicted CD4 TCEs from spacer domains were predicted to have HBA against one or more prevalent HLA types from Indian, Korean, Asia-Pacific region or global population data sets, while only <50% of CD4 TCEs in variable domains exhibited such HBA. The phylogenetically and immunologically important amino acids in the conserved spacer domains were identified. Our results suggest that the conserved spacer domains are predicted to be functionally more important than previously appreciated in immune responses to Ots infections. Changes occurring at the TCE level of TSA may contribute to the wide range of pathogenicity of Ots in humans and mouse models. CD4 T-cell functional experiments are needed to assess the immunological significance of these HBA spacer domains and their role in clearance of Ots from Indian patients.

Orientia tsutsugamushi (Ots) frequently causes severe scrub typhus infections in the Asia-Pacific region. Korean investigators have demonstrated that Ots encodes five different autotransporter domain (ATD) proteins (ScaA-ScaE). ScaA functions as an adhesin and confers protective immunity in a lethal mouse model of Ots infection. Specific antibodies are detected against ScaA and ScaC in Korean scrub typhus patients. However, there is limited data on the distribution of the Sca protein genes in diverse isolates of Ots. By BLAST analysis with the conserved beta barrel autotransporter domain (ATD) regions of the sca proteins, we discovered a sixth gene scaF among 3 of 10 new partial Ots genome sequences available at NCBI GenBank (Sido, Karp, AFSC7). We designed two to seven specific TaqMan assays to detect the ATD for each of the six sca genes. The TaqMan assays among those for each sca gene which gave the greatest sensitivity and linearity with DNA log dilutions were then used for screening DNAs from Ots isolates grown in L929 mouse cells for sca genes. The sca prevalence survey was performed for all six sca genes with 178 DNAs from isolates from 12 countries. The survey results were confirmed by conventional PCR with primers from conserved regions of the passenger domains (PD) and ATD of the sca proteins. The ATD was highly conserved between the DNAs of different genotypes compared to the sca PD but each TaqMan assay was sca specific. The percentage positivity for 56 kDa and scaA genes in the 178 DNAs using Ha primers was 59.6% and 62.4%, respectively. Our scaA conventional ATD PCR assay was positive in 98.3% but scaA was present in all 178 DNAs (100%) by ATD TaqMan. scaB, scaC, scaD, scaE and scaF were detected in 33.7%, 97.8%, 93.8%, 97.2% and 43.3% isolates by ATD TaqMan, respectively. The ATDs of Ots sca genes are thus sufficiently conserved between different genotypes for molecular assay design. Four sca genes are widely distributed among diverse Ots isolates from diverse geographical areas. scaB and scaF were detected in fewer Ots isolates and absent from some available genome sequences. Whether the utility of the ScaA, ScaC, ScaD, and ScaE antigenic passenger protein domains exceeds that of the mixed 56 kDa type surface antigens of Ots now used in combination diagnostic assays needs to be determined before they can be considered as suitable alternative serological antigens for diagnosis of scrub typhus. Orientia tsutsugamushi (Ots) frequently causes severe scrub typhus infections in the Asia-Pacific region. Korean investigators had previously demonstrated that Ots encodes five different cell surface (Sca) proteins which have functional regions that mediate their transport to the cell surface. One of the proteins (ScaA) is able to serve as a vaccine against a Korean strain of Ots. Several of the Sca proteins stimulate production of antibodies during scrub typhus infections in humans. However, very little was known about the distribution of the Sca protein genes in isolates of Ots in other countries in the Asia-Pacific region where scrub tyhus occurs. We discovered there is a sixth gene scaF in some Ots strains. We designed sensitive molecular assays from conserved regions of each protein to survey the presence of the six sca genes in 178 DNAs from isolates from 12 countries. Only four sca genes are widely distributed among diverse Ots isolates from diverse geographical areas. scaB and scaF were detected much less frequently in Ots isolates. Future studies will be required to determine whether the Sca proteins are suitable for improved diagnostic assays and vaccines for scrub typhus.

Scrub typhus is an acute febrile illness caused by a tick bite infected with the bacteria Orientia tsutsugamushi. The clinical diagnosis is difficult as the symptoms are similar to other febrile illnesses such as dengue, typhoid, leptospirosis and so on. An eschar, if present, will narrow down the provisional diagnosis towards scrub typhus. There are no data on the preferential sites of tick bites in an Indian population. We present here the preferential sites of tick bites in a South Indian population of 123 cases positive for eschar. Geographically, clothing styles vary leading to the differences in the areas of skin exposed to the bite and thus the formation of eschars. Scrub typhus, if not treated, may lead to fatal complications. As scrub typhus is one of the most under-reported illnesses in the world, clinicians should look for the presence of an eschar in the preferential sites at least to narrow down the diagnosis and treatment.