Orientia tsutsugamushi DNA load and genotypes in blood as a marker of severity.

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi and is endemic to many parts of the Asia-Pacific region. We investigated whether the genotype of O. tsutsugamushi or the DNA load would be a useful marker of disease severity in scrub typhus patients. We evaluated the clinical features, genotypes and bacterial DNA load in the blood of 118 patients, including 114 surviving and 4 non-surviving patients, admitted at Chosun University Hospital. Four patients infected with the Pajoo, Yonchon, Youngworl and Boryong genotypes died. In the 114 survivors, 100 Boryong and 2 Taguchi genotypes were identified. The genotypes involved showed significant differences between the surviving and non-surviving patients (p<0.001). The median number of O. tsutsugamushi DNA copies was 78 copies /µL (range 3,960) in surviving patients, whereas 83,800 copies/µL (range 244,600) in the non-surviving patients. We found that the genotype and DNA load in the patient's blood are useful markers of disease severity in scrub typhus.

Clevudine demonstrates potent antiviral activity in naïve chronic hepatitis B patients.

OBJECTIVES: Clevudine has demonstrated antiviral potency in the treatment of naïve chronic hepatitis B patients in pivotal studies. The objectives of this study were to evaluate the safety and efficacy of a 1-year treatment with clevudine in chronic hepatitis B patients. METHODS: This is a post-marketing surveillance using case report forms which were submitted to the health authorities. RESULTS: Analysis of individual data showed that hepatitis B virus (HBV) DNA after a 1-year treatment was <141,500 copies/ml in 96% of hepatitis B e antigen (HBeAg)-positive and 100% of HBeAg-negative patients. The proportion of patients with HBV DNA <2,000 copies/ml after a 1-year treatment was 74%: 71% of HBeAg-positive and 93% of HBeAg-negative patients. Most of the patients with HBV DNA below the detection limit with each assay at week 24 showed sustained viral suppression up to week 48. The proportion of patients who showed normal alanine aminotransferase at week 48 was 86% in HBeAg-positive patients and 87% in HBeAg-negative patients. The rates of HBeAg-loss were 21%. Two patients showed viral breakthrough during treatment. CONCLUSION: Clevudine monotherapy demonstrates potent antiviral activity as well as biochemical and serological response with a 0.7% rate of viral breakthrough in naïve chronic hepatitis B patients.