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Genotypic Heterogeneity of Orientia tsutsugamushi in Scrub Typhus Patients and Thrombocytopenia Syndrome Co-infection, Myanmar

Serologic and molecular surveillance of serum collected from 152 suspected scrub typhus patients in Myanmar revealed Orientia tsutsugamushi of genotypic heterogeneity. In addition, potential co-infection with severe fever with thrombocytopenia syndrome virus was observed in 5 (3.3%) patients. Both scrub typhus and severe fever with thrombocytopenia syndrome are endemic in Myanmar.

Scrub typhus is a miteborne febrile illness caused by the bacterium Orientia tsutsugamushi, which is endemic in the Asia-Pacific region and a major cause of undifferentiated febrile disease (1). O. tsutsugamushi infections were documented in Myanmar during the 1940s (2). Since then, however, no report has described the prevalence and genetics of scrub typhus in Myanmar, although 2 studies, including 1 from 2017, identified scrub typhus as one of the primary infections causing acute febrile illness on the Thailand–Myanmar border (3,4). These results underscore the need for research on this vectorborne infection in Myanmar, including studies defining the genotypic diversity of O. tsutsugamushi. Lack of this information has been a serious obstacle to developing effective diagnostic methods and a vaccine for scrub typhus (1). The tickborne virus severe fever with thrombocytopenia syndrome virus (SFTSV), of the genus

Author affiliations: University of Medicine 1, Yangon, Myanmar (A.M. Win, O. Kyaw, W.W. Htike); Seoul National University College of Medicine, Seoul, South Korea (Y.T.H. Nguyen, Y. Kim, N.-Y. Ha, J.-G. Kang, H. Kim, N.-H. Cho); Private practitioner, Sagaing, Myanmar (B. San); Bore Da Biotech, Seongnam, South Korea (D.-O. Choi); Hanyang University College of Medicine, Seoul (K.-H. Lee); Seoul National University Medical Research Center and Bundang Hospital, Seoul (N.-H. Cho)

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