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Background  Scrub typhus is an important endemic disease in tropical Asia caused by  Orientia tsutsugamushi  for which no effective broadly protective vaccine is available. The successful evaluation of vaccine candidates requires well-characterized animal models and a better understanding of the immune response against  O .  tsutsugamushi . While many animal species have been used to study host immunity and vaccine responses in scrub typhus, only limited data exists in non-human primate (NHP) models.    Methodology/Principle findings  In this study we evaluated a NHP scrub typhus disease model based on intradermal inoculation of  O .  tsutsugamushi  Karp strain in rhesus macaques (n = 7). After an intradermal inoculation with 10 6  murine LD 50  of  O .  tsutsugamushi  at the anterior thigh (n = 4) or mock inoculum (n = 3), a series of time course investigations involving hematological, biochemical, molecular and immunological assays were performed, until day 28, when tissues were collected for pathology and immunohistochemistry. In all NHPs with  O .  tsutsugamushi  inoculation, but not with mock inoculation, the development of a classic eschar with central necrosis, regional lymphadenopathy, and elevation of body temperature was observed on days 7–21 post inoculation (pi); bacteremia was detected by qPCR on days 6–18 pi; and alteration of liver enzyme function and increase of white blood cells on day 14 pi. Immune assays demonstrated raised serum levels of soluble cell adhesion molecules, anti- O .  tsutsugamushi -specific antibody responses (IgM and IgG) and pathogen-specific cell-mediated immune responses in inoculated macaques. The qPCR assays detected  O .  tsutsugamushi  in eschar, spleen, draining and non-draining lymph nodes, and immuno-double staining demonstrated intracellular  O .  tsutsugamushi  in antigen presenting cells of eschars and lymph nodes.    Conclusions/Significance  These data show the potential of using rhesus macaques as a scrub typhus model, for evaluation of correlates of protection in both natural and vaccine induced immunity, and support the evaluation of future vaccine candidates against scrub typhus.

plos neglected tropical diseases

Characterization of the rhesus macaque (Macaca mulatta) scrub typhus model: Susceptibility to intradermal challenge with the human pathogen Orientia tsutsugamushi Karp