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Dolley A, Goswami HB, Dowerah D, Dey U, Kumar A, Hmuaka V, Mukhopadhyay R, Kundu D, Varghese GM, Doley R, Chandra Deka R, Namsa ND. Reverse vaccinology and immunoinformatics approach to design a chimeric epitope vaccine against Orientia tsutsugamushi. Heliyon 2024; 10:e23616. [PMID: 38187223 PMCID: PMC10767154 DOI: 10.1016/j.heliyon.2023.e23616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Scrub typhus is a vector-borne infectious disease caused by Orientia tsutsugamushi and it is reportedly associated with up to 20 % of hospitalized cases of febrile illnesses. The major challenge of vaccine development is the lack of identified antigens that can induce both heterotypic and homotypic immunity including the production of antibodies, cytotoxic T lymphocyte, and helper T lymphocytes. We employed a comprehensive immunoinformatic prediction algorithm to identify immunogenic epitopes of the 56-kDa type-specific cell membrane surface antigen and surface cell antigen A of O. tsutsugamushi to select potential candidates for developing vaccines and diagnostic assays. We identified 35 linear and 29 continuous immunogenic B-cell epitopes and 51 and 27 strong-binding T-cell epitopes of major histocompatibility complex class I and class II molecules, respectively, in the conserved and variable regions of the 56-kDa type-specific surface antigen. The predicted B- and T-cell epitopes were used to develop immunogenic multi-epitope candidate vaccines and showed to elicit a broad-range of immune protection. A stable interactions between the multi-epitope vaccines and the host fibronectin protein were observed using docking and simulation methods. Molecular dynamics simulation studies demonstrated that the multi-epitope vaccine constructs and fibronectin docked models were stable during simulation time. Furthermore, the multi-epitope vaccine exhibited properties such as antigenicity, non-allergenicity and ability to induce interferon gamma production and had strong associations with their respective human leukocyte antigen alleles of world-wide population coverage. A correlation of immune simulations and the in-silico predicted immunogenic potential of multi-epitope vaccines implicate for further investigations to accelerate designing of epitope-based vaccine candidates and chimeric antigens for development of serological diagnostic assays for scrub typhus.
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Affiliation(s)
- Anutee Dolley
- Department of Molecular Biology and Biotechnology, Tezpur University, Napaam, 784028, Assam, India
| | - Himanshu Ballav Goswami
- Department of Molecular Biology and Biotechnology, Tezpur University, Napaam, 784028, Assam, India
| | - Dikshita Dowerah
- Department of Chemical Sciences, Tezpur University, Napaam, 784028, Assam, India
| | - Upalabdha Dey
- Department of Molecular Biology and Biotechnology, Tezpur University, Napaam, 784028, Assam, India
| | - Aditya Kumar
- Department of Molecular Biology and Biotechnology, Tezpur University, Napaam, 784028, Assam, India
| | - Vanlal Hmuaka
- Entomology and Biothreat Management Division, Defence Research Laboratory, Tezpur, 784001, Assam, India
| | - Rupak Mukhopadhyay
- Department of Molecular Biology and Biotechnology, Tezpur University, Napaam, 784028, Assam, India
| | - Debasree Kundu
- Department of Infectious Diseases, Christian Medical College, Vellore, 632002, Tamil Nadu, India
| | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, 632002, Tamil Nadu, India
| | - Robin Doley
- Department of Molecular Biology and Biotechnology, Tezpur University, Napaam, 784028, Assam, India
| | - Ramesh Chandra Deka
- Department of Chemical Sciences, Tezpur University, Napaam, 784028, Assam, India
| | - Nima D. Namsa
- Department of Molecular Biology and Biotechnology, Tezpur University, Napaam, 784028, Assam, India
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Nepal TN, Chhetri G. Field epidemiology, clinical findings and outcome of Scrub typhus patients admitted at Gedu District Hospital, Chhukha, Bhutan. SAGE Open Med 2023; 11:20503121231175303. [PMID: 37223671 PMCID: PMC10201154 DOI: 10.1177/20503121231175303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
Objectives This study aimed to understand the field epidemiology, clinical findings, diagnostic reports and outcome of Scrub typhus patients admitted at Gedu District Hospital, Bhutan. Methods The researcher extracted data from the records of patients admitted at the hospital from 1 January 2017 to 31 December 2020, with diagnosis of Scrub typhus. A total of 185 records were used to study the demographic distribution, results of rapid diagnostic test for Scrub typhus, presence of eschar, treatment outcome and duration of admission in the hospital. Results The months of May to October had increased admissions of 137 (74%) patients with a peak in September. Three gewogs (sub-districts) had 173 (93.5%) patients; age range was 6 months to 84 years and a greater proportion of patients were females. Conclusion Scrub typhus is endemic in the district. The absence of recorded fever or a negative rapid diagnostic test report may not exclude the diagnosis of Scrub typhus.
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Zangpo T, Phuentshok Y, Dorji K, Dorjee C, Dorjee S, Jolly P, Morris R, Marquetoux N, McKenzie J. Environmental, Occupational, and Demographic Risk Factors for Clinical Scrub Typhus, Bhutan. Emerg Infect Dis 2023; 29:909-918. [PMID: 37081000 PMCID: PMC10124658 DOI: 10.3201/eid2905.221430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Underdiagnosis and underreporting of scrub typhus has increasingly affected public health in Bhutan since its initial detection in 2008. Identifying scrub typhus risk factors would support early diagnosis and treatment for this nonspecific febrile disease, reducing the incidence of potentially fatal complications. We conducted a hospital-based, case‒control study during October‒December 2015 in 11 scrub typhus‒prone districts. We identified harvesting cardamom as the major risk factor (odds ratio 1,519; p<0.001); other factors were traditional housing, largely caused by an outside toilet location, as well as owning a goat and frequently sitting on grass. Harvesting vegetables, herding cattle in the forest, and female sex were protective. Age had a nonlinear effect; children and the elderly were more likely to seek treatment for clinical scrub typhus. This study has informed public health policies and awareness programs for healthcare workers through development of National Guidelines for Prevention, Treatment and Control of Scrub Typhus in Bhutan.
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A Case Report. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Choi S, Ahn DH, Yoo MG, Lee HJ, Cho SB, Park HB, Kim SS, Chu H. Urine Metabolite of Mice with Orientia tsutsugamushi Infection. Am J Trop Med Hyg 2023; 108:296-304. [PMID: 36623483 PMCID: PMC9896320 DOI: 10.4269/ajtmh.20-1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/23/2022] [Indexed: 01/11/2023] Open
Abstract
Scrub typhus is an acute febrile, mite-borne disease endemic to the Asia-Pacific region. In South Korea, it is a seasonal disease that occurs frequently in the autumn, and its incidence has increased steadily. In this study, we used a liquid chromatography and flow injection analysis-tandem mass spectrometry-based targeted urine metabolomics approach to evaluate the host response to Orientia tsutsugamushi infection. Balb/c mice were infected with O. tsutsugamushi Boryong, and their urine metabolite profile was examined. Metabolites that differed significantly between the experimental groups were identified using the Kruskal-Wallis test. Sixty-five differential metabolites were identified. The principal metabolite classes were acylcarnitines, glycerophospholipids, biogenic amines, and amino acids. An ingenuity pathway analysis revealed that several toxic (cardiotoxic, hepatotoxic, and nephrotoxic) metabolites are induced by scrub typhus infection. This is the first report of urinary metabolite biomarkers of scrub typhus infection and it enhances our understanding of the metabolic pathways involved.
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Affiliation(s)
- Sangho Choi
- Division of Zoonotic and Vector Borne Disease Research, Center for Infectious Disease Research, National Institute of Infectious Disease, National Institute of Health, Korea Disease Control and Prevention Agency, Osong-eup, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - Do-Hwan Ahn
- Division of Healthcare and Artificial Intelligence, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Osong-eup, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - Min-Gyu Yoo
- Division of Endocrine and Kidney Disease Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Osong-eup, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - Hye-Ja Lee
- Division of Endocrine and Kidney Disease Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Osong-eup, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - Seong Beom Cho
- Division of Healthcare and Artificial Intelligence, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Osong-eup, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - Hee-Bin Park
- Division of Zoonotic and Vector Borne Disease Research, Center for Infectious Disease Research, National Institute of Infectious Disease, National Institute of Health, Korea Disease Control and Prevention Agency, Osong-eup, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - Sung Soon Kim
- Division of Zoonotic and Vector Borne Disease Research, Center for Infectious Disease Research, National Institute of Infectious Disease, National Institute of Health, Korea Disease Control and Prevention Agency, Osong-eup, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
| | - Hyuk Chu
- Division of Zoonotic and Vector Borne Disease Research, Center for Infectious Disease Research, National Institute of Infectious Disease, National Institute of Health, Korea Disease Control and Prevention Agency, Osong-eup, Cheongju-si, Chungcheongbuk-do, 28160, Republic of Korea
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Bhandari M, Singh RK, Laishevtcev A, Mohapatra TM, Nigam M, Mori E, Vasconcelos de Lacerda BCG, Coutinho HDM, Mishra AP. Revisiting scrub typhus: A neglected tropical disease. Comp Immunol Microbiol Infect Dis 2022; 90-91:101888. [PMID: 36252451 DOI: 10.1016/j.cimid.2022.101888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/18/2022] [Accepted: 09/29/2022] [Indexed: 02/08/2023]
Abstract
Scrub typhus is an under diagnosed re-emerging vector borne disease caused by an intracellular gram negative bacteria, Orientia. The disease is commonly prevalent in rural and hilly areas of Tsutsugumashi triangle. The diagnosis of the disease is very challenging due to similarity of its early symptoms with other febrile illnesses, like dengue and COVID 19, as well as non-availability of rapid, reliable and cost-effective methods. Moreover, the diverse clinical presentation in severe cases make it significant health problem. The occupational and behavioral risks responsible for the transmission lead to urgent need of vaccine development against the disease. The complete knowledge about its pathogenesis and the interaction with host's immune cells may help the scientists in developing the appropriate diagnostic methods as well as the vaccines.
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Affiliation(s)
- Munni Bhandari
- Department of Microbiology, School of Life Sciences, Hemvati Nandan Bahuguna Garhwal University, Srinagar (Garhwal) 246174, India.
| | - Rahul Kunwar Singh
- Department of Microbiology, School of Life Sciences, Hemvati Nandan Bahuguna Garhwal University, Srinagar (Garhwal) 246174, India.
| | - Alexey Laishevtcev
- Federal Research Center - All-Russian Scientific Research Institute of Experimental Veterinary Medicine named after K.I. Skryabin and Y.R. Kovalenko of the Russian Academy of Sciences, Moscow, Russia; Laboratory of Biocontrol and Antimicrobial Resistance, Orel State, University Named After I.S. Turgenev, Orel, Russia.
| | - Tribhuvan Mohan Mohapatra
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Manisha Nigam
- Department of Biochemistry, Hemvati Nandan Bahuguna Garhwal University, Srinagar Garhwal-246174, Uttarakhand, India.
| | - Edna Mori
- CECAPE - College of Dentistry, Av. Padre Cícero, 3917, Juazeiro do Norte, São José CE 63024-015, Brazil.
| | | | | | - Abhay Prakash Mishra
- Department of Pharmacology, Faculty of Health Science, University of Free State, Bloemfontein 9300, South Africa.
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Prakash R, Negi SS, Bhargava A, Sharma K, Jagzape T, Wasnik P. Evaluation of an in-house PCR for diagnosing scrub typhus along with a preliminary study of genotypic characterization of Orientia tsutshugamushi circulating in Chhattisgarh: A prospective clinico-microbiological study. Indian J Med Microbiol 2022; 40:510-515. [PMID: 36050139 DOI: 10.1016/j.ijmmb.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Scrub typhus, caused by Orientia tsutsugamushi (O. tsutsugamushi) present nonspecific clinical features during manifestation of acute undifferentiated febrile illness (AUFI) to render its early diagnosis difficult. Accordingly, this study was undertaken to assess an in-house groEL PCR versus IgM ELISA for the diagnosis of scrub typhus and to genotypically characterise the randomly selected scrub typhus positive cases. METHODS Blood samples, collected from two hundred twenty one (221) AUFI cases were subjected to groEL PCR and IgM ELISA for diagnosis of scrub typhus. Eleven randomly selected PCR positive cases were processed for DNA sequencing to determine the genetic diversity of O. tsutsugamushi in Chhattisgarh. RESULTS Scrub typhus prevalence of 35.2% were detected among AUFI cases using both in-house groEL PCR and IgM ELISA. PCR alone showed sensitivity, specificity, positive and negative predictive values of 66.6% (CI: 55.08-76.94), 100% (CI: 90 to 100),100% (CI: 93.15 to 100) and 57.37% (CI: 44.05 to 69.96) while for IgM ELISA, these parameters were 62.8% (CI: 51.13-73.50), 100% (CI: 90 to 100), 100% (CI: 92.75 to 100) and 54.68% (CI: 41.75 to 67.18) respectively. PCR and ELISA could detect scrub typhus in 37.2% and 33.3% cases, when tested alone. groEL PCR detected the O. tsutsugamushi throughout the course of infection. Phylogenetic analysis depicted 5 of 11 positive cases belonged to Kuroki, Japan strain of O. tsutsugamushi, followed by Gilliam and Karp strain in 4 and 2 cases respectively. CONCLUSION Scrub typhus should be considered in differential diagnosis of AUFI. groEL PCR may aid on to IgM ELISA test for optimum laboratory diagnosis of scrub typhus by its implementation especially in seronegative cases. Predominance of Kuroki-like strain followed by Gillian and Karp strains of O. tsutsugamushi in Chhattisgarh confirm variable geographical distribution of O. tsutsugamushi and provide the baseline epidemiological data which will eventually be used to help the researchers for developing better diagnostic tests and vaccine covering the predominant genotypes.
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Affiliation(s)
- Rishika Prakash
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Sanjay Singh Negi
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, India.
| | - Anudita Bhargava
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Kuldeep Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Tushar Jagzape
- Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Preetam Wasnik
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Raipur, India
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Vanlalruati RSC, Hmingmawii L, Ngurchamliana S, Lallawmkima I, Lalthantluanga B, Renthlei L, Pautu L. Serological Evidence of Scrub Typhus in Mizoram, North Eastern Region of India. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:55-61. [PMID: 38633550 PMCID: PMC11022818 DOI: 10.36519/idcm.2022.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/01/2022] [Indexed: 04/19/2024]
Abstract
Objective Differentiating scrub typhus from other acute febrile illnesses is difficult due to non-specificity of clinical symptoms and relative absence of eschar in Indian population. Antibody based serological tests are mainstay of scrub typhus diagnosis. To order to determine the performance of immunochromatography and IgM ELISA, immunochromatography and scrub typhus IgM ELISA were performed to detect the presence of antibodies against Orientia tsutsugamushi in acute serum of patients with acute febrile illness. Materials and Methods A cross-sectional study was carried out in the Department of Microbiology, Civil Hospital Aizawl and Department of Microbiology, Civil Hospital Lunglei, Mizoram over a period of one year from October 1, 2018 to September 31, 2019. Serum samples from patients with acute febrile illness were processed for the detection of scrub typhus. A total of 253 samples were subjected to immunochromatography and IgM ELISA. Results Using scrub typhus IgM ELISA as gold standard, the sensitivity, specificity and negative predictive value were calculated. Of the 253 serum samples tested, 36 were positive by both scrub typhus rapid test and IgM ELISA. 27 samples which were negative by scrub typhus rapid test reacted positive by IgM ELISA. 66 samples which were positive by scrub typhus rapid test were negative by IgM ELISA. Conclusion Owing to the limitations of scrub typhus rapid test and immunfluorescence assay (IFA), commercially available recombinant IgM ELISA which has a good sensitivity and specificity may be an alternative in laboratories with moderate set up.
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Affiliation(s)
- RSC Vanlalruati
- Civil Hospital Lunglei, Department of Microbiology, Mizoram, India
| | - Lal Hmingmawii
- Civil Hospital Aizawl, Department of Microbiology, Mizoram, India
| | | | - Isak Lallawmkima
- Civil Hospital Lunglei, Department of Microbiology, Mizoram, India
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Gurung S, Karki S, Pokharel S, Bhatta K. Scrub typhus in a primary health care center of Nepal: A case series. Ann Med Surg (Lond) 2022; 75:103490. [PMID: 35386785 PMCID: PMC8978104 DOI: 10.1016/j.amsu.2022.103490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Scrub typhus is endemic in most parts of Southeast Asia including Nepal. Fever, rash, headache, myalgia, eschar are the common clinical features. Though endemic, scrub typhus is grossly underdiagnosed in our country due to the lack of diagnostic tools and non-specific presentation of the disease. Here we present a series of 23 cases of scrub typhus from a primary healthcare center of Nepal. Method This is a retrospective case series done among 23 patients diagnosed with scrub typhus and admitted to Aaruchanaute Primary health care center between August 15, 2021 to September 14, 2021. Epidemiological, clinical features and clinical outcomes of all the patients are described. Results Among 23 patients admitted to the primary health care center,78% were of age group 20–60 with 47% male patients. Fever was reported by all patients followed by headache (65%), cough (43%) and eschar (8%). All patients were diagnosed by rapid diagnostic kit. 95% of patients had complete recovery whereas 1 patient was referred to a higher center due to complications he developed during the period of hospital stay. Conclusion We conclude that when a patient presents with fever and eschar, there should be a high index of suspicion for scrub typhus, though eschar may not be present in many of the cases. Early diagnosis and prompt treatment with antibiotics is the key as the disease entity shows a good response to treatment while preventing potentially fatal complications. Scrub typhus is a mite-borne, acute, febrile illness caused by Orientia tsutsugamushi. Fever, rash, headache, myalgia, gastrointestinal symptoms and eschar are the usual clinical presentation. Mostly underdiagnosed in Nepal because of lack of specialized diagnostic tools. Can also be missed while trying to exclude COVID-19 during this pandemic. This case series analyses the clinical presentation and management in a resource-limited setting.
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Affiliation(s)
- Shekhar Gurung
- Aaruchanaute Primary Health Care Center, Aarughat, Gorkha, Nepal
| | - Saurab Karki
- Military Hospital Itahari, Sunsari, Nepal
- Corresponding author. Military Hospital, Itahari-4, Sunsari, Nepal.
| | | | - Kishor Bhatta
- Aaruchanaute Primary Health Care Center, Aarughat, Gorkha, Nepal
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Paulraj PS, Renu G, Ranganathan K, Leo VJ, Veeramanoharan R. First seroprevalence report of scrub typhus from the tribal belts of the Nilgiris district, Tamil Nadu, India. Indian J Med Res 2021; 153:503-507. [PMID: 34380797 PMCID: PMC8354048 DOI: 10.4103/ijmr.ijmr_1223_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Scrub typhus, an acute febrile Rickettsial disease is caused by the bacterial pathogen Orientia tsutsugamushi which is spread by the bite of infected chigger mite vectors belonging to the family Trombiculidae. A study was undertaken to find out the prevalence of scrub typhus among the indigenous population from Nilgiris, Tamil Nadu. Methods This study was conducted among 214 patients with fever of unknown aetiology and a recent history of febrile illness attending the Nilgiris Adivasi Welfare Association medical facilities available at Nilgiris district, Tamil Nadu. Serum samples were tested for scrub typhus IgM enzyme-linked immunosorbent assay. Results Overall, 13 (6.07%) of the 214 samples tested were positive for scrub typhus. This is the first seroprevalence report of scrub typhus from the indigenous people belonging to Irula, Kurumba, Paniyar, and Kota tribes from the Nilgiris district, Tamil Nadu. Interpretation & conclusions Early diagnosis and effective management will protect this indigenous population from this disease. This report would help in creating awareness regarding scrub typhus infection among clinicians and public health authorities in the region and take appropriate measures for treatment and control.
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Affiliation(s)
- Philip Samuel Paulraj
- Department of Health Research, ICMR-Vector Control Rresearch Centre-Field Station, Madurai, Tamil Nadu, India
| | - Govindarajan Renu
- Department of Health Research, ICMR-Vector Control Rresearch Centre-Field Station, Madurai, Tamil Nadu, India
| | | | - Victor Jerald Leo
- Department of Health Research, ICMR-Vector Control Rresearch Centre-Field Station, Madurai, Tamil Nadu, India
| | - Rajamannar Veeramanoharan
- Department of Health Research, ICMR-Vector Control Rresearch Centre-Field Station, Madurai, Tamil Nadu, India
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Tshering S, Dorji N, Dem D, Om T. Scrub typhus in pregnancy presenting with permanent hearing loss: A case report. Clin Case Rep 2021; 9:e04451. [PMID: 34306685 PMCID: PMC8294048 DOI: 10.1002/ccr3.4451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/02/2021] [Accepted: 05/30/2021] [Indexed: 12/29/2022] Open
Abstract
As clinicians, we need to be vigilant about these rare and atypical presentations given the endemic nature of scrub typhus in southern belt of the country. Timely diagnosis and appropriate treatment is the key aspect to prevent further complications.
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Affiliation(s)
- Sangay Tshering
- Department of Obstetrics & GynecologyJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
| | - Namkha Dorji
- Department of Obstetrics & GynecologyJigme Dorji Wangchuck National Referral HospitalThimphuBhutan
| | - Dago Dem
- Faculty of Post Graduate MedicineKhesar Gyalpo University of Medical Sciences of BhutanThimphuBhutan
| | - Tandin Om
- Faculty of Post Graduate MedicineKhesar Gyalpo University of Medical Sciences of BhutanThimphuBhutan
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Roy S, Yadav S, Garg S, Deshmukh PR, Narang R. Evaluation of nested PCR and loop mediated isothermal amplification assay (LAMP) targeting 47 kDa gene of Orientia tsutsugamushi for diagnosis of scrub typhus. Indian J Med Microbiol 2021; 39:475-478. [PMID: 34215476 DOI: 10.1016/j.ijmmb.2021.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Diagnostic testing, in particular early detection, is critical for scrub typhus, as most infected individuals have nonspecific symptoms that are easily confused with dengue and malaria. PCR and LAMP offer an alternative DNA amplification method for detection of Orientia tsutsugamushi. Detection of Orientia tsutsugamushi DNA by targeting the 47-kDa gene using nested PCR and LAMP for diagnosis of scrub typhus. METHODS A cross-sectional study in a tertiary care hospital in central India. The present study was done on a total of 274 patients with fever of five days or more and negative for other causes of fever viz. malaria, dengue and enteric fever. From each patient 5 ml of blood samples was collected in EDTA vial for molecular tests (PCR and LAMP) and in plain vial for serological tests (IgM IFA). The data was entered in Excel sheet and 2 × 2 tables were created to find sensitivity, specificity, positive and negative likelihood ratios, disease prevalence, positive and negative predictive values and accuracy. RESULTS PCR showed a sensitivity of 29.73% while the sensitivity of LAMP was 16.22%. The specificity of nested PCR and LAMP was very high, 99.58% and 99.16% respectively. The diagnostic accuracy of nested PCR (90.15%) was found to be marginally better than LAMP (87.96%). CONCLUSIONS For the treatment of scrub typhus, a gene-based diagnostic test would enable earlier and more accurate detection of the causative agents of the disease than serology in admission samples of patients with acute febrile illness in endemic areas.
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Affiliation(s)
- Subhasish Roy
- Dept. of Microbiology, Mahatma Gandhi Institute of Medical Science, Sewagram, Wardha, Maharashtra, 442102, India.
| | - Sneha Yadav
- Dept. of Microbiology, Mahatma Gandhi Institute of Medical Science, Sewagram, Wardha, Maharashtra, 442102, India.
| | - Shreyak Garg
- Dept. of Microbiology, Mahatma Gandhi Institute of Medical Science, Sewagram, Wardha, Maharashtra, 442102, India.
| | - Pradeep R Deshmukh
- Department of Community Medicine, All India Institute of Medical Science (AIIMS), Nagpur, 441108, India.
| | - Rahul Narang
- Dept. of Microbiology, Mahatma Gandhi Institute of Medical Science, Sewagram, Wardha, Maharashtra, 442102, India.
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Behera JR, Sahu SK, Mohanty N, Mohakud NK, Lal A. Clinical Manifestations and Outcome of Scrub Typhus in Infants From Odisha. Indian Pediatr 2021. [PMID: 33883311 DOI: 10.1007/s13312-021-2198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Das BK, Mohanty S, Sahoo PK. Association of leptospirosis and scrub typhus in acute encephalitis syndrome in a tertiary care hospital in Odisha, India. Trans R Soc Trop Med Hyg 2021; 115:1088-1090. [PMID: 33891701 DOI: 10.1093/trstmh/trab063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/18/2021] [Accepted: 03/30/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute encephalitis syndrome (AES) is a major public health concern in India, causing febrile illness principally associated with viral infection. Bacteria-like scrub typhus and leptospirosis also cause acute febrile illness. Therefore, this study was conceived to address the possible etiological agents contributing to sporadic AES in a tertiary care center in Odisha, India. METHOD This was a prospective hospital-based study that enrolled 92 consecutive patients with clinically diagnosed AES whose blood/cerebrospinal fluid samples were tested for IgM antibodies to dengue, Japanese encephalitis (JE), herpes simplex virus (HSV), Epstein-Barr virus (EBV), leptospirosis and scrub typhus. RESULTS Viral antibodies to dengue were detected in three (3.26%) cases, HSV1 in four (4.34%) and HSV2 in three (3.26%) cases. Significantly, antibodies to EBV in 22 (23.591%) and to JE in 27 (29.34%) cases were detected. Notably, 30 (32.60%) and 11(12.0%) of patients had IgM antibodies to leptospirosis and scrub typhus, respectively. CONCLUSION This observation indicates an association of leptospirosis and scrub typhus infection in sporadic cases of AES, besides other viruses.
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Affiliation(s)
- Bidyut Kumar Das
- Department of Medicine, SCB Medical College & Hospital, Manglabag, Cuttack 753007, Odisha, India
| | - Sriprasad Mohanty
- Department of Medicine, SCB Medical College & Hospital, Manglabag, Cuttack 753007, Odisha, India
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Basu A, Chowdhoury SR, Sarkar M, Khemka A, Mondal R, Datta K, Mondal K. Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis: Not a Rare Entity in Pediatric Age Group. J Trop Pediatr 2021; 67:6129646. [PMID: 33547467 DOI: 10.1093/tropej/fmab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Our goal was to study the demographic, clinical and laboratory profile and outcome of scrub typhus-associated hemophagocytic lymphohistiocytosis (HLH) in the pediatric age group. METHODS We conducted a prospective observational study in a tertiary care teaching hospital over a period of 1 year. Children in the age group of 1 month to 12 years with IgM ELISA positive for scrub typhus were included in the study. HLH was diagnosed using HLH-2004 criteria. Demographic, clinical and laboratory profile, treatment and outcome of HLH patients were noted and also compared with non-HLH scrub typhus patients. RESULTS Among 58 children with scrub typhus infection, 18 had HLH. The mean age of patients with HLH was 35.3 ± 44.8 months and 61% were male. Anemia, thrombocytopenia and hyperferritinemia were seen in all the patients. Hypertriglyceridemia, hypofibrinogenemia and coagulopathy were noted in 78%, 56% and 44%, respectively. All the patients were treated with intravenous doxycycline for an average duration of 9.5 days. Intravenous immunoglobulin and methylprednisolone were given in 33% and 22% cases, respectively. Complications like acute respiratory distress syndrome (ARDS) (p = 0.001) and MODS (p = 0.004) were significantly high in the HLH group. Younger age (<3 years), fever > 7 days, presence of convulsion, ARDS and MODS were the clinical predictors of scrub typhus-associated HLH. CONCLUSION HLH in scrub typhus infected children is being increasingly recognized. Younger age, prolonged fever, presence of convulsion, ARDS and MODS should alert clinicians of the risk of HLH. Treating the primary cause usually cures the disease and immunomodulator therapy need not be routinely administered.
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Affiliation(s)
- Ankika Basu
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal 700073, India
| | | | - Mihir Sarkar
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal 700073, India
| | - Arpita Khemka
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal 700073, India
| | - Rakesh Mondal
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal 700073, India
| | - Kalpana Datta
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal 700073, India
| | - Kalyanbrata Mondal
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal 700073, India
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Diagnostic accuracy of an in-house Scrub Typhus enzyme linked immunoassay for the detection of IgM and IgG antibodies in Laos. PLoS Negl Trop Dis 2020; 14:e0008858. [PMID: 33284807 PMCID: PMC7746293 DOI: 10.1371/journal.pntd.0008858] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/17/2020] [Accepted: 10/06/2020] [Indexed: 01/30/2023] Open
Abstract
Scrub typhus is a major cause of morbidity and mortality in Southeast Asia. Diagnosis of scrub typhus is difficult due to a lack of accessible validated diagnostic tools. Despite its objectivity, the diagnostic accuracy of ELISA tests is influenced by methodological and patient factors. This study aims to evaluate the performance of a novel in-house ELISA developed in the Mahidol Oxford Tropical Medicine Research Unit (MORU) for anti-scrub typhus group IgM and IgG compared to the “gold standard” reference IFA and PCR, and to determine whether the in-house ELISA can be used as a seroepidemiological screening tool and/or stand-alone test for scrub typhus. A total of 1,976 admission and 1,438 participant follow-up sera collected in the Lao PDR (Laos) were tested with ELISA for IgM and IgG. Samples with an ELISA OD≥0.50 were tested with IFA for IgM and/or IgG. A strong positive relationship was present between ELISA ODs and IFA titers for admission IgM (r2: 0.70, p <0.005) and IgG (r2: 0.76, p<0.005), and for follow-up IgM and IgG (both r2: 0.76, p<0.005) samples. The best compromise between sensitivity and specificity for the ELISA OD cut-off is likely to be between 0.8–1.0 for IgM antibodies and 1.2–1.8 for IgG antibodies. These results demonstrate that the diagnostic accuracy of the MORU in-house scrub typhus group ELISA is comparable to that of IFA, with similar results as reported for the commonly used InBios Scrub Typhus Detect ELISA, validating the use of the in-house ELISA. The optimal ELISA cut-off would depend on the use of the test, and the desired sensitivity and specificity. Further studies are required to authenticate the use of these cut-offs in other endemic regions. This in-house ELISA has the potential to replace the imperfect IFA, which could ultimately reduce the burden of scrub typhus by improving the rate of scrub typhus diagnoses in endemic low-resource areas. Scrub typhus is a mite-borne infectious disease, caused by the Orientia tsutsugamushi bacterium, resulting in considerable morbidity and mortality in the Asia-Pacific region. Diagnosis is difficult since it does not present with any distinctive clinical signs compared to other febrile illnesses in this region, except for a necrotic skin lesion (eschar) in some patients. Laboratory tests are therefore crucial to identify scrub typhus. Reliable laboratory tests need significant infrastructure and experienced staff, making access to accurate tests very limited in the low-resource endemic regions. This study aimed to evaluate the accuracy of less expensive and easier-to-use in-house Enzyme Linked Immunoassays (ELISAs) detecting immunoglobulin IgM and IgG antibodies against scrub typhus infection compared to the “gold-standard” Immunofluorescence Assays (IFAs). There was a strong positive relationship between ELISA and IFA antibody levels for both IgM and IgG. If the ELISA would be used as a stand-alone test for scrub typhus diagnosis in Laos, an ideal balance between sensitivity and specificity would likely be around an ELISA optical density (OD) of 0.8–1.0 for IgM and 1.2–1.8 for IgG. There is a need to investigate the use of these cut-offs in other endemic regions, which could improve the rate of scrub typhus diagnosis in low-resource settings.
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Kispotta R, Kasinathan A, Kumar Kommu PP, Manikandan M. Analysis of 262 Children with Scrub Typhus Infection: A Single-Center Experience. Am J Trop Med Hyg 2020; 104:622-627. [PMID: 33219642 DOI: 10.4269/ajtmh.20-1019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Scrub typhus, a vector-borne rickettsiosis, is the leading treatable cause of non-malarial febrile illness in Asia. The myriad of typical and atypical features poses a clinical conundrum. We aimed to study the clinical and laboratory profile of children with scrub typhus infection diagnosed by IgM ELISA. Data of children < 12 years presenting with undifferentiated fever to the pediatric services of a tertiary teaching institute between January 2012 and December 2018 were retrieved. Children with seropositive IgM ELISA (InBios International Kit) for scrub typhus were enrolled in the study. Clinical features, laboratory investigations, treatment received, and the outcome recorded were obtained. Objective evidence of organ dysfunction was taken as severe scrub typhus. In total, 262 children were diagnosed with scrub typhus. The mean age was 5 years, with male preponderance (65%). And, 13 children presented during infancy. Fever was universal, and generalized lymphadenopathy (93.5%) and hepatomegaly (70%) were the common clinical signs. Eschar was identified in 31%, with greater predilection for groin and axilla. Thrombocytopenia was striking in one-third of children. Also, 25 children (9.5%) had severe scrub typhus and 18 required intensive care stay. Elevated aspartate aminotransferase enzyme levels was a predictor of severity ([OR 3.9], P value 0.005) by multivariate analysis. Lymphadenopathy was found significantly associated with eschar (P < 0.005). No mortality was recorded. This 6-year study underscores the varied spectrum of pediatric scrub typhus infection. Zero mortality in our cohort signifies the excellent outcome with judicious first-line antibiotics.
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Affiliation(s)
- Rashmi Kispotta
- Department of Pediatrics, Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | | | - M Manikandan
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
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Kannan K, John R, Kundu D, Dayanand D, Abhilash KPP, Mathuram AJ, Zachariah A, Sathyendra S, Hansdak SG, Abraham OC, Gunasekaran K, Iyadurai R, Abraham AM, Prakash JAJ, Yesudhason BL, Veeraraghavan B, Kavitha ML, Jose LR, Sumana MN, Saravu K, Varghese GM. Performance of molecular and serologic tests for the diagnosis of scrub typhus. PLoS Negl Trop Dis 2020; 14:e0008747. [PMID: 33180784 PMCID: PMC7660479 DOI: 10.1371/journal.pntd.0008747] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/25/2020] [Indexed: 01/19/2023] Open
Abstract
Diagnosis of scrub typhus, caused by the bacterium Orientia tsutsugamushi, is challenging because of the overlap of its non-specific symptoms with other infections coupled with the lack of sufficient data on the performance of diagnostic tests. Early diagnosis of scrub typhus is crucial to improve outcomes and this study evaluates the diagnostic performance of various tests. The present study aims at assessing the accuracy of various rapid diagnostic tests, serologic tests, and nucleic acid amplification methods on well-characterized patient samples. Adult patients with acute febrile illness and manifestations suggestive of scrub typhus confirmed by positive PCR in the blood, eschar or tissue were characterized as cases. Patients with acute febrile illness and a confirmed alternate etiology such as culture-confirmed typhoid, smear/PCR positive for malaria, PCR/NS1 antigen positive for dengue, PCR positive for influenza, PCR/MAT positive for leptospirosis, PCR positive for spotted fever were characterized as controls with other infections. The healthy controls consisted of subjects from the same geographic region. We performed the following tests on blood samples for scrub typhus and calculated the sensitivity, specificity, positive predictive value, and negative predictive value: (1) Quantitative real time PCR using 47kDa gene (qPCR); (2) Conventional PCR using 56kDa gene (cPCR); (3) Loop-mediated isothermal amplification assay (LAMP assay); (4) Immunofluorescence assay (IFA); (5) Enzyme-linked immunosorbent assay (ELISA); (6) Weil-Felix test(WF test); and (7) Immunochromatographic Rapid Diagnostic Test (RDT).Among the 316 participants, 158 had confirmed scrub typhus (cases) and 158 were controls. ELISA and RDT detecting Orientia tsutsugamushi specific IgM antibodies had excellent discriminative potential with sensitivities and specificities of 92%, 94% and 92%, 92% respectively. The sensitivity and specificity of IFA were found to be 95% and 74% respectively. IgM serology had a false positivity rate of 8% with other acute febrile illnesses such as dengue, leptospirosis and spotted fever due to the nonspecific binding of the pentavalent IgM. LAMP assay had 91.7% sensitivity and 77.2% specificity while qPCR provided excellent sensitivity (97%) and perfect specificity. In conclusion, ELISA and RDT detecting Orientia tsutsugamushi specific IgM antibodies have excellent sensitivity and specificity while the accuracy of IFA is suboptimal for the diagnosis of scrub typhus. Given its perfect specificity and superior sensitivity, qPCR is preferred for diagnostic confirmation in reference laboratories particularly for diagnosis of early disease with less than 7 days duration. This study provides a comprehensive evaluation of all currently available diagnostic tests for scrub typhus.
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Affiliation(s)
- Kavitha Kannan
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rebecca John
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Debasree Kundu
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Divya Dayanand
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Alice Joan Mathuram
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anand Zachariah
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sowmya Sathyendra
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Samuel G. Hansdak
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - O. C. Abraham
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthik Gunasekaran
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Asha M. Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Balaji Veeraraghavan
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - M. L. Kavitha
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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Singla N, Mahajan V, Chander J, Guglani V. Clinicoepidemiological and Genotyping Correlation of Pediatric Scrub Typhus from Chandigarh, India. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1782-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Sharma A, Mishra B. Rickettsial disease existence in India: resurgence in outbreaks with the advent of 20thcentury. INDIAN JOURNAL OF HEALTH SCIENCES AND BIOMEDICAL RESEARCH KLEU 2020. [DOI: 10.4103/kleuhsj.kleuhsj_162_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vikram K, Agarwala P, Bhargava A, Jain Y, Jagzape T, Wasnik P. Scrub typhus and leptospirosis in rural and urban settings of central India: a preliminary evaluation. Trop Doct 2019; 50:111-115. [PMID: 31779530 DOI: 10.1177/0049475519889712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scrub typhus and leptospirosis are bacterial zoonotic diseases reported from different parts of India, whose prevalence in Chhattisgarh is unknown. Our study was carried out to delineate the prevalence of these illnesses there and to assess the clinical profiles of rural and urban patients. A total of 169 patients with acute febrile illnesses (AFI) was enrolled in our study from May to December 2018, of whom 35 (20.7%) tested positive for scrub typhus and only one tested positive for leptospirosis by respective IgM ELISA. Scrub typhus seropositivity was higher in rural patients (25.0%) than in urban (18.1%). Patients in the age group 16-30 years were the most commonly affected. The commonest presenting symptoms were fever with headache (68.57%), extreme weakness (57.14%), myalgia/arthralgia (54.29%) and abdominal pain (51.43%). The preliminary evidence for the presence of scrub typhus in Chhattisgarh necessitates its inclusion in the panel of tests for AFI.
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Affiliation(s)
- Kumar Vikram
- Senior Resident, Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Pragya Agarwala
- Senior Resident, Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Anudita Bhargava
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Yogesh Jain
- Consultant Paediatrician, Jan Swasthya Sahyog (A hospital in rural settings), Ganiyari, Bilaspur, Chhattisgarh, India
| | - Tushar Jagzape
- Additional Professor, Department of Paediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Pritam Wasnik
- Associate Professor, Department of Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Elangovan D, Perumalla S, Rose W, Verghese VP, Mammen J, Gowri MS, Jude Prakash JA. Assessment of two immunoassays for detection of IgM antibodies to scrub typhus using a serum panel. Indian J Med Microbiol 2019; 37:584-586. [PMID: 32436884 DOI: 10.4103/ijmm.ijmm_20_130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Laboratory tests are necessary for diagnosis of scrub typhus (ST) especially in the absence of the distinctive eschar. Performance of an ELISA and ICT (immunochromatography) to detect IgM antibodies to scrub typhus was assessed using a panel of 346 sera chosen from healthy individuals, those with scrub typhus and scrub-typhus like illness. A sensitivity of 98.7% for ST IgM ICT and 97.4% for ST IgM ELISA was observed while specificity was 96.3% for ICT and 95.9% for ELISA. As excellent concordance (98.8%) was noted between the two assays, IgM ICT can be used for rapid diagnosis of scrub typhus. Abbreviations: ST IgM ELISA: Scrub typhus IgM ELISA; ST IgM ICT: Scrub Typhus IgM Immunochromatography, Rapid diagnostic test: RDT.
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Affiliation(s)
- Divyaa Elangovan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Susmitha Perumalla
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Winsley Rose
- Department of Child Health-III, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Joy Mammen
- Department of Clinical Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - M S Gowri
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
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Poor Sensitivity of a Rapid Kit for Diagnosing Scrub typhus: Need for Continuous Monitoring and Regular Quality Check Type of Article: Brief Communication. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2018. [DOI: 10.22207/jpam.12.3.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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