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Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study.
Clin Infect Dis 2006; 43(10):1296-300CI

Abstract

BACKGROUND

The aim of this study was to determine the diagnostic utility of performing eschar polymerase chain reaction (PCR) for the diagnosis of scrub typhus through a prospective comparison of eschar PCR results with indirect immunofluorescent antibody assay (IFA) results.

METHODS

We conducted a multicenter prospective study involving patients with possible scrub typhus. Whole-blood samples and eschars were obtained for serological evaluation and PCR. A new crust was formed several days later at the site of the removed eschar. The newly formed crust was taken for performance of the second eschar PCR. Additional blood samples and eschars were collected, if possible, at 1-week intervals for 1 month after antibiotic treatment.

RESULTS

We prospectively studied 135 patients with possible scrub typhus. Of these patients, 118 had scrub typhus confirmed on the basis of either a single indirect immunofluorescent specific immunoglobulin M titer against Orientia tsutsugamushi of > or = 1:10 or a > or = 4-fold increase in the follow-up titer. The results of nested PCR assay of the eschars demonstrated a sensitivity of 0.86 (95% confidence interval, 0.78-0.92) and a specificity of 1 (95% confidence interval, 0.05-1). Among the 50 patients who showed positive results of eschar PCR at admission, 46 (92%) also showed positive results for the follow-up PCR test of the newly formed eschar after the treatment with antibiotics.

CONCLUSIONS

The eschar PCR assay was useful as a rapid and reliable test to confirm the diagnosis of scrub typhus, even though the patients received treatment with appropriate antibiotics, such as macrolides, quinolones, and tetracycline, which are all active against Orientia and Rickettsia species.

Authors+Show Affiliations

Division of Infectious Diseases, Department of Internal Medicine, Chosun University College of Medicine, Gwang-Ju, 501-717, Republic of Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

17051495

Citation

Kim, Dong-Min, et al. "Clinical Usefulness of Eschar Polymerase Chain Reaction for the Diagnosis of Scrub Typhus: a Prospective Study." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 43, no. 10, 2006, pp. 1296-300.
Kim DM, Kim HL, Park CY, et al. Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study. Clin Infect Dis. 2006;43(10):1296-300.
Kim, D. M., Kim, H. L., Park, C. Y., Yang, T. Y., Lee, J. H., Yang, J. T., ... Lee, S. H. (2006). Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 43(10), pp. 1296-300.
Kim DM, et al. Clinical Usefulness of Eschar Polymerase Chain Reaction for the Diagnosis of Scrub Typhus: a Prospective Study. Clin Infect Dis. 2006 Nov 15;43(10):1296-300. PubMed PMID: 17051495.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study. AU - Kim,Dong-Min, AU - Kim,Hyun Lee, AU - Park,Chi Young, AU - Yang,Tae Young, AU - Lee,Ji Hyun, AU - Yang,Jong Tae, AU - Shim,Soo-Kyoung, AU - Lee,Seung-Hyun, Y1 - 2006/10/12/ PY - 2006/05/09/received PY - 2006/07/31/accepted PY - 2006/10/20/pubmed PY - 2006/12/9/medline PY - 2006/10/20/entrez SP - 1296 EP - 300 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 43 IS - 10 N2 - BACKGROUND: The aim of this study was to determine the diagnostic utility of performing eschar polymerase chain reaction (PCR) for the diagnosis of scrub typhus through a prospective comparison of eschar PCR results with indirect immunofluorescent antibody assay (IFA) results. METHODS: We conducted a multicenter prospective study involving patients with possible scrub typhus. Whole-blood samples and eschars were obtained for serological evaluation and PCR. A new crust was formed several days later at the site of the removed eschar. The newly formed crust was taken for performance of the second eschar PCR. Additional blood samples and eschars were collected, if possible, at 1-week intervals for 1 month after antibiotic treatment. RESULTS: We prospectively studied 135 patients with possible scrub typhus. Of these patients, 118 had scrub typhus confirmed on the basis of either a single indirect immunofluorescent specific immunoglobulin M titer against Orientia tsutsugamushi of > or = 1:10 or a > or = 4-fold increase in the follow-up titer. The results of nested PCR assay of the eschars demonstrated a sensitivity of 0.86 (95% confidence interval, 0.78-0.92) and a specificity of 1 (95% confidence interval, 0.05-1). Among the 50 patients who showed positive results of eschar PCR at admission, 46 (92%) also showed positive results for the follow-up PCR test of the newly formed eschar after the treatment with antibiotics. CONCLUSIONS: The eschar PCR assay was useful as a rapid and reliable test to confirm the diagnosis of scrub typhus, even though the patients received treatment with appropriate antibiotics, such as macrolides, quinolones, and tetracycline, which are all active against Orientia and Rickettsia species. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/17051495/Clinical_usefulness_of_eschar_polymerase_chain_reaction_for_the_diagnosis_of_scrub_typhus:_a_prospective_study_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/508464 DB - PRIME DP - Unbound Medicine ER -