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Prospective evaluation of commercial antibody-based rapid tests in combination with a loop-mediated isothermal amplification PCR assay for detection of Orientia tsutsugamushi during the acute phase of scrub typhus infection.
Clin Vaccine Immunol. 2012 Mar; 19(3):391-5.CV

Abstract

Samples from 160 prospectively recruited febrile patients with typhus-like illness in an area of Thailand (Chiang Rai, northern Thailand) where scrub typhus is endemic were used to evaluate the diagnostic capabilities of four rapid immunochromatographic tests (ICTs) for the detection of Orientia tsutsugamushi IgM and total antibodies during acute scrub typhus infection. Of the 160 cases, 54 (34%) had been confirmed to have scrub typhus using the reference scrub typhus infection criteria (STIC), i.e., positive cell culture isolation, an admission IgM antibody titer of ≥1:12,800, a 4-fold rising IgM antibody titer, and/or positivity for ≥2 out of 3 PCR gene targets). The ICTs gave the following sensitivities and specificities: the Panbio IgM ICT, 46% (95% confidence interval [CI], 33 to 60) and 95% (95% CI, 89 to 98), respectively; the Standard Diagnostics IgM ICT, 68% (95% CI, 60 to 75) and 73% (95% CI, 68 to 78), respectively; the AccessBio IgM ICT, 56% (95% CI, 48 to 63) and 90% (95% CI, 87 to 94), respectively; and the AccessBio total antibody ABt ICT, 61% (95% CI, 53 to 68) and 68% (95% CI, 63 to 73), respectively. An isothermal loop amplification (LAMP) PCR assay for scrub typhus demonstrated a sensitivity of 52% (95% CI, 38 to 66) and a specificity of 94% (95% CI, 88 to 98). This study has revealed the diagnostic limitations of antibody-based assays in an acute care setting. However, the combination of ICTs with LAMP usually increased sensitivity with a minimal reduction in specificity. The best combination, the Panbio IgM ICT and LAMP, resulted in a sensitivity of 67% (95% CI, 53 to 79) and a specificity of 91% (95% CI, 83 to 95). The combination of antibody-based assays with DNA- or antigen-based tests shows promise for improved diagnostic sensitivity.

Authors+Show Affiliations

Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22219313

Citation

Blacksell, Stuart D., et al. "Prospective Evaluation of Commercial Antibody-based Rapid Tests in Combination With a Loop-mediated Isothermal Amplification PCR Assay for Detection of Orientia Tsutsugamushi During the Acute Phase of Scrub Typhus Infection." Clinical and Vaccine Immunology : CVI, vol. 19, no. 3, 2012, pp. 391-5.
Blacksell SD, Paris DH, Chierakul W, et al. Prospective evaluation of commercial antibody-based rapid tests in combination with a loop-mediated isothermal amplification PCR assay for detection of Orientia tsutsugamushi during the acute phase of scrub typhus infection. Clin Vaccine Immunol. 2012;19(3):391-5.
Blacksell, S. D., Paris, D. H., Chierakul, W., Wuthiekanun, V., Teeratakul, A., Kantipong, P., & Day, N. P. (2012). Prospective evaluation of commercial antibody-based rapid tests in combination with a loop-mediated isothermal amplification PCR assay for detection of Orientia tsutsugamushi during the acute phase of scrub typhus infection. Clinical and Vaccine Immunology : CVI, 19(3), 391-5. https://doi.org/10.1128/CVI.05478-11
Blacksell SD, et al. Prospective Evaluation of Commercial Antibody-based Rapid Tests in Combination With a Loop-mediated Isothermal Amplification PCR Assay for Detection of Orientia Tsutsugamushi During the Acute Phase of Scrub Typhus Infection. Clin Vaccine Immunol. 2012;19(3):391-5. PubMed PMID: 22219313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective evaluation of commercial antibody-based rapid tests in combination with a loop-mediated isothermal amplification PCR assay for detection of Orientia tsutsugamushi during the acute phase of scrub typhus infection. AU - Blacksell,Stuart D, AU - Paris,Daniel H, AU - Chierakul,Wirongrong, AU - Wuthiekanun,Vanaporn, AU - Teeratakul,Achara, AU - Kantipong,Pacharee, AU - Day,Nicholas P J, Y1 - 2012/01/04/ PY - 2012/1/6/entrez PY - 2012/1/6/pubmed PY - 2012/6/14/medline SP - 391 EP - 5 JF - Clinical and vaccine immunology : CVI JO - Clin Vaccine Immunol VL - 19 IS - 3 N2 - Samples from 160 prospectively recruited febrile patients with typhus-like illness in an area of Thailand (Chiang Rai, northern Thailand) where scrub typhus is endemic were used to evaluate the diagnostic capabilities of four rapid immunochromatographic tests (ICTs) for the detection of Orientia tsutsugamushi IgM and total antibodies during acute scrub typhus infection. Of the 160 cases, 54 (34%) had been confirmed to have scrub typhus using the reference scrub typhus infection criteria (STIC), i.e., positive cell culture isolation, an admission IgM antibody titer of ≥1:12,800, a 4-fold rising IgM antibody titer, and/or positivity for ≥2 out of 3 PCR gene targets). The ICTs gave the following sensitivities and specificities: the Panbio IgM ICT, 46% (95% confidence interval [CI], 33 to 60) and 95% (95% CI, 89 to 98), respectively; the Standard Diagnostics IgM ICT, 68% (95% CI, 60 to 75) and 73% (95% CI, 68 to 78), respectively; the AccessBio IgM ICT, 56% (95% CI, 48 to 63) and 90% (95% CI, 87 to 94), respectively; and the AccessBio total antibody ABt ICT, 61% (95% CI, 53 to 68) and 68% (95% CI, 63 to 73), respectively. An isothermal loop amplification (LAMP) PCR assay for scrub typhus demonstrated a sensitivity of 52% (95% CI, 38 to 66) and a specificity of 94% (95% CI, 88 to 98). This study has revealed the diagnostic limitations of antibody-based assays in an acute care setting. However, the combination of ICTs with LAMP usually increased sensitivity with a minimal reduction in specificity. The best combination, the Panbio IgM ICT and LAMP, resulted in a sensitivity of 67% (95% CI, 53 to 79) and a specificity of 91% (95% CI, 83 to 95). The combination of antibody-based assays with DNA- or antigen-based tests shows promise for improved diagnostic sensitivity. SN - 1556-679X UR - https://www.unboundmedicine.com/medline/citation/22219313/Prospective_evaluation_of_commercial_antibody_based_rapid_tests_in_combination_with_a_loop_mediated_isothermal_amplification_PCR_assay_for_detection_of_Orientia_tsutsugamushi_during_the_acute_phase_of_scrub_typhus_infection_ L2 - http://cvi.asm.org/lookup/pmidlookup?view=long&pmid=22219313 DB - PRIME DP - Unbound Medicine ER -