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The Early Diagnosis of Scrub Typhus by Metagenomic Next-Generation Sequencing.
Front Public Health. 2021; 9:755228.FP

Abstract

Introduction: Scrub typhus is a mite-borne infection widespread in Southeast Asia, with clinical symptoms such as fever, chills, skin rash, eschar at the bite site, and other signs of acute febrile illness. The Rickettsia pathogen (Orientia tsutsugamushi) is always difficult to be diagnosed at an early stage by traditional clinical diagnostic methods, especially for patients without typical eschar. This greatly increases the mortality of patients with scrub typhus. A new approach should be introduced to improve its clinical diagnosis. Methods: During May 2018 to March 2021, 13 samples from 10 patients with suspected scrub typhus were collected. Metagenomic next-generation sequencing (mNGS) and other diagnostic methods (including serology using Weil-Felix reaction and indirect immunofluorescence test (IIFT) for scrub typhus and respiratory tract profile IgM as well as culture for routine bacteria) were used to identify the pathogens in this study. Results: The results of mNGS were all positive, with mapped reads of O. tsutsugamushi ranging from 1 to 460. Eight patients (80%) were diagnosed as scrub typhus. The other two were diagnosed as suspected scrub typhus due to the limited number of reads of the pathogen (one and two, respectively). According to clinical evidences, nine of the 10 patients were finally diagnosed as scrub typhus, except for patient 9 (suspected scrub typhus by mNGS with one specific reads of the pathogen) diagnosed as acute exacerbation of chronic obstructive pulmonary disease. For the five scrub typhus patients without typical eschar, mNGS gave all positive results (4-460 specific reads). For other methods, only Weil-Felix reaction of one patient detected the pathogen. In addition, the respiratory tract profile (IgM) detected various pathogens, but all were confirmed to be false positive. Conclusions: mNGS performed better than conventional clinical methods to early diagnose scrub typhus. This approach can be routinely carried out for early and precise diagnosis in clinical infections, especially for those hard to be identified by traditional diagnostic methods.

Authors+Show Affiliations

Department of Neurology, Ganzhou People's Hospital, Ganzhou, China.Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China.Emergency Department, Ganzhou People's Hospital, Ganzhou, China.Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China.Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China.Department of Neurology, Ganzhou People's Hospital, Ganzhou, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34858931

Citation

Liu, Xianghong, et al. "The Early Diagnosis of Scrub Typhus By Metagenomic Next-Generation Sequencing." Frontiers in Public Health, vol. 9, 2021, p. 755228.
Liu X, Zhang Y, Zhang J, et al. The Early Diagnosis of Scrub Typhus by Metagenomic Next-Generation Sequencing. Front Public Health. 2021;9:755228.
Liu, X., Zhang, Y., Zhang, J., Lou, Z., Xia, H., & Lu, Z. (2021). The Early Diagnosis of Scrub Typhus by Metagenomic Next-Generation Sequencing. Frontiers in Public Health, 9, 755228. https://doi.org/10.3389/fpubh.2021.755228
Liu X, et al. The Early Diagnosis of Scrub Typhus By Metagenomic Next-Generation Sequencing. Front Public Health. 2021;9:755228. PubMed PMID: 34858931.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Early Diagnosis of Scrub Typhus by Metagenomic Next-Generation Sequencing. AU - Liu,Xianghong, AU - Zhang,Ye, AU - Zhang,Jun, AU - Lou,Zheng, AU - Xia,Han, AU - Lu,Zhijuan, Y1 - 2021/11/11/ PY - 2021/08/08/received PY - 2021/10/06/accepted PY - 2021/12/3/entrez PY - 2021/12/4/pubmed PY - 2022/4/26/medline KW - Orientia tsutsugamushi KW - early diagnosis KW - eschars KW - metagenomic next-generation sequencing KW - scrub typhus SP - 755228 EP - 755228 JF - Frontiers in public health JO - Front Public Health VL - 9 N2 - Introduction: Scrub typhus is a mite-borne infection widespread in Southeast Asia, with clinical symptoms such as fever, chills, skin rash, eschar at the bite site, and other signs of acute febrile illness. The Rickettsia pathogen (Orientia tsutsugamushi) is always difficult to be diagnosed at an early stage by traditional clinical diagnostic methods, especially for patients without typical eschar. This greatly increases the mortality of patients with scrub typhus. A new approach should be introduced to improve its clinical diagnosis. Methods: During May 2018 to March 2021, 13 samples from 10 patients with suspected scrub typhus were collected. Metagenomic next-generation sequencing (mNGS) and other diagnostic methods (including serology using Weil-Felix reaction and indirect immunofluorescence test (IIFT) for scrub typhus and respiratory tract profile IgM as well as culture for routine bacteria) were used to identify the pathogens in this study. Results: The results of mNGS were all positive, with mapped reads of O. tsutsugamushi ranging from 1 to 460. Eight patients (80%) were diagnosed as scrub typhus. The other two were diagnosed as suspected scrub typhus due to the limited number of reads of the pathogen (one and two, respectively). According to clinical evidences, nine of the 10 patients were finally diagnosed as scrub typhus, except for patient 9 (suspected scrub typhus by mNGS with one specific reads of the pathogen) diagnosed as acute exacerbation of chronic obstructive pulmonary disease. For the five scrub typhus patients without typical eschar, mNGS gave all positive results (4-460 specific reads). For other methods, only Weil-Felix reaction of one patient detected the pathogen. In addition, the respiratory tract profile (IgM) detected various pathogens, but all were confirmed to be false positive. Conclusions: mNGS performed better than conventional clinical methods to early diagnose scrub typhus. This approach can be routinely carried out for early and precise diagnosis in clinical infections, especially for those hard to be identified by traditional diagnostic methods. SN - 2296-2565 UR - https://www.unboundmedicine.com/medline/citation/34858931/The_Early_Diagnosis_of_Scrub_Typhus_by_Metagenomic_Next_Generation_Sequencing_ DB - PRIME DP - Unbound Medicine ER -