Scrub typhus: risks, diagnostic issues, and management challenges

Prakash, John Antony Jude

doi:10.2147/rrtm.s105602

Cited by 42 publications

(56 citation statements)

References 152 publications

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“…Scrub typhus is a zoonotic infection that ensues in an acute febrile illness inherent to the ‘tsutsugamushi triangle’ and caused by intracytosolic, gram-negative bacterium Orientia tsutsugamushi (Paris et al 2013 ; Prakash 2017 ). Humans are the fortuitous host of Leptotrombidium spp.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of scrub typhus: recent advancements and challenges

et al. 2020

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Scrub typhus is a mite-borne, acute febrile illness caused by the bacterium Orientia tsutsugamushi. It is a re-emerging infectious disease of the tsutsugamushi triangle. Scrub typhus is transmitted through bites of contaminated chiggers (larval stage). Diagnosis of scrub typhus is challenging as its symptoms mimic with other acute febrile illnesses. Several methods are effectual for diagnosis of scrub typhus that includes enzyme-linked immunosorbent assay (ELISA), immunofluorescence assay (IFA), immunochromatographic test (ICT), Weil-Felix, polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP). Weil-Felix test was initially used for the diagnosis of scrub typhus in underdeveloped countries but not preferred due to a lack of both specificity and sensitivity. Other immuno-based methods like IFA and ELISA are most outrank for detection of scrub typhus due to their higher sensitivity and specificity, but not vigorous to lay bare the infection at early stages and need the convalescent sampling for verification of positive samples. On another deed, PCR based methods becoming acceptable over era due to its dexterity of early-stage diagnosis with higher specificity and sensitivity but lack its applicability in circumstances of scrub typhus due to the variegated genetic makeup of Orientia tsutsugamushi among its serotypes. The present review focused on various detection methods along with their advantages and disadvantages used in the diagnosis of scrub typhus. A comparison between available methods of diagnosis with challenges in the detection of scrub typhus is also summarized.

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Section: Introductionmentioning

confidence: 99%

Diagnosis of scrub typhus: recent advancements and challenges

et al. 2020

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“…These malaria positive serum samples were tested for assessing the analytical specificity of scrub typhus IgM ELISA as previous studies have shown cross reactions. 17,18,19 to determine optimal RDT performance with antibody titre in IFA as comparator. 25 The results…”

Section: Discussionmentioning

confidence: 99%

Assessment of two immunoassays for detection of IgM antibodies to scrub typhus using a serum panel

Elangovan

Perumalla

Rose

et al. 2019

Preprint

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IntroductionScrub typhus is a vector borne zoonotic disease caused by Orientia tsutsugamushi, endemic to tsutsugamushi triangle. As the characteristic eschar is not always present, laboratory testing especially serological assay are the main stay of diagnosis. Materials and methodsA total of 346 well-characterized sera from normals and patients with scrub typhus, malaria, dengue, enteric fever and gram negative septicaemia were tested for IgM antibodies by ST IgM ELISA and ST Ig M ICT ResultsThe sensitivity and specificity of Scrub typhus IgM ICT and ELISA were 98.7, 96.3 and 97.4, 99.3 respectively. The IgM ICT and ELISA had a excellent concordance (99%) and a very high negative predictive value. ConclusionThe findings from this study suggest that IgM ICT and IgM ELISA can be used interchangeably for serodiagnosis of scrub typhus in resource poor settings. Abbrevations-STIgM ELISA-Scrub typhus Detect IgM ELISA ST IgM ICT-Scrub Typhus Detect IgM rapid test (Immunochromotography test)

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“…Scrub typhus, also called tsutsugamushi disease, is a vector-borne infectious disease primarily endemic to a region called the Asian-Pacific “tsutsugamushi triangle” (South Asia, Southeast Asia, East Asia, the Pacific Islands and Northern Australia) [1, 2], with occasional case reports from Africa, the Middle East, and South America [2, 3]. Accurate incidence data would most likely increase the current estimates of more than two billion people living in scrub typhus-endemic areas and the occurrence of one million cases of the disease annually [3–5]. Furthermore, the incidence in all known endemic regions has begun to rise over the last decade [6–8].…”

Section: Introductionmentioning

confidence: 99%

“…In severe cases, the illness can progress to the development of interstitial pneumonia, acute respiratory distress syndrome, meningoencephalitis, acute kidney injury, or disseminated intravascular coagulation. The mortality rate varies and can be as high 50% unless patients are treated sufficiently early in the course of illness with liposoluble antibiotics such as doxycycline, tetracycline, azithromycin, or somewhat less-effective chloramphenicol [3, 10, 11]. The presence of eschars is considered pathognomonic.…”

Section: Introductionmentioning

confidence: 99%

“…However, it has been reported that eschar incidence varies from 7 to 97% in endemic areas, and scrub typhus cases without eschar are clinically indistinguishable from other diseases, including malaria, dengue fever, leptospirosis, other rickettsioses, meningococcal disease, typhoid fever, infectious mononucleosis and HIV [3, 5, 12–14]. Notably, the spotted fever group of rickettsioses, insect bites (including spider bites), posttraumatic scabs and anthrax can include an inoculation eschar at the surface of the skin [3, 9]. All of the above conditions associated with an eschar make the clinical diagnosis of scrub typhus quite difficult and increase the chance of misdiagnosis, underdiagnosis and drug misuse.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016

Xin

et al. 2019

Infect Dis Poverty

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Background Scrub typhus is a life-threatening disease caused by Orientia tsutsugamushi , and specific antimicrobial medicine is available . Early and accurate diagnosis is essential for reducing the risk of severe complications and death. In this study, we aimed to evaluate the case diagnosis situation among medical care institutions and geographical regions in China, and the results will benefit both clinical practice and the disease surveillance system. Methods We extracted individual scrub typhus case data 2006–2016 from a national disease surveillance system in China. The diagnosis category and interval time from illness onset to diagnosis were compared among three levels of medical care institutions and provinces. The descriptive analysis method was performed in our study. Results During the 11-year study period, 93 481 scrub typhus cases, including 57 deaths, were recorded in the nationwide surveillance system. The overall proportion of laboratory-confirmed cases was only 4.7%, and this proportion varied greatly among primary medical centres (2.8%), county level hospitals (4.2%), and city level hospitals (6.3%). Notably, the proportion of laboratory-confirmed cases has consistently decreased from 16.3% in 2006 to 2.6% in 2016, and the same decreasing trend was found among all three levels of medical care institutions. The interval from illness onset to case diagnosis (T diag ) for all cases was 5 days (interquartile range [IQR]: 2–9 days) and decreased from 7 days (IQR: 3–11 days) in 2006 to 5 days (IQR: 2–8 days) in 2016. The risk of death for patients with a T diag of > 7 days was 2.2 times higher ( OR = 2.21, 95% CI : 1.05–5.21) than that of patients with a T diag of < 2 days. Conclusions The interval time from illness onset to diagnosis for scrub typhus cases decreased greatly in China; however, the diagnosis rate of cases with laboratory-confirmed results must be increased among all levels of medical care institutions to reduce both the risk of death and the misuse of antibiotics associated with scrub typhus. Electronic supplementary material The online version of this article (10.1186/s40249-019-0566-0) contains supplementary material, which is available to authorized users.

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Scrub typhus: risks, diagnostic issues, and management challenges

Cited by 42 publications

References 152 publications

Diagnosis of scrub typhus: recent advancements and challenges

Diagnosis of scrub typhus: recent advancements and challenges

Assessment of two immunoassays for detection of IgM antibodies to scrub typhus using a serum panel

Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016

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