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USEFULNESS OF NESTED PCR FOR THE DIAGNOSIS OF SCRUB TYPHUS IN CLINICAL PRACTICE: A PROSPECTIVE STUDY

The aims of this study were to determine the diagnostic accuracy and clinical usefulness of using nested polymerase chain reaction (PCR) for the diagnosis of scrub typhus through a prospective comparison of nested PCR and indirect immunofluorescent antibody assay (IFA). We conducted a multi-center prospective study of patients who were suffering with possible scrub typhus infection. Whole blood samples were collected for PCR testing, and sera were obtained for serology evaluation using the indirect IFA and the passive hemagglutination assay (PHA). We prospectively studied 135 patients with possible scrub typhus. One hundred eighteen patients were confirmed as having scrub typhus, 7 patients were undetermined, and 10 patients were confirmed as having other diseases. The results of nested PCR assay showed a sensitivity of 82.2% and a specificity of 100%. Ninety-six of the 118 patients were positive for IgM on their admission day. Of the 22 patients who were negative for IgM antibody at admission, 19 had positive results for nested PCR of the buffy coat. The nested PCR assay of the buffy coat is useful as a rapid and reliable test for confirming the diagnosis of scrub typhus.

Received January 26, 2006. Accepted for publication May 16, 2006.

Disclosure: The authors do not have any commercial interest or other associations that might pose a conflict of interest. The research described in this manuscript did not benefit from any external financial support.

^* Address correspondence to Mi-Yeoun Park, Division of Zoonoses, Center for Immunology and Pathology, National Institute of Health, #5 Nokbun-Dong, Eunpyung-Gu, Seoul 122-701, Korea. E-mail: miyeoun{at}nih.go.kr

Authors’ addresses: Dong-Min Kim and Na Ra Yun, Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju 501-717, Korea, Telephone: 82-62-220-3108, Fax: 82-62-234-9653, E-mail: drongkim{at}chosun.ac.kr. Tae Young Yang, Departments of Internal Medicine, Haenam General Hospital, 182-1 Haenam, Jellanamdo 536-809, Korea. Ji Hyun Lee, Departments of Internal Medicine, Jangheung General Hospital, 383-5 Jangheung, Jellanamdo 529-800, Korea. Jong Tae Yang, Departments of Internal Medicine, Muan General Hospital, 165 Muan, Jellanamdo 534-804, Korea. Soo-Kyoung Shim, Eun-Na Choi, and Mi-Yeoun Park, Division of Zoonoses, Center for Immunology and Pathology, National Institute of Health, #5 Nokbun-Dong, Eunpyung-Gu, Seoul 122-701, Korea. Seung-Hyun Lee, Department of Pediatrics, Seonam University College of Medicine, 720 Gwangchi-dong, Nam-won, Jeollabukdo 590-711, Korea, Telephone: 82-62-370-7660, Fax: 82-62-371-3092, E-mail: 31gmlakd{at}hanmil.net.

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