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RAPID DIAGNOSIS OF SCRUB TYPHUS IN RURAL THAILAND USING POLYMERASE CHAIN REACTION

The aim of this study was to evaluate the use of polymerase chain reaction (PCR) amplification of the O. tsutsugamushi 16S rRNA gene for the diagnosis of scrub typhus in rural Thailand. A prospective study of acute febrile illness in Udon Thani, northeast Thailand, identified 183 patients as having scrub typhus on the basis of immunofluorescent antibody testing (IFA) of paired sera. A further 366 febrile patients admitted concurrently with a range of other diagnoses acted as negative controls. Diagnostic sensitivity and specificity of 16S rRNA PCR was 44.8% and 99.7%, respectively, compared with IFA. PCR positivity was related to duration of symptoms and presence of eschar (P < 0.001, both cases). PCR using primers to amplify a fragment of the 56-kd gene had a sensitivity and specificity of 29.0% and 99.2%, respectively. PCR has a high specificity but low sensitivity for the rapid diagnosis of scrub typhus in this endemic setting.

Received April 25, 2006. Accepted for publication August 15, 2006.

Acknowledgments: The authors thank our colleagues at Udon Thani Hospital and the Mahidol-Oxford Tropical Medicine Research Unit and Mongkol Chenchittikul from NIH, Ministry of Public Health of Thailand, who kindly provide antigen slides for IFA testing. The authors thank Daniel Paris for critical review of the manuscript.

Financial support: This study was funded by a grant awarded to P.S. by the Federation of Infection Society, UK, and by the Wellcome Trust of Great Britain. S.P. holds a Wellcome Trust Career Development Award in Clinical Tropical Medicine.

^* Address correspondence to Sharon J. Peacock, Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. E-mail: sharon{at}tropmedres.ac

Authors’ addresses: Piengchan Sonthayanon, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok Thailand 10400, Telephone: 662-354-9100 ext. 2025, Fax: 662-354-9169, E-mail: piengchan{at}tropmedres.ac. Wirongrong Chierakul, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok Thailand 10400, Telephone: 662-354-9100 ext. 1427, Fax: 662-354-9169, E-mail: kae{at}tropmedres.ac. Vanaporn Wuthiekanun, Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok Thailand 10400, Telephone: 662-354-1395, Fax: 662-354-9169, E-mail: lek{at}tropmedres.ac. Stuart D. Blacksell, Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok Thailand 10400, Telephone: 662-354-1395, Fax: 662-354-9169, E-mail: stuart{at}tropmedres.ac. Kriangsak Pimda, Medical Department, Udon Thani Hospital, Udon Thani, 41000 Thailand. Telephone: 664-234-8888. Yupin Suputtamongkol, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand. Telephone; 662-419-7203, E-mail: siysp{at}mahidol.ac.th. Sasithon Pukrittayakamee, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok Thailand 10400, Telephone: 662-354-9100 ext., Fax: 662-354-9169, E-mail: yon{at}tropmedres.ac. Nicholas J. White, Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok Thailand 10400, Telephone: 662-354-1395, Fax: 662-354-9169, E-mail: nickwdt{at}tropmedres.ac. Nicholas P. Day, Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok Thailand 10400, Telephone: 662-354-1395, Fax: 662-354-9169, E-mail: Nickd{at}tropmedres.ac. Sharon J. Peacock, Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok Thailand 10400, Telephone: 662-354-1395, Fax: 662-354-9169, E-mail: sharon{at}tropmedres.ac.

Reprint requests: Sharon Peacock, Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. E-mail: sharon{at}tropmedres.ac.

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