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

PIENGCHAN SONTHAYANON Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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WIRONGRONG CHIERAKUL Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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VANAPORN WUTHIEKANUN Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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STUART D. BLACKSELL Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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KRIANGSAK PIMDA Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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YUPIN SUPUTTAMONGKOL Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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SASITHON PUKRITTAYAKAMEE Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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NICHOLAS J. WHITE Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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NICHOLAS P. DAY Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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SHARON J. PEACOCK Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Medical Department, Udon Thani Hospital, Udon Thani, Thailand; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

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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.

Author Notes

Reprint requests: Sharon Peacock, Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. E-mail: sharon@tropmedres.ac.
  • 1

    Saah AJ, 2000. Orientia tsutsugamushi (Scrub typhus). Mandell GL, Bennett JE, Rodin D, eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. Philadelphia: Churchill Livingstone, 2056–2057.

    • PubMed
    • Export Citation
  • 2

    Rosenberg R, 1997. Drug-resistant scrub typhus: Paradigm and paradox. Parasitol Today 13 :131–132.

  • 3

    Brown GW, Robinson DM, Huxsoll DL, Ng TS, Lim KJ, 1977. Scrub typhus: A common cause of illness in indigenous populations. Trans R Soc Trop Med Hyg 70 :444–448.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Bavaro MF, Kelly DJ, Dasch GA, Hale BR, Olson P, 2005. History of U.S. military contributions to the study of rickettsial diseases. Mil Med 170 :49–60.

  • 5

    Silpapojakul K, Varachit B, 2004. Paediatric scrub typhus in Thailand: A study of 73 confirmed cases. Trans R Soc Trop Med Hyg 98 :354–359.

  • 6

    Ogawa M, Hagiwara T, Kishimoto T, Shiga S, Yoshida Y, Furuya Y, Kaiho I, Ito T, Nemoto H, Yamamoto N, Masukawa K, 2002. Scrub typhus in Japan: epidemiology and clinical features of cases reported in 1998. Am J Trop Med Hyg 67 :162–165.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Coleman RE, Sangkasuwan V, Suwanabun N, Eamsila C, Mungviriya S, Devine P, Richards AL, Rowland D, Ching WM, Sattabongkot J, Lerdthusnee K, 2002. Comparative evaluation of selected diagnostic assays for the detection of IgG and IgM antibody to Orientia tsutsugamushi in Thailand. Am J Trop Med Hyg 67 :497–503.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Saisongkorh W, Chenchittikul M, Silpapojakul K, 2004. Evaluation of nested PCR for the diagnosis of scrub typhus among patients with acute pyrexia of unknown origin. Trans R Soc Trop Med Hyg 98 :360–366.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Singhsilarak T, Leowattana W, Looareesuwan S, Wongchotigul V, Jiang J, Richards AL, Watt G, 2005. Short report: detection of Orientia tsutsugamushi in clinical samples by quantitative real-time polymerase chain reaction. Am J Trop Med Hyg 72 :640–641.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Bozeman FM, Elisberg BL, 1963. Serological diagnosis of scrub typhus by indirect immunofluorescence. Proc Soc Exp Biol Med 112 :568–573.

  • 11

    Brown GW, Shirai A, Rogers C, Groves MG, 1983. Diagnostic criteria for scrub typhus: probability values for immunofluorescent antibody and Proteus OXK agglutinin titers. Am J Trop Med Hyg 32 :1101–1107.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Furuya Y, Yoshida Y, Katayama T, Yamamoto S, Kawamura A Jr, 1993. Serotype-specific amplification of Rickettsia tsutsugamushi DNA by nested polymerase chain reaction. J Clin Microbiol 31 :1637–1640.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Manosroi J, Chutipongvivate S, Auwanit W, Manosroi A, 2003. Early diagnosis of scrub typhus in Thailand from clinical specimens by nested polymerase chain reaction. Southeast Asian J Trop Med Public Health 34 :831–838.

    • PubMed
    • Search Google Scholar
    • Export Citation
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