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Antigenic Drift of Orientia tsutsugamushi in South Korea as Identified by the Sequence Analysis of a 56-kDa Protein-Encoding Gene

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  • Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea; Department of Internal Medicine, Handong Global University, Sunlin Hospital, Pohang, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea

This study was performed to determine the nationwide antigenic diversity of Orientia tsutsugamushi in South Korea. Sequence analysis was performed around variable domains I and II of a 56-kDa protein-encoding gene. We used eschar to overcome the disadvantages of conventional serotyping. The serological passive hemagglutination assay (PHA) was assessed based on the genotyping results. We analyzed 153 isolates from scrub typhus patients in major endemic areas and found that Boryong was the major strain (68.6%). New strains were also identified: Taguchi (19.6%), Kanda/Kawasaki (9.2%), and UAP7 (1.3%). PHA yielded significantly fewer positive results among Kawasaki strains (P < 0.001), which are not included in the PHA antigen panel. In South Korea, Boryong was still the predominant strain, but the sequence analysis identified new changes in minor strains (30.1%). This antigenic drift had a negative effect on the PHA results. Periodic surveillance of the contemporary strains using sequence analysis is needed.

Author Notes

*Address correspondence to Chang-Seop Lee, Department of Internal Medicine, Chonbuk National University Medical School, 634-18, Keumam-dong, Jeonju, 561-712, Republic of Korea. E-mail: lcsmd@chonbuk.ac.kr

Financial support: This study was supported by Grant 04-2008-068 from the Seoul National University Hospital (SNUH) Research Fund and funding from the Chonbuk National University Hospital Research Institute of Clinical Medicine.

Authors' addresses: Sang-Won Park, Department of Internal Medicine, Boramae Medical Center, Seoul 156-707, South Korea, E-mail: hswon1@snu.ac.kr. Chi Kug Lee, Department of Internal Medicine, Namwon Medical Center, Gojuk-dong, Namwon, Chonbuk 590-702, South Korea, E-mail: na25pro@hotmail.com. Yee Gyung Kwak, Chisook Moon, and Baek-Nam Kim, Department of Internal Medicine, Inje University College of Medicine, Gaeeum-dong, Busan 614-735, South Korea, E-mails: philmed202@hanmail.net, duomon@hanmail.net, and griuni@chol.com. Eu Suk Kim, Department of Internal Medicine, Dongguk University Ilsan Hospital, Siksa-dong, Goyang, Gyeonggi 410-773, South Korea, E-mail: yonathan@hanafos.com. Jae Myung Kang, Department of Internal Medicine, Handong Global University, Sunlin Hospital, Daeshin-dog, Pohang, Kyungbuk 791-704, South Korea, E-mail: joshuakang@hanmail.net. Chang-Seop Lee, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Chonbuk 561-712, South Korea, E-mail: lcsmd@chonbuk.ac.kr.

Reprint requests: Chang-Seop Lee, Department of Internal Medicine, Chonbuk National University Medical School, 634-18, Keumam-dong, Jeonju, 561-712, Republic of Korea, E-mail: lcsmd@chonbuk.ac.kr.

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