Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam.
BACKGROUND:Scrub typhus (ST) is a leading cause of non-malarial febrile illness in Southeast Asia, but evidence of its true disease burden is limited because of difficulties of making the clinical diagnosis and lack of adequate diagnostic tests. To describe the epidemiology and clinical characterist...
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ftdoajarticles:oai:doaj.org/article:5c477e45dc9e4521a4a52eb663d1117d 2023-05-15T15:15:19+02:00 Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam. Shungo Katoh Ngo Chi Cuong Sugihiro Hamaguchi Pham Thanh Thuy Do Duy Cuong Le Kim Anh Nguyen Thi Hien Anh Dang Duc Anh Eiichiro Sando Motoi Suzuki Hiromi Fujita Michio Yasunami Keisuke Yoshihara Lay-Myint Yoshida Daniel Henry Paris Koya Ariyoshi 2019-12-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007928 https://doaj.org/article/5c477e45dc9e4521a4a52eb663d1117d EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0007928 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007928 https://doaj.org/article/5c477e45dc9e4521a4a52eb663d1117d PLoS Neglected Tropical Diseases, Vol 13, Iss 12, p e0007928 (2019) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2019 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007928 2022-12-31T05:56:59Z BACKGROUND:Scrub typhus (ST) is a leading cause of non-malarial febrile illness in Southeast Asia, but evidence of its true disease burden is limited because of difficulties of making the clinical diagnosis and lack of adequate diagnostic tests. To describe the epidemiology and clinical characteristics of ST, we conducted an observational study using multiple diagnostic assays at a national tertiary hospital in Hanoi, Vietnam. METHODOLOGY/PRINCIPAL FINDINGS:We enrolled 1,127 patients hospitalized with documented fever between June 2012 and May 2013. Overall, 33 (2.9%) patients were diagnosed with ST by PCR and/or screening of ELISA for immunoglobulin M (IgM) with confirmatory tests: 14 (42.4%) were confirmed by indirect immunoperoxidase assay (IIP), and 19 (57.6%) were by IIP and PCR. Living by farming, conjunctival injection, eschar, aspartate aminotransferase elevation, and alanine aminotransferase elevation were significantly associated with ST cases (adjusted odds ratios (aORs): 2.8, 3.07, 48.8, 3.51, and 4.13, respectively), and having a comorbidity and neutrophilia were significantly less common in ST cases (aORs: 0.29 and 0.27, respectively). The majority of the ST cases were not clinically diagnosed with rickettsiosis (72.7%). Dominant IIP reactions against a single antigen were identified in 15 ST cases, whereas indistinguishably high reactions against multiple antigens were seen in 11 ST cases. The most frequently observed dominant IIP reaction was against Karp antigen (eight cases) followed by Gilliam (four cases). The highest diagnostic accuracy of IgM ELISA in acute samples was 78%. In a phylogenetic analysis of the 56-kDa type-specific antigen gene, the majority (14 cases) were located in the Karp-related branch followed by the Gilliam-related (two cases), Kato-related (two cases), and TA763-related clades (one case). CONCLUSIONS/SIGNIFICANCE:Both the clinical and laboratory diagnoses of ST remain challenging at a tertiary hospital. Implementation of both serological and nucleic acid amplification ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 13 12 e0007928 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Shungo Katoh Ngo Chi Cuong Sugihiro Hamaguchi Pham Thanh Thuy Do Duy Cuong Le Kim Anh Nguyen Thi Hien Anh Dang Duc Anh Eiichiro Sando Motoi Suzuki Hiromi Fujita Michio Yasunami Keisuke Yoshihara Lay-Myint Yoshida Daniel Henry Paris Koya Ariyoshi Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND:Scrub typhus (ST) is a leading cause of non-malarial febrile illness in Southeast Asia, but evidence of its true disease burden is limited because of difficulties of making the clinical diagnosis and lack of adequate diagnostic tests. To describe the epidemiology and clinical characteristics of ST, we conducted an observational study using multiple diagnostic assays at a national tertiary hospital in Hanoi, Vietnam. METHODOLOGY/PRINCIPAL FINDINGS:We enrolled 1,127 patients hospitalized with documented fever between June 2012 and May 2013. Overall, 33 (2.9%) patients were diagnosed with ST by PCR and/or screening of ELISA for immunoglobulin M (IgM) with confirmatory tests: 14 (42.4%) were confirmed by indirect immunoperoxidase assay (IIP), and 19 (57.6%) were by IIP and PCR. Living by farming, conjunctival injection, eschar, aspartate aminotransferase elevation, and alanine aminotransferase elevation were significantly associated with ST cases (adjusted odds ratios (aORs): 2.8, 3.07, 48.8, 3.51, and 4.13, respectively), and having a comorbidity and neutrophilia were significantly less common in ST cases (aORs: 0.29 and 0.27, respectively). The majority of the ST cases were not clinically diagnosed with rickettsiosis (72.7%). Dominant IIP reactions against a single antigen were identified in 15 ST cases, whereas indistinguishably high reactions against multiple antigens were seen in 11 ST cases. The most frequently observed dominant IIP reaction was against Karp antigen (eight cases) followed by Gilliam (four cases). The highest diagnostic accuracy of IgM ELISA in acute samples was 78%. In a phylogenetic analysis of the 56-kDa type-specific antigen gene, the majority (14 cases) were located in the Karp-related branch followed by the Gilliam-related (two cases), Kato-related (two cases), and TA763-related clades (one case). CONCLUSIONS/SIGNIFICANCE:Both the clinical and laboratory diagnoses of ST remain challenging at a tertiary hospital. Implementation of both serological and nucleic acid amplification ... |
format |
Article in Journal/Newspaper |
author |
Shungo Katoh Ngo Chi Cuong Sugihiro Hamaguchi Pham Thanh Thuy Do Duy Cuong Le Kim Anh Nguyen Thi Hien Anh Dang Duc Anh Eiichiro Sando Motoi Suzuki Hiromi Fujita Michio Yasunami Keisuke Yoshihara Lay-Myint Yoshida Daniel Henry Paris Koya Ariyoshi |
author_facet |
Shungo Katoh Ngo Chi Cuong Sugihiro Hamaguchi Pham Thanh Thuy Do Duy Cuong Le Kim Anh Nguyen Thi Hien Anh Dang Duc Anh Eiichiro Sando Motoi Suzuki Hiromi Fujita Michio Yasunami Keisuke Yoshihara Lay-Myint Yoshida Daniel Henry Paris Koya Ariyoshi |
author_sort |
Shungo Katoh |
title |
Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam. |
title_short |
Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam. |
title_full |
Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam. |
title_fullStr |
Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam. |
title_full_unstemmed |
Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam. |
title_sort |
challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern vietnam. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2019 |
url |
https://doi.org/10.1371/journal.pntd.0007928 https://doaj.org/article/5c477e45dc9e4521a4a52eb663d1117d |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 13, Iss 12, p e0007928 (2019) |
op_relation |
https://doi.org/10.1371/journal.pntd.0007928 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007928 https://doaj.org/article/5c477e45dc9e4521a4a52eb663d1117d |
op_doi |
https://doi.org/10.1371/journal.pntd.0007928 |
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PLOS Neglected Tropical Diseases |
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13 |
container_issue |
12 |
container_start_page |
e0007928 |
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1766345680109961216 |