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Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam


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Title: Challenges in diagnosing scrub typhus among hospitalized patients with undifferentiated fever at a national tertiary hospital in northern Vietnam
Other Titles: 北部ベトナムにある国立三次医療機関の診断未確定発熱入院患者におけるツツガムシ病診断上の課題
Authors: 加藤, 隼悟
Authors (alternative): Katoh, Shungo
Issue Date: 4-Mar-2020
Publisher: Public Libary of Science
Citation: Nagasaki University (長崎大学), 博士(医学) (2020-03-04)
Abstract: 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 assays covering endemic O. tsutsugamushi strains is essential.
Description: 長崎大学学位論文 学位記番号:博(医歯薬)甲第1214号 学位授与年月日:令和2年3月4日 / 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 / Citation: PLOS Neglected Tropical Diseases, 13(12), e0007928; 2019
URI: http://hdl.handle.net/10069/39730
DOI: 10.1371/journal.pntd.0007928
Rights: © 2019 Katoh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Type: Thesis or Dissertation
Text Version: ETD
Appears in Collections:dissertation

Citable URI : http://hdl.handle.net/10069/39730

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