Scrub Typhus and Leptospirosis: The fallacy of Diagnosing with IgM Enzyme Linked Immunosorbant Assay

Gupta, Nitin; Chaudhry, Rama; Mirdha, Bijay Ranjan; Das, Bimal Kumar; Dar, Lalit; Kabra, Sushil Kumar; Lodha, Rakesh; Dey, Aparajita; Sood, Rita; Wig, Naveet; Sreenivas, Vishnubhatla

doi:10.4172/1948-5948.1000265

Cited by 20 publications

(24 citation statements)

References 29 publications

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“…The limitation of the present study is that we could not accurately determine the etiological agent/ agents in these cases as we could not perform the gold standard plaque reduction and neutralization test (PRNT) due to logistic reasons. Similarly, cross-reactivity or co-infection in hyperendemic regions [ 28 ] may explain the co-positivity of scrub typhus and viruses, as was also indicated by the PCR results.…”

Section: Discussionmentioning

confidence: 91%

Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India

et al. 2018

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BackgroundAcute Encephalitis Syndrome (AES) is a major seasonal public health problem in Bihar, India. Despite efforts of the Bihar health department and the Government of India, burden and mortality of AES cases have not decreased, and definitive etiologies for the illness have yet to be identified.ObjectivesThe present study was undertaken to study the specific etiology of AES in Bihar.MethodsCerebrospinal fluid and/or serum samples from AES patients were collected and tested for various pathogens, including viruses and bacteria by ELISA and/or Real Time PCR.FindingsOf 540 enrolled patients, 33.3% (180) tested positive for at least one pathogen of which 23.3% were co-positive for more than one pathogen. Most samples were positive for scrub typhus IgM or PCR (25%), followed by IgM positivity for JEV (8.1%), WNV (6.8%), DV (6.1%), and ChikV (4.5%).M. tuberculosis and S. pneumoniae each was detected in ~ 1% cases. H. influenzae, adenovirus, Herpes Simplex Virus -1, enterovirus, and measles virus, each was detected occasionally. The presence of Scrub typhus was confirmed by PCR and sequencing. Bihar strains resembled Gilliam-like strains from Thailand, Combodia and Vietnam.ConclusionThe highlights of this pilot AES study were detection of an infectious etiology in one third of the AES cases, multiple etiologies, and emergence of O. tsutsugamushi infection as an important causative agent of AES in India.

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Section: Discussionmentioning

confidence: 91%

Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India

et al. 2018

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“…Data on cross-reactivity of various serological tests among these infections are limited. While analyzing serological and PCR-based molecular assays, molecular confirmation of scrub typhus and leptospirosis coinfection was established in only 1 among 10 IgM ELISA positive cases [24]. Clinical diagnosis of coinfections is complex in patients with AUF, as the initial symptoms, signs, and laboratory investigations overlap as is evident in our study.…”

Section: Discussionmentioning

confidence: 58%

Concurrent Coinfections in Tropics: A Hospital-Based Observational Study from Himachal Pradesh, India

Malakar¹,

Negi²,

Dutt³

et al. 2019

Recent Advances in Biology and Medicine

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India is the epicenter of tropical fever diseases. Large numbers of cases are diagnosed with scrub typhus, leptospirosis, malaria, dengue, chikungunya, and enteric fever. Coinfections as an etiology of acute undifferentiated fever (AUF) have been recently recognized. The objective of this study was to assess the prevalence of coinfections in patients admitted with AUF in a tertiary-care hospital in the rural setting of Himachal Pradesh, India. Patients with coinfections as an etiology of AUF were the subjects of the study. The clinical records of patients diagnosed with confections between July 2018 and October 2018 were analyzed retrospectively in this hospital-based cross-sectional study. Standard protocol and guidelines were followed for the case definitions. Among total patients of 1005 with AUF, 14 (1.39%) patients were found to have coinfections. The most common coinfection was scrub typhus with leptospirosis and was diagnosed in seven (50%) patients. Other coinfections were scrub typhus with dengue in four (29%) and one patient each with scrub typhus and tubercular meningitis, scrub and influenza A (H1N1/2009) infection, and scrub and malaria (P. falciparum). Scrub typhus was the most common etiological diagnosis for the AUF and was observed in 159 (15.8%) patients. All the patients with coinfections had scrub typhus as the common infection. The prevalence of coinfections among scrub typhus patients constituted 8%. In tropical regions, coinfections are not very rare. High clinical suspicion for coinfections is required. Syndromic approach in the management is justified.

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“…Possible reasons for a positive dengue serology could have been persistent antibodies from a previous infection, recent asymptomatic infection, concurrent infection, or cross-reactivity with flaviviruses such as West Nile Virus or Japanese Encephalitis. 13 The patient also had positive IgM antibodies against Legionella pneumophila, but the urinary antigen was negative. In view of a negative antigen test, low specificity of the serologic test, low incidence of legionellosis in the Indian subcontinent, and absence of therapeutic response to a trial of fluoroquinolones, the diagnosis of legionellosis was considered unlikely in this patient.…”

Section: Discussionmentioning

confidence: 95%

Every Nook and Cranny

Jain

Pile

Gupta

et al. 2019

Journal of Hospital Medicine

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Scrub Typhus and Leptospirosis: The fallacy of Diagnosing with IgM Enzyme Linked Immunosorbant Assay

Cited by 20 publications

References 29 publications

Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India

Emergence of Orientia tsutsugamushi as an important cause of Acute Encephalitis Syndrome in India

Concurrent Coinfections in Tropics: A Hospital-Based Observational Study from Himachal Pradesh, India

Every Nook and Cranny

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