TY - JOUR
T1 - State of the art of diagnosis of rickettsial diseases
T2 - The use of blood specimens for diagnosis of scrub typhus, spotted fever group rickettsiosis, and murine typhus
AU - Paris, Daniel H.
AU - Dumler, J. Stephen
N1 - Funding Information:
Financial support and sponsorship This work was supported by funding from the Wellcome Trust, NIH/NIAID, Li Ka Shing Foundation and MDRIP to D.H.P., and by grants from the National Institutes of Allergy and Infectious Diseases, Bill and Melinda Gates Foundation, Fisher Discovery Center (Johns Hopkins University), Department of Pathology, University of Maryland School of Medicine, and PAT-74-3977 from the Uniformed Services University of the Health Sciences to J.S.D.
Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Purpose of review: With improved malaria control, acute undifferentiated febrile illness studies in tropical regions reveal a startling proportion of rickettsial illnesses, especially scrub typhus, murine typhus, and spotted fever group rickettsioses. Laboratory diagnosis of these infections evolved little over the past 40 years, but combinations of technologies like PCR and loop-mediated isothermal amplification, with refined rapid diagnostic tests and/or ELISA, are promising for guidance for early antirickettsial treatment. Recent findings: The long-term reliance on serological tests - useful only late in rickettsial infections - has led to underdiagnosis, inappropriate therapies, and undocumented morbidity and mortality. Recent approaches integrate nucleic acid amplification and recombinant protein-based serological tests for diagnosing scrub typhus. Optimized using Bayesian latent class analyses, this strategy increases diagnostic confidence and enables early accurate diagnosis and treatment - a model to follow for lagging progress in murine typhus and spotted fever. Summary: A laboratory diagnostic paradigm shift in rickettsial infections is evolving, with replacement of indirect immunofluorescence assay by the more objective ELISA coupled with nucleic acid amplification assays to expand the diagnostic window toward early infection intervals. This approach supports targeted antirickettsial therapy, reduces morbidity and mortality, and provides a robust evidence base for further development of diagnostics and vaccines.
AB - Purpose of review: With improved malaria control, acute undifferentiated febrile illness studies in tropical regions reveal a startling proportion of rickettsial illnesses, especially scrub typhus, murine typhus, and spotted fever group rickettsioses. Laboratory diagnosis of these infections evolved little over the past 40 years, but combinations of technologies like PCR and loop-mediated isothermal amplification, with refined rapid diagnostic tests and/or ELISA, are promising for guidance for early antirickettsial treatment. Recent findings: The long-term reliance on serological tests - useful only late in rickettsial infections - has led to underdiagnosis, inappropriate therapies, and undocumented morbidity and mortality. Recent approaches integrate nucleic acid amplification and recombinant protein-based serological tests for diagnosing scrub typhus. Optimized using Bayesian latent class analyses, this strategy increases diagnostic confidence and enables early accurate diagnosis and treatment - a model to follow for lagging progress in murine typhus and spotted fever. Summary: A laboratory diagnostic paradigm shift in rickettsial infections is evolving, with replacement of indirect immunofluorescence assay by the more objective ELISA coupled with nucleic acid amplification assays to expand the diagnostic window toward early infection intervals. This approach supports targeted antirickettsial therapy, reduces morbidity and mortality, and provides a robust evidence base for further development of diagnostics and vaccines.
KW - ELISA
KW - Indirect immunofluorescent assay
KW - Murine typhus
KW - Orientia tsutsugamushi
KW - PCR
KW - Rickettsia
KW - Scrub typhus
KW - Spotted fever
UR - http://www.scopus.com/inward/record.url?scp=84978764779&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84978764779&partnerID=8YFLogxK
U2 - 10.1097/QCO.0000000000000298
DO - 10.1097/QCO.0000000000000298
M3 - Review article
C2 - 27429138
AN - SCOPUS:84978764779
SN - 0951-7375
VL - 29
SP - 433
EP - 439
JO - Current opinion in infectious diseases
JF - Current opinion in infectious diseases
IS - 5
ER -