Abstract
PURPOSE : Scrub typhus an acute febrile illness has diverse clinical manifestations, which
overlap with other febrile illnesses. Due to this reason, it is misdiagnosed, leading
to inappropriate treatment, sometimes resulting in fatality. Thus, accurate diagnosis
of scrub typhus is important for appropriate treatment. This study evaluated the loop-mediated
isothermal amplification (LAMP) assay as a diagnostic test for scrub typhus among
patients with fever.
MATERIALS AND METHODS : A total of 50 cases of acute febrile illness clinically resembling scrub typhus,
with or without an eschar, or cases of pyrexia of unknown origin were included in
the study. Blood samples collected from these cases were subjected to detection of
IgM antibodies to Orientia tsutsugamushi by ELISA, conventional groEL polymerase chain reaction (PCR), and the LAMP assay.
RESULTS : Twelve cases had fever for less than a week, and two had fever for more than 3 weeks.
IgM antibodies to O. tsutsugamushi were detected in 37 out of 50 samples (74%). LAMP assay was positive in 33 samples
(66%). groEL gene-based PCR detected 35 (70%) samples as positive. Two samples negative by LAMP
assay were positive by this PCR. Twenty samples collected from patients with dengue,
typhoid, and malaria tested by the LAMP assay were negative, indicating its good specificity.
LAMP assay and the conventional groEL-based PCR could detect 72.7% and 74.3% of the
samples, respectively before the 10th day after onset of fever, whereas IgM ELISA could detect only 40.5% of the 37 samples.
CONCLUSION : This study suggests that LAMP assay could be a useful diagnostic test for detecting
scrub typhus in the acute phase of the illness and a cheaper alternative to other
molecular methods in resource poor settings.
Key words Diagnosis - groEl polymerase chain reaction - loop-mediated isothermal amplification
assay - scrub typhus
