Molecular diagnosis and duration of eschar swab sample positivity post-doxycycline therapy in scrub typhus patients.

IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Rimjhim Kanaujia, Harpreet Singh, Kamlesh Bisht, Shriya Goel, Suresh Selvam, Jasleen Kaur, Karthi Nallasamy, Navneet Sharma, Manisha Biswal
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引用次数: 0

Abstract

Background: An eschar is not always present in all scrub typhus patients. Furthermore, such patients may present to tertiary care hospitals after administration of doxycycline. The present study aimed to determine the usefulness of using the swab from eschar sites in the diagnosis of scrub typhus in patients who present post-doxycycline therapy.

Methods: Blood, eschar scraping and swab samples were collected daily until patient discharge/death. Real-time SYBR green PCR targeting the groEl gene, TaqMan probe PCR targeting the 47 kDa gene and nested PCR targeting the 56 kDa gene of Orientia tsutsugamushi were carried out. Partial sequences of the 56 kDa gene of O. tsutsugamushi were sequenced by the Sanger method and phylogenetic analysis was performed using Mega X.

Results: In total, 42 samples (19 eschar scraping and 23 eschar swab samples) were collected from 22 patients. A high positivity of eschar scraping samples (89.5%, 17/19) in comparison to blood (63.2%, 12/19) was observed. The nested PCR for eschar swab samples was positive in 10 (43.5%), 47 kDa gene in nine (39.1%) and groEl in three (13%) samples. The swabs remained positive for 1-4 d after doxycycline was started. The majority of the sequences clustered with Karp-like strains.

Conclusion: The eschar swab is a good alternative sample for the diagnosis and genotyping of scrub typhus. It also has the added advantage of persistent positivity despite doxycycline administration.

恙虫病患者接受多西环素治疗后的分子诊断和脓痂拭子样本阳性持续时间。
背景:并非所有恙虫病患者都会出现痂皮。此外,这类患者可能在使用强力霉素后才到三级医院就诊。本研究旨在确定使用脓痂部位的拭子诊断多西环素治疗后恙虫病患者的有用性:方法:每天采集血液、脓疱刮片和拭子样本,直至患者出院/死亡。针对恙虫病的 groEl 基因进行了实时 SYBR green PCR,针对 47 kDa 基因进行了 TaqMan 探针 PCR,针对 56 kDa 基因进行了巢式 PCR。用桑格方法对恙虫病 56 kDa 基因的部分序列进行了测序,并用 Mega X 进行了系统进化分析:共从 22 名患者身上采集了 42 份样本(19 份焦痂刮取样本和 23 份焦痂拭子样本)。与血液样本(63.2%,12/19)相比,焦痂刮取样本的阳性率较高(89.5%,17/19)。10 份(43.5%)脓痂拭子样本的巢式 PCR 呈阳性,9 份(39.1%)样本的 47 kDa 基因呈阳性,3 份(13%)样本的 groEl 呈阳性。在开始使用多西环素 1-4 天后,拭子仍呈阳性。大多数序列与卡普类菌株聚集在一起:结论:脓痂拭子是诊断恙虫病和进行基因分型的理想替代样本。结论:脓痂拭子是诊断恙虫病和进行基因分型的良好替代样本,它还具有在使用强力霉素后仍能保持阳性的额外优势。
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来源期刊
Transactions of The Royal Society of Tropical Medicine and Hygiene
Transactions of The Royal Society of Tropical Medicine and Hygiene 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.00
自引率
9.10%
发文量
115
审稿时长
4-8 weeks
期刊介绍: Transactions of the Royal Society of Tropical Medicine and Hygiene publishes authoritative and impactful original, peer-reviewed articles and reviews on all aspects of tropical medicine.
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