Evaluation of Combined Rapid Immunoglobulin M and Immunoglobulin G Lateral Flow Assays for the Diagnosis of Leptospirosis, Scrub Typhus, and Hantavirus Infection
Evaluation of Combined Rapid Immunoglobulin M and Immunoglobulin G Lateral Flow Assays for the Diagnosis of Leptospirosis, Scrub Typhus, and Hantavirus Infection
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联合快速免疫球蛋白 M 和免疫球蛋白 G 侧流检测对钩端螺旋体病、恙虫病和汉坦病毒感染诊断的评价
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Y. Suputtamongkol
中科院分区：
文献类型：
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作者：
Y. Suputtamongkol
目的：钩端螺旋体病、丛林斑疹伤寒和汉坦病毒感染通常被认为是亚洲农村地区急性未分化发热的原因。虽然这些感染的特征性表现被很好地描述，但其中许多表现为非特异性表现。诊断通常结合接触史、临床表现和抗体检测阳性。利用免疫层析试验(ICT)诊断多种疾病的快速抗体检测方法的发展，为更准确地诊断和适当地使用抗生素治疗急性未分化发热综合征提供了工具。方法：我们使用434例经实验室确认的钩端螺旋体病(131例)或斑疹伤寒(128例)患者和175例其他原因发热的患者(175例)作为阴性对照，评估了商业上可用的联合快速ICT诊断钩端螺旋体病、斑疹伤寒和汉坦病毒感染的性能。本研究以非致病性钩端螺旋体多糖、钩端螺旋体不同血清型的嵌合重组蛋白cr56和重组蛋白r21、kr56，以及苏冲病毒的21 kDa种特异性抗原和重组CNP抗原作为诊断钩端螺旋体病、斑疹伤寒和汉坦病毒感染的抗原。结果：对钩端螺旋体病的诊断，急性期诊断的敏感性和特异性分别为38.2%(95%CI，29.946.5%)和99.0%(95%CI 97.9~100%)，恢复期分别为84.6%(95%CI，77.192.0%)和96.2%(95%CI，92.599.8%)。斑疹伤寒急性期ICT检测IgM/Ig G的敏感性和特异性分别为71.9%(95%CI，64.179.7%)和97.4%(95%CI 95.6 99.2%)，恢复期分别为84.6%(95%CI，74.894.4%)和90.2%(95%CI，85.395.1%)。在汉坦病毒感染方面，9名患者检测到汉坦病毒IgM感染。所有病例均经间接免疫荧光试验确诊为森林斑疹伤寒。结论：这种联合ICT治疗钩端螺旋体病和斑疹伤寒的效果与已发表的其他ICT的数据相当。然而，使用抗原检测快速诊断钩端螺旋体病是必要的。本研究人群中未检出汉坦病毒感染。
Objective: Leptospirosis, scrub typhus, and hantavirus infection are commonly identified as causes of acute undifferentiated fever in rural parts of Asia. Although the characteristic presentations of these infections are well described, many of them present with nonspecific manifestations. Diagnosis is usually made by combined history of exposure, clinical features and positive antibody detection. The development of rapid antibody detection assay, using an immunochromatographic test (ICT) for the diagnosis of multi-diseases, has provided tools for more accurate diagnosis and appropriate antibiotic treatment of the acute undifferentiated fever syndrome. Methods: We evaluated the diagnostic performance of a commercially available combined rapid ICT for the diagnosis of leptospirosis, scrub typhus, and hantavirus infection, using archived blood samples from 434 patients with laboratory-confirmed leptospirosis (131) or scrub typhus (128), and from patients with other causes of fever as the negative control (175). Polysaccharide of nonpathogenic Leptospira patoc, a chimeric recombinant protein cr56 and two other recombinant proteins, r21 and kr56, from different serotypes of Orientia tsutsugamushi, and 21kDa species-specific antigen and recombinant CNP antigen derived from the Soochong virus were used as antigens for the diagnosis of leptospirosis, scrub typhus, and hantavirus infection in the combined ICT used in this study. Results: For the diagnosis of leptospirosis; in acute phase, the sensitivity and specificity of the ICT detection of IgM/IgG were 38.2% (95% CI, 29.946.5%), and 99.0% (95% CI 97.9-100%); while in convalescent phase, the same were 84.6% (95%CI, 77.192.0%), and 96.2% (95%CI, 92.599.8%), respectively. For scrub typhus, in acute phase, the sensitivity and specificity of the ICT detection of IgM/IgG were 71.9% (95% CI, 64.179.7%), and 97.4% (95% CI 95.6 99.2%); while in convalescent phase, the same were 84.6% (95%CI, 74.894.4%), and 90.2% (95%CI, 85.395.1%) respectively. For hantavirus infection, nine patients had detectable IgM for hantavirus infection. All these cases were diagnosed as scrub typhus by indirect immunofluorescent assay. Conclusion: The performance of this combined ICT for leptospirosis and scrub typhus were comparable to those published data of other ICTs. However, the rapid test for the diagnosis of leptospirosis, using antigen detection, is needed. Hantavirus infection was not detected in this study population.
影响因子：
1.9
作者：
Dahanayaka, Niroshana J.;Agampodi, Suneth B.;Vinetz, Joshep M.
通讯作者：
Vinetz, Joshep M.