Why the study?
Scrub typhus is commonly misdiagnosed due to nonspecific clinical features and limited data regarding the performance of diagnostic tests.
Do multiplex real-time PCR and ICT provide better diagnostic accuracy for scrub typhus compared to IFA in adult patients with suspected infection?
Observational (n=159)
No
Do multiplex real-time PCR and ICT provide better diagnostic accuracy for scrub typhus compared to IFA in adult patients with suspected infection?
p-value: p=0.02
Multiplex real-time PCR provides highly accurate confirmation of scrub typhus, and ICT offers better early diagnostic performance than a single acute-phase IFA.
May offer superior diagnostic performance for scrub typhus; hypothesis-generating and should not yet alter practice.
Background: Scrub typhus is commonly misdiagnosed because of nonspecific clinical features and limited data on the performance of diagnostic tests. This study aimed to evaluate the accuracy of commercially available serological and molecular assays for diagnosing scrub typhus. Methods: Adult patients with suspected scrub typhus who visited a tertiary-care hospital in South Korea from July 2022 to December 2024 were prospectively enrolled. Scrub typhus was confirmed by either a positive real-time polymerase chain reaction (PCR) result for Orientia tsutsugamushi or a ≥ four-fold increase in the O. tsutsugamushi-specific total immunoglobulin (Ig) antibody titer on an immunofluorescence assay (IFA). The diagnostic performances of the serial IFA, an immunochromatography-based rapid diagnostic test (ICT), and multiplex real-time PCR targeting the groEL and 47-kDa genes were compared. Results: Among 159 patients, 81 had scrub typhus and 78 did not. The sensitivity and specificity were 64% and 100% for the serial IFA, 75% and 91% for the ICT, and 95% and 100% for multiplex PCR, respectively. The area under the curve was significantly higher for the ICT (0.819) than for the acute-phase IFA (0.743, p = 0.02). Conclusions: Multiplex real-time PCR provided rapid and highly accurate confirmation of scrub typhus, and an acute-phase ICT may be an alternative to a single acute-phase IFA for early clinical decision-making.
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Kim et al. (2026) conducted an observational in Scrub typhus (n=159). Multiplex real-time PCR and immunochromatography-based rapid diagnostic test (ICT) vs. Serial immunofluorescence assay (IFA) was evaluated on Diagnostic performance (sensitivity, specificity, and area under the curve) (p=0.02).
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