ArticlePloS one2015
How to Determine the Accuracy of an Alternative Diagnostic Test when It Is Actually Better than the Reference Tests: A Re-Evaluation of Diagnostic Tests for Scrub Typhus Using Bayesian LCMs.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03847870 (Background Seroprevalence of Rickettsial Infections in Myanmar), which is not on this map. Cited by 47 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Background Seroprevalence of Rickettsial Infections in Myanmar
Who cites it
47 citing papers in PubMed, 3 syntheses or guidelines pooled it, 72 citations in OpenAlex.
- Systematic review of the scrub typhus treatment landscape: Assessing the feasibility of an individual participant-level data (IPD) platform.PLoS neglected tropical diseases · 2021Pooled it
- The validity of diagnostic cut-offs for commercial and in-house scrub typhus IgM and IgG ELISAs: A review of the evidence.PLoS neglected tropical diseases · 2019Pooled it
- Scrub typhus point-of-care testing: A systematic review and meta-analysis.PLoS neglected tropical diseases · 2018Pooled it
- Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research.PLoS neglected tropical diseases · 2026Review
- Comparison of Diagnostic Performance of Commercially Available Serological and Molecular Tests for Detection ofJournal of clinical medicine · 2026Article
- Diagnostic heterogeneity in scrub typhus serology: A scoping review of IFA thresholds and regional standardisation needs (2005-2024).PLoS neglected tropical diseases · 2025Article
- Estimating scrub typhus and murine typhus incidence among adolescents and adults in Yangon, Myanmar.Tropical medicine & international health : TM & IH · 2025Article
- Article
- Masqueraders Around Disaster: Clinical Features of Scrub Typhus in Fukushima, Japan.Open forum infectious diseases · 2024Article
- Molecular detection of Orientia tsutsugamushi in ectoparasites & their small mammal hosts captured from scrub typhus endemic areas in Madurai district, India.The Indian journal of medical research · 2024Article
- CRISPR/Cas12a-Based Detection Platform for Early and Rapid Diagnosis of Scrub Typhus.Biosensors · 2023Article
- Geographical distribution of scrub typhus and risk of Orientia tsutsugamushi infection in Indonesia: Evidence mapping.PLoS neglected tropical diseases · 2023Review
- Comparison of the Serion IgM ELISA and Microscopic Agglutination Test for diagnosis of Leptospira spp. infections in sera from different geographical origins and estimation of Leptospira seroprevalence in the Wiwa indigenous population from Colombia.PLoS neglected tropical diseases · 2022Article
- Systematic Surveillance of Rickettsial Diseases in 27 Hospitals from 26 Provinces throughout Vietnam.Tropical medicine and infectious disease · 2022Article
- Exposure toPathogens (Basel, Switzerland) · 2021Article
- Development of a Scrub Typhus Diagnostic Platform Incorporating Cell-Surface Display Technology.Frontiers in immunology · 2021Article
- The Isolation of Orientia tsutsugamushi and Rickettsia typhi from Human Blood through Mammalian Cell Culture: a Descriptive Series of 3,227 Samples and Outcomes in the Lao People's Democratic Republic.Journal of clinical microbiology · 2020Review
- Diagnosis of scrub typhus: recent advancements and challenges.3 Biotech · 2020Review
- Prevalence of scrub typhus in a tertiary care centre in Telangana, south India.Iranian journal of microbiology · 2020Article
- Algorithm in the Diagnosis of Febrile Illness Using Pathogen-specific Rapid Diagnostic Tests.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundThe indirect immunofluorescence assay (IFA) is considered a reference test for scrub typhus. Recently, the Scrub Typhus Infection Criteria (STIC; a combination of culture, PCR assays and IFA IgM) were proposed as a reference standard for evaluating alternative diagnostic tests. Here, we use Bayesian latent class models (LCMs) to estimate the true accuracy of each diagnostic test, and of STIC, for diagnosing scrub typhus. METHODS/PRINCIPAL
findingsData from 161 patients with undifferentiated fever were re-evaluated using Bayesian LCMs. Every patient was evaluated for the presence of an eschar, and tested with blood culture for Orientia tsutsugamushi, three different PCR assays, IFA IgM, and the Panbio IgM immunochromatographic test (ICT). True sensitivity and specificity of culture (24.4% and 100%), 56kDa PCR assay (56.8% and 98.4%), 47kDa PCR assay (63.2% and 96.1%), groEL PCR assay (71.4% and 93.0%), IFA IgM (70.0% and 83.8%), PanBio IgM ICT (72.8% and 96.8%), presence of eschar (42.7% and 98.9%) and STIC (90.5% and 82.5%) estimated by Bayesian LCM were considerably different from those obtained when using STIC as a reference standard. The IgM ICT had comparable sensitivity and significantly higher specificity compared to IFA (p=0.34 and p<0.001, respectively).
conclusionsThe low specificity of STIC was caused by the low specificity of IFA IgM. Neither STIC nor IFA IgM can be used as reference standards against which to evaluate alternative diagnostic tests. Further evaluation of new diagnostic tests should be done with a carefully selected set of diagnostic tests and appropriate statistical models.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.