SynthesisPLoS neglected tropical diseases2019
The validity of diagnostic cut-offs for commercial and in-house scrub typhus IgM and IgG ELISAs: A review of the evidence.
Synthesis in PLoS neglected tropical diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 53 citations in OpenAlex.
- Global and regional seroprevalence, incidence, mortality of, and risk factors for scrub typhus: A systematic review and meta-analysis.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2024Pooled it
- Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review.The American journal of tropical medicine and hygiene · 2020Pooled it
- A Novel Quantitative ELISA Demonstrates Lack of Correlation Between Serum HDV-RNA and Anti-HDV Antibody Levels in Chronic HDV Infection.Journal of viral hepatitis · 2026Article
- Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research.PLoS neglected tropical diseases · 2026Review
- Persistence of scrub typhus IgM and IgG antibodies among patients from Karnataka, India.Annals of medicine · 2025Article
- Diagnostic heterogeneity in scrub typhus serology: A scoping review of IFA thresholds and regional standardisation needs (2005-2024).PLoS neglected tropical diseases · 2025Article
- Risk factors for scrub typhus infection in South India: population-based cohort study.Epidemiology and infection · 2025Observational
- Pleural mesothelioma patients and ex-exposed asbestos workers are immunologically poor responders to oncogenic Merkel cell polyomavirus.Translational lung cancer research · 2025Article
- Comparative Analysis of Scrub Typhus Rapid Kits and Their Relevance in Screening and Diagnosis.Cureus · 2025Article
- Article
- Helicobacter pylori seropositivity associates with hyperglycemia, but not obesity, in Danish children and adolescents.BMC medicine · 2024Article
- Estimating the Seroincidence of Scrub Typhus using Antibody Dynamics after Infection.The American journal of tropical medicine and hygiene · 2024Article
- Scrub typhus in Indonesia: A cross-sectional analysis of archived fever studies samples.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2024Article
- Development of a colloidal gold immunochromatographic assay utilizing dual-antibody sandwich method for detectingFrontiers in microbiology · 2024Article
- Article
- Diagnostic challenges and antibody kinetics in a paediatric traveller with scrub typhus.Journal of travel medicine · 2023Article
- Infection of wild-caught wood mice (Apodemus sylvaticus) and yellow-necked mice (A. flavicollis) with tick-borne encephalitis virus.Scientific reports · 2023Article
- The dynamics of neutralizing antibodies against SARS-CoV-2 in cats naturally exposed to virus reveals an increase in antibody activity after re-infection.Veterinary research communications · 2023Article
- Determination of a cut-off value for the serological diagnosis of scrub typhus by detecting anti-The Indian journal of medical research · 2023Article
- On the caveats of a multiplex test for SARS-CoV-2 to detect seroconversion after infection or vaccination.Scientific reports · 2022Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 3 countries.
Funding
Abstract
backgroundScrub typhus is a neglected tropical disease that causes acute febrile illness. Diagnosis is made based upon serology, or detection of the causative agent-Orientia tsutsugamushi-using PCR or in vitro isolation. The enzyme-linked immunosorbent assay (ELISA) is an objective and reproducible means of detecting IgM or IgG antibodies. However, lack of standardization in ELISA methodology, as well as in the choice of reference test with which the ELISA is compared, calls into question the validity of cut-offs used in diagnostic accuracy studies and observational studies. METHODOLOGY/PRINCIPAL
findingsA PubMed search and manual screening of reference lists identified 46 studies that used ELISA antibody cut-offs to diagnose scrub typhus patients, 22 of which were diagnostic accuracy studies. Overall, 22 studies (47.8%) provided little to no explanation as to how the ELISA cut-off was derived, and 7 studies (15.2%) did not even state the cut-off used. Variation was seen locally in reference standards used, in terms of both the diagnostic test and cut-off titer. Furthermore, with the exception of studies using ELISAs manufactured by InBios, there was no standardization of the selection of antigenic strains. As a result, no consensus was found for determining a cut-off, ELISA methodology, or for a single value diagnostic cut-off. CONCLUSIONS/SIGNIFICANCE: We have concluded that there is a lack of consensus in the determination of a cut-off. We recommend interpreting the results from these studies with caution. Further studies will need to be performed at each geographic location to determine region-specific cut-offs, taking into consideration background antibody levels to discriminate true disease from healthy individuals.
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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.