ArticleThe American journal of tropical medicine and hygiene2019
Determination of Optimal Diagnostic Cut-Offs for the Naval Medical Research Center Scrub Typhus IgM ELISA in Chiang Rai, Thailand.
Article in The American journal of tropical medicine and hygiene, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 16 citations in OpenAlex.
- Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research.PLoS neglected tropical diseases · 2026Review
- Scrub and murine typhus seroprevalence among blood donors in Laos.PLoS neglected tropical diseases · 2026Article
- Tissue distribution of Orientia tsutsugamushi in rodents: a molecular and immune diagnostic approach.Molecular biology reports · 2026Article
- 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
- Estimating the Seroprevalence of Scrub Typhus in Nepal.Pathogens (Basel, Switzerland) · 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
- Article
- Longitudinal comparison of bacterial pathogen seropositivity among wet market vendors in the Lao People's Democratic Republic.One health (Amsterdam, Netherlands) · 2023Article
- Prevalence of and factors associated with scrub typhus exposure among the hill tribe population living in high incidence areas in Thailand: a cross-sectional study.BMC public health · 2023Article
- Determination of a cut-off value for the serological diagnosis of scrub typhus by detecting anti-The Indian journal of medical research · 2023Article
- Risk factors analysis for neglected human rickettsioses in rural communities in Nan province, Thailand: A community-based observational study along a landscape gradient.PLoS neglected tropical diseases · 2022Observational
- Evaluation of the Diagnostic Accuracy of Antibody Assays for Patients with Scrub Typhus.Journal of clinical microbiology · 2021Article
- Diagnostic accuracy of an in-house Scrub Typhus enzyme linked immunoassay for the detection of IgM and IgG antibodies in Laos.PLoS neglected tropical diseases · 2020Article
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Authors and funding
11 authors at 4 institutions in 4 countries.
Funding
Abstract
In this diagnostic accuracy study, we evaluated data from 135 febrile patients from Chiang Rai, to determine the optimal optical density (OD) cutoffs for an in-house scrub typhus IgM ELISA. Receiver operating characteristic curves were generated using a panel of reference assays, including an IgM immunofluorescence assay (IFA), PCR, in vitro isolation, presence of an eschar, or a combination of these. Altogether, 33 patients (24.4%) were diagnosed as having scrub typhus. Correlation between positivity by IFA and increasing OD values peaked at a cutoff of 2.0, whereas there was little association between positivity by culture or eschar with increasing ELISA cutoffs-cutoffs of 3.0 and 4.0 were demonstrated to be optimal for the total absorbance of the OD at dilutions 1:100, 1:400, 1:1,600, and 1:6,400, for admission and convalescent samples, respectively. The optimal cutoff at a 1:100 dilution was found to be between 1.85 and 2.22 for admission samples and convalescent-phase samples, respectively. Sensitivities for the cutoffs varied from 57.1% to 90.0% depending on the reference test and sample timing, whereas specificities ranged from 85.2% to 99.0%. We therefore recommend a cutoff of around 2.0, depending on the sensitivity and specificity desired in clinical or epidemiological settings. The results demonstrate the ELISA to be a valuable diagnostic tool, suitable for use in resource-limited endemic regions, especially when used in combination with other diagnostic modalities such as the presence of an eschar.
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