title: Diagnosis of scrub typhus by immunohistochemical staining of Orientia tsutsugamushi in cutaneous lesions.
abstract: We assessed the clinical usefulness of immunohistochemical staining on skin biopsy specimens for the diagnosis of scrub typhus compared with indirect immunofluorescent antibody assay (IFA), the definitive diagnostic method for scrub typhus, in a prospective study of 125 patients with possible scrub typhus in 2005 and 2006. Skin biopsy specimens were obtained from 63 patients. To minimize the effects caused by antibiotics on immunohistochemical results, 46 patients were assessed before antibiotic administration (4 patients received antibiotic therapy before admission; 13 underwent skin biopsy after antibiotic administration at our hospital). Compared with IFA results, immunohistochemical results on maculopapular skin lesions demonstrated a sensitivity of 0.65 and a specificity of 1. Immunohistochemical results on eschars demonstrated a sensitivity of 1 and a specificity of 1. For immunohistochemical staining performed on skin lesions within 3 or 4 days of administration of antibiotics that are effective for Rickettsia, the antibiotics did not greatly influence diagnostic sensitivity. Immunohistochemical staining of skin biopsy specimens, particularly that of eschars, is sensitive and specific, and this technique can be reliable for confirming the diagnosis of scrub typhus.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea.
authors.forename: Dong-Min
authors.initials: DM
authors.lastname: Kim
authors.forename: Chol-Jin
authors.initials: CJ
authors.lastname: Park
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Lim
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Park
authors.forename: Won-Jong
authors.initials: WJ
authors.lastname: Jang
authors.forename: Seung-Hyun
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D012285:Orientia tsutsugamushi; D012612:Scrub Typhus / Q000175:diagnosis* / Q000188:drug therapy; D012680:Sensitivity and Specificity; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents